Dr Patrick Esser
PhD
Reader in Sport and Rehabilitation Technology
Department of Sport, Health Sciences and Social Work

Role
Dr Patrick Esser, Reader, is the Director of the Centre for Movement, Occupation and Rehabilitation Sciences (MORES) at Oxford Brookes University, where he leads the Movement Science theme.
Patrick has been trained in Mechanical Engineering and Medical Technology in the Netherlands. He then went on to complete his PhD in Clinical Biomechanics, during which he created easy and objective assessment tools for measuring the quality and quantity of movement in neurological conditions.
His academic activities include research and knowledge exchange, where he takes the lead in multidisciplinary teams developing and evaluating bespoke hard- and software solutions for real-world medical applications. In addition, Patrick is involved in the development and evaluation of novel technological-based products from commercial entities.
Patrick also sits on various steering group committees (e.g. OxInAHR & Alzheimer's Research UK Thames Valley Network Centre) and actively engages with outfacing knowledge exchange activities (e.g. Faculty Innovation Team) such as start-up companies under InnovationUK funding schemes.
Teaching and supervision
Courses
- Physiotherapy (Pre-Registration) (MSc)
- Sport, Physical Activity and Health Promotion (BSc (Hons), DipHE, CertHE)
- Physiotherapy (BSc (Hons))
- Sport and Exercise Science (BSc (Hons))
- Sport, Coaching and Physical Education (BSc (Hons))
Modules taught
Sports Degrees
- Independent Studies 1 (Sem1&2)
- Independent Studies 2 (Sem1&2)
- Emerging Technology in Exercise and Health
- Project / Dissertation
Physiotherapy Degree:
- Human Movement and Dysfunction
- Specialist & Advanced Physiotherapy
Biomedical & Medical Sciences Degree:
- Research Methods
- Independent Studies
- Project Dissertation
Supervision
At the Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), we recognise the immense potential of aspiring researchers like you and believe that your contribution could significantly impact the future of our end-users and stakeholders.
If you possess a strong academic background, a curious and inquisitive mind and a desire to engage in groundbreaking research, I encourage you to consider applying to one of our PhD programmes by contacting me at the details at the top of this website.
Research Students
Name | Thesis title | Completed |
---|---|---|
Sam Burden | Cardiac function of the left ventricle in obese adolescents with the establishment of links to metabolic health and physiological and perceptual exercise responses | Active |
Ed Daly | Concussion characterisation using current concussion diagnosis and evaluation measures compared to novel objective testing methods | Active |
Josh Eales | Changing the rules of the game: A longitudinal investigation on the implementation of ecological dynamics within a Premier League football club | Active |
Daniel Newcombe | The Environment Design Framework: Bridging the gap between the theoretical understanding and the practical application of constraints-led approach | Active |
Zoe Taylor | Power training for fall rehabilitation and prevention in over 56s and comparisons of recovery mechanisms for loss of balance between fallers and non-fallers | Active |
Research
Centres and institutes
- Oxford Institute of Applied Health Research
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS)
Groups
- Clinical Applied Nutrition (CAN)
- Health Innovation and Technology Trials (HITT)
- Occupational Sciences
- Rehabilitation Sciences
- Trauma and Musculoskeletal Health (TraMH)
- Movement Sciences
Projects
- Exploration of lifestyle including dietary patterns on later life quality of movement
Projects as Principal Investigator, or Lead Academic if project is led by another Institution
- “A Natural History Study of Congenital Myasthenic Syndromes, to establish reliable outcome measures suitable for clinical and research assessment” (led by OUHNFT) (01/02/2022 - 31/01/2024), funded by: Amplo Biotechnolgy Inc, funding amount received by Brookes: £0
- Alzheimer’s Research UK Thames Valley Network Centre 2022 (led by University of Oxford) (01/01/2022 - 31/12/2023), funded by: Alzheimer's Research UK, funding amount received by Brookes: £0
Publications
Journal articles
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Weedon BD, Esser P, Collett J, Izadi H, Joshi S, Meaney A, Delextrat A, Kemp S, Dawes J, 'The Relationship Between Motor Competence Physical Activity Cardiorespiratory Fitness and BMI in UK Adolescents'
Research Quarterly for Exercise and Sport [online first] (2023)
ISSN: 0270-1367 eISSN: 2168-3824AbstractPublished herePurpose: This study set out to identify the extent of the relationships between subsections of the Movement Assessment Battery for Children 2nd Edition - MABC2 (manual dexterity, aiming and catching, and balance) to PA, CRF and BMI in adolescents.
Methods: Height, BMI, the MABC2, a 20m shuttle run test and wrist-worn accelerometery PA levels (mins) were measured. Multivariable linear regression models, adjusting for sex, height and BMI were used to assess the relationship of the three subsections of the MABC2 with PA, CRF and BMI.
Results: A total of 155 adolescents, aged 13-14 years, took part in this study (77 girls, 78 boys). Balance reported significant relationships with moderate to vigorous PA (unstandardised Beta B=0.15, 95%CI 0.02-0.28), vigorous PA (B=0.06, 95%CI 0.02-0.09) and BMI (B=-0.01, 95%CI -0.02-0.005). Balance in addition to aiming and catching skills were both significantly related to adolescent CRF (B=0.30, 95%CI 0.17-0.42 and B=0.29, 95%CI 0.14-0.45, respectively).
Conclusion: This study suggests that balance is the strongest correlate skill to achieving the highest intensities of PA and healthier BMI status in adolescents.
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Baskerville R, Krijgsveld N, Esser P, Jeffery G, Poulton J, 'The Effect of Photobiomodulation on the Treatment of Hereditary Mitochondrial Diseases'
Journal of Lasers in Medical Sciences 14 (2023) pp.e41-
ISSN: 2008-9783 eISSN: 2228-6721AbstractPublished hereBackground
Despite the wide variety of clinical presentations in the hereditary Mitochondrial Diseases, muscle fatigue is a common theme and impairs quality of life and ability to function. Current treatments are only supportive and include nutritional supplementation and physical therapy. Photobiomodulation therapy (PBMT) using low intensity, narrow spectrum light in the red/near infra-red NIR range, from low level laser, or light emitting diode sources, enhances mitochondrial function in preclinical and clinical studies on a range of conditions. However little research has been done on the effectiveness of photobiomodulation in hereditary mitochondrial disorders.Methods
We performed a scoping review of the evidence of the beneficial effects of photobiomodulation for treating the muscle-related symptoms of hereditary Mitochondrial Disease.Results
No studies were identified of photobiomodulation in hereditary mitochondrial disease. However in other clinical conditions featuring acquired mitochondrial impairment,we identified studies that suggested improved function, although sample sizes were small in number and statistical power.Conclusion
There is emerging evidence of efficacy for PBMT for diseases involving acquired mitochondrial insufficiency. We identified no published research on PBMT in hereditary mitochondrial disease, but this review confirms a theoretical rationale for a positive effect and suggests further research. -
Emad Al-Yahya1,2*, Patrick Esser3, Benjamin D. Weedon3, Shawn Joshi3,4,5, Yan-Ci Liu3,6, Daniella N. Springett3,7, Piergiorgio Salvan8, Andy Meaney3, Johnny Collett3, Mario Inacio3,9, Anne Delextrat3, Steve Kemp3, Tomas Ward10, Hooshang Izadi11, Heidi Johansen-Berg8, Hasan Ayaz4,12, Helen Dawes3,13, 'Motor learning in developmental coordination disorder: behavioral and neuroimaging study'
Frontiers in Neuroscience 17 (2023)
ISSN: 1662-4548 eISSN: 1662-453XAbstractPublished here Open Access on RADARDevelopmental coordination disorder (DCD) is characterized by motor learning deficits that are poorly understood within whole-body activities context. Here we present results of one of the largest nonrandomized interventional trials combining brain imaging and motion capture techniques to examine motor skill acquisition and its underpinning mechanisms in adolescents with and without DCD. A total of 86 adolescents with low fitness levels (including 48 with DCD) were trained on a novel stepping task for a duration of 7 weeks. Motor performance during the stepping task was assessed under single and dual-task conditions. Concurrent cortical activation in the prefrontal cortex (PFC) was measured using functional near-infrared spectroscopy (fNIRS). Additionally, structural and functional magnetic resonance imaging (MRI) was conducted during a similar stepping task at the beginning of the trial.
The results indicate that adolescents with DCD performed similarly to their peers with lower levels of fitness in the novel stepping task and demonstrated the ability to learn and improve motor performance. Both groups showed significant improvements in both tasks and under single- and dual-task conditions at post-intervention and follow-up compared to baseline. While both groups initially made more errors in the Stroop task under dual-task conditions, at follow-up, a significant difference between single- and dual-task conditions was observed only in the DCD group. Notably, differences in prefrontal activation patterns between the groups emerged at different time points and task conditions. Adolescents with DCD exhibited distinct prefrontal activation responses during the learning and performance of a motor task, particularly when complexity was increased by concurrent cognitive tasks. Furthermore, a relationship was observed between MRI brain structure and function measures and initial performance in the novel stepping task. Overall, these findings suggest that strategies that address task and environmental complexities, while simultaneously enhancing brain activity through a range of tasks, offer opportunities to increase the participation of adolescents with low fitness in physical activity and sports.
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Mario Inacioa,b,c, Patrick Essera, Junxian Lid,e, Lei Xue, Hui Zenge, Rui Hee, Helen Dawesa,f,g,h, Fang Liud,e , 'Spectral parameters of gait differentiate diabetic patients from healthy individuals'
The Foot 56 (2023)
ISSN: 0958-2592 eISSN: 1532-2963AbstractPublished here Open Access on RADARPurpose: Diabetes mellitus (DM) is a clinical condition that affects gait performance and control in millions of individuals worldwide. Contrary to basic spatiotemporal parameters, gait-based spectral analysis may provide useful insights into gait neuromotor control. This study is to answer that whether there is a difference between differential application of spectral gait analysis and spatiotemporal gait outcomes, and their differences between those with and without DM.
Materials and Methods: Total 1117 individuals [658 DM and 649 healthy adults (HA)] performed a 10m walk while wearing an inertial measurement unit over the fourth lumbar vertebra. Mann-Whitney-U test was used for between-group gait parameters comparisons.
Results: DM group had a slower step time (1.2%, ppHz vs HA:0.25Hz on average, pHz vs HA:1.76Hz on average, pvs HA:5.96%, p
Conclusions: It was demonstrated for the first time that the gait spectral content, not only corroborates spatiotemporal characteristics, but also provides further insight into their neuromotor control deficits in diabetic patients. Ultimately, this type of analysis in the diabetic population can help guide the therapeutic interventions to prevent diabetic foot. achieve more adequate and effective outcomes.[zj1]
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Lining Dong1, Yanyun Hu1, Lei Xu2, Hui Zeng2, Wenqi Shen2, Patrick Esser3, Helen Dawes3*, Fang
Liu1*, 'Abnormal vibration perception threshold alters the gait features in type 2 diabetes mellitus patients'
Frontiers in Endocrinology 13 (2023)
ISSN: 1664-2392 eISSN: 1664-2392AbstractPublished here Open Access on RADARObjective: It is still unclear how the abnormal foot sensation influences the gait during walking in type 2 diabetes mellitus (T2DM). For the purpose of gaining a better insight into the alterations of detailed gait parameters and figuring out the important aspect in the gait indexes by peripheral neuropathy in elder T2DM patients, we compared the gait features in participants with normal glucose tolerance (NGT) controls, as well as diabetic individuals complicated with and without peripheral neuropathy.
Subjects and Methods: Gait parameters was observed during the 10-m walk on the flat land among different conditions of diabetes in 1741 participants from three clinical centers. Subjects were divided into 4 groups: persons with NGT were taken as control groups, patients with T2DM including 3 subgroups: DM control (no chronic complications), DM-DPN (DM complicated only with peripheral neuropathy), and DM-DPN+LEAD (DM complicated with both neuropathy and artery disease). The clinical characteristics
and gait parameters were assessed and compared among these four groups. Analyses of variance were employed to verify possible differences of gait parameters between groups and conditions. Stepwise multivariate regression analysis was performed to reveal possible predictors of gait deficits. ROC curve analysis was employed to find any discriminatory power of DPN for the step time.
Results: In participants burdened with DPN, whether complicated with LEAD or not, step time increased sharply (pAUC value was 0.608 (95% CI: 0.562-0.654, p Conclusions: In addition to sex, age and leg length, VPT was a distinct factors that associated with altered gait parameters. Diabetic peripheral neuropathy is associated with increased step time and the step time increases with the worse VPT in type 2 diabetes. -
Inacio M, Esser P, Weedon BD, Joshi S, Meaney A, Delextrat A, Springett D, Kemp S, Ward T, Izadi H, Johansen-Berg H, Dawes H, 'Learning a novel rhythmic stepping task in children with probable Developmental Coordination Disorder '
Clinical Biomechanics 102 (2023)
ISSN: 0268-0033 eISSN: 1879-1271AbstractPublished here Open Access on RADARBackground: Developmental coordination disorder affects approximately 6% of children, interfering with participation in physical activity and can persist through adulthood. However, no studies have investigated the neuromotor mechanisms of learning of a novel task with rhythmic cueing.
Methods: Movement Assessment Battery for Children-2nd edition was used to identify 48 children with probable developmental coordination disorder (13.9±0.05 yrs, 27% male) and 37 typically developed (13.9±0.10 yrs, 54% male). While instrumented with an inertial measurement unit, both groups performed a novel rhythmic stepping task and with a concurrent auditory stroop test (dual-task), underwent seven weeks of intervention with step training with rhythmic cuing and were tested for retention five weeks post-intervention.
Findings: Initially, the group with probable developmental coordination disorder had a higher variability of step timing (coefficient of variation: 0.08±0.003-typically developed – 0.09±0.004-probable developmental coordination disorder, ppppppp
Interpretation: Rhythmic cueing shows strong promise for enhancing motor learning in children with probable developmental coordination disorder.
Trial registration: Retrospectively registered on ClinicalTrials.gov with reference: NCT03150784
Keywords: Developmental Coordination Disorder, stepping, motor learning, intervention, rhythmic cueing.
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Daly E, Pearce AJ, Esser P, Ryan L, 'Evaluating the relationship between neurological function, neuromuscular fatigue and subjective performance measures in professional rugby union players'
Frontiers in Sports and Active Living 4 (2022)
ISSN: 2624-9367 eISSN: 2624-9367AbstractPublished here Open Access on RADARManaging the health and wellbeing of full-time professional athletes is a multifaceted task. In elite high-performance environments, medical staff and strength training coaches attempt to identify improved methods to monitor player health. Monitoring player health could indicate potential injury risk and assist in adjustments to training and workload management. Measuring fatigue is a notable component of monitoring player readiness before and after training sessions, and after competitive fixtures.
In the present study, a novel method of gathering non-invasive player data was investigated by utilising the Omegawave (OW) to monitor direct current (DC) potential brainwave activity. This method allowed for non-invasive data gathering to assess recovery, player readiness and indicators of workload that may affect optimal performance. DC potential is based on recording low electrical frequencies (>0.5 Hz) that is derived from 1) Stabilization point of DC potential (mV), 2) Stabilization time (1.0‐7.0) and 3) Curve shape (1.0‐7.0). These measures evaluate the athlete’s internal stress, readiness to perform, and neurological function through DC potential brain wave activity and heart rate variability (HRV) assessments. The primary aim of this case series was to compare the efficacy of objective DC potential brainwave activity measurements (neurological function) with neuromuscular fatigue data using reactive strength index modified (RSImod) and profile of mood states (POMS) questionnaires to assess a player’s state of readiness to train.
The participants in this study were eleven male senior professional rugby union players with a mean stature (±SD) of 185.2 ± 8.6 cm, mass of 101.1 ± 12.9 kg, and age of 27.1 ± 2.1 years. All players were tested three days per week over a six-week mid-season period. Results from this case study suggest that DC potentials could be used as an objective measure to indicate player readiness and managing individual player workload The final analyses identified a weak negative correlation (r = -0.17) between the RSImod data and the DC potential data was observed. DC potential brainwave activity data could be used in conjunction with subjective measures such as POMS, RSImod and reported injury status to adjust player daily activity.
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Taylor Z, Walsh GS, Hawkins H, Inacio M, Esser P
, 'Perturbations during gait: a systematic review of methodologies and outcomes'
Sensors 22 (15) (2022)
ISSN: 1424-8220 eISSN: 1424-8220AbstractPublished here Open Access on RADARBackground: Despite extensive literature regarding laboratory-based balance perturbations, there is no up-to-date systematic review of methods. This systematic review aimed to assess current perturbation methods, and outcome variables used to report participant biomechanical responses during walking.
Methods: Web of Science, CINAHL and PubMed online databases were searched, for records from 2015, the last search was on 30th of May 2022. Studies were included where participants were 18+ years, with or without clinical conditions, conducted in non-hospital settings. Reviews were excluded. Participant descriptive, perturbation method, outcome variables and results were extracted and summarised. Bias was assessed using the Appraisal tool for Cross-sectional Studies risk of bias assessment tool. Qualitative analysis was performed as the review aimed to investigate methods used to apply perturbations.
Results: 644 records were identified and 33 studies were included, totaling 779 participants. The most frequent method of balance perturbation during gait was by means of a treadmill translation. The most frequent outcome variable collected was participant step width, closely followed by step length. Most studies reported at least one spatiotemporal outcome variable. All included studies showed some risk of bias, generally related to reporting of sampling approaches. Large variation in perturbation type, duration and intensity and outcome variables were reported.
Conclusions: This review shows the wide variety of published laboratory perturbation methods. Also demonstrating the significant impact on outcome measures of a study based on the type of perturbation used.
Registration: PROSPERO ID: CRD42020211876 -
Joshi S, Weedon BD, Esser P, Liu Y, Springett DN, Meaney A, Inacio M, Delextrat A, Kemp S, Ward T, Izadi H, Dawes H, Ayaz H, 'Neuroergonomic Assessment of Developmental Coordination Disorder'
Scientific Reports 12 (2022)
ISSN: 2045-2322 eISSN: 2045-2322AbstractPublished here Open Access on RADARUntil recently, neural assessments of gross motor coordination could not reliably handle active tasks, particularly in realistic environments, and offered a narrow understanding of motor-cognition. By applying a comprehensive neuroergonomic approach using optical mobile neuroimaging, we probed the neural correlates of motor functioning in young people with Developmental Coordination Disorder (DCD), a motor-learning deficit affecting 5-6% of children with lifelong complications. Neural recordings using fNIRS were collected during active ambulatory behavioral task execution from 37 Typically Developed and 48 DCD Children who performed cognitive and physical tasks in both single and dual conditions. This is the first of its kind study targeting regions of prefrontal cortical dysfunction for identification of neuropathophysiology for DCD during realistic motor tasks and is one of the largest neuroimaging study (across all modalities) involving DCD.
We demonstrated that DCD is a motor-cognitive disability, as gross motor /complex tasks revealed neuro-hemodynamic deficits and dysfunction within the right middle and superior frontal gyri of the prefrontal cortex through functional near infrared spectroscopy. Furthermore, by incorporating behavioral performance, decreased neural efficiency in these regions were revealed in children with DCD, specifically during motor tasks. Lastly, we provide a framework, evaluating disorder impact in ecologically valid contexts to identify when and for whom interventional approaches are most needed and open the door for precision therapies.
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Charlotte Trevillion, Lars-Erik Malmberg, Patrick Esser
, 'Working Memory, Sustained Attention and Physical Activity: An intraindividual study '
Psychology of Sport and Exercise 60 (2022)
ISSN: 1469-0292 eISSN: 1469-0292AbstractPublished here Open Access on RADARObjective: Experimental studies show small to moderate effects of both acute and regular physical activity on executive functions, these being strongly associated with academic performance at school. In order to understand the naturally occurring associations between primary school-aged children’s working memory (WM), selfreported concentration, and physical activity (PA), 35 children (M age = 9.8 years, range = 7.6-11.4 years old) in Years 3-6 of primary school took part in a two-week long intraindividual study. Method: Participants wore an accelerometer wristband throughout the study, and carried out a working memory task (digit recall) and completed a sustained attention measure each morning and afternoon, giving 517 time-points nested in 4-10 schooldays (M obs = 15.8 situations, n obs = 4-18). Results: Using multilevel structural equation models (MSEM) we found that working memory was stable across time (within-person b = 0.29) and trait-like ( ICC s = 0.58). Across situations, state working memory was higher later in the calendar week. Acute moderate to vigorous physical activity (MVPA) was not associated with stateworking memory, but exertion of a higher level of MVPA than usual the previous day was associated with lower state-working memory the following day. Trait-sustained attention (across the two weeks) predicted higher trait-working memory and older students outperformed younger students. Conclusions: Implications for timing and intensity of students’ physical activity in educational settings is discussed.
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Weedon BD, Liu F, Mahmoud W, Burden SJ, Whaymand L, Esser P, Collett J, Izadi H, Joshi S, Meaney A, Delextrat A, Kemp S, Jones A, Dawes H, 'Declining fitness and physical education lessons in UK adolescents'
BMJ Open Sport & Exercise Medicine 8 (2022)
ISSN: 2055-7647 eISSN: 2055-7647AbstractPublished here Open Access on RADARObjectives The objective was to determine recent cross-sectional trends in health-related fitness (HRF) in secondary school students by studying the 13–14 years old age group repeatedly over 6 years, considering parallel national trends in physical education (PE).
Methods Height, weight, broad jump, grip strength, 20 m shuttle run and throwing and catching skills were measured by the same research team using standardised techniques from 2014 to 2019. Trends in these HRF measures were assessed by linear regression, adjusting for school, sex and height. Interactions with fitness and body mass index (BMI) were tested. The number of PE lessons reported in the UK Annual School Workforce Census between 2010 and 2019 for all state-funded secondary schools was analysed.
Results Grip strength (B=−0.60, 95% CI −0.78 to –0.41), broad jump (B=−1.16, 95% CI −1.99 to –0.34), 20 m shuttle run (B=−1.85, 95% CI −2.58 to –1.12) and throwing and catching skills (B=−0.12, 95% CI −0.15 to –0.08) declined significantly over the study period. There was a greater reduction in broad jump and grip strength in adolescents with low fitness and a greater reduction in fitness and motor competence in adolescents with normal BMI. These declines coincided with a 16% reduction nationally in secondary school PE between 2010 (333 800 hours) and 2019 (280 725 hours).
Conclusion Adolescent HRF has declined in recent years, in parallel with PE lessons. Declines were observed across all young people and particularly those of low fitness and normal BMI. To reach the majority of young people, policy makers could increase PE in schools to increase activity and prevent worsening fitness and health in future generations.
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Eda Cinar1, Benajmin David Weedon2, Patrick Esser2, Shawn Joshi3, Yan-Ci Liu4, Anne
Delextrat2, Andy Meaney2 , Johnny Collett2, Daniella Nicole Springett2, Helen Dawes2,5,6, 'Dual-task effect on gait in healthy adolescents: Association between health-related indicators and DT performance'
Journal of Motor Behavior 53 (6) (2021) pp.707-716
ISSN: 0022-2895 eISSN: 1940-1027AbstractPublished here Open Access on RADARThe purpose of this study was to determine how dual-task (DT) effect on gait differs among adolescents with different fitness and health profiles. The gait performances of 365 adolescents aged 13-14 years were assessed at single and DT walking. The proportional changes in gait parameters from single to dual were regressed against gender, body mass index (BMIz), three components of MABC-2 (balance, aiming &catching and manual dexterity), group (high vs low motor competence), body strength, physical fitness level using multiple regression analyses; and gender and four items of balance subtest of MABC-2 in the secondary analysis. The analyses showed that being female was associated with greater reduction in gait speed and stride length and an increase in double support time and step time; and having lower score in balance was related to greater reduction in gait speed, and cadence, and an increase in step time. Only zig-zag hopping item of the balance subtest was associated with DT effect on gait speed and stride length. No significant relationships were found between DT effect on gait and the rest of the predictors. Females and adolescents with lower level of balance function may be at higher risk of having DT deficit during walking.
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Delextrat A, Esser P, Beale N, Bozon F, Eldridge E, Izadi H, Johansen-Berg H, Wheatley C, Dawes H, 'Effects of gender, activity type, class location and class composition on physical activity levels experienced during physical education classes in British secondary schools: a pilot cross-sectional study'
BMC Public Health 20 (2021)
ISSN: 1471-2458 eISSN: 1471-2458AbstractPublished here Open Access on RADARBackground. Pupils in secondary schools do not meet the targets for physical activity levels during physical education (PE) sessions, and there is a lack of data on the vigorous physical activity domain (VPA) in PE known to be positively associated with cardio metabolic health While PE session intensity depends on a variety of factors, the large majority of studies investigating these factors have not taken into account the nested structure of this type of data set. Therefore, the aim of this study was to investigate the relationship between various factors (gender, activity type, class location and class composition) and various activity levels during PE classes in secondary schools, using a multi-level statistical approach.
Methods. Year eight (12–13 years old) adolescents (201 boys and 106 girls) from six schools were fitted with accelerometers during one PE session each, to determine the percentage (%) of the PE session time spent in sedentary (SPA), light (LPA), moderate (MPA), vigorous (VPA) and moderate-to-vigorous (MVPA) intensity levels. Two- and three-level (pupils, n = 307; classes, n = 13, schools, n = 6) mixed-effect models were used to assess the relationship between accelerometer-measured physical activity levels (% of class time spent in various activity levels) and gender, activity type, class location and composition.
Results. Participants engaged in MVPA and VPA for 30.7 ± 1.2% and 11.5 ± 0.8% of PE classes, respectively. Overall, no significant association between gender or class composition and PA was shown. A significant relationship between activity type and PA was observed, with Artistic classes significantly less active than Fitness classes for VPA (5.4 ± 4.5 vs. 12.5 ± 7.1%, p = 0.043, d:1.19). We also found a significant association between class location and PA, with significantly less time spent in SPA (24.8 ± 4.8% vs. 30.0 ± 3.4%, p = 0.042, d:0.77) and significantly more time spent in VPA (12.4 ± 3.7% vs. 7.6 ± 2.0%, p = 0.022, d:1.93) and MVPA (32.3 ± 6.7% vs.24.8 ± 3.8%, p = 0.024, d:1.33) in outdoors vs. indoors classes.
Conclusions. The results suggest that class location and activity type could be associated with the intensity of PA in PE. It is essential to take into account the clustered nature of this type of data in similar studies if the sample size allows it.
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Muhaidat J, Al-Yahya E, Mohammad MT, Qutishat D, Okasheh R, Al-Khlaifat L, Lawrie S, Esser P, Dawes H, 'Dual-tasking in older women: Physical activity or else?'
Journal of Women and Aging 34 (1) (2020) pp.101-111
ISSN: 0895-2841AbstractPublished here Open Access on RADARThe interplay between gender, Physical Activity (PA), and Dual Tasking (DT) in older adults is unclear. This study aimed to address DT based on gender and PA level. One-hundred and twenty older adults (81 women and 39 men) participated. Timed up and go test and spatiotemporal gait measures were collected in single and DT conditions. Participants were grouped according to gender and PA level. Physical activity did not explain gender differences, women were slower and had shorter stride lengths when DT regardless of PA level. Findings indicate the necessity for tailored PA and functional interventions to improve women’s performance.
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Zhu J, Zheng Z, Liu Y, Lawrie S, Esser P, Izadi H, Dawes H, Xia Z, Wang C, Xiong Y, Ma X, Wade D, 'The effects of small-needle-knife therapy on pain and mobility from knee osteoarthritis: a pilot randomized controlled study'
Clinical Rehabilitation 34 (12) (2020) pp.1497-1505
ISSN: 0269-2155 eISSN: 1477-0873AbstractPublished here Open Access on RADARObjective: To investigate the effect of small needle-knife therapy in people with painful knee osteoarthritis.
Design Pilot randomised, controlled trial.
Setting. Rehabilitation hospital.
Subjects. In-patients with osteo-arthritis of the knee.
Interventions: Either 1-3 small needle-knife treatments over 7 days or oral Celecoxib. All patients stayed in hospital three weeks, receiving the same mobility-focused rehabilitation.
Measures. Oxford Knee Score (OKS), gait speed and kinematics were recorded at baseline, at 3 weeks (discharge) and at three-months (OKS only). Withdrawal from the study, and adverse events associated with the small needle knife therapy were recorded.
Results: 83 patients were randomized: 44 into the control group, of whom 10 were lost by 3 weeks and 12 at 3 months; 39 into the experimental group of whom 8 were lost at 3 weeks and 3 months. The mean (SE) OKS scores at baseline were Control 35.86 ( 1.05), Exp 38.38 ( 0.99); at three weeks 26.64 (0.97) and 21.94
(1.23); and at three months 25.83 (0.91) and 20.48 (1.14) The mean (SE) gait speed at baseline was 1.07 (0.03) m/sec (Control) and 0.98 (0,03), and at three weeks was 1.14 (0.03) and 1.12 (0.03) (p Conclusions: Small needle-knife therapy added to standard therapy for patients with knee osteoarthritis, was acceptable, safe, and reduced pain and improved global function on the Oxford Knee Score. Further research is warranted. -
Mansoubi M, Weedon BD, Esser P, Mayo N, Fazel M, Wade W, Ward TE, Kemp S, Delextrat A ,Dawes H, 'Cognitive performance, quality and quantity of movement reflect unhealthy psychological symptoms in adolescents'
Journal of Sports Science and Medicine 19 (2) (2020) pp.364-373
ISSN: 1303-2968AbstractPublished here Open Access on RADARPurpose: The presentation of unhealthy psychological symptoms are rising sharply in adolescents. Detrimental lifestyle behaviours are proposed as both possible causes and consequences. This study set out to compare selected measures of quality and quantity of movement between adolescents with and without unhealthy psychological symptoms.
Methods: Using a cross sectional design, 96 participants completed the study from a whole year group of 166, age (13.36 ± 0.48) male 50.6% from a secondary school in Oxfordshire, England as a part of a larger study (EPIC) between January and April 2017. Measures were taken of quality and quantity of movement: reaction/movement time, gait pattern & physical activity, alongside psychological symptoms. Differences in movement behaviour in relation to psychological symptom and emotional problem presentation were determined using ANOVA. In the event of a significant result for the main factor of each parameter, a Bonferroni -corrected post hoc test was conducted to show the difference between categories in each group. Results for both unhealthy psychological symptoms and emotional problems were grouped into four categories (‘Close to average’, ‘slightly raised’, ‘high’ and ‘very high’).
Results: Early adolescents with very high unhealthy psychological symptoms had 16.79% slower reaction times (p = .003, ηp2 = .170), 13.43% smaller walk ratio (p = .007, ηp2 = .152), 7.13% faster cadence (p = .005, ηp2 = .149), 6.95% less step time (p = .007, ηp2 = .153) and 1.4% less vigorous physical activity (p = .04, ηp2 = .102) than children with close to average psychological symptoms. Early adolescents with very high emotional problems had 12.25% slower reaction times (p = .05, ηp2 = .081), 10.61% smaller walk ratio (p = .02, ηp2 = .108), 6.03% faster cadence (p = .01, ηp2 = .134), 6.07% shorter step time (p = .007, ηp2 = .141) and 1.78% less vigorous physical activity (p = .009, ηp2 = .136) than children with close to average emotional problems.
Conclusions: Different movement quality and quantity of was present in adolescents with unhealthy psychological symptoms and emotional problems. We propose movement may be used to both monitor symptoms, and as a novel therapeutic behavioural approach. Further studies are required to confirm our findings. -
Tektonidis TG, Coe S, Esser P, Maddock J, Buchanan S, Mavrommati F, Schott JM, Izadi H, Richards M, Dawes H, 'Diet quality in late midlife is associated with faster walking speed in later life in women, but not men: findings from a prospective British birth cohort'
British Journal of Nutrition 123 (8) (2019) pp.913-921
ISSN: 0007-1145 eISSN: 1475-2662AbstractPublished here Open Access on RADARHealthy diet has been linked to better age-related physical functioning, but evidence on the relationship of overall diet quality in late midlife and clinically relevant measures of physical functioning in later life is limited. Research on potential sex differences in this relationship is scarce. The aim was to investigate the prospective association between overall diet quality, as assessed by the Healthy Eating Index-2015 at age 60-64y and measures of walking speed seven years later, among men and women from the Insight46, a neuroscience sub-study of the Medical Research Council National Survey of Health and Development. Diet was assessed at age 60-64y using five-day food diaries, from which total HEI-2015 was calculated. At age 69-71y, walking speed was estimated during four 10-meter walks at self-selected pace, using inertial measurement units. Multivariable linear regression models with sex as modifier, controlling for age, follow-up, lifestyle, health, social variables and physical performance were used. The final sample was 164 women and 167 men (n=331). Women had higher HEI-2015 scores and slower walking speed than men. A 10 point increase in HEI-2015 was associated with faster walking speed seven years later among women (B: 0.024, 95% CI: 0.006, 0.043), but not men. The association remained significant in the multivariable model (B: 0.021, 95% CI: 0.003, 0.040). In women in late midlife higher diet quality is associated with faster walking speed. A healthy diet in late midlife is likely to contribute towards better age-related physical capability and sex differences are likely to affect this relationship.
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Mahmoud W, Delextrat A, Esser P, Dawes H, 'School-based Screening Tool for Adolescents with Low Motor Coordination Abilities'
Perceptual and Motor Skills 126 (5) (2019) pp.779-796
ISSN: 0031-5125 eISSN: 1558-688XAbstractPublished here Open Access on RADARThis study sought to select the most relevant test items from the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOTMP-2) and from a selection of health-related fitness tests for identifying school teenagers with poor motor coordination. The 241 participants in this study (144 boys, 97 girls aged 13–14 years old) were tested on the short form of the BOTMP-2 and on the following additional fitness tests: (a) seated medicine ball test, (b) broad jump, (c) handgrip strength, (d) alternate hand ball wall toss, (e) 10 × 5-meter agility shuttle run, and (f) Chester step test. We performed a factor analysis of participant scores on these various tasks and BOTMP-2 test items to reduce them to the least number of meaningful and useful items. Four factors explained 45% of the data variance: gross motor skills and power (including broad jump, hand ball toss, shuttle run, and sit-ups tests); fine motor skills (including copying star, following the maze and paper folding); core strength and balance (including push-ups, hopping, and balance beam); and general body strength (including medicine ball throw and handgrip). We conclude that an efficient school-based battery of test items to screen 13-14 year old adolescents for fitness and coordination should assess these four factors and might especially rely upon the broad jump, copying a star shape, hopping handgrip strength, aerobic fitness, and wall ball toss.
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van Essen TA, den Boogert HF, Cnossen MC, de Ruiter GCW, Haitsma I, Polinder S, Steyerberg EW, Menon D, Maas AIR, Lingsma HF, Peul WC, CENTER-TBI Investigators and Participants, including Esser P, Dawes H, Collett J, 'Correction to: Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study'
Acta Neurochirurgica 161 (3) (2019) pp.451-455
ISSN: 0001-6268 eISSN: 0942-0940AbstractPublished hereThe names of the members of the IOPS MS study Group was inverted in the original paper and is now corrected in this article.
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Al-Yahya E, Mohammad MT, Muhaidat J, Al Demour S, Qutishat D, Al-Khalaifat L, Okasheh R, Lawrie S, Esser P, Dawes H, 'Functional balance and gait characteristics in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia'
American Journal of Men's Health 13 (3) (2019)
ISSN: 1557-9883 eISSN: 1557-9891AbstractPublished here Open Access on RADARObjectives. To compare gait characteristics and functional balance abilities in men with LUTS secondary to BPH to those of matching controls under different conditions of increasing difficulties; single-task, dual-task motor, and dual-task cognitive. Subjects and methods. In this cross-sectional experimental study we recruited a group of 43 men diagnosed with symptomatic BPH and control group of 38 older men. Participants performed the timed up and go (TUG) and 10-meter walking tests under different conditions of increasing difficulties. Namely, single task, dual-task motor, and dual-task cognitive. Time to complete the tests and spatial and temporal gait parameters were compared between groups and conditions via mixed-design ANOVA. Results. Under dual-task conditions, individuals in both groups performed significantly worse in a functional balance task and a simple walking to usual walking. However, as the complexity of the walking task increased, from dual-task motor to dual-task cognitive, significant differences between groups emerged. In particular, men with PBH performed worse than older adults in tasks demanding increased attentional control. Conclusion. Health care providers for men with LUTS due to BPH should assess for abnormal gait and maintain vigilant for balance problems that may lead to decreased mobility and falls. Dual task approach seems a feasible method to distinguish gait and balance impairments in men with BPH.
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Al-Yahya E, Mahmoud W, Meester D, Esser P, Dawes H, 'Neural substrates of cognitive motor interference during walking; peripheral and central mechanisms'
Frontiers in Human Neuroscience 12 (2019)
ISSN: 1662-5161AbstractPublished here Open Access on RADARCurrent gait control models suggest that independent locomotion depends on central and peripheral mechanisms. However, less information is available on the integration of these mechanisms for adaptive walking. In this cross-sectional study, wWe investigated gait control mechanisms in people with Parkinson’s disease (PD) and healthy older (HO) adults: at self-selected walking speed (SSWS) and at fast walking speed (FWS). We measured effect of additional cognitive task (DT) and increased speed on prefrontal (PFC) and motor cortex (M1) activation, and Soleus H-reflex gain. Under DT-conditions we observed increased activation in PFC and M1. Whilst H-reflex gain decreased with additional cognitive load for both groups and speeds, H-reflex gain was lower in PD compared to HO while walking under ST condition at SSWS. Attentional load in PFC excites M1, which in turn increases inhibition on H-reflex activity during walking and reduces activity and sensitivity of peripheral reflex during the stance phase of gait. Importantly this effect on sensitivity was greater in HO. We have previously observed that the PFC copes with increased attentional load in young adults with no impact on peripheral reflexes and we suggest that gait instability in PD may in part be due to altered sensorimotor functioning reducing the sensitivity of peripheral reflexes.
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van Veen E, van der Jagt M, Cnossen MC, Maas AIR, de Beaufort ID, Menon DK, Citerio G, Stocchetti N, Rietdijk WJR, van Dijck JTJM, Kompanje EJO, CENTER-TBI investigators and participants (including Dawes H, Esser P, Collett J), 'Brain death and postmortem organ donation: report of a questionnaire from the CENTER-TBI study'
Critical Care 22 (2018)
ISSN: 1364-8535AbstractPublished here Open Access on RADARBackground. We aimed to investigate the extent of the agreement on practices around brain death and postmortem organ donation. Methods. Investigators from 67 Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study centers completed several questionnaires (response rate: 99%). Results. Regarding practices around brain death, we found agreement on the clinical evaluation (prerequisites and neurological assessment) for brain death determination (BDD) in 100% of the centers. However, ancillary tests were required for BDD in 64% of the centers. BDD for nondonor patients was deemed mandatory in 18% of the centers before withdrawing life-sustaining measures (LSM). Also, practices around postmortem organ donation varied. Organ donation after circulatory arrest was forbidden in 45% of the centers. When withdrawal of LSM was contemplated, in 67% of centers the patients with a ventricular drain in situ had this removed, either sometimes or all of the time. Conclusions. This study showed both agreement and some regional differences regarding practices around brain death and postmortem organ donation. We hope our results help quantify and understand potential differences, and provide impetus for current dialogs toward further harmonization of practices around brain death and postmortem organ donation.
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Lawrie S, Dong Y, Steins D, Xia Z, Esser P, Sun S, Li D, Amor J, James JC, Izadi H, Chao Y, Wade D, Mayo N, Dawes H, 'Evaluation of a Smartwatch-based Intervention Providing Feedback of Daily Activity within a Research-Naive Stroke Ward: a pilot randomised controlled trial'
Pilot and Feasibility Studies 4 (2018)
ISSN: 2055-5784AbstractPublished here Open Access on RADARBackground. The majority of stroke patients are inactive outside formal therapy sessions. Tailored activity feedback via a Smartwatch has the potential to increase inpatient activity. Objective. to identify the challenges and support needed by ward staff and researchers and to examine the feasibility of conducting a randomised controlled trial (RCT) using Smartwatch activity monitors in research naive rehabilitation wards. Objectives (Phase 1 and 2) were to report any challenges and support needed and determine the recruitment and retention rate, completion of outcome measures, Smartwatch adherence rate (Phase 2 only) readiness to randomise, adherence to protocol (intervention fidelity) and potential for effect. Methods. First admission, stroke patients (onset
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Coe S, Franssen M, Collett J, Boyle D, Meaney A, Chantry R, Esser P, Izadi H, Dawes H, 'Physical activity, fatigue and sleep in people with Parkinson’s: a secondary per protocol analysis from an intervention trial.'
Parkinson's Disease 2018 (2018)
ISSN: 2090-8083 eISSN: 2090-8083AbstractPublished here Open Access on RADARSymptoms of Parkinson’s can result in low physical activity and poor sleep patterns which can have a detrimental effect on a person’s quality of life. To date, studies looking into exercise interventions for people with Parkinson’s (PwP) for symptom management are promising but inconclusive. The aim of this study is to estimate the effect of a clearly defined exercise prescription on general physical activity levels, fatigue, sleep, and quality of life in PwP. Method. PwP randomised into either an exercise group (29; 16 males, 13 females; mean age 67 years (7.12)) or a control handwriting group (36; 19 males; 17 females; mean age 67 years (5.88)) as part of a larger trial were included in this substudy if they had completed a 6-month weekly exercise programme (intervention group) and had complete objective physical activity data (intervention and control group). Sleep and fatigue were recorded from self-reported measures, and physical activity levels measured through the use of accelerometers worn 24 hours/day over a seven-day testing period at baseline and following the 24-week intervention. A Wilcoxon’s test followed by a Mann–Whitney post hoc analysis was used, and effect sizes were calculated. Results. Participants showed a significant increase in time spent in sedentary and light activities during the overnight period postintervention in both exercise and handwriting groups (p
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Valkanova V, Esser P, Demnitz N, Sexton CE, Zsoldos E, Mahmood A, Griffanti L, Kivimaki M, Singh-Manoux A, Dawes H, Ebmeier KP, 'Association between gait and cognition in an elderly population based sample'
Gait & Posture 65 (2018) pp.240-245
ISSN: 0966-6362 eISSN: 1879-2219AbstractBackground. Gait is thought to have a cognitive component, but the current evidence in healthy elderly is mixed. We studied the association between multiple gait and cognitive measures in a cohort of older people. Methods. 178 cognitively healthy participants from the Whitehall II Imaging Sub-study had a detailed clinical and neuropsychological assessment, as well as a MRI scan. Spatiotemporal and variability gait measures were derived from two 10m walks at self-selected speed. We did a linear regression analysis, entering potential confounders with backwards elimination of variables with p≥0.1.The remaining variables were then entered into a second regression before doing a stepwise analysis of cognitive measures, entering variables with p<0.05 and removing those with p≥0.1. Results. Amongst absolute gait measures, only greater stride length was associated with better performance in the TMT A and the BNT. The STV was associated with performance in the TMT A. Age was associated with poorer walking speed and stride time, female sex with shorter strides and stride time, as well as shorter doubles stance. Length of full-time education was associated with faster walking speed and shorter stride time, and a history of muscular-skeletal disease with slower walking speed, shorter stride length and longer stride time. Interestingly, volume of WMH in FLAIR MRI images did not contribute independently to any of the gait variables. Conclusions. No strong relationship between gait and non-motor cognition was observed in a cognitively healthy, high functioning sample of elderly. Nevertheless we find some relationships with spatial, but not temporal gait which warrant further investigation. WMH made no independent contribution to gait.Published here Open Access on RADAR -
Esser P, Collett J, Maynard K, Steins D, Hillier A, Buckingham J, Tan GD, King L, Dawes H, 'Single sensor gait analysis to detect diabetic peripheral neuropathy: A proof of principle study'
Diabetes and Metabolism Journal 42 (2018)
ISSN: 2233-6079 eISSN: 2233-6087AbstractThis study explored the potential utility of gait analysis using a single sensor unit (inertial easurement unit [IMU]) as a simple tool to detect peripheral neuropathy in people with diabetes. Seventeen people (14 men) aged 63±9 years (mean±SD) with diabetic peripheral neuropathy performed a 10-m walk test instrumented with an IMU on the lower back. Compared to a reference healthy control data set (matched by gender, age, and body mass index) both spatiotemporal and gait control variables were different between groups, with walking speed, step time, and SDa (gait control parameter) demonstrating good discriminatory power (receiver operating characteristic area under the curve >0.8). These results provide a proof of principle of this relatively simple approach which, when applied in clinical practice, can detect a signal from those with known diabetes peripheral neuropathy. The technology has the potential to be used both routinely in the clinic and for tele-health applications. Further research should focus on investigating its efficacy as an early indicator of or effectiveness of the management of peripheral neuropathy. This could support the development of interventions to prevent complications such as foot ulceration or Charcot’s foot.Published here Open Access on RADAR -
Weedon B, Liu F, Mahmoud W, Metz R, Beunder K, Delextrat A, Morris M, Esser P, Collett J, Meaney A, Howells K, Dawes H, 'The relationship of gross upper and lower limb motor competence to measures of health and fitness in adolescents aged 13-14 years'
BMJ Open Sport & Exercise Medicine 4 (1) (2018)
ISSN: 2055-7647 eISSN: 2055-7647AbstractIntroduction: Motor competence (MC) is an important factor in the development of health and fitness in adolescence. Aims: This cross-sectional study aims to explore the distribution of MC across 13-14 year old school students and the extent of the relationship of MC to measures of health and fitness across genders. Methods: A total of 718 participants were tested from three different schools in the UK, 311 girls, and 407 boys (aged 13-14 years), pairwise deletion for correlation variables reduced this to 555 (245 girls, 310 boys). Assessments consisted of, body mass index, aerobic capacity, anaerobic power, upper limb and lower limb MC. The distribution of MC and the strength of the relationships between MC and health/fitness measures were explored.Published here Open Access on RADAR
Results: Girls performed lower for MC and health/fitness measures compared to boys. Both measures of MC showed a normal distribution and a significant linear relationship of MC to all health and fitness measures for boys, girls, and combined genders. A stronger relationship was reported for upper limb MC and aerobic capacity when compared to lower limb MC and aerobic capacity in boys (t= -2.21, df= 307, p = 0.03, 95%CI -0.253 -0.011). Conclusion: Normally distributed measures of upper and lower limb MC are linearly related to health and fitness measures in adolescents in a UK sample.
Trial Registration: NCT02517333 -
Maryse C. Cnossen, Jilske A. Huijben, Mathieu van der Jagt , Victor Volovici, Thomas van Essen , Suzanne Polinder , David Nelson , Ari Ercole , Nino Stocchetti, Giuseppe Citerio, Wilco C. Peul, Andrew I. R. Maas, David Menon , Ewout W. Steyerberg, Hester F. Lingsma on behalf of the CENTER-TBI investigators, 'Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: a survey in 66 neurotrauma centers participating in the CENTER-TBI study'
Critical Care 21 (233) (2017)
ISSN: 1364-8535AbstractBackground. No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI.Published here Open Access on RADAR
Methods. A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study.
Results. The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n = 60, 91%) and designated level I trauma centers (n = 44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately 90% of the participants (n = 58) indicated placing an ICP monitor in patients with severe TBI and computed tomographic abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n = 32, 48%), whereas the others were considered more conservative (n = 34, 52%).
Conclusions. Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research. -
Cuzzolin F, Sapienza M, Esser P, Saha S, Franssen M, Collett J, Dawes H, 'Metric learning for Parkinsonian identification from IMU gait measurements'
Gait & Posture 54 (May 2017) (2017) pp.127-132
ISSN: 0966-6362 eISSN: 1879-2219AbstractDiagnosis of people with mild Parkinson’s symptoms is difficult. Nevertheless, variations in gait pattern can be utilised to this purpose, when measured via Inertial Measurement Units (IMUs). Human gait, however, possesses a high degree of variability across individuals, and is subject to numerous nuisance factors. Therefore, off-the-shelf Machine Learning techniques may fail to classify it with the accuracy required in clinical trials. In this paper we propose a novel framework in which IMU gait measurement sequences sampled during a 10 metre walk are first encoded as hidden Markov models (HMMs) to extract their dynamics and provide a fixed-length representation. Given sufficient training samples, the distance between HMMs which optimises classification performance is learned and employed in a classical Nearest Neighbour classifier. Our tests demonstrate how this technique achieves accuracy of 85.51% over a 156 people with Parkinson’s with a representative range of severity and 424 typically developed adults, which is the top performance achieved so far over a cohort of such size, based on single measurement outcomes. The method displays the potential for further improvement and a wider application to distinguish other conditions.Published here Open Access on RADAR -
Del Din S, Hickey A, Ladha C, Stuart S, Bourke A, Esser P, Rocherster L, Godfrey A, 'Instrumented gait assessment with a single wearable: an introductory tutorial'
F1000Research 5 (2016)
ISSN: 2046-1402AbstractGait is a powerful tool to identify ageing and track disease progression. Yet, its measurement via traditional instrumentations remains restricted to the laboratory or bespoke clinical facilities. The potential for that to change is due to the advances in wearable technology where the synergy between accelerometer-based body worn monitors and smart algorithms has provided the potential of ‘a gait lab on a chip’. The deployment of wearables can allow the researcher/clinician to continuously assess the participant accurately and robustly over time. Commercially available wearables for gait quantification remain expensive and are restricted to a limited number of characteristics unsuitable for a comprehensive clinical assessment. However, the increasing demand for low cost diagnostics has fuelled the shift in how health-related resources are distributed. As such the interest in open platform technology and novel research methodologies has begun to harmonise engineering solutions with clinical needs. We provide an introduction to conduct an instrumented gait assessment with a discrete, low cost, accelerometer-based body worn monitor. We show that the capture and interpretation of raw gait signals with a common scripting language (MATLAB®) can be straightforward. In addition, we highlight best approaches and hope that this will help compliment any analytical tool-kit as part of any modern clinical assessment.Published here Open Access on RADAR -
Demnitz N, Esser P, Dawes H, Valkanova V, Johansen-Berg H, Ebmeier KP, Sexton C, 'A systematic review and meta-analysis of cross-sectional studies examining the relationship between mobility and cognition in healthy older adults'
Gait & Posture 50 (2016) pp.164-174
ISSN: 0966-6362 eISSN: 1879-2219AbstractAgeing is associated with declines in cognitive function and mobility. The extent to which this relationship encompasses the subdomains of cognition and mobility remains unclear, however. We searched MEDLINE and EMBASE databases for cross-sectional studies examining the association between objective mobility measures (gait, lower-extremity function, balance) and cognitive function (global, executive function, memory, processing speed) in healthy older adults. Of the 642 studies identified, 26 studies met the inclusion criteria, with a total of 26,355 participants. For each feature of physical mobility, the relation to each aspect of cognition was reviewed. In the context of each association, we summarised the results to date and performed random-effects meta-analyses of published data. Reviewed findings suggest that individuals with better mobility perform better on assessments of global cognition, executive function, memory and processing speed. Not all measures of mobility were equally associated with cognitive function, however. Although there was a larger number of gait and lower-extremity function studies, and this may have driven findings, most studies examining balance and cognition measures reported no significant results. Meta-analyses on reported associations supported results by revealing significant, albeit small, effect sizes in favour of a positive association between performance on mobility measures and cognitive assessments. Future research should aim to establish the mechanisms driving this relationship, as this may identify predictors of age-related impairments.Published here Open Access on RADAR -
Delextrat A, Bateman J, Esser P, Targen N, Dawes H, 'The potential benefits of Zumba Gold® in people with mild-to-moderate Parkinson’s: feasibility and effects of dance style and number of sessions'
Complementary Therapies in Medicine 27 (2016) pp.68-73
ISSN: 0965-2299 eISSN: 1873-6963AbstractObjectivesPublished here Open Access on RADARTo assess the feasibility of Zumba Gold® in people with PD, and to investigate the effects of dance styles and number of sessions on activity levels and physiological load.
Design
Repeated measure uncontrolled (single group) feasibility study.
Setting
Eleven participants (age: 64.0 ± 8.1 years) with mild-to-moderate idiopathic PD (Hoehn & Yahr stage < 3.0) took part in a screening session, followed by six Zumba Gold® workouts each separated by one week, and a follow-up interview six months later.
Main outcome measures
The main feasibility parameters measured were retention, compliance, and adverse events. Furthermore, during each Zumba Gold® session, physical activity levels were measured using tri-axial accelerometers, while physiological load was assessed by average heart rate (HRmean). A two-way ANOVA with repeated measures assessed the effects of dance styles and session number on activity level and HR.
Results
73% retention and 81% compliance were achieved, and no adverse events were recorded. Participants’ enjoyment was high and 38% started Zumba Gold® classes in the community after intervention. HR values were similar between dance styles and within the American College of Sports Medicine (ACSM)’s recommendations in 50% of participants. Backwards steps reduced physiological load but improvements in activity levels between the first and last sessions show that steps could be learnt with time.
Conclusions
Zumba Gold® is safe and enjoyable for people with PD. The excellent compliance and positive participants’ feedback suggest the need for a larger-scale trial.
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Esser P, Dent S, Jones C, Sheridan BJ, Bradley A, Wade DT, Dawes HT, 'Utility of the MOCA as a cognitive predictor for fitness to drive'
Journal of Neurology, Neurosurgery and Psychiatry 87 (5) (2015) pp.567-568
ISSN: 0022-3050 eISSN: 1468-330XAbstractPublished hereDetermining fitness to drive is a major concern affecting aging and disabled populations, particularly concerning reduced cognitive functioning, functional limitations and reduced vision [1, 2]. The Royal Society for Prevention of Accidents encourages aging drivers to maintain their licence (for independence, mobility and quality of life), emphasising that prematurely removing someone’s driving licence negatively affects their quality of life - the consequences of which outweigh the chance of being involved in a collision, for both the driver and the remainder of society [3].
The gold standard test in the United Kingdom (UK) to determine the ability to drive is an on-road driving assessment, and clinicians have the opportunity to refer patients to an independent Mobility Centre (accredited by Driving Mobility) where an assessment will be performed based upon on-road driving experience as judged by a professional driving instructor and occupational therapist[4]. The assessment is resource expensive and only a limited number of individuals are referred. To date no screening test is clinically implemented in the UK which accurately determines fitness to drive[4].
This study sets out to evaluate the potential of the Montreal Cognitive Assessment (MOCA) as a screening tool, for people with concerns regarding cognitive capacity; to determine pass/fail cuts offs for on-road driving assessment.
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Esser P, Dent S, Jones C, Sheridan BJ, Bradley A, Wade DT, Dawes H, 'Utility of the MOCA as a cognitive predictor for fitness to drive'
Journal of Neurology, Neurosurgery and Psychiatry 87 (2015) pp.567-568
ISSN: 0022-3050AbstractLetterPublished here -
Collett J, Esser P, Khalil H, Busse M, Quinn L, DeBono K, Rosser A, Nemeth AH, Dawes H, 'Insights into gait disorders: Walking variability using phase plot analysis, Huntington's disease'
Gait & Posture 40 (4) (2014) pp.694-700
ISSN: 0966-6362 eISSN: 1879-2219AbstractHuntington's disease (HD) is a progressive inherited neurodegenerative disorder. Identifying sensitive methodologies to quantitatively measure early motor changes have been difficult to develop. This exploratory observational study investigated gait variability and symmetry in HD using phase plot analysis. We measured the walking of 22 controls and 35 HD gene carriers (7 premanifest (PreHD)), 16 early/mid (HD1) and 12 late stage (HD2) in Oxford and Cardiff, UK. The unified Huntington's disease rating scale-total motor scores (UHDRS-TMS) and disease burden scores (DBS) were used to quantify disease severity. Data was collected during a clinical walk test (8.8 or 10 m) using an inertial measurement unit attached to the trunk. The 6 middle strides were used to calculate gait variability determined by spatiotemporal parameters (co-efficient of variation (CoV)) and phase plot analysis. Phase plots considered the variability in consecutive wave forms from vertical movement and were quantified by SDA (spatiotemporal variability), SDB (temporal variability), ratio for all (ratio SDA: SDB) and Delta angle beta (symmetry). Step time CoV was greater in manifest HD (p < 0.01, both manifest groups) than controls, as was stride length CoV for HD2 (p < 0.01). No differences were found in spatiotemporal variability between PreHD and controls (p > 0.05). Phase plot analysis identified differences between manifest HD and controls for SDB, Ratio for all and Delta angle (all p < 0.01, both manifest groups). Furthermore Ratio for all was smaller in PreHD compared with controls (p < 0.01). Ratio for all also produced the strongest correlation with UHDRS-TMS (r = -0.61, p < 0.01) and was correlated with DBS (r = -0.42, p = 0.02). Phase plot analysis may be a sensitive method of detecting gait changes in HD and can be performed quickly during clinical walking tests.Published here -
Steins D, Dawes H, Esser P, Collett J, 'Wearable accelerometry-based technology capable of assessing functional activities in neurological populations in community settings: a systematic review'
Journal of NeuroEngineering and Rehabilitation 11 (1) (2014)
ISSN: 1743-0003 eISSN: 1743-0003AbstractPublished hereBackground
Integrating rehabilitation services through wearable systems has the potential to accurately assess the type, intensity, duration, and quality of movement necessary for procuring key outcome measures.
Objectives
This review aims to explore wearable accelerometry-based technology (ABT) capable of assessing mobility-related functional activities intended for rehabilitation purposes in community settings for neurological populations. In this review, we focus on the accuracy of ABT-based methods, types of outcome measures, and the implementation of ABT in non-clinical settings for rehabilitation purposes.
Data sources
Cochrane, PubMed, Web of Knowledge, EMBASE, and IEEE Xplore. The search strategy covered three main areas, namely wearable technology, rehabilitation, and setting.
Study selection
Potentially relevant studies were categorized as systems either evaluating methods or outcome parameters.
Methods
Methodological qualities of studies were assessed by two customized checklists, depending on their categorization and rated independently by three blinded reviewers.
Results
Twelve studies involving ABT met the eligibility criteria, of which three studies were identified as having implemented ABT for rehabilitation purposes in non-clinical settings. From the twelve studies, seven studies achieved high methodological quality scores. These studies were not only capable of assessing the type, quantity, and quality measures of functional activities, but could also distinguish healthy from non-healthy subjects and/or address disease severity levels.
Conclusion
While many studies support ABT’s potential for telerehabilitation, few actually utilized it to assess mobility-related functional activities outside laboratory settings. To generate more appropriate outcome measures, there is a clear need to translate research findings and novel methods into practice.
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Steins D, Sheret I, Dawes H, Esser P, Collett J, 'A smart device inertial-sensing method for gait analysis'
Journal of Biomechanics 47 (15) (2014) pp.3780-3785
ISSN: 0021-9290 eISSN: 1873-2380AbstractPublished hereThe purpose of this study was to establish and cross-validate a method for analyzing gait patterns determined by the center of mass (COM) through inertial sensors embedded in smart devices. The method employed an extended Kalman filter in conjunction with a quaternion rotation matrix approach to transform accelerations from the object onto the global frame. Derived by double integration, peak-to-trough changes in vertical COM position captured by a motion capture system, inertial measurement unit, and smart device were compared in terms of averaged and individual steps. The inter-rater reliability and levels of agreement for systems were discerned through intraclass correlation coefficients (ICC) and Bland–Altman plots. ICCs corresponding to inter-rater reliability were good-to-excellent for position data (ICCs,.80–.95) and acceleration data (ICCs,.54–.81). Levels of agreements were moderate for position data (LOA, 3.1–19.3%) and poor for acceleration data (LOA, 6.8%–17.8%). The Bland–Altman plots, however, revealed a small systematic error, in which peak-to-trough changes in vertical COM position were underestimated by 2.2 mm; the Kalman filter׳s accuracy requires further investigation to minimize this oversight. More importantly, however, the study׳s preliminary results indicate that the smart device allows for reliable COM measurements, opening up a cost-effective, user-friendly, and popular solution for remotely monitoring movement. The long-term impact of the smart device method on patient rehabilitation and therapy cannot be underestimated: not only could healthcare expenditures be curbed (smart devices being more affordable than today‘s motion sensors), but a more refined grasp of individual functioning, activity, and participation within everyday life could be attained.
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Jayaram G, Stagg CJ, Esser P, Kischka U, Stinear J, Johansen-Berg H, 'Relationships Between Functional and Structural Corticospinal Tract Integrity and Walking Post Stroke'
Clinical Neurophysiology 123 (2012) pp.2422-2428
ISSN: 1388-2457 eISSN: 1872-8952AbstractStroke rehabilitation therapies may be more effective if they are tailored to an individual patient’s surviving anatomical and physiological substrates. However, development of such strategies first requires identification of functional and structural measures that are associated with clinical status that could in future be tested as predictors of outcomes. Studies on upper limb recovery following stroke have highlighted the importance of the structural and functional integrity of the corticospinal tract (CST) in determining clinical outcomes. However, such relationships have not been fully explored for the lower limb. There is some evidence of increased activity in the ipsilateral (contralesional) motor cortex during paretic lower limb movements in more severely impaired patients but the functional and clinical significance of such activity is unclear.Published here -
Esser P, Dawes H, Collett J, Feltham M, Howells K, 'Validity and inter-rater reliability of inertial gait measurements in Parkinson's disease: A pilot study'
Journal of Neuroscience Methods 205 (1) (2012) pp.177-181
ISSN: 0165-0270AbstractPublished hereWalking models driven by centre of mass (CoM) data obtained from inertial measurement units (IMU) or optical motion capture systems (OMCS) can be used to objectively measure gait. However current models have only been validated within typical developed adults (TDA). The purpose of this study was to compare the projected CoM movement within Parkinson's disease (PD) measured by an IMU with data collected from an OMCS after which spatio-temporal gait measures were derived using an inverted pendulum model. The inter-rater reliability of spatio-temporal parameters was explored between expert researchers and clinicians using the IMU processed data. Participants walked 10 m with an IMU attached over their centre of mass which was simultaneously recorded by an OMCS. Data was collected on two occasions, each by an expert researcher and clinician. Ten people with PD showed no difference (p = 0.13) for vertical, translatory acceleration, velocity and relative position of the projected centre of mass between IMU and OMCS data. Furthermore no difference (p = 0.18) was found for the derived step time, stride length and walking speed for people with PD. Measurements of step time (p = 0.299), stride length (p = 0.883) and walking speed (p = 0.751) did not differ between experts and clinicians. There was good inter-rater reliability for these parameters (ICC3.1 = 0.979. ICC3.1 = 0.958 and ICC3.1 = 0.978, respectively). The findings are encouraging and support the use of IMUs by clinicians to measure CoM movement in people with PD.
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Esser P, Dawes H, Collett J, Feltham M, Howells K, 'Assessment of spatio-temporal gait parameters using inertial measurement units in neurological populations'
Gait & Posture 34 (4) (2011) pp.558-560
ISSN: 0966-6362AbstractPublished hereLaboratory based gait analysis techniques are expensive, time consuming and require technical expertise. Inertial measurement units can directly measure temporal parameters and in combination with gait models may provide a solution to obtain spatial gait measurements within daily clinical assessments. However it is not known if a model and standard correction factor determined by Zijlstra and Hof [8] to estimate step and stride length parameters in typically developed adults (TDA) can be accurately used in neurologically impaired gaits.This research estimated the stride length over two 10 m walks at self selected walking speed in people with neurological conditions, using a previously established model and correction factor for TDA. The relation of the correction factor to walking speed was explored. We recruited TDA (n = 10) and participants with Parkinson's disease (PD; n = 24), muscular dystrophy (MD; n = 13), motor neuron disease (MND; n = 7) and stroke survivors (n = 18) for the study who twice walked 10 m at a self-selected pace. Stride length correction factors, for TDA (1.25 +/- 0.01), PD (1.25 +/- 0.03), and MD (1.21 +/- 0.08) (p = 0.833 and p = 0.242) were the same as previously reported in TDA (Zijlstra and Hof [8]). Correction factors for stroke (1.17 +/- 0.42) and MND (1.10 +/- 0.08) were different (p < 0.01 and p = 0.028 respectively). However there was a high level of variability for correction factors within groups, which did not relate to walking speed. Our findings support that correction factors should be determined for each individual to estimate average step/stride length in patients suffering from a neurological condition.
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Elsworth C, Winward C, Sackley C, Meek C, Freebody J, Esser P, Izadi H, Soundy A, 'Supported community exercise in people with long-term neurological conditions: a phase II randomized controlled trial'
Clinical Rehabilitation 25 (7) (2011) pp.588-598
ISSN: 0269-2155 eISSN: 1477-0873AbstractObjective: Adults with long-term neurological conditions have low levels of participation in physical activities and report many barriers to participation in exercise. This study examines the feasibility and safety of supporting community exercise for people with long-term neurological conditions using a physical activity support system. Design: A phase II randomized controlled trial using computer-generated block randomization, allocation concealment and single blind outcome assessment. Setting: Oxfordshire and Birmingham community Inclusive Fitness Initiative gyms. Subjects: Patients with a long-term neurological condition. Interventions: The intervention group (n = 51) received a 12-week, supported exercise programme. The control group (n = 48) participants received standard care for 12 weeks and were then offered the intervention. Main measures: Physical activity, adherence to exercise, measures of mobility, health and well-being. Results: Forty-eight patients (n = 51) completed the intervention, achieving 14 gym attendances (range 0-39) over the 12 weeks. Overall activity did not increase as measured by the Physical Activity Scale for the Elderly (change score mean 14.31; 95% confidence interval (CI) -8.27 to 36.89) and there were no statistically significant changes in body function and health and well-being measures. Conclusions: People with long-term neurological conditions can safely exercise in community gyms when supported and achieve similar attendance to standard exercise referral schemes, but may reduce other life activities in order to participate at a gym.Published here -
Meek C, Sackley C, Clarke C, Soundy A, Winward C, Esser P, Patel S, Dawes H, 'Long-Term Individual Fitness Enablement (LIFE) for Parkinson's Disease: A Feasibility Study'
Movement Disorders 25 (3) (2010) pp.713-713
ISSN: 0885-3185 -
Esser P, Dawes H, Collett J, Howells K, 'IMU: Inertial sensing of vertical CoM movement'
Journal of Biomechanics 42 (2009) pp.1578-1581
ISSN: 0021-9290AbstractThe purpose of this study was to use a quaternion rotation matrix in combination with an integration approach to transform translatory accelerations of the centre of mass (CoM) from an inertial measurement unit (IMU) during walking, from the object system onto the global frame. Second, this paper utilises double integration to determine the relative change in position of the CoM from the vertical acceleration data. Five participants were tested in which an IMU, consisting of accelerometers, gyroscopes and magnetometers was attached on the lower spine estimated centre of mass. Participants were asked to walk three timed through a calibrated volume at their self-selected walking speed. Synchronized data were collected by an IMU and an optical motion capture system (OMCS); both measured at 100 Hz. Accelerations of the IMU were transposed onto the global frame using a quaternion rotation matrix. Translatory acceleration, speed and relative change in position from the IMU were compared with the derived data from the OMCS. Peak acceleration in vertical axis showed no significant difference (p >= 0.05). Difference between peak and trough speed showed significant difference (p = 0.05). These results indicate that quaternions, in combination with Simpsons rule integration, can be used in transforming translatory acceleration from the object frame to the global frame and therefore obtain relative change in position, thus offering a solution for using accelerometers in accurate global frame kinematic gait analyses. (C) 2009 Elsevier Ltd. All rights reserved.Published here -
Esser P, Dawes H, Collett J, Howells K, 'IMU: Inertial sensing of vertical CoM movement'
Journal of Biomechanics 42 (10) (2009) pp.1578-1581
ISSN: 0021-9290AbstractPublished hereThe purpose of this study was to use a quaternion rotation matrix in combination with an integration approach to transform translatory accelerations of the centre of mass (CoM) from an inertial measurement unit (IMU) during walking, from the object system onto the global frame. Second, this paper utilises double integration to determine the relative change in position of the CoM from the vertical acceleration data. Five participants were tested in which an IMU, consisting of accelerometers, gyroscopes and magnetometers was attached on the lower spine estimated centre of mass. Participants were asked to walk three timed through a calibrated volume at their self-selected walking speed. Synchronized data were collected by an IMU and an optical motion capture system (OMCS); both measured at 100 Hz. Accelerations of the IMU were transposed onto the global frame using a quaternion rotation matrix. Translatory acceleration, speed and relative change in position from the IMU were compared with the derived data from the OMCS. Peak acceleration in vertical axis showed no significant difference (p >= 0.05). Difference between peak and trough speed showed significant difference (p < 0.05) but relative peak-trough position between the IMU and OMCS did not show any significant difference (p >= 0.05). These results indicate that quaternions, in combination with Simpsons rule integration, can be used in transforming translatory acceleration from the object frame to the global frame and therefore obtain relative change in position, thus offering a solution for using accelerometers in accurate global frame kinematic gait analyses.
Conference papers
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Tektonidis TG, Esser P, Coe S, Maddock J, Buchanan S, Mavrommati F, Schott JM, Izadi H, Richards M, Dawes H, 'DIET QUALITY IN LATE MIDLIFE IS ASSOCIATED WITH FASTER WALKING SPEED IN LATER LIFE IN WOMEN, BUT NOT MEN: FINDINGS FROM A BRITISH BIRTH COHORT'
38 (S1) (2019) pp.S316-S317
Published here Open Access on RADAR -
Joshi S, Weedon BD, Esser P, Liu YC, Springett DN, Meaney A, Delextrat A, Kemp S, Ward T, Ayaz H, Dawes H, 'Revealing Cortical Activation Patterns of Novel Task Performance in Children With Low Coordination via fNIRS'
Frontiers in Human Neuroscience (2018)
ISSN: 1662-5161Published here Open Access on RADAR
Other publications
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Esser P, Weedon BD, Meaney A, Delextrat A, Mahmoud W, Salvan P, Wassenaar T, Joshi S, Liu Y, Kemp S, Ward T, Johansen-Berg J, Dawes H, 'Brain plasticity and motor skill competence development in adolescents with poor motor skill acquisition and performance: Trial Protocol for a controlled experimental paradigm', (2019)
Published here -
Meek C, Sackley CM, Clarke CE, Soundy AA, Winward C, Esser P, Patel S, Dawes H, 'Long-term Individual Fitness Enablement (life) for Parkinsons Disease: a Feasibility Study', (2010)
Professional information
Memberships of professional bodies
- Alzheimer's Research UK Oxford - Committee Member
- The Society for Research in Rehabilitation (SRR) - Member
- European Society for Movement Analysis in Adults and Children (ESMAC) - Member
- European Group for Research into Elderly and Physical Activity (EGRAPA) - Member