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The Orthotic Research & Locomotor Assessment Unit (ORLAU) (http://www.rjah.nhs.uk/ORLAU) has run multidisciplinary services to improve the function and lifestyle of severely disabled patients since 1975. New specialist clinical services have been established, based on research and development activity. The effectiveness of these services has been the subject of further investigations. Work has focused on the development of novel technology (in gait analysis and orthotics) and increasing understanding of human movement. Conditions treated include cerebral palsy, spinal cord injury, neuromuscular disorders, arthritis and stroke. Technological developments have led to licencing within the commercial sector. ORLAU has also contributed to the development of national and international clinical education and guidelines.
Functional electrical stimulation (FES) to the ankle dorsi-flexors is an assistive technology that aims to counter foot drop, a common symptom in people with neurological impairment. Our research has facilitated a better understanding of the clinical potential of FES as a means to enhance walking capability and ultimately the quality of life of people with gait abnormalities associated with "dropped foot". The production and dissemination of this research has directly had an impacted on local NHS clinical treatment practice and NHS clinical service evaluation/re-design in support of self-managed care of people with long-term conditions such as Cerebral Palsy, Stroke, and Multiple Sclerosis.
Impact: Health and welfare: reducing morbidity; providing evidence to disinvest in an ineffective and damaging treatment; policy change.
Significance: Since 2009, applied clinical trial findings have resulted in approximately 6000 fewer complications (e.g., skin breaks) in the UK. Stocking use has decreased by 95%, which has saved the NHS in excess of £20M per annum.
Beneficiaries: Stroke patients worldwide, the NHS and healthcare delivery organisations, the economy.
Attribution: Trials were designed and led by Professor M Dennis, UoE.
Reach: Changed national guidelines in at least seven countries worldwide (Europe, N America, South Africa, Singapore).
Dysphagia affects >50% of stroke patients with increased risk of aspiration and pneumonia, costing the NHS approximately £400m pa. Until recently there has been no effective treatment. Over the last 15 years, Hamdy has identified the mechanisms underlying dysphagia after stroke and demonstrated that electrostimulation delivered to the pharynx dramatically alters brain regions controlling swallowing beneficially. This work has gone through extensive clinical evaluation and forms the basis of a company, Phagenesis Ltd (~£10m VC funding), which has now commenced implementation of the technology (PhagenyxTM), gained CE marking and has sold >£2.0m of product in the UK, Europe and the Middle East.
Impact: Health and welfare; a large randomised controlled trial (third International Stroke Trial (IST)-3) and meta-analysis determined that the thrombolytic agent recombinant tissue plasminogen activator alteplase is a long-term effective treatment for acute ischaemic stroke in a wide range of patients.
Significance: Thrombolysis would result in 1488 more stroke patients being alive and independent per year in the UK.
Beneficiaries: Stroke patients, the NHS and healthcare delivery organisations, the UK economy.
Attribution: The IST-3 trial was led from UoE (Sandercock), with UoE (Wardlaw, Dennis) and University of Sydney (Lindley) colleagues.
Reach: Worldwide. Applicable to 4 million stroke patients per year; guidelines changed in Europe, N America, Asia, Australia.
Narrowing of one of the carotid arteries in the neck (carotid stenosis) is an important cause of stroke, a major public health problem. The results of an international multicentre randomised clinical trial, organised and led by Professor Martin Brown at the UCL Institute of Neurology, have been incorporated into national and international guidelines on the treatment of carotid stenosis. The trial evaluated carotid artery stenting (CAS), a new treatment to prevent stroke from carotid stenosis, in comparison to the standard treatment, carotid endarterectomy (CEA) (carotid surgery). The number of patients treated by CAS in England did not increase between 2006 and 2012, whereas the numbers of patients treated by CEA increased by 30%, a finding consistent with a response to the findings of our trials indicating that CEA was safer than CAS.
Stroke is the leading cause of disability in Europe. There are around 1.2 million stroke survivors in the UK. More than half have been left with disabilities that affect their daily life.
The annual cost of stroke to the UK economy was £8.9 billion. Clinical response to stroke has often focused on resulting physical disabilities, but cognitive disability can be an equally substantial source of difficulty for patients and their carers. Sensitive and reliable assessment of cognitive disability following stroke is essential for identifying these needs in patients, and early assessment is a major benefit because problems soon after stroke are a strong prognostic indicator of future problems, and appropriate rehabilitation is most effective when started early.
Founded on longstanding expertise in neuropsychological studies, the University of Birmingham group has developed a comprehensive stroke-specific screening tool (the BCoS), which enables early and efficient detection of cognitive impairment after a stroke for a wider range of patients than is possible with existing methods. Through this development and its associated training programme, the BCoS is changing the way stroke survivors are assessed in the UK and internationally and it is influencing practice in other areas, such as traumatic brain injury.
Up to 10% of stroke patients experience persistent hemispatial neglect, a lack of perception of space in one half of their visual field, despite their eyesight functioning properly. University of Glasgow researcher Dr. Monika Harvey has led the development of a vision rehabilitation method that was implemented by German stroke units (2011) and applied to over 60 stroke patients. In July 2011 Harvey formulated content for an advanced training module called `Vision after Stroke', a Scottish Government supported online training resource for stroke healthcare professionals provided by the Stroke Training and Awareness Resources (STARs) Project. In just eight months since launch (December 2012) the module series has had 17 473 unique visitors nationally and internationally with `Vision after Stroke' the second most popular module in Scotland. To date, 152 healthcare professionals have successfully completed the `Vision after Stroke' module certificate.
Impact: Health and welfare; saving lives by determining that aspirin is an effective treatment for acute stroke and that heparin anticoagulation is ineffective.
Significance: In the UK, treating all acute stroke patients with aspirin and avoiding heparin means 1800 people avoid death or disability each year; aspirin is also highly cost-effective.
Beneficiaries: Stroke patients, the NHS, the economy.
Attribution: Sandercock, UoE, designed, led and reported the International Stroke Trial, and was on the steering committee of the Chinese Acute Stroke Trial.
Reach: Up to 15M stroke patients annually affected by guideline changes worldwide, encompassing Europe, North America and Australasia; educational events by the World Stroke Academy promote aspirin use.
Approximately 152,000 strokes and 49,000 stroke-related deaths occur in the UK every year; of these, 85% are caused by blockage of a blood vessel in the brain (acute ischaemic stroke). The economic burden of stroke in the UK is estimated at £3.75bn with hospital inpatient care accounting for 82% this cost. Since the 1990s advances in thrombolytic treatments (which dissolve blood clots) have limited the extent of damage and subsequent impairment; however their use has been restricted due to ambiguity between stroke onset and stroke symptom presentation. University of Glasgow research has challenged the restrictions associated with thrombolysis treatment which has significantly influenced the wider use and applicability of thrombolytic treatment. This research has influenced new guideline recommendations and emergency stroke care patterns, through the implementation of dedicated acute stroke centres, and contributed to the on-going improvement in stroke survival rates.