Professor Nick Ward, UCL Institute of Neurology

Investigating spontaneous early recovery after stroke: why do some patients recover whilst others do not? 

Professor Nick Ward was awarded a Brain Research UK project grant in September 2018 for research that sets out to explain different recovery trajectories between stroke patients.

He will use neuroimaging to determine whether the different trajectories can be explained by differences in patterns of anatomical brain damage and in early post-stroke brain repair mechanisms. This will help determine treatment pathways for individual patients, to enable them to make the best recovery.

Following rigorous assessment as part of our competitive project grant round, this project was selected for funding because the members of our Scientific Advisory Panel felt that it would make an important contribution to knowledge in an important area, with high unmet need. Stroke recovery remains a huge clinical problem and this project will advance understanding of the mechanisms of recovery and determine ‘who’ and ‘when’ to treat with current therapies. 

Background: About stroke

A stroke occurs when the blood supply to part of the brain is cut off. This starves the brain of oxygen and can have devastating consequences, including death and serious disability.

It is estimated that there are 1.2 million stroke survivors in the UK today, more than half of whom have been left with a life-limiting disability. This may include limb weakness, impaired mobility, or problems with speech, balance and co-ordination. This seriously impacts on their ability to live a productive, independent life.

In addition to the huge personal impact on the lives of survivors, the impact on society is enormous. The economic burden of stroke in the UK is estimated at £9 billion a year – including health and social care costs, informal care, productivity losses and benefit payments. Two-thirds of working age survivors are unable to return to work.

Improving stroke recovery is therefore a key goal. 

Read more: Stroke

The project: Why do some patients regain function whilst others do not? 

Nick Ward is Professor of Clinical Neurology and Neurorehabilitation at UCL Institute of Neurology, and a consultant neurologist at the National Hospital for Neurology and Neurosurgery. His special clinical interest is in stroke and neurorehabilitation, focusing in particular on recovery of arm and hand function, through his upper limb neurorehabilitation programme. This programme is the first of its kind, offering high quality, high intensity, high dose upper limb rehabilitation to people with stroke.

The starting point for the current project is the observation in patients whose arms and hands are quite severely affected early after stroke, that about half have good early recovery (over the first three months) whilst the other half do not. Understanding the difference between these two groups will tell us what factors are important in the recovery process itself, highlighting opportunities for - and barriers to - better outcomes. 

Prof Ward will use advanced brain imaging techniques to study differences in the pattern of anatomical brain damage between the two groups of patients, and differences in early post-stroke brain repair mechanisms. 

“This will tell us about mechanisms of recovery and thereby pave the way for potential interventions, and make sure that proper pre-trial stratification is possible so as not to mix apples and oranges and miss potential benefits. It cannot be over-emphasized how important this kind of difficult mechanism-based human work is.” External reviewer.

The impact: What difference will this make? 

Stroke is devastating. It is a leading cause of disability, and is associated with a greater range of disabilities than any other condition.

Upper limb impairments are particularly debilitating; they have a huge impact on people's ability to take care of themselves and live independently. Recovery of upper limb function is unacceptably poor.

In this project, Professor Ward and colleagues aim to provide the scientific basis for understanding how to radically improve upper limb recovery. This has the potential to quickly change clinical practice and improve outcomes for patients.

“Stroke recovery in general, and of motor recovery in particular, remains a huge scientific and clinical problem. The critical importance of doing this work if we are ever going to move beyond our current impasse cannot be overstated.” External reviewer.

Related research projects

Acquired brain and spinal cord injury - which includes stroke - is one of our current priority research areas, reflecting the large unmet need in this area. Our aim is to fund research to advance understanding of how to promote repair of the brain and spinal cord following injury.

Other research projects currently funded under this theme include: