This network will focus on developing the next generation of advanced technologies for rehabilitation, targeting musculoskeletal, cardiorespiratory, neurological and mental health conditions. It will be connected to the new £70 million National Rehabilitation Centre (NRC), a major national investment in patient care, innovation and technology, due to open to patients in 2024. The NRC is being co-located with the specialist £300m+ Defence Medical Rehabilitation Centre on the Stamford Hall Rehabilitation Estate so that the two centres can benefit from the sharing of a wealth of knowledge, expertise and facilities. This EPSRC networkplus is therefore an exceptionally timely opportunity to capitalise on this significant investment, actively involving the UK Engineering & Physical Science community in this initiative and embedding technology innovation at the earliest stage. Advances in medicine have resulted in a significant increase in survival rates from trauma and injury, disorders and disease (acute and chronic). However, survival is often just the start, and the higher rates have led to an increase in rehabilitation needs, involving many patients with complex conditions. Technology has an increasingly important part to play in rehabilitation, to support a limited number of skilled healthcare professionals, reduce hospital stays, improve engagement with rehabilitation programmes, increase independence and improve outcomes. Speeding up recovery and helping patients get back to work and life has considerable personal, social and economic impact. This network will bring together researchers, healthcare providers, patient & user groups, industrial partners and supporting organisations (e.g. policy makers, charities) to develop a world-class research community and infrastructure for advanced rehabilitation technologies. By connecting new innovative technologies and advanced materials with our growing understanding of mental and physical health, this network will support the provision of novel, transformative, affordable solutions that will address current issues, allowing patients to lead more independent and fulfilling lives and reducing the burden on limited NHS resources. Supported by a core membership of experts from the rehabilitation field, this network aims to introduce researchers who are not typically involved in rehabilitation technology research into a network of rehabilitation experts. Central to the grant will be a series of Grand Challenge Blended Workshops and supported conversations designed to identify critical areas for research, with funding for feasibility projects to build those collaborations and drive forward innovation. The network will explore multimodal approaches that target both physical and mental rehabilitation. Technology innovation will focus around three key areas: 1) advanced functional materials, 2) patient-specific devices & therapy, and 3) closed loop measurement and rehabilitation.

The UK's healthcare system faces unprecedented challenges. We are the most obese nation in Europe and our ageing population is especially at risk from isolation, depression, strokes and fractures caused by falls in the home. UK health expenditure is already very substantial and it is difficult to imagine the NHS budget rising to meet the future needs of the UK's population. NHS staff are under particular pressure to reduce hospital bed-days by achieving earlier discharge after surgery. However this inevitably increases the risk that patients face post operative complications on returning home. Hospital readmission rates have in fact grown 20% since 1998. Many look to technology to mitigate these problems - in 2011 the Health Minister asserted that 80% of face-to-face interactions with the NHS are unnecessary. SPHERE envisages sensors, for example: 1) That employ video and motion analytics to predict falls and detect strokes so that help may be summoned. 2) That uses video sensing to analyse eating behaviour, including whether people are taking their prescribed medication. 3) That uses video to detect periods of depression or anxiety and intervene using a computer-based therapy. The SPHERE IRC will take a interdisciplinary approach to developing these sensor technologies, in order that: 1) They are acceptable in people's homes (this will be achieved by forming User Groups to assist in the technology design process, as well as experts in Ethics and User-Involvement who will explore issues of privacy and digital inclusion). 2) They solve real healthcare problems in a cost-effective way (this will be achieved by working with leading clinicians in Heart Surgery, Orthopaedics, Stroke and Parkinson's Disease, and recognised authorities on Depression and Obesity). 3) The IRC generates knowledge that will change clinical practice (this will be achieved by focusing on real-world technologies that can be shown working in a large number of local homes during the life of the project). The IRC "SPHERE" proposal has been developed from day one with clinicians, social workers and clinical scientists from internationally-recognised institutes including the Bristol Heart Institute, Southampton's Rehabilitation and Health Technologies Group, the NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle and the Orthopaedic Surgery Group at Southmead hospital in Bristol. This proposal further includes a local authority that is a UK leader in the field of "Smart Cities" (Bristol City Council), a local charity with an impressive track record of community-based technology pilots (Knowle West Media Centre) and a unique longitudinal study (the world-renowned Avon Longitudinal Study of Parents and Children (ALSPAC), a.k.a. "The Children of the Nineties"). SPHERE draws upon expertise from the UK's leading groups in Communications, Machine Vision, Cybernetics, Data Mining and Energy Harvesting, and from two corporations with world-class reputations for research and development (IBM, Toshiba).

Hearing loss affects approximately 500 million people worldwide (11 million in the UK), making it the fourth leading cause of years lived with disability (third in the UK). The resulting burden imposes enormous personal and societal consequences. By impeding communication, hearing loss leads to social isolation and associated decreases in quality of life and wellbeing. It has also been identified as the leading modifiable risk factor for incident dementia and imposes a substantial economic burden, with estimated costs of more than £30 billion per year in the UK. As the impact of hearing loss continues to grow, the need for improved treatments is becoming increasingly urgent. In most cases, the only treatment available is a hearing aid. Unfortunately, many people with hearing aids don't actually use them, partly because current devices, which are little more than simple amplifiers, often provide little benefit in social settings with high sound levels and background noise. Thus, there is a huge unmet clinical need with around three million people in the UK living with an untreated, disabling hearing loss. The common complaint of those with hearing loss, "I can hear you, but I can't understand you", is echoed by hearing aid users and non-users alike. Inasmuch as the purpose of a hearing aid is to facilitate communication and reduce social isolation, devices that do not enable the perception of speech in typical social settings are fundamentally inadequate. The idea that hearing loss can be corrected by amplification alone is overly simplistic; while hearing loss does decrease sensitivity, it also causes a number of other problems that dramatically distort the information that the ear sends to the brain. To improve performance, the next generation of hearing aids must incorporate more complex sound transformations that correct these distortions. This is, unfortunately, much easier said than done. In fact, engineers have been attempting to hand-design hearing aids with this goal in mind for decades with little success. Fortunately, recent advances in experimental and computational technologies have created an opportunity for a fundamentally different approach. The key difficulty in improving hearing aids lies in the fact that there are an infinite number of ways to potentially transform sounds and we do not understand the fundamentals of hearing loss well enough to infer which transformations will be most effective. However, modern machine learning techniques will allow us to bypass this gap in our understanding; given a large enough database of sounds and the neural activity that they elicit with normal hearing and hearing impairment, deep learning can be used to identify the sound transformations that best correct distorted activity and restore perception as close to normal as possible. The required database of neural activity does not yet exist, but we have spent the past few years developing the recording technology required to collect it. This capability is unique; there are no other research groups in the world that can make these recordings. We have already demonstrated the feasibility of solving the machine learning problem in silico. We are now proposing to collect the large-scale database of neural activity required to fully develop a working prototype of a new hearing aid algorithm based on deep neural networks and to demonstrate its efficacy for people with hearing loss.

Groups that experience the worst health outcomes include people in coastal communities (like in the North East and North Cumbria), experiencing homelessness, dependent on drugs or alcohol, vulnerable migrants, people in contact with the justice system and other socially excluded groups. In the North East, 32% of people live in the most deprived 20% of the national population. The recent Levelling up White paper (2022), the White paper on health and social care integration (2022) and the NHS's Core20PLUS5 framework (2022) all highlight the role of housing as a key determinant of health. This consortium will investigate and co-produce integrated, community led, asset-based approaches to supporting people with multiple and complex needs who have been homeless, to improve individual and community wellbeing and address health disparities in the North East North Cumbria Integrated Care System (NENC ICS). The project will: (1) Provide training for and work closely with a group of Experts by Experience (who have been homeless), who will support evidence development and decision making into practice, policy and research in this area. They will: share their experiences and views on how services might best support people with multiple and complex needs; make use of an 'innovation budget' to improve a service and evaluate their innovations; help with mapping existing services. They will be an integral part of the project, leading many aspects of it. (2) Identify all the research evidence in the area of community support for people who experience homelessness, and identify the data being held by relevant stakeholders (local authorities, health services, voluntary sector) and how it might be shared to gain a better understanding of regional needs and monitor progress. (3) Identify one integrated care service (integrating, health, social care and housing), which will be improved and evaluated by experts by experience. (4) Identify and map all local community assets and services supporting people with multiple and complex needs, particularly in relation to housing, in the NENC. The mapping will create a directory of all services, statutory or otherwise, which community members can access for support. This will form the basis of a digital dynamic data sharing platform accessed by all relevant stakeholders, which will become a virtual consortium, directly connecting research on community assets with health and social care integration efforts, and community members, to reduce health disparities. For this bid we have brought together an interdisciplinary team of experts across academia (covering expertise in housing; health inequalities; humanities; health economics; mental health; addictions; participatory research), service (housing; NHS) and policy (ICS) partners. The project is supported by Tyne Housing, a third sector organisation working with people experiencing precarious housing and homelessness; the NIHR NENC Applied Research Collaboration (a a partnership bringing together six regional universities, the NHS, health and social care providers, local authorities, the voluntary sector, community groups and members of the public); and the NENC Deep End network (a network of GP surgeries working in the most deprived areas regionally).

In the UK, musculoskeletal disorders (joint and back problems) affect one in five people long term. While joint replacements are successful, they are challenged by demands of an active and younger population presenting with disorders due to trauma, obesity, or other lifestyle choices. One of the causes for joint and back pain is the deterioration of the different soft tissues acting as cushions in the joints. New surgical interventions are being developed to repair or locally replace those soft tissues in order to delay or prevent a total joint replacement. There is no clear indication yet on which patients benefit the most from them. There is an urgent need to define the type of patients for which new and existing interventions are most beneficial. The local anatomy or level of tissue deterioration differs greatly between patients, and there is currently a lack of biomechanical evidence that takes into account these large variations to help matching patients to interventions. To tackle these issues, this Fellowship, MSKDamage, will develop novel testing methods and tools combining laboratory simulation with computer modelling and imaging. MSKDamage methods will be used to predict the variation in the mechanical performance of a series of treatments at various levels of joint deterioration. This will enable the different interventions to be matched to different patient's characteristics. I will focus on three musculoskeletal disorders and associated repairs: 1. Emerging treatments involving the injection of biomaterials in the intervertebral disc: I will produce realistic testing conditions that can be personalised to a specific patient, assessing each patient's chance of success and identifying areas for treatment optimisation. 2. Evaluation of meniscus repairs in the knee and their interaction with cartilage defects: I will provide new information on the type of cartilage defect that reduces the chances of success of a meniscus replacement in the knee. The research will develop guidance on the type of cartilage defects that need repair for a meniscus replacement to be successful. 3. Optimisation of custom wrist repair: I will help optimise patient-specific wrist repairs so that they reduce the damage in tendons and ligaments in the wrist. MSKDamage builds on my strong track-record in the field and network of industry, clinical and academic collaborators, as well as my recent work that demonstrates the specific information which need to be included in models of degraded tissues in the spine and the knee. MSKDamage aims to (1) develop a methodology to test interventions for a specific patient and its specific tissue degradation, (2) carry out a series of case studies which demonstrate the capacity to test a range tissues disorders and repairs. This work is a particularly suitable for a Fellowship, as it will allow me to develop fundamental engineering tools and methods while engaging with end users for significant economic and societal impact. I will also develop as a leader in the field, leading a growing research group and taking actions for the research community, directly related to the research, with advocacy on sharing more research outcomes openly for creation of more impact, and indirectly related to act as an ambassador for public and patient involvement for research related to computer simulations in healthcare.