Access all areas? A holistic approach to disability
UEA is at the forefront of research that improves the lives of people with disabilities. From improving the links between theory and practice in clinical rehabilitation to working with families to ensure people with disabilities have the support they need, UEA takes a holistic approach to disability research that considers all aspects of life.
Our academics are also heavily involved with training and retraining professionals in a wide range of clinical professions, including psychologists, doctors and nurses, to help them better understand the lives and needs of people with disabilities.
LINKING RESEARCH AND PRACTICE
Professor Valerie Pomeroy is co-chair of the Acquired Brain Injury Rehabilitation Alliance (ABIRA), a network of clinicians, service providers and clinical researchers dedicated to improving interventions for people with brain injuries. Within ABIRA, Professor Pomeroy's research focuses on the first few months after somebody has suffered a brain injury – a window of time in which it's crucial to identify which therapies will deliver the best outcomes.
This research combines: neurophysiology, to study how the nervous system links the brain and movement; with biomechanics, to study how efficiently movement is performed; with evaluations of the efficacy of specific therapies. This tripartite combination of sciences is informing understanding of not only which approaches work, but also why they work in the context of an individual’s specific injury.
For example, a therapy that helps a stroke survivor to regain mobility might have different levels of effect depending on what part of the brain has been damaged. By contributing to and building on this emerging body of evidence, Professor Pomeroy is working to give physiotherapists the tools to create programmes of therapy that are tailored to the individual.
This approach can be seen in the FAST INdiCATE trial, which is led by Professor Pomeroy and sponsored by UEA. FAST INdiCATE investigates which stroke patients respond better to Functional Strength Training, and which to Movement Performance Therapy – two cornerstones of routine stroke rehabilitation.
An innovative feature of the trial is the use of neuroimaging and neurophysiology to capture participants' brain structure and activity at different points in recovery. This allows different hypotheses to be tested – such as, for instance, whether the condition of the main connective pathway between the brain and muscle, the corticospinal tract, can predict whether or not a stroke survivor improves in response to a particular therapy.
It may be surprising that tailoring treatments to their underlying causes is considered a novel approach in neurorehabilitation – but the discipline itself is also relatively new. It emerged during the 1990s when physiotherapists and other rehabilitation professionals began applying the new discoveries of neuroscience to their work. For example, before new technology allowed investigation of how the brain works, it was thought that the brain could not recover from injury in adulthood. This belief has now been turned on its head, and the discovery of this so-called neuroplasticity allowed the science of neurorehabilitation to develop. As an evolving discipline, it is particularly important that new therapies and treatments are rigorously assessed.
In another application of hi-tech equipment to ABIRA's mission, UEA recently launched a three-year PhD programme in partnership with Virtualware to investigate the potential of VirtualRehab – a virtual reality neurorehabilitation platform that uses gaming models to help stroke patients to recover mobility. The programme, led by Dr Niamh Kennedy and involving Professor Pomeroy, will see a PhD student at UEA evaluate this approach.
Though solutions like VirtualRehab may seem futuristic, they're part of a growing trend in therapy toward "telerehabilitation" – the use of haptic and communications technologies to deliver therapies remotely. This can be particularly valuable when patients are unable to travel to a clinic for therapy.
LIVING WITH DISABILITY
While Professor Pomeroy's research largely focuses on the science of rehabilitation, medical sociologist Professor Tom Shakespeare's work concerns what he calls "the people end of things" – but even here there's room to apply an academic, evidence-based approach.
Professor Shakespeare's research at UEA focuses on the lives of people with disabilities, starting with the personal level, exploring both the challenges and barriers people face, but also the effect a newly acquired disability can have on a person's identity and self-image. At the wider level, Shakespeare analyses changing attitudes toward disability and rehabilitation, and the roles families, support workers and government policy can play in empowering disabled people.
In 2015, he presented research at the House of Lords on how the closure of the Independent Living Fund (ILF), a fund designed to assist people with high support needs, could affect some of the most vulnerable people in society. The research highlighted, among other things, the lack of transition arrangements between the ILF and councils following the closure of the scheme, and disparities in the ways local authorities interpreted needs and rights to independent living.
This data was part of a wider, ESRC-funded study on Personal Assistance Relationships, which gathers qualitative evidence on how disabled people and their personal assistants relate to each other, and specifically, what makes these forms of social care work effectively.
Professor Shakespeare's approach is rooted in the human rights approach and prioritises direct involvement of disabled people themselves. For example, he also leads a CLARHC-funded study of ‘rights based rehabilitation’, exploring disabled people’s own views of the rehabilitation process. A new EU-funded research fellow, Dr Dikmen Bezmez of Koç University in Istanbul, is joining Professor Shakespeare’s team for 13 months to conduct fieldwork in Norwich rehabilitation settings, exploring the role of the family in the rehabilitation of people who have experienced brain injury or amputations.
This represents just a small snapshot of the research on disability and rehabilitation at UEA. Our field-leading academic roster also includes Professor Ruth Hancock, whose research examines the impact of disability benefit reforms and provision of care for older people; Dr Simon Horton, a specialist in acquired communication impairments, Dr Anne Killett, who focuses on dementia care and quality of life within care homes, and Professor Fiona Poland, a sociologist who studies the role of carers and community support in rehabilitation – among many others.
We're extremely proud at UEA to be at the forefront of so many areas of disability research, and we will continue to focus our resources on work that improves the functioning and participation of disabled people in all areas of society.
Since publication of this case study Prof Tom Shakespeare has left the University of East Anglia