Development of User-Friendly Wearable Electronic Textiles for Healthcare Applications.

This paper presents research into a user-friendly electronic sleeve (e-sleeve) with integrated electrodes in an array for wearable healthcare. The electrode array was directly printed onto an everyday clothing fabric using screen printing. The fabric properties and designed structures of the e-sleeve were assessed and refined through interaction with end users. Different electrode array layouts were fabricated to optimize the user experience in terms of comfort, effectivity and ease of use. The e-sleeve uses dry electrodes to facilitate ease of use and the electrode array can survive bending a sufficient number of times to ensure an acceptable usage lifetime. Different cleaning methods (washing and wiping) have been identified to enable reuse of the e-sleeve after contamination during use. The application of the e-sleeve has been demonstrated via muscle stimulation on the upper limb to achieve functional tasks (e.g., hand opening, pointing) for eight stroke survivors.

The application of precisely controlled functional electrical stimulation to the shoulder, elbow and wrist for upper limb stroke rehabilitation: a feasibility study.

BACKGROUND: Functional electrical stimulation (FES) during repetitive practice of everyday tasks can facilitate recovery of upper limb function following stroke. Reduction in impairment is strongly associated with how closely FES assists performance, with advanced iterative learning control (ILC) technology providing precise upper-limb assistance. The aim of this study is to investigate the feasibility of extending ILC technology to control FES of three muscle groups in the upper limb to facilitate functional motor recovery post-stroke. METHODS: Five stroke participants with established hemiplegia undertook eighteen intervention sessions, each of one hour duration. During each session FES was applied to the anterior deltoid, triceps, and wrist/finger extensors to assist performance of functional tasks with real-objects, including closing a drawer and pressing a light switch. Advanced model-based ILC controllers used kinematic data from previous attempts at each task to update the FES applied to each muscle on the subsequent trial. This produced stimulation profiles that facilitated accurate completion of each task while encouraging voluntary effort by the participant. Kinematic data were collected using a Microsoft Kinect, and mechanical arm support was provided by a SaeboMAS. Participants completed Fugl-Meyer and Action Research Arm Test clinical assessments pre- and post-intervention, as well as FES-unassisted tasks during each intervention session. RESULTS: Fugl-Meyer and Action Research Arm Test scores both significantly improved from pre- to post-intervention by 4.4 points. Improvements were also found in FES-unassisted performance, and the amount of arm support required to successfully perform the tasks was reduced. CONCLUSIONS: This feasibility study indicates that technology comprising low-cost hardware fused with advanced FES controllers accurately assists upper limb movement and may reduce upper limb impairments following stroke.

Exploring virtual funding committee practices in the allocation of National Institute for Health and Care Research funding: A netnographic study.

Background: Funding committees, comprising members with a range of knowledge, skills, and experience, are considered integral to the decision-making process of funding organisations for recommending or allocating research funding. However, there is limited research investigating the decision-making processes, the role of members and their social interactions during funding committee meetings conducted both virtually and face-to-face. Methods: Using a mixed-methods design and following netnography principles, the study observed nine National Institute for Health and Care Research programmes funding committee meetings conducted virtually during October 2020 to December 2021; complemented by interviews with committee chairs and members (18 interviews) and NIHR staff (12 interviews); an online survey (50 responses); and documentary analysis. Personal reflections through immersive journals also formed part of the analysis. Results: Three main themes were identified from the observations, interviews, and online survey: efficiency of virtual committee meetings (importance of preparation, and the role of formality, process, and structure); understanding the effect of virtual committee meetings on well-being (effects of fatigue and apprehension, and the importance of work life balance); understanding social interactions and engagement (levels of engagement, contribution and inclusivity, awareness of unconscious bias and the value of social networking). Conclusions: Examining the decision-making practices of one funding organisation across several research programmes, across multiple committee meetings over one year has generated new insights around funding committee practices that previous studies have not been able to explore or investigate. Overall, it was observed that fair and transparent funding recommendations and outcomes can be achieved through virtual funding committees. However, whilst virtual funding committees have many benefits and opportunities, such as the potential to increase membership diversity and inclusivity, and be more environmentally sustainable, more evidence is needed to evaluate their effectiveness, with particular focus on issues of fatigue, engagement, and committee cohesion, especially when new committee members join.

Online survey exploring researcher experiences of research funding processes in the UK: the effort and burden of applying for funding and fulfilling reporting requirements.

OBJECTIVE: To explore researchers' experiences of funding processes, the effort and burden involved in applying for funding, obtaining funding and/or fulfilling reporting requirements with a UK health and social care research funder. DESIGN/SETTING: A cross-sectional online survey study with open (free-text) and closed questions (August to November 2021). PARTICIPANTS: Researchers with experience of applying for/obtaining funding and/or experience of fulfilling reporting requirements for UK health and social care research funded between January 2018 and June 2021. RESULTS: The survey was completed by 182 researchers, of which 176 had experience with applying for/obtaining funding, and 143 had experience with fulfilling reporting requirements during the timeframe. The majority of the 176 respondents (58%) completed between 7 and 13 key processes in order to submit an application and 69% felt that it was critically important to undertake these key processes. Respondents (n=143) reported submitting an average of 17 reports as part of research monitoring to a range of organisations (eg, funders, Higher Education Institutions). However, only 33% of respondents felt it was critically important to provide the requested reporting information to the different organisations. Thematic analysis of free-text questions on application and reporting identified themes relating to process inefficiencies including streamlining and alignment of systems, lack of understanding of processes including a need for improved communication and feedback from organisations with clear explanations about what information is needed, when and why, the support required by respondents and the time, effort and impact on workload and well-being. CONCLUSIONS: Through this study, we were able to identify funding processes that are considered by some to be effortful, but necessary, as well as those that were perceived as unnecessary, complex and repetitive, and may waste some researchers time and effort and impact on well-being. Possible solutions to increase efficiency and enhance value in these processes were identified.

An in-depth exploration of researcher experiences of time and effort involved in health and social care research funding in the UK: The need for changes.

The need to reform the way in which research is undertaken is clear, with reducing research bureaucracy and waste at the forefront of this issue for the UK government, funding organisations, higher education institutions and wider research community. The aim of this study was to describe researchers' experiences of the time, effort and burden involved in funding processes-namely applying for research funding and fulfilling reporting requirements. This was an in-depth qualitative study using semi-structured interviews with researchers who had experience applying for funding and/or completing reporting requirements for a UK health and social care research funder between January 2018 and June 2021. Following thematic analysis, five key themes were identified describing researcher experiences of key issues around time, efforts and burden associated with funding processes. These themes encompassed (1) issues with the current funding model for health and social care research, (2) time and effort involved in funding processes, (3) the need for a streamlined end-to-end process, (4) implications for work-life balance, and (5) addressing the need for better support and communication. The findings from this study describe researcher experiences of tasks in the research pathway that currently take considerable time and effort. It was clear that whilst some of this time and effort is considered necessary, some is exacerbated by inefficient and ineffective processes, such as perceived under-funding of research or lack of clarity with regards to funder expectations. This in turn contributes to unnecessary researcher burden, research waste and negative research culture. Better investment in health and social care research and in the researchers themselves who design and deliver the research, alongside improvements in transparency, streamlining and research support could ensure a more positive research culture, and improve the quality of funded research.

Using eye movement measures to investigate effects of age on memory for objects in a scene.

We examined whether there were age-related differences in eye movements during intentional encoding of a photographed scene that might account for age-related differences in memory of objects in the scene. Younger and older adults exhibited similar scan path patterns, and visited each region of interest in the scene with similar frequency and duration. Despite the similarity in viewing, there were fundamental differences in the viewing-memory relationship. Although overall recognition was poorer in the older than younger adults, there was no age effect on recognition probability for objects visited only once. More importantly, re-visits to objects brought gain in recognition probability for the younger adults, but not for the older adults. These results suggest that the age-related differences in object recognition performance are in part due to inefficient integration of information from working memory to longer-term memory.

Functional electrical stimulation mediated by iterative learning control and 3D robotics reduces motor impairment in chronic stroke.

BACKGROUND: Novel stroke rehabilitation techniques that employ electrical stimulation (ES) and robotic technologies are effective in reducing upper limb impairments. ES is most effective when it is applied to support the patients' voluntary effort; however, current systems fail to fully exploit this connection. This study builds on previous work using advanced ES controllers, and aims to investigate the feasibility of Stimulation Assistance through Iterative Learning (SAIL), a novel upper limb stroke rehabilitation system which utilises robotic support, ES, and voluntary effort. METHODS: Five hemiparetic, chronic stroke participants with impaired upper limb function attended 18, 1 hour intervention sessions. Participants completed virtual reality tracking tasks whereby they moved their impaired arm to follow a slowly moving sphere along a specified trajectory. To do this, the participants' arm was supported by a robot. ES, mediated by advanced iterative learning control (ILC) algorithms, was applied to the triceps and anterior deltoid muscles. Each movement was repeated 6 times and ILC adjusted the amount of stimulation applied on each trial to improve accuracy and maximise voluntary effort. Participants completed clinical assessments (Fugl-Meyer, Action Research Arm Test) at baseline and post-intervention, as well as unassisted tracking tasks at the beginning and end of each intervention session. Data were analysed using t-tests and linear regression. RESULTS: From baseline to post-intervention, Fugl-Meyer scores improved, assisted and unassisted tracking performance improved, and the amount of ES required to assist tracking reduced. CONCLUSIONS: The concept of minimising support from ES using ILC algorithms was demonstrated. The positive results are promising with respect to reducing upper limb impairments following stroke, however, a larger study is required to confirm this.

Researchers' perspective of real-world impact from UK public health research: A qualitative study.

Research funded by the National Institute for Health Research Public Health Research Programme is being undertaken in a complex system which brings opportunities and challenges for researchers to maximise the impact of their research. This study seeks to better understand the facilitators, challenges and barriers to research impact and knowledge mobilisation from the perspective of UK public health researchers. A qualitative study using semi-structured interviews, informed by the Payback Framework, with public health researchers who held a research award with the National Institute for Health Research Public Health Research programme up to March 2017 was conducted. Following a thematic analysis, three strongly interlinked themes were extracted from the data and three key factors were highlighted as important for facilitating knowledge mobilisation and impact in UK public health research: (1) Public health researcher's perception of the purpose of the research (2) Approaches to undertaking Knowledge mobilisation activities (3) The complex nature of public health research in the wider research context. These have been reflected onto the Payback framework. Public health researchers can maximise the likelihood for impact by being aware of the context in which they are undertaking research, using different methods, and employing several strategies to take advantage of opportunities. There is a need to support researchers with knowledge mobilisation activities and for funders to identify their expectations of the impact resulting from research. Our findings have relevance to public health researchers and funders interested in increasing the benefit that research brings to society.

What works for peer review and decision-making in research funding: a realist synthesis.

INTRODUCTION: Allocation of research funds relies on peer review to support funding decisions, and these processes can be susceptible to biases and inefficiencies. The aim of this work was to determine which past interventions to peer review and decision-making have worked to improve research funding practices, how they worked, and for whom. METHODS: Realist synthesis of peer-review publications and grey literature reporting interventions in peer review for research funding. RESULTS: We analysed 96 publications and 36 website sources. Sixty publications enabled us to extract stakeholder-specific context-mechanism-outcomes configurations (CMOCs) for 50 interventions, which formed the basis of our synthesis. Shorter applications, reviewer and applicant training, virtual funding panels, enhanced decision models, institutional submission quotas, applicant training in peer review and grant-writing reduced interrater variability, increased relevance of funded research, reduced time taken to write and review applications, promoted increased investment into innovation, and lowered cost of panels. CONCLUSIONS: Reports of 50 interventions in different areas of peer review provide useful guidance on ways of solving common issues with the peer review process. Evidence of the broader impact of these interventions on the research ecosystem is still needed, and future research should aim to identify processes that consistently work to improve peer review across funders and research contexts.

Identification and comparison of key criteria of feedback of funding decisions: mixed-methods analysis of funder and applicant perspectives.

OBJECTIVE: This study investigated the content, quality and value of feedback given to applicants who applied to one of four research programmes in the UK funded (or jointly funded) by the National Institute for Health Research (NIHR). METHODS: A mixed-method phased approach was conducted using document analysis and an online survey. Phase 1 examined 114 NIHR applicant feedback documents comprised written feedback from funding committees and external peer-reviewers and a conceptual framework of the key components of feedback was developed using content analysis. Phase 2 was an online survey completed by 113 NIHR applicants. Frequencies of responses to closed questions were calculated. Perceptions of quality and value of feedback were identified using content analysis of open-text responses. RESULTS: In phase 1, a conceptual framework was developed with seven overarching categories: 'Study structure and quality'; 'Team and infrastructure'; 'Acceptability to patients and professionals'; 'Study justification and design'; 'Risks and contingencies'; 'Outputs'; 'Value for money'. A higher frequency of feedback was provided at stage 2 and for successful applications across the majority of components. In phase 2, frequency data showed that opinion on feedback was dependent on funding outcome. Content analysis revealed four main themes: 'Committee transparency'; 'Content validity and reliability'; 'Additional support'; Recognition of effort and constraints'. CONCLUSIONS: This study provides key insights and understanding into the quality, content and value of feedback provided to NIHR applicants. The study identified key areas for improvement that can arise in NIHR funding applications, as well as in the feedback given to applicants that are applicable to other funding organisations. These findings could be used to inform funding application guidance documents to help researchers strengthen their applications and used more widely by other funders to inform their feedback processes.

Eye movements reveal a similar positivity effect in Chinese and UK older adults.

The "positivity effect" (PE) reflects an age-related increase in the preference for positive over negative information in attention and memory. The present experiment investigated whether Chinese and UK participants produce a similar PE. In one experiment, we presented pleasant, unpleasant, and neutral pictures simultaneously and participants decided which picture they liked or disliked on a third of trials, respectively. We recorded participants' eye movements during this task and compared time looking at, and memory for, pictures. The results suggest that older but not younger adults from both China and UK participant groups showed a preference to focus on and remember pleasant pictures, providing evidence of a PE in both cultures. Bayes Factor analysis supported these observations. These findings are consistent with the view that older people preferentially focus on positive emotional information, and that this effect is observed cross-culturally.

Decision-making approaches used by UK and international health funding organisations for allocating research funds: A survey of current practice.

Innovations in decision-making practice for allocation of funds in health research are emerging; however, it is not clear to what extent these are used. This study aims to better understand current decision-making practices for the allocation of research funding from the perspective of UK and international health funders. An online survey (active March-April 2019) was distributed by email to UK and international health and health-related funding organisations (e.g., biomedical and social), and was publicised on social media. The survey collected information about decision-making approaches for research funding allocation, and covered assessment criteria, current and past practices, and considerations for improvements or future practice. A mixed methods analysis provided descriptive statistics (frequencies and percentages of responses) and an inductive thematic framework of key experiences. Thirty-one responses were analysed, representing government-funded organisations and charities in the health sector from the UK, Europe and Australia. Four themes were extracted and provided a narrative framework. 1. The most reported decision-making approaches were external peer review, triage, and face-to-face committee meetings; 2. Key values underpinned decision-making processes. These included transparency and gaining perspectives from reviewers with different expertise (e.g., scientific, patient and public); 3. Cross-cutting challenges of the decision-making processes faced by funders included bias, burden and external limitations; 4. Evidence of variations and innovations from the most reported decision-making approaches, including proportionate peer review, number of decision-points, virtual committee meetings and sandpits (interactive workshop). Broadly similar decision-making processes were used by all funders in this survey. Findings indicated a preference for funders to adapt current decision-making processes rather than using more innovative approaches: however, there is a need for more flexibility in decision-making and support to applicants. Funders indicated the need for information and empirical evidence on innovations which would help to inform decision-making in research fund allocation.

Lateralisation of spatial processing and age.

Studies assessing spatial ability suggest right hemisphere specialisation for coordinate spatial processing and left hemisphere specialisation for categorical spatial processing. With regard to healthy ageing, spatial abilities may be affected selectively, with right hemisphere based coordinate processes being more vulnerable to age-related decline, but previous research has been inconsistent. In the present study, age and hemispheric specialisation of categorical and coordinate spatial abilities were explored. Testing 56 right-handed younger and older participants clearly showed a left hemisphere advantage for the categorical task and a right hemisphere advantage for the coordinate spatial task, for both age groups combined. Older adults were slower to process information and make a spatial judgement; nevertheless, the neural specialisation underlying spatial abilities seems to have remained consistent with age.

Factors affecting rehabilitation and use of upper limb after stroke: views from healthcare professionals and stroke survivors.

BACKGROUND: Training of the upper limb (UL) is limited in stroke rehabilitation, and about 50% of stroke survivors do not regain useful function in their upper limb. OBJECTIVES: This study explored what factors affect rehabilitation and use of upper limb after stroke from a stroke survivor and healthcare professional perspective to better understand low engagement in UL rehabilitation in the chronic stages of stroke. METHOD: Eight chronic stroke survivors and 21 healthcare professionals took part in semi-structured interviews or in one of three focus groups, respectively. RESULTS: Thematic analysis revealed three main themes: Availability of resources, Healthcare professional-patient relationship, and Psychosocial factors. Availability of resources and Healthcare professional-patient relationship indicated that due to resource pressures and a lack of communication and education, positive upper limb rehabilitation behaviors (e.g. engaging and integrating the upper limb in daily activity) were not always established in the early stages post-stroke. Psychosocial factors illustrated the cognitive and psychological barriers to sustained engagement with upper limb rehabilitation. CONCLUSION: The findings indicate that stroke survivors and healthcare professionals have very similar understandings of barriers to UL activity, and positive upper limb rehabilitation behaviors are not always established early in recovery post-stroke. Increased resources and healthcare professional-patient relationships seem key factors to establishing positive perceptions of UL rehabilitation. Addressing psychosocial issues and resource limitations may help sustain engagement with UL rehabilitation.

Upper limb and eye movement coordination during reaching tasks in people with stroke.

PURPOSE: To enhance understanding of the relationship between upper limb and eye movements during reaching tasks in people with stroke. METHODS: Eye movements were recorded from 10 control participants and 8 chronic stroke participants during a visual orienting task (Experiment 1) and a series of reaching tasks (Experiment 2). Stroke participants completed the reaching tasks using (i) their less impaired upper limb, (ii) their more impaired upper limb without support, and (iii) their more impaired upper limb, with support (SaeboMAS gravitational support and/or electrical stimulation). Participants were tested individually and completed both experiments in the same session. RESULTS: Oculomotor control and the coordination between the upper limb and the oculomotor system were found to be intact in stroke participants when no limb movements were required, or when the less impaired upper limb was used. However, when the more impaired upper limb was used, success and accuracy in reaching decreased and patterns of eye movements changed, with an observed increase in eye movements to the limb itself. With upper limb support, patterns of hand-eye coordination were found to more closely resemble those of the control group. CONCLUSION: Deficits in upper limb motor systems result in changes in patterns of eye movement behavior during reaching tasks. These changes in eye movement behavior can be modulated by providing upper limb support. Implications for Rehabilitation Deficits in upper limb motor systems can result in changes in patterns of eye movement behavior during reaching tasks. Upper limb support can reduce deficits in hand-eye coordination. Stroke rehabilitation outcomes should consider motor and oculomotor performance.

Using Functional Electrical Stimulation Mediated by Iterative Learning Control and Robotics to Improve Arm Movement for People With Multiple Sclerosis.

Few interventions address multiple sclerosis (MS) arm dysfunction but robotics and functional electrical stimulation (FES) appear promising. This paper investigates the feasibility of combining FES with passive robotic support during virtual reality (VR) training tasks to improve upper limb function in people with multiple sclerosis (pwMS). The system assists patients in following a specified trajectory path, employing an advanced model-based paradigm termed iterative learning control (ILC) to adjust the FES to improve accuracy and maximise voluntary effort. Reaching tasks were repeated six times with ILC learning the optimum control action from previous attempts. A convenience sample of five pwMS was recruited from local MS societies, and the intervention comprised 18 one-hour training sessions over 10 weeks. The accuracy of tracking performance without FES and the amount of FES delivered during training were analyzed using regression analysis. Clinical functioning of the arm was documented before and after treatment with standard tests. Statistically significant results following training included: improved accuracy of tracking performance both when assisted and unassisted by FES; reduction in maximum amount of FES needed to assist tracking; and less impairment in the proximal arm that was trained. The system was well tolerated by all participants with no increase in muscle fatigue reported. This study confirms the feasibility of FES combined with passive robot assistance as a potentially effective intervention to improve arm movement and control in pwMS and provides the basis for a follow-up study.

Attention and eye-movement control in reading: The selective reading paradigm.

We introduced a novel paradigm for investigating covert attention and eye-movement control in reading. In 2 experiments, participants read sentence words (shown in blue color) while ignoring interleaved distractor strings (shown in orange color). Each single-line text display contained a target word and a critical distractor. Critical distractors were located just prior to the target in the text and were either words or symbol strings (e.g., @#%&). Target word availability for parafoveal processing (i.e., preview validity) was also manipulated. The results indicated much shallower processing of distractors than targets, and this pattern was more pronounced for symbol than word distractors. The influences of word frequency and fixation location on first-pass fixation durations on distractors were dramatically different than the well-documented pattern obtained in normal reading. Robust preview benefits were demonstrated both when the critical distractors were fixated and when the critical distractors were skipped. Finally, with the exception of larger preview benefits that were obtained in the condition in which the target and critical distractor were identical, the magnitude of the preview effect was largely unaffected by the nature of the critical distractor. Implications of the present paradigm and findings to the study of eye-movement control in reading are discussed. (PsycINFO Database Record

Computational models of upper-limb motion during functional reaching tasks for application in FES-based stroke rehabilitation.

Functional electrical stimulation (FES) has been shown to be an effective approach to upper-limb stroke rehabilitation, where it is used to assist arm and shoulder motion. Model-based FES controllers have recently confirmed significant potential to improve accuracy of functional reaching tasks, but they typically require a reference trajectory to track. Few upper-limb FES control schemes embed a computational model of the task; however, this is critical to ensure the controller reinforces the intended movement with high accuracy. This paper derives computational motor control models of functional tasks that can be directly embedded in real-time FES control schemes, removing the need for a predefined reference trajectory. Dynamic models of the electrically stimulated arm are first derived, and constrained optimisation problems are formulated to encapsulate common activities of daily living. These are solved using iterative algorithms, and results are compared with kinematic data from 12 subjects and found to fit closely (mean fitting between 63.2% and 84.0%). The optimisation is performed iteratively using kinematic variables and hence can be transformed into an iterative learning control algorithm by replacing simulation signals with experimental data. The approach is therefore capable of controlling FES in real time to assist tasks in a manner corresponding to unimpaired natural movement. By ensuring that assistance is aligned with voluntary intention, the controller hence maximises the potential effectiveness of future stroke rehabilitation trials.

Electrical stimulation and iterative learning control for functional recovery in the upper limb post-stroke.

Therapies using functional electrical stimulation (FES) in conjunction with practice of everyday tasks have proven effective in facilitating recovery of upper limb function following stroke. The aim of the current study is to develop a multi-channel electrical stimulation system that precisely controls the assistance provided in goal-orientated tasks through use of advanced model-based 'iterative learning control' (ILC) algorithms to facilitate functional motor recovery of the upper limb post-stroke. FES was applied to three muscle groups in the upper limb (the anterior deltoid, triceps and wrist extensors) to assist hemiparetic, chronic stroke participants to perform a series of functional tasks with real objects, including closing a drawer, turning on a light switch and repositioning an object. Position data from the participants' impaired upper limb was collected using a Microsoft Kinect® and was compared to an ideal reference. ILC used data from previous attempts at the task to moderate the FES signals applied to each muscle group on a trial by trial basis to reduce performance error whilst supporting voluntary effort by the participant. The clinical trial is on-going. Preliminary results show improvements in performance accuracy for each muscle group, as well as improvements in clinical outcome measures pre and post 18 training sessions. Thus, the feasibility of applying precisely controlled FES to three muscle groups in the upper limb to facilitate functional reach and grasp movements post stroke has been demonstrated.

Aging, eye movements, and object-location memory.

This study investigated whether "intentional" instructions could improve older adults' object memory and object-location memory about a scene by promoting object-oriented viewing. Eye movements of younger and older adults were recorded while they viewed a photograph depicting 12 household objects in a cubicle with or without the knowledge that memory about these objects and their locations would be tested (intentional vs. incidental encoding). After viewing, participants completed recognition and relocation tasks. Both instructions and age affected viewing behaviors and memory. Relative to incidental instructions, intentional instructions resulted in more accurate memory about object identity and object-location binding, but did not affect memory accuracy about overall positional configuration. More importantly, older adults exhibited more object-oriented viewing in the intentional than incidental condition, supporting the environmental support hypothesis.