The People 1st Bridges Service Improvement Programme:
A sustainable model of integrating self-management support in stroke and neurological services across East of England
- Funding: Health Education England
- Key UEA contact: Dr Nicola Hancock
UEA has been commissioned to conduct an independent evaluation of the Bridges Service Improvement Programme. The aim of the service improvement work is to embed an existing, sustainable model of person-centred self-management support into everyday clinical practice within stroke and neurological teams and to evaluate its impact on service users, individual staff, multi-professional teams and services.
Bridges Self-Management Support is an established improvement programme that was developed using evidence-based methods and by means of co-production with patients and health professionals. The programme has already been adopted by a number of stroke teams across the UK in both acute and community settings. Bridges provides training to multi-disciplinary teams about self-management for people with stroke and other neurological conditions and how the approach can be incorporated into their everyday practice. Teams are supported to evaluate and change their practice and to create a shared approach to self-management support.
UEA will evaluate the introduction of the Bridges approach across a number of NHS Sustainability and Transformation Partnerships (STPs) in the East.
NIHR Brain Injury MedTech Co-operative
- Funding: National Institute for Health Research
- Key UEA contact: Professor Valerie Pomeroy
- Key contact for the Brain Injury Med Tech Co-operative: Mita Brahmbhatt, Programme Manager www.brainmic.nihr.ac.uk
The NIHR Brain Injury MedTech Co-operative has a UK-wide remit for a further five years, 2018 to 2023, to drive MedTech innovation for people after an acquired brain injury. Specifically to:
- Provide a structured and systematic approach to find areas of unmet need that might be amenable to a technology-based innovation
- Facilitate the generation of innovative solutions
- Foster the translation of viable solutions from initial concept to successful market adoption and sustainable clinical impact.
Professor Pomeroy leads the Neuro-Rehabilitation Theme that is focused on MedTech to enable: technology-aided evidenced-based rehabilitation interventions; improved predictive markers and measures of response to neurorehabilitation; and implementation of rehabilitation technology into the care pathway.
Development and initial evaluation of the efficacy of afferent reawakening treatment of the foot on lower limb function after stroke: a feasibility study in preparation for the START OFF trial.
NIHR Doctoral Fellowship for Alison Aries registered from the School of Health and Rehabilitation in the Faculty of Medicine and Health Sciences at Keele University.
- Funding: NIHR
- Key UEA contact: Professor Valerie Pomeroy
- Key contact for the study: Alison Aries, Keele University
- Lead supervisor: Dr Sue Hunter, Keele University
Recovery of walking is a top-ten research priority for people after stroke. Although rehabilitation does enhance walking recovery, many people at six months after stroke are unable to walk without assistance. Of those who regain independent walking, many remain unable to cross the road before the pedestrian lights change. This project is focused on restoring sensation of the foot and ankle that is crucial for balance and within-body (intrinsic) feedback during walking. Therapy known as 'mobilisation and tactile stimulation' (MTS) provides somatosensory stimulation which has been shown to improve recovery of the upper limb after stroke. MTS is used clinically to improve recovery of the lower limb but there is a lack of research evidence for its use. An alternative means of providing sensory stimulation is to wear textured insoles in the shoes but again there is a lack of research evidence. The aims of this project are: (a) to develop a standardised protocol for MTS for the foot and ankle iteratively with people with stroke and clinicians; (b) to develop a standardised protocol for using in-shoe textured insoles iteratively with people with stroke and clinicians; (c) to undertake a feasibility trial of MTS and textured insoles in preparation for a subsequent clinical efficacy trial. The results of this project will provide co-designed standardised protocols for MTS and textured insoles for use in stroke rehabilitation and inform the design of an adequately powered, randomised clinical trial to compare MTS and textured insoles for their benefits on restoring walking ability for people after stroke.
Performance and functional ability after insertion of the Journey II Bi-Cruciate Stabilised Knee System compared with the Genesis II prosthesis: Capability Trial
- Funding: Smith & Nephew Clinical Fund
- Key contact: Dr Celia Clarke
The Capability Trial aims to develop knowledge and understanding of the function after a TKR (Total Knee Replacement), and participant’s experiences and satisfaction.
Osteoarthritis of the knee is a common musculoskeletal condition and its prevalence is expected to significantly increase during the next two decades as the incidence of obesity and ageing rises in the population (OA Nation, 2004) thus predicting an associated increase in total knee replacement usage of 670% between 2003 and 2030. This study will investigate the kinematic outcomes of different Total Knee Replacement (TKR) prosthesis designs through a range of typical activities of everyday mobility. The GENESIS II system made by Smith and Nephew is frequently used in standard practice within the NHS. A new device, JOURNEY II BCS, also manufactured by Smith and Nephew has been developed to provide improved kinematic outcomes compared to the GENESIS II (Moore and Lenz (2012)). However, there is no definitive data to support the hypothesis that in a pragmatic clinical study, the JOURNEY II BCS affords improved patient reported, surgical and kinematic outcomes compared to the GENESIS II system.
An innovative method for delivering Functional Strength Training exercises for the Upper Limb – a feasibility study
- Funding: Health Foundation
- Key contact: Dr Kath Mares
FeSTivAPP is a bespoke app that has been developed by colleagues at UEA, Norfolk and Norwich University Hospital NHS Foundation Trust and Norfolk Community Health and Care NHS Trust with industrial partner ApplinSkinner. The App will allow physiotherapists across the clinical stroke pathway to be able to prescribe arm exercises to stroke survivors with the aim of helping them to engage more with their exercise programme. The use of real-time video provides a better representation of the exercises than the current practice of ‘stickmen’ and the reminders and feedback built into the App should increase motivation as well as provide information regarding exercise frequency and duration for the physiotherapist.
This pilot study will determine the feasibility and acceptability of this intervention to stroke survivors and therapists.
ViaTherapy App Service Evaluation
Better rehabilitation methods for enhancing movement recovery after stroke to enable independent living
- Funding: UEA Impact Funding (HEIF)
- Key contact: Dr Nicola Hancock
ViaTherapy is an App developed by a collaboration of world-renowned, interdisciplinary experts in stroke rehabilitation research. ViaTherapy App is a tool that aids decision making about upper limb rehabilitation after stroke for the primary use of rehabilitation providers actively engaged in the rehabilitation of those with arm impairment after a stroke. This service evaluation with one of our clinical partners will explore clinician acceptability of use of the App in community rehabilitation practice, using a service improvement model to underpin the work. The project aims to contribute to core NHS organisational values of innovation, professionalism and empowerment.
Rapid assessment of corticospinal neuroplasticity
- Funding: SRMRC and BMA
- Key contact: Dr Michael Grey
Neuroplasticity is critical for neurorehabilitation. Transcranial magnetic stimulation (TMS) can be used to measure corticospinal excitability, which is a surrogate marker for neuroplasticity. Both stimulus-response curves and excitability maps have been used in research studies to explore neuroplasticity. However, their clinical use is restricted by the time it takes to acquire the data (typically 10-15 min). We recently demonstrated that data to construct SR curves and excitability maps can be acquired in less than two minutes (Mathias et al. 2014, van de Ruit et al. 2015). We are developing these techniques so they may be used in the clinic, thus translating a laboratory-based measure into clinically-feasible measure of neuroplasticity.
Concussion in sport
- Funding: SRMRC
- Key contact: Dr Michael Grey
Recent high profile incidences in professional sport and the media have highlighted the need for greater awareness and acknowledgment of concussion in sport. In practise, medical professionals at the side of the pitch have a very difficult return-to-play decision to make when faced with an athlete who may or may not be concussed. We are developing physiological-based tests that can be added to the toolkit thus providing more information for both the medical staff and the athlete. Our work at the University of East Anglia is being conducted in collaboration with the Trauma Centre at Queen Elizabeth Hospital Birmingham. Work in our laboratory has been featured on BBC Panorama and BBC Inside-Out.
Processing of light touch for the control of postural stability during standing and walking in balance-impaired patients (LITPAC)
- Funding: Federal Ministry of Education and Research of Germany (BMBF) in collaboration with the German Balance and Vertigo Centre (DSGZ) in Munich.
- Key Contact: Dr Leif Johannsen
This project aims to investigate the cortical processes involved in the integration and disambiguation of task-specific haptic feedback for the control of sway in quiet standing. In neurologically healthy individuals, activity within specific cortical areas will be modulated by Transcranial Magnetic Stimulation (TMS) and resulting behavioural effects on parameters of postural stability will be assessed. We expect that inhibition and excitation of activity within the posterior parietal cortices by TMS will regulate the efficiency of processes responsible for the integration and disambiguation of body sway-related tactile feedback. Behavioural data gained from healthy participants will be compared with behavioural data of individuals with circumscribed brain lesions. We also intend to evaluate in chronic stroke patients whether a training programme consisting of diverse exercises promoting the use of actively acquired sway-related light touch feedback results in permanently improved control strategies and postural stability during dynamic activities such as reaching while standing and over ground locomotion.
Robotic light touch support during locomotion in balance impaired humans (ROLITOS)
- Funding: German Research Council (DFG) through the TUM International Graduate School of Science and Engineering (IGSSE)
- Key Contact: Dr Leif Johannsen
Which qualities make an expert healthcare provider so efficient in the provision of adaptive manual support to balance-impaired patients? We believe the answer lies in the ability to anticipate a patient’s movement dynamics. We are interested in defining the specific perceptual, cognitive and motor skills experts in balance support and manual patient handling have acquired during their extensive clinical experience. We assume that expert support providers are not only more able to process and interpret visual and tactile information regarding their patient’s dynamics of sway and body excursions during dynamic postural activities but also more able to control and support the motion dynamics of the patient by the provision of light, finely adjusted contact to the patients’ body. The scientific aim of this project is to understand the interpersonal dynamics of light touch balance support in general and caregiver-patient interaction during light interpersonal touch stabilisation in particular. Our engineering aim is the translation of the principles of human-to-human interpersonal coordination for light tactile balance support into a robotic solution. The feasibility of a robotic solution for deliberately light postural support will be explored in balance-impaired individuals. A critical test will be participants’ state anxiety of falling in situations simulated postural threat.
Accelerometry-based evaluation of a relationship between repetitive head impacts and changes in cognitive-sensorimotor functions and structural brain anatomy in soccer players (KONTAKTS)
- Funding: Federal Institute for Sport Science (BISP), Germany.
- Key contact: Dr Leif Johannsen
Will repetitive but mild (subconcussive) head impacts such as headings pose a long-term health risk to soccer players? This project aims to assess mid-term changes in cognitive and sensorimotor functions as well as anatomical structures of the brain as a consequence of repetitive head impacts. Using quantitative head accelerometry, the frequency and intensity of all head impacts during training and competitive field play will be recorded and correlated with any systematic changes in neurocognitive functions and in brain structure. In a prospective study we will follow two teams of male and female players of the regional football league in southern Germany across two soccer seasons to test whether the risk for mild traumatic brain injury (mTBI) is higher in female players. We intend to inform the development of guidelines for the prevention of mTBI in soccer players.
Current PhD Programmes
Fiona Ellis: Virtual Reality in real world rehabilitation
Alison Welsh: The use of aerobic exercise within stroke rehabilitation to elicit improvements in cognitive function
Kawthar Ajaj: Optimal delivery of mirror therapy to enhance upper limb recovery after stroke
Sarah Bajuaifer: Development of a mirror therapy intervention applicable to lower limb rehabilitation after stroke
Capt Ziad Shabana: Effects of exposure to potential neurotoxic working environments on tankers
Recently Completed PhD Programmes