Rehabilitation and living with disability

We are national and international leaders in stroke rehabilitation research guided by patient, carer and public involvement and engagement (PCPIE).

Our multidisciplinary team brings together expertise from The University of Manchester, Manchester Metropolitan University and the Northern Care Alliance NHS Foundation Trust.

This diverse group of psychologists, speech and language therapists, physiotherapists, occupational therapists, orthoptists, methodologists, students and people with lived experience is united by a common goal: to improve experience and health outcomes, transforming the lives of individuals with neurodisability.

Our research

Our research promotes an understanding of unmet needs, mechanisms of adjustment and recovery, intervention effectiveness, and optimal care pathways.

Aligned with the NHS England National Stroke Service Model, our research spans hospital and community settings. Our research portfolio includes studies led by us, as well as collaborations on studies led by external research groups.

Examples of current studies led by us:

Spatial Inattention Grasping Therapy (SIGHT) for rehabilitation of spatial neglect post-stroke

Funder: NIHR Efficacy and Mechanism Evaluation programme
Funding Amount: £1.2 million
Chief Investigator: Dr Stephanie Rossit (University of East Anglia)
Local Co-investigators: Professor Audrey Bowen, Dr Claire Howard, Ann Bamford
External Co investigators: Dr Erika Sims Dr Allan Clark, Dr Davinia Fernández-Espejo,Dr Kneale Metcalf, Mrs Jennifer Crow,Professor Fiona Rowe,Professor Hugh Markus,
Professor Kathryn Radford, Professor Niall Broomfield, Professor Valerie Pomeroy

Wellbeing After Stroke-2 (WaterS-2)

Funder: Stroke Association
Researchers: Emma Patchwood, Audrey Bowen, Verity Longley, Sarah Cotterill
External researchers: Shirley Thomas, Niki Chouliara, Jess Zadik, Paul Conroy
PCPI partners: WaterS-2 Research Advisory panel (RAP) led by Ann Bamford

Stroke survivors face a range of mental health difficulties adjusting post-stroke, yet there are few evidence-based treatment options and workforce challenges from under-resourced clinical psychology services. Acceptance and Commitment Therapy (ACT) has been used in clinical services to improve wellbeing.

In the recently completed WaterS feasibility study, we co-developed an online group intervention based on ACT, and a staff training programme for delivery by non-psychologists. Both proved acceptable to stroke survivors and staff.

This led to WaterS-2, which started in October 2023, and will develop and test an accessible and inclusive psychological support programme for stroke survivors, considering real-world implementation from the start.

Hannah Foote submitted her PhD thesis, based on WaterS, in February 2024.

• Learn more about WaterS-2

Development of a Core Outcome Set for Clinical Research on Interventions for Speech Impairments in Stroke (COS-Speech)

Funder: NIHR
Researchers: Claire Mitchell, Jamie Kirkham, Kate Woodward-Nutt, Audrey Bowen
External partners: Paul Conroy, Sarah Wallace, Brooke-Mai Whelan, Sabrina El Kouaissi
PCPI partners: Annette Dancer, Joe Buglar, Stephen Taylor (HEARD)

Dysarthria (reduced speech intelligibility) is a common consequence of stroke, leading to social isolation and low self-confidence. This speech difficulty after stroke has been neglected, with few research studies.

The study aims to agree what aspects of communication we should measure when monitoring speech recovery: what is the core outcome set (COS) for all types of dysarthria caused by any type of stroke?

• Learn more about COS-Speech

Speech after Stroke Recovery Study (SayS): Exploring Speech Recovery over Time and Agreement of a Core Outcome Set with Measures

Funder: Stroke Association
Researchers: Claire Mitchell,, Jamie Kirkham, Kate Woodward-Nutt, Shahd Benafif (PhD student), Audrey Bowen
External partners: Paul Conroy, Sarah Wallace, Brooke-Mai Whelan
PCPI partners: Annette Dancer, Joe Buglar, Stephen Taylor (HEARD)

Around 50% of stroke survivors have dysarthria. This research aims to understand how people recover from dysarthria over time, and improve our understanding of how to measure dysarthria’s impact on a stroke survivor’s life.

This can allow researchers and healthcare professionals to measure recovery to find new treatments and support for stroke survivors with dysarthria.

• Learn more about SayS (Stroke Association)

Validation of the Mcast CommunicAtion Screening Tool (VAMCAST)

Funder: NIHR
Researchers: Dr Mark Jayes, Calvin Heal
External partners: Rebecca Palmer, Nele Demeyere, Paula Beech, Gill Pearl
PCPI partners: This study includes the expertise of people with lived experience

This project aims to help healthcare staff to support patients with communication problems to make decisions. These may be important decisions about treatment or leaving hospital.

Research shows that many staff do not know how to help these patients to make decisions. They do not always ask speech and language therapists for expert help. Some staff assume wrongly that these patients cannot make decisions.

We have developed a new communication test. The aim of the test is to show staff when a patient has communication problems and how to help the patient to make a decision. The test tells staff when to ask a speech and language therapist for help.

We need to do this research to find out if the test gives correct and consistent results and if staff can use it accurately.

• Learn more about VAMCAST on the NIHR and MMU websites

PhD projects

We are lucky to have a fantastic multidisciplinary team of 10 PhD/DClinPsy students who contribute to our ongoing projects and conduct their own studies.

Below are examples of some of the current PhD projects.

How does the relationship between therapist and stroke survivor affect stroke recovery?

PhD student: Lauren Lucas
Supervisors: Audrey Bowen, Sarah Peters, Sarah Cotterill
Funder: Stroke Association
PCPI partners: This study includes the expertise of people with lived experience

Recovery after stroke is tough, but with the right specialist support and a ton of courage and determination, the brain can adapt. Almost 75% of stroke patients require physiotherapy at home, and survivors may need support for many years after to live the best life they can.

The relationship between a therapist and patient is thought to be important. However, very little is known about how this relationship impacts recovery with the physical effects of stroke in the long term.

This research is the first step to understand if new guidelines, training, tools and treatments should focus on this aspect of care to improve recovery after stroke. The research will also identify the most important aspects of the relationship that could improve recovery and life after stroke in the long term.

• Learn more about this stroke recovery study (Stroke Association)

Exploring the management of facial palsy after stroke

PhD student: Havva Sumeyye Eroglu
Supervisors: Claire Mitchell, Audrey Bowen, Matt Checketts
Sponsor: Turkish government

Havva is exploring facial palsy after stroke to understand how we assess and treat people for this distressing condition.

There is limited guidance around this topic, and Havva is also trying to understand which health care professionals are involved in this work.

Havva will be exploring the impact of facial palsy with stroke survivors and working with people who have lived experience to plan research into this topic.

 

Managing dysarthria after stroke in the Arabic-speaking population and trajectory of recovery for dysarthria

PhD student: Shahd Benafif
Supervisors: Claire Mitchell, Paul Conroy
Sponsor: Saudi Arabia

Shahd is exploring what post-stroke dysarthria assessment and treatment options are available to the Arabic-speaking population.

She is also involved in the Speech After Stroke Recovery Study (SayS), and exploring the impact of dysarthria on people at 6 and 16 months post-stroke.

Shahd works with the HEARD PPI group for this study.

Understanding the experience of caring for a friend or family member after their stroke

Research team: Bethany Harcourt, Professor  Audrey Bowen and Professor Richard J Brown 

We have carried out a study exploring informal caregiving following stroke. In this summary report we provide information about the purpose of the study, followed by our main findings and what we plan to do next.  

Stroke Research Study [accessible summary report]

Patient, carer and public involvement and engagement

Patient, carer and public involvement and engagement in research (PCPIE) is central to the research within this theme.

It ensures that every aspect of research involves collaboration with those who are affected by the topic at hand. PCPIE members are actively involved in research and are equal partners within projects.

Ann Bamford, a patient with lived experience and experienced PCPIE contributor, emphasises the importance of patient and researcher collaboration, stating how it helps keep research relevant, timely and of importance to those who it is intended.

“I really believe it improves the relevance and quality of research for patient benefit. Being able to work with a researcher also improves my feelings of self-worth and being able to hold a useful place in society,” she says.

If you are interested in becoming part of the rehabilitation and living with disability PCPIE team, please get in touch with Ann.

Email: ann.bamford@manchester.ac.uk

The HEARD (Healing, Empowering and Recovering from Dysarthria) Group

One example of successful PCPIE in our research is the HEARD group from Claire Mitchell’s dysarthria studies.

Acting as advisors to help shape and manage our research, the HEARD team consists of three stroke survivors affected by dysarthria. See some of the work they have done in this video: Core outcome set-speech (COS-Speech) results (YouTube).

Work with us

We welcome new academic and clinical collaborations, and are happy to discuss placements, internships and funded pre-doctoral and doctoral level fellowships.

For more information, please contact the Theme Co-Leads.

Audrey Bowen
Email: audrey.bowen@manchester.ac.uk

Claire Mitchell
Email: claire.mitchell@manchester.ac.uk