Doctoral Bursaries - Centre for Health, Activity and Rehabilitation Research

Background
Holmberg and Jalanko (2016) reviewed the major medical issues following paediatric kidney transplantation and recommended a shift of research focus from definitive but rare outcomes (e.g. mortality and graft survival) to longer term, patient-focused outcomes. Children and Young People’s (CYP) physical and psychosocial development and neurocognitive function for optimum integration into societal roles and functions are now the new challenges. Furthermore, CYP with Chronic Kidney Disease (CKD) say that physical activity (PA), school, social activities and fatigue are the most important areas that they want to improve [Kerklaan et al. 2020]. Unfortunately, evidence from large-scale longitudinal or interventional studies exploring the impact of PA interventions on outcomes that matter to CYP are extremely scarce. The proposed PhD project will aim to initiate the process, on how to best synthesise existing evidence and evaluate the feasibility of co-developing approaches of stimulating engagement with healthier and more physically active life-style choices. As part of this programme of PhD study, we will aim to collaborate with colleagues from Edinburgh and other European countries and collect data from CYP in all stages of CKD. We will also run on-line sessions with children and families to get their feedback on their experiences with this study and with the type of information we need to gather for future research.   This approach will provide valuable initial data to help us design and undertake feasible multi-centre research trials in the future.

Examples of the research questions of the proposed studentship include:

• What are the current consensus and practices around physical function and physical activity related outcomes in CYP with CKD?
• What are the patterns and types of physical activities undertaken by CYP with CKD?
• What are the patterns and characteristics of psychosocial function and quality of life outcomes in CYP with CKD
• What are CYP’s and parents’ opinions and preferences of different PA/behavioural interventions, and on best  implementation contexts and practices

Please contact for further information: Dr Pelly Koufaki (pkoufaki@qmu.ac.uk)

Background information

This PhD project addresses the need to develop sustainable solutions to the under-exploitation of fermented soy pulp cake, which is a co-product from soy sauce manufacturing, in order to prevent the environmental and economic impact associated with its disposal as industrial waste. A preliminary study carried out at QMU identified its potential as flavouring ingredient and salt replacer for the food industry. Building on these preliminary results, this PhD project aims to create high added-value solutions for the co-product, with the development of novel food ingredients and formulations with nutritional and environmental benefits.

During the PhD, a lab-scale processing method will be developed for the material, and the composition of the novel ingredient will be assessed. A range of potential food formulations and food packaging applications of this ingredient will be screened, following which prototypes of the selected products will be developed. The impact of the use of the novel ingredient on the formulations will be assessed using a range of methods, including sensory analysis, nutritional profiling, instrumental analysis throughout shelf-life (including texturometry, colourimetry, water activity and moisture analysis). The microbiological profile of the novel products will be also monitored throughout shelf-life.

The project will be run in collaboration with the Scottish Centre for Food Development and Innovation (SCFDI), which is based at QMU, and with a number of food industry partners. The PhD student will gain experience in new product development, ingredient functionality, sensory panel training, product quality analysis and technical feasibility. They will join an active team of food science researchers at QMU and will have the opportunity to publish their results in peer-reviewed food science journals and to present their findings at conferences. At the end of the PhD, they will have developed a combined profile in fundamental and applied food science, which will prepare them for a future career in either academia or the food industry.

Examples of research questions this studentship may include:

• What is the optimal way to process this industry co-product?
• What are the viable food applications of the resulting novel ingredient?
• Can this novel ingredient allow to reformulate food products with a salt reduction nutritional claim?
• What is the impact of the use of this novel ingredient on the sensory profile of the reformulated food products?
• Can the shelf-life of the new products be maintained while using this novel ingredient?

Contact for further information: Dr Julien Lonchamp (JLonchamp@qmu.ac.uk)

There are numerous causes of foot drop which relates to the inability to keep the foot up when walking. Foot drop which is common in people living with conditions such as Multiple Sclerosis¹, Stroke², Cerebral Palsy² and Peripheral Neuropathy³, has negative effects on walking and can lead to trips and falls, with substantial impacts on quality of life^2,4. Foot drop is complex and influenced by multiple factors. Most published research on foot drop focuses on the effectiveness or experience of using interventions to achieve improvements in walking, such as Functional Electrical Stimulation and Ankle Foot Orthoses^2,5,6.

The involvement of CHEARR researchers in this area has led to innovation and KE activity. A new device has been developed to support people with foot drop - footwear with inbuilt dorsiflexion support. The Health Design Collective (spin-out Social Enterprise) team have tested multiple prototypes and submitted a patent relating to this innovation; ( https://www.healthdesigncollective.co.uk/). As a team we have now reached the point of evaluating the footwear in comparison with other devices for supporting foot drop. As for previous research, evaluation of the footwear innovation is affected by substantial heterogeneity in the presentation of foot drop, with numerous influencing factors.

The lack of research into the multifactorial nature of foot drop inhibits progress in the development and prescription of appropriate interventions. While there are many devices available to support people who have foot drop, more knowledge is needed that provides guidance which will inform people about what may or may not work for them depending on the characteristics of their foot drop, for example, in relation to muscle strength, ability to activate the lower limb muscles, (passive) range of motion and spasticity. It would be valuable to develop a system (such as an algorithm or decision tree) that takes account of the characteristics of a person’s foot drop. This could provide guidance about the best options for support, enabling people with foot drop and clinicians to make more informed decisions in relation to footwear and orthotic interventions. This would support both clinical and self-management for people with foot drop. In order to address this gap and support the progression of work within CHEARR, we propose the following research questions:

Example research questions

1. Are there common patterns in foot drop presentation derived from measurements of range of motion, spasticity, strength, gait and fatigability and what are these patterns?
2. Are there associations between the characteristics of foot drop described above and the effectiveness of different orthotic devices, and what are these?
3. Is it possible to use insights from 1 and 2 to create guidance in relation to the most appropriate orthotic device prescription for people depending on the characteristics of their foot drop?

For more information: please contact Professor Cathy Bulley cbulley@qmu.ac.uk

References

1. Miller L, Rafferty D, Paul L, Mattison P.. The impact of walking speed on the effects of functional electrical stimulation for foot drop in people with multiple sclerosis. Disabil Rehabilitation: Assist Technol. 2016; 11:478-483.
2. Prenton S, Hollands KL, Kenney LPJ, et al. Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research. J Rehabil Med. 2018; 50(2):129-139.
3. York G, Chakrabarty S. A survey on foot drop and functional electrical stimulation. Int J Intel Robot Appl. 2019; 3:4-10
4. Matsuda PN, Shumway-Cook A, Bamer AM, Johnson SL Amtmann D, Kraft GH. Falls in multiple sclerosis. PM&R. 2011; 3:624-632.
5. Van der Linden ML, Scott SM, Hooper JE, Cowan P, Mercer TH 2014. Gait kinematics of people with multiple sclerosis and the acute application of functional electrical stimulation. Gait Posture. 2014; 39:1092-1096.
6. Bulley C, Meagher C, Street T, Adonis A, Peace C, Singleton C, Burridge J. Development of Clinical Guidelines for Service Provision of Functional Electrical Stimulation to Support Walking: Mixed Method Exploration of Stakeholder Views. BMC Neurol. 2021; 21 Article number: 263.

Since the 1st of January 2018, Frame Running (www.framerunning.org), formerly known as RaceRunning, has been a World Para Athletics (WPA) event. Frame Running athletes propel themselves using a running frame which has three wheels, a saddle, breast plate for support and handlebars. Athletes propel themselves with their legs using a variety of propulsion techniques. Frame Running specifically caters for athletes unable to walk or with severe difficulty walking.

Para sport classification determines which athletes are eligible to compete in a sport and how athletes are grouped together for competition. In Para sports, athletes are grouped by the degree of activity limitation resulting from their impairment [1] and as such classification aims to minimise the impact of eligible impairments on the outcome of competition [2]. Since 2007 classification systems are required to be based on scientific evidence and a new classification for Frame Running has been developed supported by research [3,4]. However, it is important that further data continues to be collected to further strengthen the evidence base for the classification, monitor and if necessary update this proposed classification system.

Examples of the research questions this studentship may include:

• How do Dyskinesia and Ataxia impact Frame Running performance?
• What is the test–retest reliability of the measures in the proposed evidence-based classification system in the Frame Running athlete population?
• Are the measures in the proposed evidence-based classification system susceptible to Intentional Misrepresentation [5] and if so, how can this be detected?

For more information please contact: Marietta van der Linden (mvanderlinden@qmu.ac.uk)

References

[1] International Paralympic Committee https://www.paralympic.org/classification

[2] Tweedy SM, Vanlandewijck YC (2011). International Paralympic Committee position stand —background and scientific principles of classification in Paralympic sport. Br J Sports Med; 45:259–69.

 [3] van der Linden M, Jahed S, Tennant N, Verheul M (2018). The influence of lower limb impairments on RaceRunning performance in athletes with hypertonia, ataxia or athetosis.  Gait Posture; 61:362-367.

[4] van der Linden ML, Corrigan O, Tennant N, Verheul MHG (2020). Cluster analysis of impairment measures to inform an evidence-based classification structure in RaceRunning, a new World Para Athletic event for athletes with hypertonia, ataxia or athetosis. Journal of Sports Sci; 39: 159–166.

[5] Altmann VC, Hendriks N, Lammens EA, Janssen M. (2022). Development of Tests for Arm Coordination Impairment in Paralympic Classification. Front Rehabilit Sci; 3:865133. doi: 10.3389/fresc.2022.865133.

Supporting information