Current Projects

The ABIRA team are involved in a wide range of research projects aimed at enhancing the benefits of rehabilitation for people who have sustained a brain injury through disease or trauma. Here are some of our current projects.


Performance and functional ability after insertion of the Journey II Bi-Cruciate Stabilised Knee System compared with the Genesis II prosthesis : Capability Trial

Key Contact: Dr Celia Clarke Funder: Smith & Nephew Clinical Fund

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 outcomes, patient reported, surgical and kinematic, compared to the GENESIS II system.

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Key Contact: Dr Celia Clarke
Funder: Smith & Nephew Clinical Fund

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 outcomes, patient reported, surgical and kinematic, compared to the GENESIS II system.


Rapid assessment of corticospinal neuroplasticity

Key Contact: Dr Michael Grey Funder: SRMRC and BMA

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.

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Key Contact: Dr Michael Grey
Funder: SRMRC and BMA

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.

Further information


REhabilitation and recovery of peopLE with Aphasia after StrokE (RELEASE)

Key Contact: Dr Simon Horton

REhabilitation and recovery of peopLE with Aphasia after StrokE (RELEASE): Utilizing secondary data to enhance speech and language therapy interventions for people with aphasia after stroke. NIHR HS&DR. Professor Marian Brady; Dr S Horton et al. (2015-2017)

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Key Contact: Dr Simon Horton

REhabilitation and recovery of peopLE with Aphasia after StrokE (RELEASE): Utilizing secondary data to enhance speech and language therapy interventions for people with aphasia after stroke. NIHR HS&DR. Professor Marian Brady; Dr S Horton et al. (2015-2017)


Tele-rehabilitation device to enhance walking following ABI

Key Contact: Dr Celia Clarke

After a brain injury some people may experience difficulty moving their leg and therefore have problems with walking. The ability to control ankle movement has been shown to be an important feature of walking recovery following a brain injury and therefore the design of rehabilitation programmes and devices which can improve ankle control is desirable.

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Key Contact: Dr Celia Clarke

After a brain injury some people may experience difficulty moving their leg and therefore have problems with walking. The ability to control ankle movement has been shown to be an important feature of walking recovery following a brain injury and therefore the design of rehabilitation programmes and devices which can improve ankle control is desirable.

Research programmes have investigated whether virtual reality systems can be used to deliver exercises aimed at improving ankle control, and there is evidence to suggest that these systems have led to better walking recovery. However these systems are often bulky and expensive. In this project we want to develop a smart ‘wobble board’ which will be designed to deliver ankle exercises to people with brain injury. This product aims to be a portable low cost system that could be used in both clinical settings and in people’s own home.

The research was funded/supported by the National Institute for Health Research (NIHR) Brain Injury Healthcare Technology Co-operative based at Cambridge University Hospitals NHS Foundation Trust and University of Cambridge.  The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the department of Health.


The HeART of Stroke

Feasibility of a randomised controlled trial of an Arts for Health group intervention to support self-confidence and psychological wellbeing following a stroke

Key Contact: Dr Fergus Gracey

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Feasibility of a randomised controlled trial of an Arts for Health group intervention to support self-confidence and psychological wellbeing following a stroke

Key Contact: Dr Fergus Gracey

Email: f.gracey@uea.ac.uk

Stroke is a leading cause of acquired physical disability that can lead to long term emotional distress which if unresolved, can lead to long-term costs for stroke survivors, their families and health and social services. Health services currently focus on the practical and visible aspects of life, leaving emotional challenges hidden. Theoretical models, based on empirical evidence, have been developed by Ellis-Hill and colleagues (Life Thread Model) and Gracey and colleagues (Y-shaped model) to understand the processes involved in re-establishing a positive sense of self and confidence in life following a stroke. Key is being able to reconstruct a sense of meaning, predictability and coherence in everyday life, when previously taken for granted assumptions no longer hold true; developing new ways of ‘being in the world’.

Through the use of imagination, Arts for Health (AfH) practices offer the opportunity for self-development using internal resources not usually available in everyday life. Within a group setting, a collective sense of identification and belonging facilitates the process of self-development and acceptance. This instils a sense of self-confidence, despite facing unfamiliarity, allowing people to get their lives ‘back on track’ and maintain or develop a sense of wellbeing. Arts and Health interventions have been shown to be helpful in GP practices for people who are isolated and have low confidence, however, their value has not been explored with people living with a stroke after leaving hospital.

Our team, led by Dr Caroline Ellis-Hill (Bournemouth University) is conducting a study to look at the feasibility of a larger multi-centre trial comparing our Arts for Health group (HeART of Stroke) alongside usual care with usual care only, to see if a) the methods we are planning work b) the ways of assessing participants’ well-being, mood, quality of life, confidence and use of health services are appropriate c) stroke survivors want to take part and d) they value the intervention. The study is being run in Bournemouth (Dr Caroline Ellis-Hill, CI) and Cambridgeshire (Dr Fergus Gracey, PI).

To find out more about the study contact Dr Fergus Gracey f.gracey@uea.ac.uk or https://research.bournemouth.ac.uk/2015/08/heart-of-stroke-study/

Funding

This summary presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0212-27054.The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.


ViaTherapy App Service Evaluation Better rehabilitation methods for enhancing movement recovery after stroke to enable independent living

Key Contact: Dr Nicola Hancock Funder: UEA Impact Funding

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.

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Key Contact: Dr Nicola Hancock
Funder: UEA Impact Funding

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.


Virtual Learning Environment

Key Contact: Dr Andrew Bateman

Email: Andrew.Bateman@ozc.nhs.uk

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Key Contact: Dr Andrew Bateman

Email: Andrew.Bateman@ozc.nhs.uk

Virtual Learning Environment  for neuropsychological rehabilitation in the community following stroke or acquired brain injury

In previous research the project has found a high rate of occurrence of fatigue that limits patients’ abilities to take part in rehabilitation and resume their day-to-day lives. When asked, the problems reported most frequently by people who have sustained brain injury relate to memory and executive difficulties (problems remembering to do things, holding onto information, planning, sequencing, monitoring progress toward a goal). Sadness, anxiety and frustration are frequent emotional problems experienced.

Previously as part of a NIHR CLAHRC -funded PhD studentship, Dr Sara Simblett used an online computerised Cognitive Behavioural Therapy platform that was written originally to help neurologically intact people with mild-moderate anxiety and depression. She evaluated the benefit of this commercially available programme with people living with the consequences of stroke.

Based on this thesis, the current project is seeking to develop a flexible package with a wider range of self-help materials. Early work with a range of collaborators has been completed as steps towards developing the memory management and adapted mood management materials. This will potentially provide remote access to high quality guidance to help individuals overcome problems they are experiencing in these domains. The proposed platform has the potential advantage of providing a route to remote assessment and collation of routine clinical data, which could be a valuable tool for research studies as well as service evaluation.

This research was funded/supported by the National Institute for Health Research (NIHR) and currently benefits from the support of “Innovation Connect BV”, the Netherlands Enterprise Agency, in an exciting new collaboration with an SME, Werson Management.