Heath Reed

Head-Up; An interdisciplinary, participatory and co-design process informing the development of a novel head and neck support for people living with progressive neck muscle weakness.

Abstract This paper presents the Head-Up project, that aims to provide innovative head support to help improve posture, relieve pain and aid communication for people living with progressive neck muscle weakness. The initial focus is motor neurone disease. The case study illustrates collaborative, interdisciplinary research and new product development underpinned by participatory design. The study was initiated by a 2-day stakeholder workshop followed by early proof-of-concept modelling and patient need evidence building. The work subsequently led to a successful NIHR i4i application funding a 24-month iterative design process, patenting, CE marking and clinical evaluation. The evaluation has informed amendments to the proposed design refered to here as the Sheffield Support Snood (SSS). The outcome positively demonstrates use and performance improvements over current neck orthoses and the process of multidisciplinary and user engagement has created a sense of ownership by MND participants, who have since acted as advocates for the product.

Assessment of the Sheffield Support Snood, an innovative cervical orthosis designed for people affected by neck muscle weakness

BACKGROUND This study aimed at quantifying the biomechanical features of the Sheffield Support Snood, a cervical orthosis specifically designed for patients with neck muscle weakness. The orthosis is designed to be adaptable to a patients level of functional limitation using adjustable removable supports, which contribute support and restrict movement only in desired anatomical planes. METHODS The snood was evaluated along with two commercially available orthoses, the Vista and Headmaster, in a series of flexion, extension, axial-rotation and lateral flexion movements. Characterization was performed with twelve healthy participants with and without the orthoses. Two inertial-magneto sensors, placed on the forehead and sternum, were used to quantify the necks range of motion. FINDINGS In its less supportive configuration, the snood was effective in limiting movements to the desired planes, preserving free movement in other planes. The Headmaster was only effective in limiting flexion. The range of motion achieved with the snood in its rigid configuration was equivalent (P>0.05, effect size<0.4) to that achieved with the Vista, both in trials performed reaching the maximum amplitude (range of motion reduction: 25%-34% vs 24%-47%) and at maximum speed (range of motion reduction: 24%-29% vs 25%-43%). INTERPRETATION The Sheffield Support Snood is effectively adaptable to different tasks and, in its most supportive configuration, offers a support comparable to the Vista, but providing a less bulky structure. The chosen method is suitable for the assessment of range of motions while wearing neck orthoses and is easily translatable in a clinical context.

Evaluating a novel cervical orthosis, the Sheffield Support Snood, in patients with amyotrophic lateral sclerosis/motor neuron disease with neck weakness

Abstract Current practice and guidelines recommend the use of neck orthoses for people with amyotrophic lateral sclerosis (ALS) to compensate for neck weakness and to provide surrogate neck control. However, available options are frequently described by patients as restrictive and unsuitable and there was a need for a new device that addressed the needs of people with ALS. This project utilized a co-design process to develop a new neck orthosis that was more flexible yet supportive. Following development of a prototype device, a mixed methods cohort study was undertaken with patients and carers, in order to evaluate the new orthosis. Twenty-six patients were recruited to the study, with 20 of these completing all phases of data collection. Participants described the impact of neck weakness on their life and limitations of existing supports. Evaluation of the new orthosis identified key beneficial features: notably, increased support while providing a greater range of movement, flexibility of use, and improved appearance and comfort. In conclusion, the results of this evaluation highlight the value of this alternative option for people with ALS, and potentially other patient groups who require a neck orthosis.

The Reed-Stanton press rig for the generation of reproducible fingermarks: Towards a standardised methodology for fingermark research

In the search for better or new methods/techniques to visualise fingermarks or to analyse them exploiting their chemical content, fingermarks inter-variability may hinder the assessment of the method effectiveness. Variability is due to changes in the chemical composition of the fingermarks between different donors and within the same donor, as well as to differential contact time, pressure and angle. When validating a method or comparing it with existing ones, it is not always possible to account for this type of variability. One way to compensate for these issues is to employ, in the early stages of the method development, a device generating reproducible fingermarks. Here the authors present their take on such device, as well as quantitatively describing its performance and benefits against the manual production of marks. Finally a short application is illustrated for the use of this device, at the method developmental stages, in an emerging area of fingerprinting research concerning the retrieval of chemical intelligence from fingermarks.

Communication of medical images to diverse audiences using multimodal imaging

A study has been completed examining design issues concerning the interpretation of and dissemination of multimodal medical imaging data sets to diverse audiences. To create a model data set mouse fibrosarcoma tissue was visualised via magnetic resonance imaging (MRI), Matrix-Assisted Laser Desorption/Ionisation-Mass Spectrometry (MALDI-MSI) and histology. MRI images were acquired using the 0.25T Esaote GScan; MALDI images were acquired using a Q-Star Pulsar I mass spectrometer. Histological staining of the same tissue sections used for MALDI-MSI was then carried out. Areas assigned to hemosiderin deposits due to haemorrhaging could be visualised via MRI. In the MALDI-MSI data obtained the distribution sphingomyelin species could be used to identify regions of viable tumour. Mathematical ‘up sampling’ using hierarchical clustering-based segmentation provided a sophisticated image enhancement tool for both MRI and MALDI-MS and assisted in the correlation of images.

Experience of using a haptic interface to follow a robot without visual feedback

Search and rescue operations are often undertaken in smoke filled and noisy environments in which rescue teams must rely on haptic feedback for navigation and safe exit. In this paper, we discuss designing and evaluating a haptic interface to enable a human being to follow a robot through an environment with no-visibility. We first discuss the considerations that have led to our current interface design. The second part of the paper describes our testing procedure and the results of our first tests. Based on these results we discuss future improvements of our design.

A comfort assessment of existing cervical orthoses

Abstract Purpose: Identify location and intensity of discomfort experienced by healthy participants wearing cervical orthoses. Method: Convenience sample of 34 healthy participants wore Stro II, Philadelphia, Headmaster, and AspenVista® cervical orthoses for four-hour periods. Participants reported discomfort level (scale 0–6) and location. Results: Participants reported mean discomfort for all orthoses over the four-hour test between ‘a little discomfort’ and ‘very uncomfortable’ (mean discomfort score = 1.64, SD = 1.50). Seven participants prematurely stopped tests due to pain and six reported maximum discomfort scores. Significant linear increase in discomfort with duration of wear was found for all orthoses. Significantly less discomfort was reported with Stro II than Headmaster and Philadelphia. Age correlated with greater perceived discomfort. Orthoses differed in the location discomfort was experienced. Conclusion: Existing cervical orthoses cause discomfort influenced by design and duration of wear with orthoses’ design the more significant factor. This work informed the design of a new orthosis and future orthoses developments. Practitioner Summary: The purpose of this study was to gain greater knowledge about the discomfort caused by wearing of existing neck orthoses in order to inform the design and development of a new neck orthosis. This study gathers empirical data from a surrogate population and concludes that orthosis design is more influential than the duration of wear.

P30 - Patient involvement at every stage: design and coproduction of the Head Up neck support collar

Aims Patient and public involvement (PPI) in antimicrobial medicines development research is a new and challenging area. We aim to share some of the barriers and strategies to developing a toolkit to support PPI in this area. The PPI toolkit development is part of COMBACTE-MAGNET, a European project funded by the Innovative Medicines Initiative Joint Undertaking (www.imi.europa.eu) to seek new ways of treating multi-resistant bacterial infections. Why is it important and to whom? There is currently no literature focusing on PPI in antimicrobial medicines development research. The toolkit addresses the need for evidence-based guidance on how to carry out PPI throughout the antimicrobial medicines development lifecycle. Learning from the toolkit development process will be important to researchers, PPI leads, and patient and public contributors who are interested in developing PPI in new and/or challenging clinical areas. What difference has, or could, this project make? The toolkit will showcase the importance of PPI in antimicrobial medicines development research, to change perception and increase the receptivity of various stakeholders, including pharmaceutical companies, towards PPI. This is intended to result in the establishment or improvement of PPI-related policies in this area, with the toolkit serving as a practical guide on how to conduct and evaluate PPI. Key learning points Delegates will learn about the challenges of developing a toolkit with European collaborators in an area of research that is driven by the pharmaceutical industry, with little/no experience of PPI to date, due to concerns about its complexities and confidentiality issues. They will also learn about strategies that can facilitate the toolkit development process, which may be useful for their own projects.All abstracts from the NIHR INVOLVE Conference 2017. Poster 27 - P27 Discovering the role of public co-applicant on a National Institute for Health Research (NIHR) Programme grant Research Involvement and Engagement 2017, 3(Suppl 1):P27

Proving the proof of concept; developing new methods and knowledge to evaluate products supporting cancer therapy

ABSTRACT This article illuminates through a case study, SuPPORT 4 All (Support, Positioning and Organ stabilisation during breast cancer radiation therapy/S4A). It describes how three-dimensional design research assesses, assimilates and is applied to define product requirements in a cross-disciplinary research team, activity occurring concurrently, yet also informing the act of designing the eventual products themselves. The study describes how a multidisciplinary research and development team, more specifically the design researchers within it, developed a range of holistic knowledge sets to establish critical criteria to validate physical outcomes. The study illustrates the methods used and developed to elicit the scale of the challenge and discusses the validity of these methods and technologies when wide-ranging design specifications may not exist at project outset.