Health Sciences Research Centre

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Health Sciences Research Centre

1. Quantification of free-living behaviours – PhD Proposal

The quantification of free-living physical activities is important in understanding how physical activity and also sedentary behaviours impact on health. Quantification of these behaviours is also important in determining how interventions might modify free-living behaviour to enhance health. Small body-worn monitors are used to collect movement data and from this data activities can be classified. The volumes and patterns of these activities are a measure of human physical behaviour. At the University of Salford we have international leading expertise in the measurement and quantification of free-living physical behaviours.

At present accelerometer data is used to classify body postures. In general these devices use the data to determine the inclination of one or more body segments and from this data derive positional information. At the basic level we can divide all physical behaviours into upright and sedentary behaviours. Upright behaviours can be divided into standing and stepping behaviours and stepping behaviours can further be classified based on stepping rate.

The aim of this project is to extend this “vocabulary” of behaviours to incorporate activities such as sleeping, cycling, sitting whilst in moving vehicle, etc. The expansion of this physical behaviour “vocabulary” would enhance our ability to understand human behaviour and the effects that interventions have on behaviour.

The student would gain experience in activity monitoring techniques and the analysis of body-worn accelerometer data. The outcomes of this research will advance the ability to understand free-living human physical behaviours. It is anticipated that this project will result in presentations at international conferences and a number of publications in high impact peer-reviewed journals.

For further information contact: Professor Malcolm Granat, Professor in Health and Rehabilitation Sciences. Email:M.H.Granat@Salford.ac.uk, Tel: +44 161 295 2568

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2. Modifying sedentary behaviour – PhD Proposal

Physical inactivity is a major cause of death worldwide and in the UK it is estimated that the direct cost of physical inactivity to the NHS is £10 billion. With the ageing population and the increase in life expectancy this is likely to increase. It has now become clear that too much time in sedentary postures increases the risk of poor physical health and that this is independent of the amount of physical activity taken during the rest of the day. In addition long continuous periods of sitting can reduce life expectancy. Sitting for period of more than three hours a day can reduce life expectancy by two years.

It is possible to accurately monitor sedentary behaviour for extended periods by the use of a thigh worn monitor. Pilot data has shown that it is possible to provide haptic feedback, using a vibratory motor, from such devices in order to provide the wearer with information on how long they have been sitting. At present little is known how this feedback could be used as an intervention to reduce sedentary time and break up long periods of sitting.

The aim of this project is to investigate the use of haptic feedback to promote behaviour change in a number of populations to try and reduce sedentary time and break up long periods of sitting. It is anticipated that the ability to modify sedentary behaviours would provide an intervention option that could have significant health benefits.

The student would gain experience in activity monitoring techniques and the analysis of data from body-worn accelerometers. It is anticipated that this project will result in presentations at international conferences and a number of publications in high impact peer-reviewed journals.

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3. Development of a new technique to quantify household and community walking – PhD Proposal

The quantification of free-living physical behaviours is important in understanding how physical activity and sedentary behaviour impact on health and also on how interventions might modify free-living behaviour to enhance health. Body-worn monitors have been used to record data which is used to classify these physical behaviours into sedentary, upright and stepping. Often a summary of stepping (number of steps and cadence) has been used as the main outcome of intervention and also as an indicator of compliance to public health guidelines. However it is important not just to quantify the number of steps taken but to understand where this stepping occurred, within the household or out in the community. It is proposed that stepping events could be automatically classified into household stepping events and community stepping events, and that this classification could be based on the length of the stepping events, their cadence and the proximity of these stepping events to each other.

The aim of this project is to investigate how stepping periods can be automatically classified into household and community stepping. This method will be applied to look at free-living stepping behaviour of an older adult population and then to quantify the effect of an intervention on this group. It is anticipated that this technique would applicable to the extensive existing data sets from a range of populations.

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4. Automatic identification of sleeping and waking patterns form a body-worn activity monitor – Sandwich Programme Proposal

The quantification of free-living physical activities is important in understanding how physical activity and also sedentary behaviours impact on health. Small body-worn monitors are used to collect movement data and from this data activities can be classified. The volumes and patterns of these activities are a measure of human physical behaviour. At the University of Salford we have international leading expertise in the measurement and quantification of free-living physical behaviours.

At present accelerometer data can used to classify basic body postures. In general these devices use the data to determine the inclination of one or more body segments and from this data derive positional information. At the basic level we can divide all physical behaviours into upright and sedentary behaviours. However at present, using a single body worn device, it has not been possible to separate the two basic postures of sitting and lying [which will include sleep periods]. It is proposed that using data from the triaxial accelerometer of the activPAL we can reliable separate and classify sitting and lying behaviours.

The aim of this project is to develop and test algorithms that can separate sitting and lying using data from the triaxial accelerometer. These algorithms may also be used to determine body position whilst lying and therefore provide an indication of quality of sleep. It is anticipated that this technique would applicable to the extensive existing data sets from a range of populations.

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5. Analysis of walking patterns in patients with Intermittent Claudication - Sandwich Programme Proposal

Many individuals with Intermittent Claudication report that they need to regularly stop whilst walking due to ischaemic pain. Generally the more frequently a patient needs to stop the more severely they are affected by the condition. We have shown that, using body-worn monitors to record walking patterns over a seven-day period, we can objectively quantify the fragmented nature of walking in patients with Intermittent Claudication. This could significantly enhance the clinicians’ ability to objectively determine the effectiveness of interventions in both clinical and research environments.

The aim of this study will be to explore how measures of walking patterns can be used to quantify the effectiveness of clinical interventions. Data from a cohort of patients with Intermittent Claudication whom have received a variety of treatments has been obtained. This data includes continuous seven-day record of physical behaviours as well as a detailed clinical assessment. It is anticipated that this work will lead to improved assessment in this patient group.

The student would gain experience in activity monitoring techniques and the analysis of data from body-worn accelerometers. It is anticipated that this project will result in a presentation at an international conference and a number of publications in high impact peer-reviewed journals.

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6. Compliance with physical activity guidelines - Sandwich Programme Proposal

There is compelling evidence that maintaining a physically active lifestyle has important health benefits and reduces the risk of all-cause mortality and chronic diseases. Accordingly, promoting and prescribing health enhancing physical activity has become a public health priority worldwide. As a result a number of different physical activity guidelines and health messages have evolved over recent years. These have generally been developed from epidemiological studies based on self-reported physical activity levels. However, when assessed using objective body-worn monitors, compliance with these guidelines has been shown to be poor.

It is proposed that objective measurement of physical activity levels and their patterns, using body-worn monitors, can better inform guidelines. The aim of this project is to assess the way in which health enhancing physical activity is accumulated in a healthy working population and to explore the relationship between these levels and patterns to the current guidelines. It is anticipated that this work will have implications for the formulation of physical activity guidelines.

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7. Physical Behaviour (activity and sedentary) profiling in British Workers: relationships with health and work performance in an ageing workforce - PHD / Sandwich Programme Proposal

Although there is considerable evidence regarding the relationship between physical activity and health related outcomes (DH, 2011), far less is known about sedentary behaviour patterns of adults and the impact of sedentary behaviour on health outcomes (Biddle et al., 2010). Work has become increasingly sedentary across the globe and concerns are growing regarding the potential health and business consequences (Dugdill and Coffey, 2009) – for example increasing obesity prevalence in some sectors of the NHS workforce is of concern (Black, 2008). In addition, the workforce will continue to age as the statutory pension age has now been removed; and this is of concern as physical activity also normally decreases with age (HSE, 2008).

The aim of this research project will be to develop a cross-sectional analysis of physical behaviours (lying/sitting, standing, walking) in a range of occupational groups of British Workers in order to assess how the pattern of sedentary/non-sedentary behaviours relate to health and work performance outcomes. The project will involve the development of behavioural profiles (using the activePAL activity monitor) in cohorts of workers (by gender, age, work type, business size etc). In additional health outcome data will be collected (anthropometric data, Quality of Life) and some job-related data (including job satisfaction and productivity).

Very few studies to date have attempted to explore these relationships because the technology for measuring behavioural profiles has only become available in recent years.

Team: Prof Lindsey Dugdill, Prof Malcolm Granat & Dr Margaret Coffey

For further information contact: Prof Lindsey Dugdill, Professor of Public Health. Email:

l.dugdill@Salford.ac.uk, Tel: +44 161 295 2365

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8. Physical activity behaviours of wheelchair users - PHD / Sandwich Programme Proposal

Wheelchairs offer the potential for greatly improved mobility and integration in people with long term mobility-limiting conditions. However, multiple factors may combine to influence the extent to which a particular person can exploit this potential. For example, the design of the wheelchair itself, the appropriate matching of a wheelchair to its recipient, as well as wider issues, such as the design of the built environment and the confidence of the user. One aspect that will help our understanding of this complex problem is data on current patterns of wheelchair use. Surprisingly, this is a poorly researched area, with few objective studies published, and most of these coming from a small number of centres in the US [1]. Professor Malcolm Granat’s research has focused on characterisation of physical behaviours, using body, or device-worn monitoring devices (see, for example http://www.paltech.plus.com/products.htm). He has developed tools for the monitoring of physical behaviours in wheelchair users, based on the use of wheel-mounted accelerometers [2, 3], which allow for objective measurement of distance, speed and duration of activities performed in the wheelchair. In the proposed study you will use the existing tool to characterise a range of different wheelchair users in a range of different environments. Subsequent work may investigate how users’ behaviours may be influenced by the environment, the wheelchair characteristics and other factors.

1. Oyster, M.L., et al., Investigation of factors associated with manual wheelchair mobility in persons with spinal cord injury. Arch Phys Med Rehabil, 2011. 92(3): p. 484-90.

2. Wilson, S.K., et al., Objective assessment of mobility of the spinal cord injured in a free-living environment. Spinal Cord, 2008. 46(5): p. 352-7.

3. Coulter, E.H., et al., Development and validation of a physical activity monitor for use on a wheelchair. Spinal Cord, 2011. 49(3): p. 445-50.

Team: Prof Malcolm Granat and Dr Laurence Kenney

Website:http://www.seek.salford.ac.uk/profiles/MGranat.jsp

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9. Upper limb prosthetic evaluation – PHD / Sandwich Programme Proposal

Upper limb prostheses are designed to replace the function and appearance of the missing anatomy. However, despite recent advances, typified by the new generation of prosthetic hands (see, for example http://www.touchbionics.com/) it is believed that both function and ease of use remain somewhat limited. One of the key limitations with all commercial devices is the lack of proprioceptive feedback from the prosthesis to the body and hence users are forced to rely on alternative feedback mechanisms, typically vision. In addition, there are limited sites on the residual limb from which to pick up control signals and current signal processing methods implemented in commercial systems do not fully exploit the information content of the measured signals. While there is considerable research addressing both of these problems, there is less attention devoted to how to evaluate such innovations.

A recent PhD developed novel tools for the evaluation of upper limb myoelectrically controlled prostheses. In this PhD Mohammad Sobuh characterised the upper limb motion changes that occur with learning to use a prosthesis, as well as gaze behaviour using a head-mounted eye tracker system. The results show that amputees, perhaps unsurprisingly, focus their gaze on different parts of a task scene than anatomically intact subjects. The unusual patterns of gaze behaviour may suggest amputees may be required to pay greater attention to an upper limb task than persons with anatomically intact upper limbs and in turn, these findings may give some insight into why people find prostheses difficult to use.

We are seeking a student to further develop measures of prosthetic performance and to develop new training methods. The work in this area is being coordinated with collaborators in the Netherlands and Canada and opportunities for visiting the overseas labs can be explored.

For further information contact: Dr Laurence Kenney, PhD. Email:

l.p.j.kenney@salford.ac.uk, Tel: +44 161 295 2289

Website:http://www.seek.salford.ac.uk/profiles/KENNEY619.jsp Key Words: prosthetics, upper limb, visuomotor behaviours.

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10. Development of assessment methodologies for identification of unstable walking aid use - PHD / Sandwich Programme Proposal

Walking aids are used by 29-49% of older people. However, although designed to provide stability, they do not eliminate falls-risk: indeed they are a risk factor themselves for falls and have been linked to fall-related injuries. This apparent contradiction may stem from the fact that no uniform guidelines/procedures exist to assist in their prescription, user training and monitoring. Hence, inappropriate device selection and incorrect use may limit their usefulness. It is our objective to improve fall prevention in walking aid users through methodological developments that will impact on falls services and walking aid manufacturers. Specifically, we aim to

1. Challenge the merit of existing stability measures, designed for unassisted walking, in the context of mobility aid use.

2. Develop novel measures reflective of stable interaction between body and mobility aid. 3. Develop clinically useful assessment tools.

To date progress towards our aims has been made through three studentships and one grant (Peel Trust), resulting in one publication (Grootveld et al. Med Eng Phys 2013, accepted, in press) and a further manuscript in progress. You will be placed within the School of Health Sciences, one of the country’s leading research centres in the Allied Health field; over 20 academic staff and 30 post graduate research students work in the 3 dedicated biomechanics & human performance laboratories and world class clinical facilities on site. In collaboration with the School of Computing, Science and Engineering we provide a platform for high quality biomechanics research that focuses on clinical movement analysis.

For further information contact: Dr Sibylle Thies, PhD. Email:s.thies@salford.ac.ukTel: +44 161 295 2679

Website:https://www.seek.salford.ac.uk/profiles/STHIES.jsp

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11. Functional electrical stimulation control - PHD / Sandwich Programme Proposal

Functional electrical stimulation has been shown to improve function after damage to the central nervous system, both as an active orthosis and as a tool to modulate the functioning of the neuromuscular system. There is significant evidence of effectiveness in a range of applications. For example, NICE Guidelines now support the use of FES for foot drop and there is a growing body of evidence of the effectiveness of FES in the restoration of upper limb function. However, there remains a need to improve both the robustness and ease-of-use of FES devices, In our group we bring together expertise in mechanical engineering and a range of allied health professions to address the following problems:

1. Development of new approaches to FES control 2. Novel approaches to evaluation of FES interventions

Through a series of externally funded projects we have developed new approaches to the control of upper limb FES systems (see, for example [1, 2]). We are now working towards a commercial product for this application, in collaboration with Odstock Medical Ltd. The group has also been involved in the development of two major innovations in drop foot stimulator technologies, one of which is now marketed through Finetech Medical [3]. In the area of evaluation, a recent thesis has shed new light on the mechanisms by which FES for foot drop benefits the users [4].

We welcome interest from students who have either a physiotherapy or an engineering background.

1. Tresadern, P.A., et al., Simulating Acceleration From Stereophotogrammetry For Medical Device Design. J Biomech Eng, 2009. 131(6): p. 061002.

2. Tresadern, P., et al., Rapid prototyping for functional electrical stimulation control. IEEE Pervasive Computing, 2008. 7(2): p. 62-69.

3. Kenney, L., et al., An implantable two channel drop foot stimulator: initial clinical results. Artif Organs, 2002. 26(3): p. 267-70.

4. McAdam, J., The effects of Functional Electrical Stimulation on motor-cognitive interference during gait in people with foot drop following stroke, 2013, University of Salford.

For further information contact: Dr Laurence Kenney, PhD or Prof Dave Howard. Email:

l.p.j.kenney@salford.ac.uk or d.howard@salford.ac.uk, Tel: +44 161 295 2289

Website:http://www.seek.salford.ac.uk/profiles/KENNEY619.jsp /

http://www.seek.salford.ac.uk/profiles/DHOWARD.jsp

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12. Psychometric testing of Patient Reported Outcome Measures (PROMs) - Sandwich Programme Proposal

At the Centre for Health Sciences Research we are developing a suite of psychometrically robust, patient-centred Patient Reported Outcome Measures (PROMs) to evaluate difficulties in activities, participation and hand function for people with musculoskeletal conditions. These can be used to: evaluate the impact of these conditions on patients’ lives; identify patients’ rehabilitation needs; evaluate the effect of therapy clinically; and as outcome measures in pharmacological and non-pharmacological studies where patient-centred PROMs are required. Specifically, we will test their psychometric properties: internal consistency, construct validity, test-retest reliability, and minimal detectable difference. The Exploratory factor analysis, Mokken Scaling and Rasch analysis will be used to test internal construct validity; correlations with other measures of general function, role/participation and hand function (Health Assessment Questionnaire, SF-36v2 and Arthritis Impact Measurement Scales 2 (Hand and Arm Function sub-scales) will establish concurrent validity; and test-retest reliability (over a two week interval) will be evaluated using kappa and intra-class coefficients. It is anticipated that this project will also result in the publication of high impact peer-reviewed scientific papers.

For further information contact: Dr Yeliz Prior, PhD. Email: y.prior@salford.ac.uk, Tel: +44 161 295 0211

Website: http://www.seek.salford.ac.uk/profiles/YGreenhill.jsp

Key Subject Words: Occupational Therapy; Patient Reported Outcome Measures; Psychometric Testing; Rheumatoid Arthritis; Musculoskeletal Conditions; Quantitative methods

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13. The treatment and measurement of gait adaptability in stroke survivors - PHD / Sandwich Programme Proposal

The high prevalence of falls in community dwelling stroke survivors (it is estimated that 50-70% of community dwelling stroke survivors will fall) may be due to diminished capacity to adapt the already impaired underlying gait coordination pattern to allow avoidance of obstacles, changes in direction, speed or foot-placement, as dictated by the environment. Indeed many studies have shown that stroke survivors have impaired abilities to adapt walking according to environmental demands and time constraints. Currently there are few clinical tests which measure adaptability of gait and evidence indicates that current approaches to rehabilitation of gait, which predominantly focus on straight walking ability (e.g. gait speed, walking endurance/capacity) and not flexibility of the walking pattern (e.g. turning, obstacle avoidance, reactive changes to foot-placement) have only modest effects on impairment and activity. It has therefore been suggested that new more effective treatments and outcome measures need to be developed and tested within robust, early phase studies.

In line with this suggestion, a series of projects are being undertaken by the Rehabilitation Research Group in the School of Health Sciences which are focused on the development of treatment approaches and outcome measures which are targeted at impaired functional adaptability of walking. Project students will have the opportunity to take part in studies evaluating and developing outcome measures and efficacy of new rehabilitation approaches for functionally adaptive gait abilities using state-of-the-art gait analysis systems.

For further information contact: Dr Kristen Hollands, PhD, Email: k.hollands@salford.ac.uk

Tel: +44 161 295 3238

Website:http://www.seek.salford.ac.uk/profiles/KLHollands.jsp