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Article ; Online: A systematic review of vestibular stimulation in post-stroke visual neglect.

Wheeler, Charlotte / Smith, Laura J / Sakel, Mohamed / Wilkinson, David

2024 , Page(s) 1–33

Abstract: Unilateral visual neglect is a condition that negatively impacts the lives of many stroke survivors. Studies have investigated different forms of vestibular stimulation as a potential therapy, but evidence is yet to be systematically reviewed. We ... ...

Abstract	Unilateral visual neglect is a condition that negatively impacts the lives of many stroke survivors. Studies have investigated different forms of vestibular stimulation as a potential therapy, but evidence is yet to be systematically reviewed. We therefore reviewed the effects of vestibular stimulation on outcomes of neglect and activities of daily living (ADL) for people with visual neglect. We searched relevant databases up until September 2022. Eligible articles included any form of vestibular stimulation, study design, or control condition. Included participants were 18 years or older, presenting with neglect following a haemorrhagic or ischaemic stroke. Relevant outcomes were clinically validated measures of neglect and ADL. Cochrane risk of bias tools were used to assess study quality. Meta-analyses and narrative methods were used to synthesize the data. Our search returned 17 relevant studies comprising 180 participants. Meta-analyses showed no difference between galvanic vestibular stimulation and sham conditions on outcomes, whereas caloric vestibular stimulation led to improvement compared to pre-stimulation scores. Narrative syntheses showed mixed results. Clinical and methodological heterogeneity was found both within and between studies. Overall, results were inconsistent regarding the effects of vestibular stimulation as a treatment for neglect. Further trials are warranted but require more careful methodological planning.
Language	English
Publishing date	2024-04-12
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1080508-4
ISSN	1464-0694 ; 0960-2011
ISSN (online)	1464-0694
ISSN	0960-2011
DOI	10.1080/09602011.2024.2338603
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Article ; Online: Is it time for a paradigmatic shift in relation to healthcare in the UK? A reflection.

Saunders, Karen / Sakel, Mohamed / Cooper, Cary L

BMJ leader

2023 Volume 7, Issue 4, Page(s) 251–254

Abstract: Context: Conflict is a driver of change and unions representing professional groups across the National Health Service (NHS) are currently engaged in direct conflict with the government. For the first time in the history of the NHS, healthcare ... ...

Abstract	Context: Conflict is a driver of change and unions representing professional groups across the National Health Service (NHS) are currently engaged in direct conflict with the government. For the first time in the history of the NHS, healthcare professionals have taken industrial strike action. Junior doctors and consultant physicians are currently engaged in their respective union ballots and indicative poll surveys regarding potential strike action in the future. In the wake of such widespread industrial action, we have taken time to think deeply about the confronting challenges and issues and offer this reflection as an opportunity to redefine and re-frame an unsustainable healthcare system into one that is the best it can be in terms of fit for purpose. Insights and resource signposting: We present the current context with a reflective framework table focused on 'What do we do well? What is not done so well? What could some possible ideas and solutions be? and How could this change be supported?'We outline how a culture of well-being could be strategically and operationally introduced into the NHS workplace using research-based evidence and practical tools supported by expert guidance.
MeSH term(s)	Humans ; State Medicine ; Delivery of Health Care ; Health Personnel ; Health Facilities ; United Kingdom
Language	English
Publishing date	2023-12-20
Publishing country	England
Document type	Journal Article
ISSN	2398-631X
ISSN (online)	2398-631X
DOI	10.1136/leader-2023-000762
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Article ; Online: Co-creating system-wide improvement for people with traumatic brain injury across one integrated care system in the United Kingdom to initiate a transformation journey through co-production.

Manley, Kim / Saunders, Karen / Wilkinson, David / Faruqui, Rafey / Sakel, Mohamed

Health expectations : an international journal of public participation in health care and health policy

2023 Volume 26, Issue 2, Page(s) 869–881

Abstract: Background and objective: There is a need for better integration of services across communities and sectors for people living with traumatic brain injury (TBI) to meet their complex needs. Building on insights gained from earlier pilot work, here we ... ...

Abstract	Background and objective: There is a need for better integration of services across communities and sectors for people living with traumatic brain injury (TBI) to meet their complex needs. Building on insights gained from earlier pilot work, here we report the outcomes of a participatory workshop that sought to better understand the challenges, barriers and opportunities that currently exist within the care pathway for survivors of TBI. Methods: A diverse range of stakeholders from the acute and rehabilitation care pathway and the health and social care system were invited to participate in a 3-h workshop. The participants worked in four mixed subgroups using practice development methodology, which promotes person-centred, inclusive and participatory action. Results: Thematic analysis identified shared purposes and values that were used to produce a detailed implementation and impact framework for application at both the level of the care interface and the overarching integrated care system. A variety of enablers were identified that related to collective values and behaviours, case management, team leadership and integrated team working, workforce capability, evidence-based practice and resourcing. The clinical, economic, cultural and social outcomes associated with these enablers were also identified, and included patient safety, independence and well-being, reduced waiting times, re-admission rates, staff retention and professional development. Conclusion: The co-produced recommendations made within the implementation and impact framework described here provide a means by which the culture and delivery of health and social care services can be better tailored to meet the needs of people living with TBI. We believe that the recommendations will help shape the formation of new services as well as the development of existing ones. Patient or public contribution: Patient and public involvement have been established over a 10-year history of relationship building through a joint forum and events involving three charities representing people with TBI, carers, family members, clinicians, service users, researchers and commissioners, culminating in a politically supported event that identified concerns about the needs of people following TBI. These relationships formed the foundation for the interactive workshop, the focus of this publication.
MeSH term(s)	Humans ; United Kingdom ; Brain Injuries, Traumatic ; Caregivers ; Family ; Delivery of Health Care, Integrated
Language	English
Publishing date	2023-01-30
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2119434-8
ISSN	1369-7625 ; 1369-6513
ISSN (online)	1369-7625
ISSN	1369-6513
DOI	10.1111/hex.13712
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Zs.A 5896: Show issues

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Article ; Online: Co‐creating system‐wide improvement for people with traumatic brain injury across one integrated care system in the United Kingdom to initiate a transformation journey through co‐production

Kim Manley / Karen Saunders / David Wilkinson / Rafey Faruqui / Mohamed Sakel

Health Expectations, Vol 26, Iss 2, Pp 869-

2023 Volume 881

Abstract: Abstract Background and Objective There is a need for better integration of services across communities and sectors for people living with traumatic brain injury (TBI) to meet their complex needs. Building on insights gained from earlier pilot work, here ...

Abstract	Abstract Background and Objective There is a need for better integration of services across communities and sectors for people living with traumatic brain injury (TBI) to meet their complex needs. Building on insights gained from earlier pilot work, here we report the outcomes of a participatory workshop that sought to better understand the challenges, barriers and opportunities that currently exist within the care pathway for survivors of TBI. Methods A diverse range of stakeholders from the acute and rehabilitation care pathway and the health and social care system were invited to participate in a 3‐h workshop. The participants worked in four mixed subgroups using practice development methodology, which promotes person‐centred, inclusive and participatory action. Results Thematic analysis identified shared purposes and values that were used to produce a detailed implementation and impact framework for application at both the level of the care interface and the overarching integrated care system. A variety of enablers were identified that related to collective values and behaviours, case management, team leadership and integrated team working, workforce capability, evidence‐based practice and resourcing. The clinical, economic, cultural and social outcomes associated with these enablers were also identified, and included patient safety, independence and well‐being, reduced waiting times, re‐admission rates, staff retention and professional development. Conclusion The co‐produced recommendations made within the implementation and impact framework described here provide a means by which the culture and delivery of health and social care services can be better tailored to meet the needs of people living with TBI. We believe that the recommendations will help shape the formation of new services as well as the development of existing ones. Patient or Public Contribution Patient and public involvement have been established over a 10‐year history of relationship building through a joint forum and events involving ...
Keywords	co‐production ; neuro‐rehabilitation ; person‐centred care ; practice development ; system and workforce transformation ; transdisciplinary ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Ethical issues and dilemmas in spinal cord injury rehabilitation in the developing world: a mixed-method study.

Uddin, Taslim / Shakoor, M A / Rathore, Farooq A / Sakel, Mohamed

Spinal cord

2022 Volume 60, Issue 10, Page(s) 882–887

Abstract: Study design: Mixed-method study (small group discussions and online literature search).: Objectives: Identify the ethical issues and dilemmas faced by rehabilitation professionals involved in the service delivery to the persons with spinal cord ... ...

Abstract	Study design: Mixed-method study (small group discussions and online literature search). Objectives: Identify the ethical issues and dilemmas faced by rehabilitation professionals involved in the service delivery to the persons with spinal cord injury (SCI) in the low income and lower-middle-income countries (LIC/LMIC) located in Asia. Setting: Small group discussions in three biomedical conferences in Dhaka, Bangladesh and Kualalampur, Malaysia. Methods: Three small group discussions (30-45 min each) were held during three international conferences in 2019. The conferences brought together experts in the fields of neurology, rehabilitation, neurorehabilitation, and bioethics. A summary of SCI practice points and dilemmas were documented including goals of care, duties of rehabilitation professionals, health care worker-patient relationships, roles, and expectations of family members at different care settings. Results: There is a paucity of literature on this topic. The application of the principles of contemporary bioethics in the pluralistic societies of LIC/LMIC can be challenging. The ethical dilemmas faced by rehabilitation professionals working in LIC/LMIC are diverse and different from those reported from the Western and developed countries. Ethical issues and dilemmas identified were understanding patient autonomy in decision making, lack of insurance for SCI rehabilitation, financial challenges, challenges of providing emerging technology in SCI rehabilitation and SCI rehabilitation during disasters. Conclusions: We have summarized the possible ethical issues and dilemmas which rehabilitation professionals in LIC/LMIC may encounter during delivery of SCI rehabilitation services. We hope it generates a discussion on an often-neglected aspect of SCI care in the LIC/LMIC and helps identify the complexities of ethical dilemmas unique to persons with SCI living in a developing country.
MeSH term(s)	Asia ; Bangladesh ; Ethics ; Health Personnel ; Humans ; Neurological Rehabilitation/ethics ; Spinal Cord Injuries/rehabilitation
Language	English
Publishing date	2022-05-06
Publishing country	England
Document type	Journal Article
ZDB-ID	1316161-1
ISSN	1476-5624 ; 1362-4393
ISSN (online)	1476-5624
ISSN	1362-4393
DOI	10.1038/s41393-022-00808-8
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Zs.A 198: Show issues

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Article ; Online: BCI controlled robotic arm as assistance to the rehabilitation of neurologically disabled patients.

Casey, Anthony / Azhar, Hannan / Grzes, Marek / Sakel, Mohamed

Disability and rehabilitation. Assistive technology

2019 Volume 16, Issue 5, Page(s) 525–537

Abstract: Purpose: Brain-computer interface (BCI)-controlled assistive robotic systems have been developed with increasing success with the aim to rehabilitation of patients after brain injury to increase independence and quality of life. While such systems may ... ...

Abstract	Purpose: Brain-computer interface (BCI)-controlled assistive robotic systems have been developed with increasing success with the aim to rehabilitation of patients after brain injury to increase independence and quality of life. While such systems may use surgically implanted invasive sensors, non-invasive alternatives can be better suited due to the ease of use, reduced cost, improvements in accuracy and reliability with the advancement of the technology and practicality of use. The consumer-grade BCI devices are often capable of integrating multiple types of signals, including Electroencephalogram (EEG) and Electromyogram (EMG) signals. Materials and methods: This paper summarizes the development of a portable and cost-efficient BCI-controlled assistive technology using a non-invasive BCI headset "OpenBCI" and an open source robotic arm, U-Arm, to accomplish tasks related to rehabilitation, such as access to resources, adaptability or home use. The resulting system used a combination of EEG and EMG sensor readings to control the arm. To avoid risks of injury while the device is being used in clinical settings, appropriate measures were incorporated into the software control of the arm. A short survey was used following the system usability scale (SUS), to measure the usability of the technology to be trialed in clinical settings. Results: From the experimental results, it was found that EMG is a very reliable method for assistive technology control, provided that the user specific EMG calibration is done. With the EEG, even though the results were promising, due to insufficient detection of the signal, the controller was not adequate to be used within a neurorehabilitation environment. The survey indicated that the usability of the system is not a barrier for moving the system into clinical trials.Implication on rehabilitationFor the rehabilitation of patients suffering from neurological disabilities (particularly those suffering from varying degrees of paralysis), it is necessary to develop technology that bypasses the limitations of their condition. For example, if a patient is unable to walk due to the unresponsiveness in their motor neurons, technology can be developed that used an alternate input to move an exoskeleton, which enables the patient to walk again with the assistance of the exoskeleton.This research focuses on neuro-rehabilitation within the framework of the NHS at the Kent and Canterbury Hospital in UK. The hospital currently does not have any system in place for self-driven rehabilitation and instead relies on traditional rehabilitation methods through assistance from physicians and exercise regimens to maintain muscle movement.This paper summarises the development of a portable and cost-efficient BCI controlled assistive technology using a non-invasive BCI headset "OpenBCI" and an open source robotic arm, U-Arm, to accomplish tasks related to rehabilitation, such as access to resources, adaptability or home use. The resulting system used a combination of EEG and EMG sensor readings to control the arm, which could perform a number of different tasks such as picking/placing objects or assist users in eating.
MeSH term(s)	Brain-Computer Interfaces ; Electroencephalography ; Humans ; Quality of Life ; Reproducibility of Results ; Robotic Surgical Procedures
Language	English
Publishing date	2019-11-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2221782-4
ISSN	1748-3115 ; 1748-3107
ISSN (online)	1748-3115
ISSN	1748-3107
DOI	10.1080/17483107.2019.1683239
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Article: Neuro-rehabilitation service during COVID-19 pandemic: Best practices from UK.

Sakel, Mohamed / Saunders, Karen / Chandi, Jettender / Haxha, Shyqyri / Faruqui, Rafey

JPMA. The Journal of the Pakistan Medical Association

2020 Volume 70Suppl 3, Issue 5, Page(s) S136–S140

Abstract: This paper provides the context of COVID-19 outbreak with special reference to hospital-based neurorehabilitation services in the UK and transferrable lessons for similar services globally. While the COVID-19 pandemic has created numerous challenges at ... ...

Abstract	This paper provides the context of COVID-19 outbreak with special reference to hospital-based neurorehabilitation services in the UK and transferrable lessons for similar services globally. While the COVID-19 pandemic has created numerous challenges at all levels and forced us to confront our own vulnerabilities as individuals, teams, services, communities and on the global stage, it has also simultaneously offered us opportunities for transformation. Converting catastrophe into opportunity requires creativity, diligence, innovation, strategy and vision. This reflection serves to identify the challenges we encountered, the solutions we applied and the opportunities that we have taken. In the wake of an information avalanche, service and clinical practice challenge, service capacity challenge and above all, a unique and timely reminder of our own humanity and the inter-connectedness and fragility of human societies, we have endeavoured to identify and describe some crucial leadership facets, which are supporting our journey through this global health crisis.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Cross Infection ; Delivery of Health Care ; Health Personnel ; Humans ; Nervous System Diseases/complications ; Nervous System Diseases/rehabilitation ; Nervous System Diseases/therapy ; Neurological Rehabilitation/organization & administration ; Neurological Rehabilitation/statistics & numerical data ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2 ; United Kingdom
Keywords	covid19
Language	English
Publishing date	2020-06-09
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
DOI	10.5455/JPMA.33
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Article ; Online: Truly independent research is impossible.

Sakel, Mohamed

BMJ (Clinical research ed.)

2008 Volume 337, Page(s) a1881

MeSH term(s)	Biomedical Research/ethics ; Clinical Trials as Topic/ethics ; Interprofessional Relations/ethics ; Professional Autonomy
Language	English
Publishing date	2008-10-01
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.a1881
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Article ; Online: Key demographics and psychological skills associated with adjustment to progressive Multiple Sclerosis early in the diagnosis.

Bogosian, Angeliki / Day, Fern / Norton, Sam / Silber, Eli / Sakel, Mohamed / Sharrack, Basil / Moss-Morris, Rona

Frontiers in rehabilitation sciences

2022 Volume 3, Page(s) 966133

Abstract: Background/purpose: Being diagnosed with a progressive type of multiple sclerosis (MS) has been associated with worse psychological outcomes compared to relapsing-remitting type. Previous studies of adjustment to MS have primarily focused on relapsing- ... ...

Abstract	Background/purpose: Being diagnosed with a progressive type of multiple sclerosis (MS) has been associated with worse psychological outcomes compared to relapsing-remitting type. Previous studies of adjustment to MS have primarily focused on relapsing-remitting type MS. The present study aims to examine psychological adjustment for people newly diagnosed with progressive multiple sclerosis. Methods: This was a multicenter cross-sectional survey of 189 people newly diagnosed with progressive MS. A composite measure of psychological adjustment was created from questionnaires measuring psychological distress, positive affect, perceived-stress, life satisfaction and self-concept. Predictor variables included coping strategies, social support, relationship with partner, psychological vulnerability, MS-related beliefs, and responses to symptoms. Data were analysed using a regularised regression model to indicate which group of all variables are associated with adjustment. Results: People who were older ( Conclusions and implications: Helping newly diagnosed people to find ways to tolerate anxiety-causing situations by encouraging acceptance may help people adjust to progressive MS by lowering their avoidance. Further, building confidence in managing the illness and addressing relationship issues are key focus areas in psychological interventions for people with progressive multiple sclerosis.
Language	English
Publishing date	2022-08-29
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-6861
ISSN (online)	2673-6861
DOI	10.3389/fresc.2022.966133
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Article ; Online: Feasibility and Safety of a Powered Exoskeleton for Balance Training for People Living with Multiple Sclerosis: A Single-Group Preliminary Study (Rapper III).

Sakel, Mohamed / Saunders, Karen / Hodgson, Philip / Stephensen, David / Phadke, Chetan P / Bassett, Paul A / Wilkinson, David

Journal of rehabilitation medicine

2022 Volume 54, Page(s) jrm00357

Abstract: Objective: To evaluate the feasibility, usability, safety, and potential health benefits of using an exoskeleton device for rehabilitation of people living with multiple sclerosis.: Design: Single-group preliminary study.: Subjects: Eleven adults ... ...

Abstract	Objective: To evaluate the feasibility, usability, safety, and potential health benefits of using an exoskeleton device for rehabilitation of people living with multiple sclerosis. Design: Single-group preliminary study. Subjects: Eleven adults living with multiple sclerosis, with Expanded Disability Status Scores that ranged from 6 to 7.5 (mean age (standard deviation; SD) 54.2 (11.8) years), were recruited. Methods: Individual participants undertook a balance rehabilitation exercise programme using the Rex Rehab robotic exoskeleton device. Each participant undertook 4 × 45-60 min supervised, balance exercise sessions. Primary outcomes were: (i) the number of participants who completed the trial protocol safely, and (ii) the number and nature of adverse events reported. Secondary outcomes were: mobility; balance; spasticity; sleep; functional independence; quality of life; and device satisfaction. Results: Ten out of 11 participants completed the trial protocol safely. Four adverse events were recorded (1 serious), all of which were deemed unrelated to the trial. Secondary outcomes showed allied improvements in balance, joint mobility, spasticity and quality of life. All participants found the device acceptable to use. Conclusion: These results suggest that it is feasible and safe to use the Rex Rehab exoskeleton device to assist with balance rehabilitation for people living with multiple sclerosis.
MeSH term(s)	Adult ; Humans ; Exoskeleton Device ; Multiple Sclerosis/rehabilitation ; Quality of Life ; Exercise Therapy/methods ; Robotics ; Muscle Spasticity/etiology ; Feasibility Studies
Language	English
Publishing date	2022-12-09
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	2039427-5
ISSN	1651-2081 ; 1651-2235 ; 0891-060X ; 1650-1977
ISSN (online)	1651-2081 ; 1651-2235
ISSN	0891-060X ; 1650-1977
DOI	10.2340/jrm.v54.4544
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