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Queen Square Centre for Neuromuscular Diseases

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Rehabilitation

The Neuromuscular physiotherapy team is is embedded within the wider peripheral nerve and muscle disease teams.

Our staff develop and lead research as well as working face to face with patients.

The team work closely with specialist neurological physiotherapy, speech and language and Occupational Therapy colleagues based at National Hospital sites.

There are also strong links with the specialist orthotics clinic at the National Hospital.

There are strong links with Transition clinics, and Great Ormond Street Hospital - supporting people with neuromuscular diseases with the transition from child to adult services.

Our mission statement

"We aim to study the impact of living with a neuromuscular disease and trial interventions to maximise peoples' physical abilities, function and general health".

  • Arthur-Farraj, P.J., Murphy, S.M., Laura, M., Lunn, M.P., Manji, H., Blake, J., Ramdharry, G., Fox, Z., Reilly, M.M., 2012. Hand weakness in Charcot-Marie-Tooth disease 1X. Neuromuscul. Disord. 22, 622-626.
  • Brouner, J, Ramdharry, G and Swann, N. (2014). An isokinetic method for inducing a localised fatigue effect in the plantar flexors and dorsiflexors of the ankle, Journal of Electromyography and Kinesiology, 24: 841-847
  • Cortese, A., Machado, P., Morrow, J., Dewar, L., Hiscock, A., Miller, A., Brady, S., Hilton-Jones, D., Parton, M., Hanna, M.G., 2013. Longitudinal observational study of sporadic inclusion body myositis: Implications for clinical trials. Neuromuscul. Disord. 23, 404-412.
  • Davidson, G.L., Murphy, S.M., Polke, J.M., Laura, M., Salih, M.A.M., Muntoni, F., Blake, J., Brandner, S., Davies, N., Horvath, R., Price, S., Donaghy, M., Roberts, M., Foulds, N., Ramdharry, G., Soler, D., Lunn, M.P., Manji, H., Davis, M.B., Houlden, H., Reilly, M.M., 2012. Frequency of mutations in the genes associated with hereditary sensory and autonomic neuropathy in a UK cohort. J. Neurol. 259, 1673-1685.
  • Hiscock A, L Dewar, M Parton, P Machado, M Hanna, G Ramdharry. Frequency and circumstances of falls in people with Inclusion Body Myositis: a questionnaire survey to explore falls management and physiotherapy provision. Physiotherapy, 100 (1): 61-65, 2014.
  • Hiscock, A., Dewar, L., Ramdharry, G., 2012. Workshop on physiotherapy for adults with neuromuscular diseases held at the MRC Centre for Neuromuscular Diseases, Queen Square, London, UK on 28th March 2011. Neuromuscul. Disord. 22, 1029-1031.
  • Machado PM, Ahmed M, Brady S, Gang Q, Healy E, Morrow JM, Wallace AC, Dewar L, Ramdharry G, Parton M, Holton JL, Houlden H, Greensmith L, Hanna M (2014). Ongoing developments in sporadic inclusion body myositis. Current Rheumatology Reports, 16: 477
  • Marsden, J., Ramdharry, G., Stevenson, V., Thompson, A., 2012. Muscle paresis and passive stiffness: key determinants in limiting function in Hereditary and Sporadic Spastic Paraparesis. Gait Posture 35, 266-271.
  • Murphy, S.M., Laura, M., Fawcett, K., Pandraud, A., Liu, Y.-T., Davidson, G.L., Rossor, A.M., Polke, J.M., Castleman, V., Manji, H., Lunn, M.P.T., Bull, K., Ramdharry, G., Davis, M., Blake, J.C., Houlden, H., Reilly, M.M., 2012a. Charcot-Marie-Tooth disease: frequency of genetic subtypes and guidelines for genetic testing. J. Neurol. Neurosurg. Psychiatr. 83, 706-710.
  • Murphy, S.M., Ovens, R., Polke, J., Siskind, C.E., Laura, M., Bull, K., Ramdharry, G., Houlden, H., Murphy, R.P.J., Shy, M.E., Reilly, M.M., 2012b. X inactivation in females with X-linked Charcot-Marie-Tooth disease. Neuromuscul. Disord. 22, 617-621.
  • Ramdharry, G., 2006. Case report: physiotherapy cuts the dose of botulinum toxin. Physiother Res Int 11, 117-122.
  • Ramdharry, G.M., 2010. Rehabilitation in practice: management of lower motor neuron weakness. Clin Rehabil 24, 387-397.
  • Ramdharry, G.M., Marsden, J.F., Day, B.L., Thompson, A.J., 2006. De-stabilizing and training effects of foot orthoses in multiple sclerosis. Mult. Scler. 12, 219-226.
  • Ramdharry, G.M., Day, B.L., Reilly, M.M., Marsden, J.F., 2009. Hip flexor fatigue limits walking in Charcot-Marie-Tooth disease. Muscle Nerve 40, 103-111.
  • Ramdharry G. Chapter 9: Polyneuropathies. In Stokes & Stack: Physical Management for Neurological Conditions, 2011; 3rd Edition, Elsevier, Oxford, UK.
  • Ramdharry, G.M., Day, B.L., Reilly, M.M., Marsden, J.F., 2012a. Foot drop splints improve proximal as well as distal leg control during gait in Charcot-Marie-Tooth disease. Muscle Nerve 46, 512-519.
  • Ramdharry, G.M., Pollard, A.J., Marsden, J.F., Reilly, M.M., 2012b. Comparing gait performance of people with Charcot-Marie-Tooth disease who do and do not wear ankle foot orthoses. Physiother Res Int 17, 191-199.
  • Ramdharry, G.M., Thornhill, A., Mein, G., Reilly, M.M., Marsden, J.F., 2012c. Exploring the experience of fatigue in people with Charcot-Marie-Tooth disease. Neuromuscul. Disord. 22 Suppl 3, S208-213.
  • Ramdharry G, Pollard A, Anderson C, Laurá M; Murphy S; Dudziec M, Dewar E, Hutton E, Grant R, Reilly MM. A Pilot Study of Proximal Strength Training in Charcot Marie Tooth Disease. Journal of the Peripheral Nervous System,19:328-3, 2014
  • Statland, J.M., Bundy, B.N., Wang, Y., Trivedi, J.R., Raja Rayan, D., Herbelin, L., Donlan, M., McLin, R., Eichinger, K.J., Findlater, K., Dewar, L., Pandya, S., Martens, W.B., Venance, S.L., Matthews, E., Amato, A.A., Hanna, M.G., Griggs, R.C., Barohn, R.J., 2012. A quantitative measure of handgrip myotonia in non-dystrophic myotonia. Muscle Nerve 46, 482-489.

Aerobic training in CMT and IBM

Full Title Aerobic training in Charcot-Marie-Tooth and Inclusion Body Myositis
Sponsor University College London Hospitals NHS Trust (UCLH Trust)
Funder NIHR Research for Patient Benefit (RFPB)
Project Grant PI Dr Gita Ramdharry
Status This study is now closed to recruitment

Aerobic de-conditioning and secondary disuse muscle atrophy are common in people with neuromuscular diseases (NMD) and are likely to contribute towards reduced general activity levels.

The aim of this study will be to investigate the impact of aerobic training on fitness levels, muscle strength and function in two common neuromuscular diseases (NMD), one primarily neuropathic and one principally myopathic. Secondary objectives of the study include the safety, feasibility and impact on quality of life of this type of exercise training in these groups.

This study will use a randomized, single blinded, crossover design with training and control periods. Both disease groups will be investigated concurrently with the same methods but will be viewed and analyzed as separate studies.

30 patients with Charcot-Marie-Tooth disease (CMT) and 30 patients with Inclusion Body Myositis (IBM) will be recruited. The trial will include people aged between 18 and 75 years, with genetically diagnosed CMT1A and clinically diagnosed IBM.

The study will last for 36 weeks with 4 assessment sessions;, a 12 week period of aerobic exercise and, a 12 week control period in a randomly allocated order; as well as an 8 week wash out period in between.

Subjects will be training in their local gyms and will be assessed in the Centre for Neuromuscular Diseases (CNMD) in the National Hospital for Neurology and Neurosurgery (NHNN).

For more information about the study please contact: Principle Investigator Dr Gita Ramdharry: g.ramdharry@ucl.ac.uk


BALTiC Trial

Full Title BALTiC Trial: Randomised controlled feasibility study of home based balance training for people with CMT
Status In set up phase
Sponsor UCL/UCLH
Funder CMT United Kingdom charity; Kingston University PhD studentship
PI Dr. Gita Ramdharry
Patients recruited Not yet open to recruitment

People with neuromuscular disorders commonly report falls. Frequent falling exposes them to the risk of injury, as well as decreases mobility as a consequence of avoidance of activities which might be perceived to increase the threat of falls.

The aim of this study is to explore the feasibility of implementing a home based balance and strength training program plus falls management education, compared to falls management education alone. This is a randomised, controlled study design with a proposed recruitment target of 20 people.

Study recruitment will start in spring 2016 and will continue until spring 2017.

For more information about the study please contact: Principle Investigator: Dr Gita Ramdharry at: g.ramdharry@ucl.ac.uk

Doctoral student: Magdalena Dudziec


Haptic insoles for peripheral neuropathy

Full Title A feasibility study to explore the effect haptic insoles on postural stability in people with peripheral neuropathy
Status In set up phase
Sponsor UCL/UCLH
Funder Kingston University PhD Studentship; FHSCE Kingston University Small Research Grants Award
PI Dr. Gita Ramdharry
Patients recruited Not yet open to recruitment

People with neuromuscular disorders commonly report falls. Frequent falling exposes them to the risk of injury, as well as decreases mobility as a consequence of avoidance of activities which might be perceived to increase the threat of falls.

The aim of this study is to explore the effect that haptic insoles that provide vibration feedback to the sole of the foot may have on the stability of standing posture for people with sensory predominant peripheral neuropathy.

Study recruitment started in spring 2016 and will continue until spring 2017.

For more information about the study please contact: Principle Investigator: Dr Gita Ramdharry at: g.ramdharry@ucl.ac.uk

Doctoral student: Magdalena Dudziec


Ankle stiffness and balance in CMT

Full Title The effect of stiffening the ankle with ankle foot orthoses on postural stability for people with Charcot Marie Tooth disease
Status In set up phase
Sponsor UCL/UCLH
Funder Kingston University PhD Studentship; FHSCE Kingston University Small Research Grants Award
PI Dr Gita Ramdharry
Patients recruited Not yet open to recruitment

People with neuromuscular disorders commonly report falls. Frequent falling exposes them to the risk of injury, as well as decreases mobility as a consequence of avoidance of activities which might be perceived to increase the threat of falls.

The aim of this study is to explore the effect that stiffening the ankle with an ankle foot orthosis may have on the stability of standing posture for people with CMT with distal motor weakness.

Study recruitment will start in spring 2016 and will continue until spring 2017.

For more information about the study please contact: Principle Investigator: Dr Gita Ramdharry at: g.ramdharry@ucl.ac.uk

Doctoral student: Magdalena Dudziec

Name
Job Title 
Email 
Sherryl Chatfield Specialist Physiotherapist: McArdle's disease sherryl.chatfield@uclh.nhs.uk
Magdalena Dudziec  PhD Student m.dudziec@ucl.ac.uk
Sarah Holmes Clinical Specialist Physiotherapist: Mitochondrial disease sarah.holmes@uclh.nhs.uk
Dr Katherine Jones Research Physiotherapist katherine.jones@uclh.nhs.uk
Dr. Gita Ramdharry Neuromuscular Rehabilitation Research Group LeadClinical Specialist Physiotherapist: Peripheral Neuropathy g.ramdharry@ucl.ac.uk
gita.ramdharry@uclh.nhs.uk

Address

MRC Centre for Neuromuscular Diseases
UCL Institute of Neurology
Box 102
The National Hospital for Neurology and Neurosurgery
Queen Square
London
WC1N 3BG

Dubowitz Centre, Institute for Child Health

Danielle Ramsay Research Physiotherapist danielle.ramsay12@ucl.ac.uk
Victoria Selby PhD Student and Research Team Lead victoria.selby12@ucl.ac.uk

Further information

The group has grown and developed with a number of experienced clinicians who have established interest in both muscle and nerve conditions. The group has a track record of high quality research activity.

We are committed to developing an expert group with support for therapists of all grades and levels of experience to join a clinician researcher academic career path.

We believe it is paramount that specialist clinicians drive forward research activity that will ultimately benefit the people they work with in their clinical practice.

Funding

The research group has an ongoing programme of successful research backed by external funding. In 2012 we were successful in obtaining highly competitive funding through the NIHR Research for Patient Benefit funding stream. Dr. Ramdharry holds a NIHR clinical lecturer fellowship and we have also successfully received grants from Muscular Dystrophy UK, the Myaesthenia Gravis Association, Myositis Support Group and CMT United Kingdom.