Designing properties of nanofiber yarns and textile structures in garments as a tool to modify neural pathways and treat weakness post stroke.
Lead Research Organisation:
Royal College of Art
Department Name: Helen Hamlyn Centre for Design
Abstract
This fellowship proposal builds on doctoral research designing nanofiber yarns and novel 'bead' structures within everyday, familiar garments to contribute to functional changes in upper limb (UL) recovery from neurological deficits; specifically post stroke UL weakness. It aims to develop world-leading research positioning garments as highly effective applications of neurological treatments, which are responsive to medical and social needs, improving the translation of treatments into routine everyday life. By employing a STEAM agenda it combines material science, stroke rehabilitation with technical fashion/ textiles expertise.
Improving UL recovery post stroke represents a major clinical goal. Currently up to 75% of survivors have persisting weakness and are currently underserved by the system; with methods failing to achieve the minimum guidelines of training required by around 240%.
Current treatments are often primitive and lack a principled understanding, with exercise programmes being difficult to maintain and failing to accommodate lifestyle choices and behaviours of the individual.
Muscle spindle afferents (MSA) are a major sensory input to the motor system, sensing the length and rate-of-change of length of muscles. This signal is vital to our sense of proprioception, telling us where the limbs are located in space. MSA can be activated artificially with a sharp mechanical tap. Generating such precisely-timed activation of MSA injects a powerful signal into the brain and spinal cord. This can activate circuits which may be immediately helpful - for example, in facilitating a weak muscle, or suppressing one which is overactive and generating an unhelpful co-contraction. MSA activation can also be paired with other stimuli (e.g. sound); then, the interval between stimuli can be controlled to modulate the induction of long-term plastic changes outlasting the stimulus. At present, most methods use electrical stimulation to activate sensory nerves for these purposes, but this is non-selective activating both cutaneous (skin tactile) nerves, as well as muscle spindles.
The goal is to develop novel familiar textile-based methods of treating post stroke weakness by enhancing the precision and control of MSA activation. Placed early enough in recovery this method may prevent/ reduce the effects of further deficits.
The bead enables the modification of neural pathways through the manipulation of patent pending piezoelectric properties by targeting the MSA in ways which current vibrational devices cannot achieve. The ease of its integration within textile structures takes advantage of the regular, intimate contact that a garment holds with the human body; presenting an opportunity to re-consider the delivery and positioning of rehabilitation between public and private contexts. In order to do so, considerations for perceptions of 'normal' body behaviours and the familiarities of how a garment and our identity impacts our being in the world are to be considered.
The fellowship takes a highly multidisciplinary approach. It develops samples, conducts wearer tests and pre-analysis using design probe kits in collaboration with survivors and stakeholders, maps participants' existing behaviour with clothing, rehabilitation and levels of weakness with electrophysiological and material characterisation data. Independent reviews will document the impact of combining garments and 'medical devices', whilst body scanning and motion capture will be used to simulate effectiveness of textile structures prior to sampling.
17 million incidences of strokes are reported worldwide per annum. This number is expected to rise by 123% in the next 20 years. Delivering effective treatments which are easy to use and appropriate to lifestyles is a top priority. The fellowship will establish a world-leading research lab, placing a focus on delivering impactful non-invasive neurological treatments in everyday garments.
Improving UL recovery post stroke represents a major clinical goal. Currently up to 75% of survivors have persisting weakness and are currently underserved by the system; with methods failing to achieve the minimum guidelines of training required by around 240%.
Current treatments are often primitive and lack a principled understanding, with exercise programmes being difficult to maintain and failing to accommodate lifestyle choices and behaviours of the individual.
Muscle spindle afferents (MSA) are a major sensory input to the motor system, sensing the length and rate-of-change of length of muscles. This signal is vital to our sense of proprioception, telling us where the limbs are located in space. MSA can be activated artificially with a sharp mechanical tap. Generating such precisely-timed activation of MSA injects a powerful signal into the brain and spinal cord. This can activate circuits which may be immediately helpful - for example, in facilitating a weak muscle, or suppressing one which is overactive and generating an unhelpful co-contraction. MSA activation can also be paired with other stimuli (e.g. sound); then, the interval between stimuli can be controlled to modulate the induction of long-term plastic changes outlasting the stimulus. At present, most methods use electrical stimulation to activate sensory nerves for these purposes, but this is non-selective activating both cutaneous (skin tactile) nerves, as well as muscle spindles.
The goal is to develop novel familiar textile-based methods of treating post stroke weakness by enhancing the precision and control of MSA activation. Placed early enough in recovery this method may prevent/ reduce the effects of further deficits.
The bead enables the modification of neural pathways through the manipulation of patent pending piezoelectric properties by targeting the MSA in ways which current vibrational devices cannot achieve. The ease of its integration within textile structures takes advantage of the regular, intimate contact that a garment holds with the human body; presenting an opportunity to re-consider the delivery and positioning of rehabilitation between public and private contexts. In order to do so, considerations for perceptions of 'normal' body behaviours and the familiarities of how a garment and our identity impacts our being in the world are to be considered.
The fellowship takes a highly multidisciplinary approach. It develops samples, conducts wearer tests and pre-analysis using design probe kits in collaboration with survivors and stakeholders, maps participants' existing behaviour with clothing, rehabilitation and levels of weakness with electrophysiological and material characterisation data. Independent reviews will document the impact of combining garments and 'medical devices', whilst body scanning and motion capture will be used to simulate effectiveness of textile structures prior to sampling.
17 million incidences of strokes are reported worldwide per annum. This number is expected to rise by 123% in the next 20 years. Delivering effective treatments which are easy to use and appropriate to lifestyles is a top priority. The fellowship will establish a world-leading research lab, placing a focus on delivering impactful non-invasive neurological treatments in everyday garments.
| Title | London Design Biennale at 10 Downing Street |
| Description | A 3D printed mannequin of a stroke survivor with one of our garment prototypes incorporating the PowerBead prototype |
| Type Of Art | Artistic/Creative Exhibition |
| Year Produced | 2023 |
| Impact | Invitation to exhibit at the London Design Biennale - which we will action once our second patent has been processed |
| Description | To date, the research has achieved significant ground with the development of the PowerBead technology, specifically, in proving theoretically and practically, how the device works and why. Our understanding of the theoretical physics behind the mechanism has been supported by the strategic partnerships created with professors in Exeter University and Ramakrishna Mission Residential College in Kolkata. The collaborative work has proven to improve the efficiency of the device and improve device safety, particularly in regards to alleviating concerns regarding interference of our device with other implantable medical devices within the body. New IP arising from the development of the PowerBead has led to the drafting of a second patent application that is due to be submitted later this year (2024). Within our patient engagement work, the research has identified that a garment may not be the most appropriate product type to embed the PowerBead into for access and ease-of-use by stroke survivors. The ability to don the garment on and off with the level of tension required in the sleeve to hold the PowerBead in place can present an issue with compliance. Further, depending on the level of elasticity, the textile may 'dull' forces delivered by the PowerBead therefore reducing its performance. We are now working towards a sleek accessory that can be worn on the wrist with a new mechanism for ease of fastening and adjusting. This means a pivot to working within the jewellery department and utilising our expertise with 3D printers to a greater extent. Having said this, the importance of the textile as a surrounding support structure which the PowerBead is integrated within may hold some additional benefits to recovery. We will explore the impact of compression on motor control with our neuroscience partner, Professor Stuart Baker. However, issues with compliance in being able to dress into and out of compressive garments still needs to be addressed. Beyond this, data from testing the device has identified that a lower dose may be acceptable (3 hours versus 6 hours use per day) in order to see long-term recovery of hand and finger function. We still have a long way to go with testing, with delays caused by lack of facilities within our host organisation. This is being dealt with by the PI. Further significant discoveries and achievements for the award to date include: Developed an award winning start-up (KnitRegen Ltd) as a result of the research with the sole purpose of bringing the technology into the hands of stroke survivors in order for them to benefit from the treatment. Won the Mayor of London Entrepreneur award 2021 within the Health category for the PowerBead Invited to showcase the PowerBead at 10 Downing Street as part of the London Design Biennale celebration of the UK's top innovators. The PowerBead prototype was integrated into a long-sleeved garment to demonstrate the importance of context of medical devices to instil desirability and therefore compliance. Salisbury explained the target demographic and importance of the treatment in improving equality within stroke care. |
| Exploitation Route | In the first instance, the findings are informing a plan for commercialisation for the start-up KnitRegen, and the building of a product with commercial viability. Currently clinical test data will be taken forward to shape the research question and design of a clinical trial with the PowerBead. However, such test data from evaluating the impact of the PowerBead is important to groups like Professor John Krakauer, Professor Stuart Baker, Professor Steve Beeby and others who have an interest in the use of alternative stimulation methods for inducing long-term synaptic plasticity, and/or, to evaluate the specificity of using a mechanical versus an electrical stimuli for a range of treatments. Salisbury is preparing three papers to publish in order for such data to be available more widely within the community. |
| Sectors | Healthcare |
| URL | https://www.rca.ac.uk/news-and-events/news/rca-researcher-laura-salisbury-awarded-ukri-future-leaders-fellowship/ |
| Description | Lab testing* of the medical device ('The PowerBead') has lead to: - Eliciting a muscle response in stroke survivors who have little to no movement remaining in their hand/fingers - Over 70% of participants reporting reduced spasticity and a more 'relaxed, open hand' - Over 15% of participants reporting flickers of movement in a previously immobile limb * Testing included half of the treatment over just 1.5 hours in a single dose |
| First Year Of Impact | 2024 |
| Sector | Healthcare |
| Impact Types | Societal |
| Description | E-Textiles Steering Committee |
| Geographic Reach | Europe |
| Policy Influence Type | Participation in a guidance/advisory committee |
| URL | https://www.izm.fraunhofer.de/en/news_events/events/e-textiles-conference.html |
| Description | E-textiles advisory group |
| Geographic Reach | Europe |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Impact | Led to increased content of textile craft and design in the education of e-textiles communities |
| URL | https://e-textilesconference.com/e-textiles-2023/ |
| Description | Electromagnetic simulations of the PowerBead |
| Organisation | University of Exeter |
| Department | School of Physics |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Our research team have contributed towards the design of the PowerBead, research into suitable materials for their intended purpose in the PowerBead and constructing prototypes of the device. |
| Collaborator Contribution | Our partners have contributed towards theoretical calculations and simulations of the PowerBead to inform us as to how the material properties and positioning within the device influence device performance. |
| Impact | Outputs and outcomes are ongoing but to date, there is a draft patent application that is to be submitted later this year. This collaboration is multi-disciplinary including the following disciplines: - Material science; - Theoretical physics; - Electrical engineering; - Textiles. |
| Start Year | 2023 |
| Description | Reticulospinal tract plasticity testing |
| Organisation | Newcastle University |
| Department | Institute of Neuroscience |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Our research team has provided the technology for testing (PowerBead), material know-how and understanding of textile technologies. We have also been able to open up opportunities and events available to the design community to our partners that would have otherwise not been available. |
| Collaborator Contribution | Our partners have trained our research team in using the equipment for clinical testing of the device with stroke survivors. They have further up-skilled us in understanding the algorithms behind the data analysis that is required for post-processing data obtained from the tests. Our partners have provided us with platforms for disseminating our research outputs (conferences) and are joining us in writing a publication for the data we have captured together from our PowerBead device. |
| Impact | The partnership as so far resulted in us being able to test our medical device in the laboratory yielding results to further prove the concept behind the treatment we are looking to provide. Our partners have the correct set-up for testing the device within their lab and have helped us to establish a suitable set-up in our own (pending) laboratory in the Royal College of Art enabling us to expand the activities of our own lab space. We have also presented at an conference together where we gained further insight into the potential impact of the device we are creating. This is a multi-disciplinary collaboration involving the following disciplines: - Material science; - Neuroscience; - Textiles; - Electrical engineering. |
| Start Year | 2021 |
| Description | Reticulospinal tract plasticity testing |
| Organisation | University College London |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Our research team has provided the technology for testing (PowerBead), material know-how and understanding of textile technologies. We have also been able to open up opportunities and events available to the design community to our partners that would have otherwise not been available. |
| Collaborator Contribution | Our partners have trained our research team in using the equipment for clinical testing of the device with stroke survivors. They have further up-skilled us in understanding the algorithms behind the data analysis that is required for post-processing data obtained from the tests. Our partners have provided us with platforms for disseminating our research outputs (conferences) and are joining us in writing a publication for the data we have captured together from our PowerBead device. |
| Impact | The partnership as so far resulted in us being able to test our medical device in the laboratory yielding results to further prove the concept behind the treatment we are looking to provide. Our partners have the correct set-up for testing the device within their lab and have helped us to establish a suitable set-up in our own (pending) laboratory in the Royal College of Art enabling us to expand the activities of our own lab space. We have also presented at an conference together where we gained further insight into the potential impact of the device we are creating. This is a multi-disciplinary collaboration involving the following disciplines: - Material science; - Neuroscience; - Textiles; - Electrical engineering. |
| Start Year | 2021 |
| Title | Muscle stimulation |
| Description | A stimulation system 110a-c for a wearable article comprises an actuator 120 controllable to deliver a mechanical stimulus to a muscle of a wearer of the article, and one or more electrodiagnostic sensors 130 operable to sense muscle activity from a wearer. The actuator 120 may be a piezoelectric actuator having tubular or part tubular nanofiber mesh structure, and the one or more electrodiagnostic sensors may be one or more electromyography sensors. The stimulation system may have a casing 34 that includes an indentation region 141 operable to indent a muscle of a wearer and wherein the actuator is operable to tap against an interior of the casing at least at the indentation region. Also described is a wearable article (50, fig 6) that comprises the stimulation system 110a-c, and a method of manufacturing a piezoelectric actuator. The system is intended to provide muscle stimulation to a wearer suffering from muscle weakness. |
| IP Reference | GB2599225 |
| Protection | Patent / Patent application |
| Year Protection Granted | 2022 |
| Licensed | No |
| Impact | A further patent is in process as a result of further development from the technology described in this patent |
| Title | The PowerBead |
| Description | A wearable med tech device, the PowerBead, is a small e-textiles device that acts as a form of wearable physiotherapy. The device targets the forearm extensor muscles to improve hand and finger function enabling stroke survivors to regain hand and finger movement. The technology is currently at TRL 5 with more extensive testing on stroke survivors required in order to reach a design freeze. The most recent principal source of funding is VC funding raised in June 2023. This fund supports the commercialisation activities for the company, supplementing the research undertaken by the fellowship. |
| Type | Therapeutic Intervention - Medical Devices |
| Current Stage Of Development | Refinement. Non-clinical |
| Year Development Stage Completed | 2023 |
| Development Status | Under active development/distribution |
| Impact | Notable impacts arising from the development process include: The device has demonstrated it can lead to changes in reticulospinal input and therefore long-term recovery of the use of the hand and fingers. Notably, the device's minimum dose may be lower than anticipated at around 3 hours per day rather than 6 hours. Further observations during testing of the device has seen the potential for the device to influence the recovery of lost sensation in the limb. More data is required to understand this to a greater degree. We anticipate that the product may reach as many as 32,000 new stroke survivors in the UK each year alone. |
| Company Name | Knitregen |
| Description | Knitregen develops a medical device for people who have experienced strokes, that aims to utilise energy from body movements to help other parts of the body. |
| Year Established | 2020 |
| Impact | Notable achievements include: - Featuring on BBC Click, in The Times - Securing over £500k in VC funds to date - Collaborated with subcontractors utilising £197k State Aid for business developments (European Regional Development Fund) - Awarded Highly Commended in Medilink's Start Up awards 2021 - Showcased at 10 Downing Street - Finalist for Wandsworth Enterprise Hub award (winners to be announced on 20th March 2024) Number of FTE scientific posts in company = 1 |
| Website | https://www.knitregen.com/ |
| Description | BBC Click |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Technology programme BBC Click reports on the status of prototyping of a new smart sweatshirt featuring the PowerBead. The aim was to generate wider awareness of the work undertaken and support our recruitment campaign to gain wider participation in studies. As a result, we received interest from over the UK, Scotland, France, India and Canada for participation in studies and for how to gain access to the device for use at home. It demonstrated the need for the technology and increased our waiting list of participants to test with us, improving the diversity of participants needed to understand impact on wider demographics. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://www.youtube.com/watch?v=DLB4S7CQ75s |
| Description | BBC Radio 3 Podcast |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | This New Thinking conversation is part of a mini-series of Arts and Ideas podcasts made to mark the anniversary of the NHS 75 years ago. It was produced in partnership with the Arts and Humanities Research Council, part of UKRI. New Generation Thinker Elsa Richardson hears from two leading designers whose new research ideas have transformed the lives of stroke survivors and the elderly. Laura Salisbury is founder of the Wearable MedTech Lab at the Royal College of Art and CEO of KnitRegen and Professor Alastair Macdonald is Senior Researcher in the School of Design at The Glasgow School of Art. Dr Elsa Richardson is a Chancellor's Fellow at the University of Strathclyde in the Centre for the Social History of Health and Healthcare (CSHHH) and is a BBC/AHRC New Generation Thinker. They discuss the importance of collaborative design and testing usability. Laura tells us about her PowerBead design - a garment embedded with beads that aid in the rehabilitation of stroke survivors. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://www.bbc.co.uk/programmes/p0fy7g30 |
| Description | BBC recording for international news |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | A radio recording for the programme 'People Fixing the World' with BBC World News and BBC Radio 4. Coverage was shot in January 2025 with Dr Salisbury (PI), Professor Stuart Baker (project partner, Newcastle University), Nigel Pelling (consenting study participant and stroke survivor), Alex Murphy (celebrity ambassador for stroke). The recording featured insights into the new technology developed in our Wearable MedTech Lab as part of the UKRI FLF and the benefits gained from participant Nigel, so far. Further insights into the unmet need with stroke in the area of research were highlighted with the purpose of generating awareness and boosting support globally. No known impacts as of yet since the programme is due to air in May 2025 - the above information is a projected figure of reach (broadcast internationally), and based on previous reach from other BBC recordings made. |
| Year(s) Of Engagement Activity | 2025 |
| Description | Compliance and adoption workshops |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | 1. Two focus groups at Southampton consisting of 7-8 practising NHS physiotherapists and occupational therapists 2. One focus group at West Middlesex University Hospital consisting of 9 NHS stroke rehabilitation staff Purpose: to gain feedback on prototype device and understand challenges with adoption and use by a therapist within the NHS or private practice. |
| Year(s) Of Engagement Activity | 2022,2023 |
| Description | Steering committee activities |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | Consultation with steering committee to rewrite plain English summary for information sheets and consent forms, ensuring its legibility to survivors/ public with communication difficulties so wider participation may be achieved. |
| Year(s) Of Engagement Activity | 2022,2023 |
| Description | Stroke co-design workshops |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | <20 co-design workshops with community support workers, stroke survivors and community physiotherapists (mix of online and in-person to enable wider participation) Purpose: To understand how the device fits into everyday use and the lives of stroke survivors; noting any issues with use and compliance as well as values that need to be embedded within the product to align with the needs of the target users. Outcomes: Refined the design of the medical device |
| Year(s) Of Engagement Activity | 2021,2022,2023,2024 |