The University of Southampton
Health SciencesOur research

Neuro-Rehabilitation Project Cluster

Upright posture is characteristic of human mobility and a fundamental part of everyday life. The control of posture and balance is a requirement for safe functional mobility, physical independence and everyday activities. Our research aims to enable everyday activities amongst people with neurological conditions, in particular functional mobility, using a range of research approaches and health technologies appropriate for current and future practice.

Purpose

Our ultimate aim is to enable safe functional mobility while minimising unwanted secondary effects such as falls and injuries and the negative impact of deteriorating motor control on the quality of life of people with neurological conditions such as stroke and Parkinson’s disease. The control of movement, posture and balance are influenced both by age and neurological pathology. The multifaceted nature of neurological conditions with ageing means that our research has a strong multidisciplinary and collaborative profile.

Our research focuses on:
  • Assessments: The development of tests for balance control, measures of posture and fall events
  • Movement science: Exploring the mechanisms underpinning the control of movement and balance
  • Characterisation: Characterising people with stroke and PD with poor balance control and at risk of falls
  • Prediction: Predicting fall events and recovery and deterioration over time
  • Management: The development and evaluation of interventions for people with PD and stroke in the acute and chronic stages focusing in particular on mobility and balance.

Research Approaches

Our multidisciplinary collaborations are with Clinicians, the Comprehensive Local Research Network (Stroke Research and DeNDRoN), national and international rehabilitationists, social scientists, engineers, basic scientists (inflammation), medical statistician, health economist, Research Development Unit, Clinical trials Unit and User Group.

Research approaches range from:

  • Movement analysis laboratory-based studies of normal and abnormal function
  • Proof of concept and feasibility studies of interventions and assessments for use in the home and clinical settings
  • Observational and predictive studies in the hospital and community
    Randomised control trials in the hospital acute settings, and community.
  • Cochrane review

We are concerned with pragmatic interventions and health economics; we have a strong emphasis on long-term management. We use quantitative and qualitative research methodologies and integrate both in clinical trials. We have demonstrated a successful package of integrating basic science and social science research with rehabilitation science in the rehabilitation programme of the Stroke Association Rehabilitation Research Centre, funded 2004 - 2010.

We work along side CLRN funded stroke research network clinical trials coordinators. The network supports the evaluation of medical and rehabilitation technologies for acute and chronic care following stroke in Hampshire and Isle of Wight. Professor Ashburn is the Local Clinical Lead for Stroke Research in Hampshire and the Isle of Wight.

Collaboration

We have local, national and international collaborations
with Medical Statistics (Pickering), Social Science (Wiles), Biomed Science (VHPerry), Engineering (Allen), RD Unit (Robison, Ballinger), Academic Elderly Care (Roberts), Clinicians. Also close links with Newcastle, Birmingham, Glasgow, Ulster and Warwick Universities and International Universities: Radboud, The Netherlands; Leuven, Belgium; Melbourne; AUT University NZ.

Health Technologies

We are recognised internationally for technological developments and innovative applications in the following;

Management of People who fall

Primary Research
As a result of our research we can characterise people with stroke and Parkinson’s disease who are at risk of falling. We have identified physical and cognitive predictors of those who are at risk and we have described, in depth, environmental issues and circumstances surrounding falls and identified turning as a fall related activity. Our randomised controlled trial of exercises and strategies had the largest sample of people with PD when published in 2007.

Secondary Research
We have contributed to a meta-analysis of predictors of people with PD at risk of falling. We lead a Cochrane review on the management of people with stroke who fall.

Stroke Rehabilitation

Recovery
In our observational research study of more than 400 people with stroke we explored the recovery and deterioration of movement and functional mobility plus everyday levels of activity for three years post-stroke. We have utilised both quantitative and qualitative research methodologies. We have described and monitored the influence of infection, stroke type and changes in activity levels over time in hospital and the community.

  • Infection
    We used extracted data from the medical notes to describe the influence of infection at the time of stroke and during the hospital stay on survival.
  • Personal insight
    We utilised qualitative methodologies to explore personal insights into the process of recovery and rehabilitation following stroke and for the first time followed people in this way for three years.
  • Activity Monitor

We monitored the activity level of people with stroke, using activity monitors, which were worn at specified times during the day in hospital and then, at years one, two and three in the community.

Functional Electrical Stimulation (FES)

  • Our research focused on the return of standing balance in the acute stage of rehabilitation; surface electrodes were attached to the hip muscles. We conducted a three-group feasibility randomised controlled trial to evaluate the FES intervention with exercise.
  • We worked with VICTHOM, Quebec, Canada, on a feasibility study of implanted electrodes for dorsiflexors post-stroke.

Head and trunk control
Through our research we examined profiles of movement adopted by the healthy elderly and those with an acute and chronic stroke whilst reaching sideways. Information from this study will inform strategies in rehabilitation.

Mechanism underpinning Balance;We have examined whole body movements of healthy elderly and people with Parkinson’s disease and stroke whilst turning round in response to a visual trigger. The latency of movement of the eyes, head shoulder pelvis and feet to a trigger to demonstrate the delay in PD and potential risk to perturbation.

Movement analysis; We have conducted 3-dimensional movement analyses using CODAMotion, Kistler force plate and visio goggles eye camera and the SpinalMouse®. We have a portable CODAmotion and a system in situ.

Outcome measures; Verheyden has led the development of clinical outcome measure for recording balance control post-stroke. This clinical tool continues to be translated into a number of languages.
We have developed a procedure for using the SpinalMouse® to measure spinal posture in people with Parkinson’s disease.

Consumer Group; We worked with INVOLVE to set up our consumer group of people with stroke which was established in 2006. We are currently proposing to expand the group. Members advise us on improving the presentation of information for research participants, the research procedures from a participants view and research priorities.

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