NIHRDataInsights/HRCSData huggingface dataset:
Title: Improving patient assessment after stroke: The Cambridge and Oxford Automated Screening Test (COAST)
Funder: Wellcome Trust

Abstract: Every year 150,000 UK residents suffer a stroke. Cognitive problems (e.g. difficulties with language) and low mood are common and undermine recovery. Consequently NHS guidelines recommend that all patients have brief test ‘screens’ to detect these problems and better target care. Unfortunately, due to a lack of materials, skilled staff and staff-time, audits show these targets are often unmet.The Cambridge and Oxford Automated Screening Test (COAST) is designed to solve this problem. It is a set of brief computerised cognitive and mood measures, easily administered by staff using touchscreen tablets. COAST guides health workers through the tests, collects responses from patients, and automatically generates clinical reports. The tests are specially designed to detect problems prevalent after stroke and to include all patients. It is highly portable and requires no specialist equipment beyond devices already widely in use. It frees staff from administrative chores allowing increased patient contact. A project team led by Dr Tom Manly (MRC Cambridge) and Professor Glyn Humphreys (University of Oxford) have developed COAST from a rigorous evidence-base. The award will support the crucial final stages of the project (collecting assessment results from patient and healthy populations and NHS field trials), enabling COAST to make a real difference to clinical care within 3 years.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: STROKE
Title: Delayed, subcutaneous neurotrophin-3 infusion improves recovery after stroke: mechanisms of recovery, automation of testing and markerless kinematics
Funder: Medical Research Council

Abstract: After stroke, sensorimotor reflexes become abnormal; grasping and walking are commonly impaired. Neurotrophin-3 (NT3) is a growth factor that is made at high levels in infant skeletal muscles and which is required for development of proprioceptive circuits from muscle to the spinal cord. However, the levels of NT3 are very low in adult and elderly humans. We have shown that elevating the levels of NT3 normalised a proprioceptive reflex to a hand muscle and promoted sensorimotor recovery in adult and elderly rats when infused subcutaneously for one month, starting 24 hours after stroke. Excitingly, five trials show that NT3 is well tolerated when given subcutaneously at high doses to people with other conditions. We will test the hypothesis that: Neurotrophin-3 normalises proprioceptive spinal circuits and promotes sensorimotor recovery after stroke by binding to TrkC receptors on sensory neurons in dorsal root ganglia when subcutaneous infusion is initiated after 24 hours. Aim 1: We will assess the mechanism of recovery of arm, hand and leg movements in wildtype mice after large cortical strokes and 24h-delayed, one-month subcutaneous infusion of NT3. We will assess dexterity using novel automated in-cage MouseBots and we will assess mechanisms of recovery using viral tracing and chemogenetic silencing, neurophysiology and biochemistry. Aim 2: We will determine whether deletion of TrkC neurotrophin receptors in Dorsal Root Ganglia or neurons in motor cortex 24h after stroke prevents recovery after subcutaneous NT3 infusion. We will use inducible, conditional genetic strategies to delete TrkC neurotrophin receptors in peripheral sensory neurons or neurons in motor cortex after stroke. Aim 3: We will use deep learning algorithms to track limbs and digits without the need to attach reflective markers to the joints, allowing automated kinematics and quantification of recovery. These advances will help move this therapy towards the clinic.


Research activity codes: 5.1 PHARMACEUTICALS
Health categories: STROKE
Title: Stimulating language recovery after stroke: Tailored non-invasive electrical stimulation of the domain-general frontoparietal network.
Funder: Medical Research Council

Abstract: Stroke-related aphasia is a major cause of disability with a UK incidence of ~30,000 per annum. A sound understanding of the mechanisms that underpin recovery of language function is an unmet need. Most therapeutic strategies for aphasia have largely focused on language-specific processes and brain systems with limited success. I have previously shown that domain-general brain networks are also critical in recovery of language function after stroke, building the case for investigating their potential as a prognostic biomarker and therapeutic target. The overarching aim of this proposal is to investigate the compensatory role of the well-established bilateral frontoparietal domain-general network (FPN) in recovery after aphasic stroke. Using real-time functional MRI combined with machine learning in patients after stroke, I will rapidly assess the activity of the FPN across a wide range of language and non-language tasks, with the aim of identifying a novel prognostic biomarker for longitudinal language recovery. I have shown in a pilot study that this is feasible in patients with stroke. In a second study, I will use a second real-time machine learning MRI combined with transcranial Alternating Current Stimulation (tACS) to rapidly tailor tACS parameters (phase and frequency) to maximise the function of the FPN in each individual patient. In the third behavioural study, the patients will undergo tACS stimulation using their individualised stimulation parameters identified in the previous step to investigate whether tACS induced increases in activity of FPN will improve behavioural responses during a language (speech production) and non-language (calculation) task. By using optimal stimulation parameters, this proposal will definitively address the question of modulating brain function using tACS. This approach will have far-reaching implications for cognitive neuroscience and rehabilitation in multiple clinical domains beyond aphasic stroke.


Research activity codes: 5.4 SURGERY
Health categories: STROKE
Title: Clinical outcome modelling of rapid dynamics in acute stroke with joint-detail, continuous, remote, body motion analysis
Funder: Medical Research Council

Abstract: Stroke is characterised by rapid temporal dynamics and marked functional heterogeneity, with early changes in the dynamics of upper limb recovery shown to be predictive of longer-term functional outcomes. Optimal stroke care therefore requires both detailed characterisation of the functional deficit and a high-resolution index of its rate of change. While such high-definition clinical supervision could be delivered, it would require close to a 1:1 staff/patient ratio, and could not be standardised with formal, objective models of the relation between outcomes and clinical features. Recent advances in deep learning-assisted modelling of ordinary video data have enabled the real-world extraction of detailed body motion information, resolved down to major joints, without body-worn devices and robust to large variations in body characteristics, dress and environmental context. My clinical and engineering collaborators have developed an inexpensive miniaturised device-MoCat-that combines in analysing body motion the richness and anatomical detail of a clinician with the objectivity and automatic deployability of a machine, in real time, within real-world clinical environments. Crucially, MoCat does not store or transmit video data, preserving patient privacy, and does not require any alteration to current care pathways (e.g. addition of body markers) or major changes to a hospital's digital or estate infrastructure, rendering it readily deployable throughout the NHS and beyond. We propose to deploy MoCat on the Hyperacute Stroke Unit at King's College Hospital. We shall quantify (1) within high-dimensional predictive models, the relationship between trajectories of motor deficits at different time scales and clinical outcomes of interest and actionable care pathway deviations; and (2) within high-dimensional lesion-deficit anatomical inferential models, the relation between trajectories of motor deficits at different temporal scales and stroke lesion patterns.


Research activity codes: 6.3 MEDICAL DEVICES
Health categories: STROKE
Title: A scalable solution for supporting informal stroke caregivers in Malaysia: systematic development and feasibility study
Funder: Medical Research Council

Abstract: Stroke is a leading cause of death and disability in Malaysia. Most stroke survivors experience multiple disabilities and are functionally dependent when they are discharged from the hospital. Physical therapy and help with mobility and daily activities (e.g. feeding, bathing and dressing) is generally provided by family members (caregivers) who are supported by community rehabilitation services in high-income countries. However, in the absence of community rehabilitation services, caregivers take on most of the patient care responsibilities in Malaysia. They are untrained and unprepared for this role, which impacts negatively on outcomes for stroke patients and the physical, emotional, social and financial health of the caregivers. Informed by our previous work in India, and the planned contextual analysis in Malaysia, we will develop a culturally tailored intervention (in-person training coupled with sustained support through a mobile phone application) to improve caregivers' skills in managing the physical and psychological needs of stroke patients and their own needs. We will assess the feasibility and acceptability of the intervention and undertake a stakeholder analysis to establish the need for further evaluation or implementation in the Malaysian healthcare system. The social and economic cost of stroke disability to Malaysia is tremendous, as stroke sufferers and their caregivers are typically of working age. Our intervention to support stroke caregivers could yield health and developmental dividends for Malaysia and reduce disparities.


Research activity codes: 7.4 RESOURCES AND INFRASTRUCTURE (DISEASE MANAGEMENT)
Health categories: STROKE
Title: Clopidogrel genotype testing after ischaemic stroke or transient ischaemic attack [DAP65]
Funder: Department of Health and Social Care

Abstract: A stroke occurs when the supply of blood to the brain is cut off. Symptoms of stroke happen suddenly and vary depending on which part of the brain is affected. They usually include problems with movement, speech, vision and the face drooping on one side. A related condition, known as “transient ischaemic attack” (TIA), occurs when the blood supply to the brain is temporarily interrupted causing a mini-stroke. There are around 100 000 strokes every year in the UK and around 60 000 people will have a TIA._x000D_ _x000D_ People who have a stroke or TIA are at greater risk of having another stroke. To reduce the chances of this happening, doctors will often prescribe medication. The most common medication used to prevent further strokes is called “clopidogrel”. However, clopidogrel does not work for everyone. One reason for this is having specific variations of a common gene called the CYP2C19 gene._x000D_ _x000D_ We want to know whether introducing genetic testing to identify variations in the CYP2C19 gene for people who have had a stroke or TIA will mean that more people can receive treatment that will work for them, reducing the risk of having another stroke. We also want to know whether introducing this type of testing is a good use of NHS money._x000D_ _x000D_ We are going to review the existing research, send out a survey to labs that do genetic tests, and develop economic (cost) models to answer the following questions:_x000D_ 1. Do people who have had a stroke or TIA, and who have specific variations in their CYP2C19 gene, have fewer strokes if they are given an alternative treatment to clopidogrel?_x000D_ 2. Which test should people have to find out if they have the variation in their CYP2C19 gene that means that clopidogrel may not work so well for them?_x000D_ 3. Is testing people for CYP2C19 gene variations and then giving them treatment based on which gene variations they have a cost-effective use of NHS money?

Lay abstract: The overall aim of this project is to summarise the evidence on the clinical- and cost-effectiveness of genetic testing to identify clopidogrel resistance in people with non-cardioembolic ischaemic stroke or TIA.

Research activity codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES;6.1 PHARMACEUTICALS
Health categories: STROKE
Title: Development and Initial Testing of an Innovative Targeted pOsture-and-griP-STrEngth Rehabilitation (TOPSTER) Glove-Based Device for Stroke Patients.
Funder: Chief Scientist Office, Scotland

Abstract: Stroke is a clinical priority within Scotland and the Scottish Government Stroke Improvement Plan highlights the importance of effective interventions that support Stroke survivors by promoting self-care and independent living. To date remotely monitoring home rehabilitation exercises among stroke survivors remains a key challenge. This proposed research aims: (a) to further develop and evaluate an advanced rehabilitation prototype exercise glove called TOPSTER and (b) to determine via qualitative interviews its acceptability and potential benefits with ten patients recovering from stroke. The findings of this study will inform further refinement of the TOPSTER as a basis for a future clinical trial.


Research activity codes: 6.3 MEDICAL DEVICES
Health categories: STROKE
Title: Promoting Physical Activity and Exercise After Stroke Using a Text Messaging Intervention.
Funder: Chief Scientist Office, Scotland

Abstract: 70% of stroke survivors experience enduring physical impairments and associated disabilities. After rehabilitation, survivors are signposted to exercise opportunities (post-stroke exercise classes, walking groups, conventional gyms and given home exercises) to support recovery. Despite this, our research shows many struggle with motivation and feel abandoned by services after rehabilitation. Consequently, participation in physical activity (PA) and exercise is low. Behaviour change interventions delivered by Short Message Service (SMS) can improve motivation and adherence to physical activity (PA) in older populations and could ameliorate feelings of abandonment at the end of rehabilitation. Our pilot work shows that most stroke survivors use SMS messaging. An SMS intervention that provides real-time support for goal setting, planning, and prompts for self-monitoring after rehabilitation is a potentially effective way to enhance motivation, combat the feeling of abandonment, and support PA and exercise adherence. We will: a) Conduct focus groups with stroke survivors to understand how an SMS intervention could work and what features are acceptable (text frequency content, tone, narrative features) b) Co_x0002_design, develop, pilot and refine a new SMS intervention with stroke survivors and health professionals c) examine intervention and key aspects of study feasibility and acceptability for testing in a future trial


Research activity codes: 6.7 PHYSICAL
Health categories: STROKE
Title: Cochrane Living Systematic Review: Physical rehabilitation to improve function and mobility in people after stroke (‘Living SPRUCE’).
Funder: Chief Scientist Office, Scotland

Abstract: Stroke is a leading cause of long-term physical disability. Around 80% of stroke survivors have problems with movement, and commonly receive physiotherapy. Cochrane systematic reviews bring research evidence together to give information on the best care and treatment choices. A Cochrane review by our team showed that physiotherapy can improve function and walking after stroke, but we are unsure what sort of physiotherapy is best. Because the review has not been updated since 2012, treatment decisions might not be based on the most recent evidence. COVID-19 has impacted on stroke rehabilitation and there are new questions about how to deliver physiotherapy. Updating and expanding this review could answer important new questions. Patient and Public Involvement: We will form a group of 12-15 stroke survivors, carers and physiotherapists, with varied backgrounds, from across the UK. We will also hold two international meetings to get input from beyond the UK. This involvement will make sure that the review answers the questions of most importance to people affected by stroke, and that the right people and organisations learn about the results. Plan: We will do a major update and expansion of our Cochrane review of physiotherapy. This review will bring together evidence for effectiveness of physiotherapy on function and walking after stroke


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: STROKE
Title: Development and validation of a patient-reported measure (PRM) of treatment burden in stroke.
Funder: Chief Scientist Office, Scotland

Abstract: Many treatments are recommended after discharge from hospital with a stroke e.g. medications or physiotherapy and this can have considerable impact on an individual’s life. We define the workload of healthcare and the impact on wellbeing for people with long-term conditions as treatment burden. Treatment burden can arise from having a lot of tasks to do for example take multiple medications or attend numerous appointments, or it can arise from deficiencies in the way care is provided, for example difficulties accessing care when it is needed. We need to be able to measure treatment burden to test ways of lessening it, but currently there are no good measurement tools for use with people who have experienced a stroke. We aim to test a new self-reported questionnaire that measures treatment burden after stroke (PETS-stroke). We have developed questions for PETS-stroke by amending a questionnaire used in non-stroke patients (PETS) using knowledge gained from our previous research involving stroke survivors. We then conducted interviews with stroke survivors to evaluate if PETS-stroke is understandable and relevant to them. We now plan to test PETS-stroke in a large group of stroke survivors living at home to test if it measures treatment burden accurately and reliably using statistical methods. This involves giving out survey packs to stroke survivors that are completed at home and sent back to the research team. In future we plan to use PETS-stroke to measure how treatment burden affects outcomes such as quality-of life and develop and test new ways of providing healthcare that lessen treatment burden


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.4 RESOURCES AND INFRASTRUCTURE (DISEASE MANAGEMENT)
Health categories: STROKE
Title: Saeboglove therapy for severe Upper limb disability and Severe Hand Impairment after stroke: a pragmatic, multicentre, parallel-group, randomised controlled trial with blinded outcome assessment and process evaluation (SUSHI).
Funder: Chief Scientist Office, Scotland

Abstract: Severe arm and hand weakness causes disability after stroke. Recovery is best when people practice high numbers of movements needed for everyday life, such as reaching and grasping. Often people with severe weakness are excluded from rehabilitation trials or receive treatments that don’t work well because they lack sufficient hand opening movement to do these functional movements. This limits recovery for those most in need. SaeboGlove is a new rehabilitation aid that helps hand opening. It can help people grasp and release objects such as cutlery, clothes or a hairbrush during everyday activities, even when weakness is severe. This may enable people with severe weakness to practice beneficial movements based on everyday functional-based tasks and may increase their chance of a better recovery. Some clinical services use SaeboGloves but they lack a high-quality evidence-base. We will find out if SaeboGloves help people with reduced hand opening to take part in functionalbased therapy and recover better, and if they should be used in the NHS. All participants will receive usual care. Half will also receive 6-weeks of SaeboGlove therapy involving independent practice +/- help from a carer. Outcomes will be assessed. Thereafter control participants will also be offered SaeboGlove therapy.


Research activity codes: 6.3 MEDICAL DEVICES
Health categories: STROKE
Title: Proving the utility of fast field cycling MRI in stroke and small vessel disease (PUFFINS)
Funder: Chief Scientist Office, Scotland

Abstract: Fast field cycling MRI (FFC-MRI) is an innovative imaging technology pioneered at the University of Aberdeen. It has the ability to image human tissues non-invasively over a wide range of magnetic field strengths, directly informing on multi-scale tissue structure from nanometres to micrometres. This is not possible with traditional MRI. The world-first whole body clinical FFC-MRI scanner was commissioned in Aberdeen in 2016. Preliminary results from stroke patients show that the area of damage in the brain can be identified at magnetic fields 10,000 times lower than those used in conventional clinical MRI scanners. The purpose of this application is to compare FFC MRI and standard MRI images from patients with strokes due to blocked blood vessels or haemorrhage as well as in people with small vessel disease. The data gained will be used to develop methods to extract the most information from the FFC MRI scans. The study will reveal where this safe and affordable technology can fit with standard stroke imaging. It will also underpin development of new image analysis techniques, which will be used for future studies focusing on other diseases such as cancer and liver disease.


Research activity codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: STROKE
Title: Creating digital, interactive, smart home exercise environments for older adults with stroke
Funder: Economic and Social Research Council

Abstract: The main objectives of this study are: -To gather information on the personal and environmental constraints in using fitness equipment and technologies in homes. -To co-develop a concept and a prototype including software and hardware for the self-management of resistance exercises through patients, carers and practitioners' inputs. -To explore the patients perceptions and engagements through interviews and observations in using the prototype.

Lay abstract: Stroke has debilitative effects on the body and can hinder physical and cognitive function. Recovery after stroke depends on participating in a structured exercise program of meaningful activities. However, older adults with stroke find it challenging to maintain an optimal level of physical activity for brain recovery due to physical and cognitive impairments, lack of motivation and age-related factors such as frailty, losing muscle mass and depression. To encourage participation in physical activity, the exercise programme should be structured, home/community-based, simple, efficient, patient-led and with minimum supervision to increase exercise adherence, especially for the patients with severe limb impairments. In this study, we aim to co-design an interactive and digital resistance exercise solution for community-dwelling older stroke survivors with moderate to severe impairments in upper limbs. We will co-design it by testing accessible and affordable fitness equipment such as rubber bands and barbells and will involve older adults (>65 years) with chronic stroke (6 months after stroke) to take part in this process throughout the study period to share their viewpoints. First, we will co-develop a multimedia exercise package to use with fitness equipment for upper limbs, lower limbs and trunk that would be feasible even for people with upper limb paralysis to perform at home with maximum safety and minimum mental efforts and supervision, then we will co-design the solutions (app and hardware design) that make the fitness equipment interactive, digital and patient-centred to increase physical activity and limbs mobility.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: STROKE