NIHRDataInsights/HRCSData huggingface dataset:
Title: Early intervention to improve upper limb function after perinatal stroke
Funder: Department of Health and Social Care

Abstract: Perinatal stroke is the leading cause of hemiplegic cerebral palsy, with life-long personal, social and financial consequences. No standardised early intervention exists despite robust scientific evidence for a critical therapeutic window in the first 6 months of life. Promoting activity of the potentially affected side during this unique period of plasticity could mitigate the consequences of perinatal stroke to an extent not possible with later intervention, by preserving the normal pattern of development of descending pathways controlling movement. I will develop and evaluate a non-invasive, evidence-based, parent-led, home-delivered early intervention based on this approach, in preparation for a multicentre trial.

Lay abstract: Perinatal stroke is the leading cause of hemiplegic cerebral palsy, with life-long personal, social and financial consequences. No standardised early intervention exists despite robust scientific evidence for a critical therapeutic window in the first 6 months of life. Promoting activity of the potentially affected side during this unique period of plasticity could mitigate the consequences of perinatal stroke to an extent not possible with later intervention, by preserving the normal pattern of development of descending pathways controlling movement. I will develop and evaluate a non-invasive, evidence-based, parent-led, home-delivered early intervention based on this approach, in preparation for a multicentre trial.

Research activity codes: 5.7 PHYSICAL
Health categories: STROKE;NEUROLOGICAL
Title: Usability study of an online speech therapy platform for stroke survivors and people with Parkinson's
Funder: Department of Health and Social Care

Abstract: 64% of stroke survivors and 89% of people with Parkinson s have communication difficulties [1] including slurred speech, quiet and hoarse voice, and difficulty understanding others or expressing themselves. Being able to assess and improve therapy outcomes for a range of communication difficulties is the number three concern in stroke rehabilitation, identified in the James Lind Alliance top ten priorities for patients, families and clinicians [2]. The state-of-the-art treatment for speech difficulties is speech and language therapy, which recommends a minimum of 45-minute daily practice per national clinical guidance [3]. However, due to limited public healthcare resources, treatment quality and quantity are compromised [4], resulting in long waiting lists and 45% of stroke survivors feeling abandoned [5]. The proposed project will aid the development of the Beautiful Voice platform &ndash; a software designed to enable accessible and effective speech therapy for people with neurological conditions. The platform aims to deliver evidence-based exercises to users at home, enabling improved therapy outcomes while reducing burdens on carers and healthcare professionals. Preliminary results from 12 volunteers using the platform for 1 month have indicated improvements on speech and voice metrics: loudness (+3dB); intelligibility (+10%); home training time (+30%). However, usability and training compliance remain key challenges for enabling a practical and effective home therapy platform for people with neurological conditions. This project aims to investigate the usability and adherence of the prototype platform with 15 patients for daily use over a period of 2 months. The quantitative and qualitative feedback from the study will help optimise user-interface and platform features, enabling further development towards a solution that maximises user engagement and therapy outcomes. At this early stage, funding to demonstrate usability and adherence, and accelerate product improvements will de-risk the business, enhance user-centric designs and user experience, and justify further public and private investments.


Research activity codes: 6.7 PHYSICAL
Health categories: STROKE;NEUROLOGICAL
Title: Predicting the response to plasticity-inducing protocols of non-invasive brain stimulation (NIBS)
Funder: Medical Research Council

Abstract: Non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (TDCS), is a successful treatment for medically refractory depression and is a potentially useful additional treatment for a wide range of other neurological conditions. However there is considerable inter-individual variation in the response to NIBS in healthy people and this probably explains why many patients respond better/worse to therapeutic applications than others. Recent evidence suggests that a substantial proportion of the inter-individual variance to an rTMS protocol (intermittent theta burst iTBS) can be predicted by much simpler measures of the response to single pulse TMS, which in turn may reflect subtle differences in cortical anatomy/physiology. The objective of the proposal is to identify predictors of the response to two other commonly used forms of NIBS, TDCS and paired associative stimulation (PAS). Extrapolating from our previous iTBS study this will require testing 50 healthy individuals. We will then test whether these measures predict the response to a single therapeutic intervention (iTBS or cathodal TDCS) for hand function in 25 patients with chronic stroke. The predictor for PAS will be used in a second experiment. Patients with dystonia have a larger response to PAS than age matched healthy individuals. We will test whether their responses are also predictable from the simple TMS measures that depend on cortical anatomy/physiology. If so then it may be that structural factors rather than intrinsic differences in synaptic plasticity are responsible for the effects. Finally in collaboration with Dr A Thielscher we will use detailed models of current flow induced in individual brains to test whether individual differences in anatomy can account for much of the variation in TMS/TDCS response.


Research activity codes: 6.3 MEDICAL DEVICES
Health categories: STROKE;NEUROLOGICAL
Title: Funding for Cognitive Imaging
Funder: Medical Research Council

Abstract: The future programme is investigating three disease groups with MRI techniques; left hemisphere stroke patients with aphasia; patients with mild-to-moderate Alzheimer's disease; and patients with chronic temporal lobe epilepsy. All patient groups will undergo anatomical volumetric scanning, diffusion tensor imaging to investigate white matter tract integrity, and functional MRI (fMRI). The scanning data will be analysed using FSL software (FMRIB, Oxford, UK). The functional data will be analysed using both univariate statistics, to observe regional effect size, and multivariate statistics (principally independent component analyses), to assess functional connectivity across the brain. The stroke project is designed to observe the natural change in language impairment over the three months after stroke, at which time recovery is usually maximal. Early and late scanning sessions will assess lesion size and distribution, the integrity of intrahemispheric language tracts within the left hemisphere, and changes in the distributed connectivity across the brain that relate to better natural recovery. The hypothesis is that these measures will give a reliable set of imaging biomarkers that predict outcome after aphasic stroke. The project on Alzheimer's disease is specifically investigating the integrity of the right fronto-parietal network for sustained attention. Our hypothesis is that the forgetfulness of AD patients is partly due to a failure to register information, in addition to problems with memory encoding and retrieval. We have piloted a behavioural verbal task that robustly activated the right fronto-parietal system, and this will be applied to AD patients before and after treatment with a disease-modifying agent. The TLE project is using DTI and fMRI to investigate the reorganisation of semantic memory temporal lobe networks in response to repeated clinical and sub-clinical seizure activity. This addresses issues about anterior temporal lobectomy.


Research activity codes: 4.1 DISCOVERY AND PRECLINICAL TESTING OF MARKERS AND TECHNOLOGIES;2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health categories: STROKE;NEUROLOGICAL
Title: Temporal lobe connections and parallel networks for memory: possible mechanisms of resilience and recovery after stroke
Funder: Medical Research Council

Abstract: The main objective is to study the effects of focal stroke affecting temporal lobe white matter tracts; and to use this knowledge to develop a scientifically informed framework to stratify patients based on accurate predictions of prognosis. The design combines prospective investigation of two cohorts: a clinical cohort with recent stroke; and a cohort from an existing longitudinal population-based study with incident stroke. The combination of these cohorts is a key strength: the Rotterdam cohort offers replication, and the strongest test of the main hypothesis because of the presence of prospectively collected data on pre-stroke cognitive trajectory. The King's cohort will provide deeper insight into mechanisms, through more detailed characterisation of brain structure and memory profile. The potential for independent replication and cross-validation are key strengths. Diffusion tensor MRI will be used to reconstruct and quantify the microstructural properties of major temporal association tracts implicated in memory, including fornix, uncinate and parahippocampal cingulum. The applicant's prior work has demonstrated the central role of the fornix in the healthy brain and in ageing, and that non-fornical tracts become disproportonately important in early memory breakdown. The diffusion and tractography methodology are established and validated in older and clinical groups. The functional relevance of specific tracts will be investigated further at the neuropsychological level, using tests that probe decision-making, semantic and familiarity aspects of memory. Multivariate pattern recognition of images has been applied to diagnosis. Here, we will apply a Bayesian framework to the problem of predicting prognosis and stratification of patients based on prognosis. A novel aspect will be developing an approach to predict the whole profile of memory (rather than a single measure), and to try to extract additional prognostic information from brain images.


Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION;2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health categories: STROKE;NEUROLOGICAL
Title: Inflammatory mechanisms and treatment strategies in post-stroke dementia
Funder: The Dunhill Medical Trust

Abstract: Cerebrovascular disease in the elderly is a common cause of morbidity, mortality and dementia. Our longitudinal study in older cognitively intact stroke survivors showed 25% succumbed to dementia during a mean follow up period of 3.8 years. Experimental and human studies indicate that inflammatory mechanisms prior and after acute ischaemic injury influence neurological and cognitive outcomes. Both innate and adaptive immune responses are activated after stroke. Pre-existing systemic infection, inflammatory process or autoimmune conditions such as vasculitis, antiphospholipid syndrome or rheumatoid arthritis may modulate outcomes. We propose to compare the influence of inflammatory mechanisms in demented and non-demented stroke survivors (n=350) by investigating inflammatory and immune system markers 1) in post-mortem brain tissues using histopathological methods and 2) in baseline (pre-dementia) bloods by generating inflammation specific proteomic or cytokine signatures. Results will inform whether post-stroke inflammatory responses play a role in the aetiology of dementia after stroke and whether it influences mortality.


Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health categories: STROKE;NEUROLOGICAL
Title: Structural brain changes with learning and recovery from stroke.
Funder: Wellcome Trust

Abstract: Whenever we learn a new skill, such as piano playing or juggling, the physical structure of our brain changes. Structural changes also occur when our brains recover from damage such as stroke. Studies in animals have shown that this structural change can be detected under the microscope: for example, brain cells grow more branches and form more links with other cells. However, microscopic techniques can only be performed post-mortem and so cannot help us to understand changes that happen when hu mans learn new skills or recover from brain damage. By contrast, non-invasive brain scanning techniques, such as MRI, allow us to study brain structure in living humans. The proposed work tests whether brain scans can detect the subtle microstructural changes that occur with learning and recovery. By carrying out studies using both brain scanning and microscopic techniques in animals, I will be able to test which microscopic changes influence the changes detected on brain scans. Understan ding how the brain recovers from damage has important clinical implications. For example, if we can detect regions that change with recovery then it might be possible to specifically target these regions with brain stimulation therapy in order to speed up or improve recovery.


Research activity codes: 1.1 NORMAL BIOLOGICAL DEVELOPMENT AND FUNCTIONING;2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health categories: STROKE;NEUROLOGICAL
Title: Assessing the mechanisms of recovery of aphasic speech production
Funder: Wellcome Trust

Abstract: Spontaneous recovery from aphasic stroke occurs within three months. Recovery may depend as much on lesion site as size, and the capacity for integrated activity over a widely distributed left hemisphere network, encompassing temporal, parietal and frontal cortex. This study will identify this network, and the anatomical and functional connectivity within it that influences prognosis. Disorders of articulatory control, such as dysarthria, will not form part of this study. Fifty aphasic stroke pa tients with content word retrieval impairment during spontaneous speech production will undergo behavioural assessment at one week, two weeks and three months after the ictus. At two weeks and three months each patient will undergo functional and anatomical imaging (fMRI, DTI and T1-weighted MRI). Twenty-five patients with left hemisphere stroke without aphasia and 25 normal subjects will also provide functional and anatomical imaging data at two time points 10 weeks apart. All stroke patients w ill also undergo an fMRI assessment of the effects of recent stroke on the haemodynamic response function, and this data will be incorporated into the analyses. The fMRI data will be subjected to both conventional univariate and more sensitive multivariate analysis, and the results related to behavioral outcome and the degree of recovery.


Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: STROKE;NEUROLOGICAL
Title: EPSRC-NIHR HTC Partnership Award: IMPRESS Network, Incontinence Management and Prevention through Engineering and Sciences
Funder: Engineering and Physical Sciences Research Council

Abstract: Faecal Incontinence (FI) is defined as the inability to fully control the passage of faeces through the anus. This may arise due to a weakened anal sphincter muscle (typically following child birth), problems with nerve supply (e.g. stroke, multiple sclerosis), or in association with other gastrointestinal conditions (e.g. irritable bowel syndrome). It is a common and distressing condition that causes shame, embarrassment, depression, social isolation, secrecy, poor self-esteem, and sexual avoidance. As a result, more than 54% of patients with FI have not discussed their symptoms with a physician , and only one-quarter of patients with FI are referred by their GP for specialist treatment . Its exact prevalence is difficult to determine but best estimates suggest that in the adult population it is around 10%, and that 0.5% - 1% below 65 years and 3% - 8% over 65 years experience regular faecal incontinence. Urinary Incontinence (UI) is defined as involuntary leakage of urine, UI presents a major burden on NHS resources. It is a common and distressing condition, which impacts of quality of life. The main forms of UI are stress incontinence (SUI), which is leakage with physical exertion, and urge incontinence (UUI), which is leakage with a strong desire to void. Mixed urinary incontinence is a combination of SUI and UUI. The prevalence of UI increases with age and is higher in institutionalised adults, who tend to be older and suffer associated co-morbidity. It is more often a problem for females, with prevalence rates of UI ranging from 4.5% to 53% in women, as compared to 1.5% and 24% in men. Although previously considered in isolation, it is increasingly recognised that many forms of FI and UI share a common underlying pathophysiology and frequently co-exist with pelvic organ prolapse Incontinence places a massive burden on the NHS and impacts significantly on quality of life for thousands of patients in the UK. Whilst many areas of medical engineering share a growth in the engagement of engineers and scientists to push forward the exploitation of emerging technologies it is arguably the case that the nature of this disease prevents engineering and science research leaders seeing the potential for some rich research challenges. This proposed network will provide a step change in the increased engagement of leading UK technologists (from academia and industry) to provide a substantial impact to incontinence sufferers.


Research activity codes: 5.9 RESOURCES AND INFRASTRUCTURE (TREATMENT DEVELOPMENT)
Health categories: STROKE;NEUROLOGICAL;REPRODUCTIVE HEALTH AND CHILDBIRTH;RENAL AND UROGENITAL;ORAL AND GASTROINTESTINAL
Title: Future of Animal-sourced Foods (FOAF)
Funder: Wellcome Trust

Abstract: Changes in the amount and type of animal-sourced food (ASF) we consume, and in the way they are produced, are critical drivers of global human health and environmental quality. The project will develop novel policy tools and interventions to allow more informed and effective action to be taken to maximise the health and environmental co-benefits of changes in ASF consumption. We shall build a quantitative food system model incorporating economic, health and environmental modules that will allow the effects of existing drivers and novel policy interventions to be assessed. We shall exploit unique epidemiological resources to provide new evidence about how different types of ASF affect health, and conduct experiments to develop new interventions to influence the consumption of ASFs and ASF substitutes. A social-science component will research how social norms and political economic factors affect the practicality and acceptability of interventions, and how this may be changed. The effects of different types of ASF production on climate change, water use and quality, and ecosystem functions will be measured and brought together for the first time. The project will develop a distinct work stream in China and engagement with multiple audiences will be integral to all its activities.


Research activity codes: 3.5 RESOURCES AND INFRASTRUCTURE (PREVENTION)
Health categories: STROKE;ORAL AND GASTROINTESTINAL;GENERIC HEALTH RELEVANCE;CARDIOVASCULAR;CANCER AND NEOPLASMS
Title: 2016 GPARTS Dr Rachel Martin - A Study to assess preparedness of GP Trainees to deliver health promotion advice for physical activity
Funder: Health and Social Care Research and Development Division (HSC R&D) of Public Health Agency, Northern Ireland

Abstract: “Physical inactivity is an important risk factor for a variety of diseases, including heart disease, diabetes and even some cancers. In Northern Ireland (NI), and indeed across the globe, people are not getting enough physical activity. It has been proposed that GPs should be routinely counselling their patients about physical activity. Little is known about how prepared GP Trainees feel to do this, and how much training they receive in preparation for their future practice. This study aims to assess GP Trainees’ preparedness to deliver PA advice and assess the level of training received using mixed methods. GP Trainees in their final year of training (ST3) in NI will be invited to participate. Training Programme Directors (TPDs) of the locality training groups in NI will also be asked to take part. Participants will be invited via e-mail, sent through the Northern Ireland Medical and Dental Training Agency (NIMDTA). GPST3s and TPDs will be asked to complete a questionnaire. Descriptive analysis will be employed to analyse responses. GPST3s will then be invited to take part in a focus group. It is envisaged up to 3 focus groups will be required with up to 6 participants in each. The TPDs will also be invited to take part in a focus group. An interview schedule will be employed as a guide for the researcher and this will be informed by responses from the questionnaires. Focus groups will be audio recorded and transcribed. Following this, a thematic analysis will be conducted on the data.”


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: STROKE;ORAL AND GASTROINTESTINAL;METABOLIC AND ENDOCRINE;CARDIOVASCULAR;CANCER AND NEOPLASMS
Title: Evaluation of the impact of tobacco control mass media campaigns on quitting behaviour, smoking prevalence and smoking-related health outcomes.
Funder: Chief Scientist Office (Scotland)

Abstract: This study aims to assess the effectiveness and cost-effectiveness of tobacco control mass media campaigns. First, we will characterise all Scottish national tobacco control mass media campaigns (and tobacco control mass media campaigns reaching Scottish populations through UK terrestrial or satellite TV and radio) in terms of campaign characteristics (primary audience target, campaign aims, content and style), delivery medium, duration and campaign intensity (population reach X frequency of show). Then, we will determine the impact of different campaigns and campaign types on quit attempts, uptake of smoking cessation support, smoking prevalence and smoking related health outcomes both in the adult general population and sub-groups in the population (age group and socioeconomic status) and assess their cost-effectiveness. Finally, we will combine data collected by this and an on-going MRC-funded study of the effectiveness of English tobacco control mass media campaigns, thus increasing power to detect changes in health outcomes in population sub-groups.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: STROKE;RESPIRATORY;CANCER AND NEOPLASMS;CARDIOVASCULAR