Sheffield investigators

Professor Sue Mawson

Sheffield researchers

Dr Jack Parker


University of Bath

Sheffield Hallam University

University of Ulster

Bath Institute of Mechanical Engineering

Newcastle University

Expert Patients Programme

The Stroke Association





About the project

An 'intelligent' shoe could help improve a stroke survivor's walking, aiding independence and preventing the likelihood of falls, according to research.

The SMART 2 Personalised Self-management Rehabilitation System uses a set of sensors to capture motion while stroke survivors practise vital rehabilitation exercises – instantly relaying feedback on how fast they are walking, distance travelled, steps taken and whether there is equal weight distribution in their step and balance.

Researchers from CATCH and the National Institute for Health Research's Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) for South Yorkshire, hosted by Sheffield Teaching NHS Foundation Trust, have incorporated a hi-tech set of WalkiNSense insoles developed by local Sheffield company Kinematix into a computer-based personalised self-management rehabilitation system.

The system could transform stroke recovery by enabling patients to self-manage their ongoing rehabilitation in the comfort of their homes.

Studies highlight that fall rates can be as high as 50% in stroke survivors, with between 14–39% of sufferers experiencing one or more falls during their hospital stay. Approximately three-quarters of these will fall in the six months following hospital discharge.

The pioneering research is being led by Professor Sue Mawson, Professor of Health Service Research at the University of Sheffield. It is to be tested with patients at home and in a rehabilitation setting.

Dr Jack Parker, a research physiotherapist working on the SMART 2 project, said:

"Stroke recovery through rehabilitation is really critical as the damage caused to the brain through strokes can have a massive impact on so many aspects of a patient's life and wellbeing.

"This new device could represent a massive advancement in stroke recovery care as it makes it much easier for patients to continue with all-important rehabilitation exercises and for physiotherapists to track a patient's progress, preventing falls and motivating patients to regain independence. The feedback generated from the computer-based technology is much more sophisticated, too, and provides more accurate and detailed information about where weakness in balance and step lie. This can only be a good thing for the patient.

"Another advantage is stroke survivors are often less confident to carry on with their rehab at home and current paper-based exercises easily get mislaid, damaged or forgotten about so really hopeful that this easy-to-use system, with clear goals and objectives tailored to patients' needs, should inspire them back on their feet."

The computer-based technology detects the two most common physical constraints leading to falls in stroke survivors – weight distribution and heel strike pressure detection – through a hi-tech pair of insoles fitted with sensors. These sensors then relay information about a patient's progress back to a tablet computer via a smartphone link and can be used as part of a stroke recovery rehabilitation programme.

Professor Sue Mawson, director of NIHR CLAHRC for South Yorkshire, said:

"This cutting-edge research takes existing technology developed by Tomorrow Options and integrates it into a new way of enabling stroke survivors to manage self-manage rehabilitation."

Once set up, physiotherapists can set specific exercises and goals for patients to achieve. Achievements can then be easily interpreted by patients through a simple traffic light system, with 'green' indicating when patients have exceeded targets, 'amber' when they have done what would have been expected and 'red' when they have not achieved as much as expected.

The technology also enables stroke survivors and physiotherapists to compare performance over last three attempts and provides stroke patients with a percentage score. In addition, it can measure mood and monitor wellness – with an inbuilt prompt for patients to ring an ambulance in an emergency or to speak to a GP if they are feeling unwell and/or have been feeling low for two weeks.

Bob Barwell, 72, from Beauchief, Sheffield, suffered a stroke four years ago while at home in his living room, and is the first person to have tried the intelligent shoe system:

"I was really impressed. I didn't actually believe the shoes would be as useful as the physiotherapist said they would be. When I tried them I really had to concentrate, which is great as I don't spend much time on my feet so I need a lot of encouragement. Instantly knowing I had 47% balance is definitely motivational, too."

The SMART 2 Personalised Self-management Rehabilitation System will be tested on half a dozen stroke survivors at Sheffield's Assessment and Rehabilitation Centre shortly. A full evaluation will take place in the new year. The centre provides assessment and rehabilitation treatment during the day to stroke survivors. Researchers will also be studying if they can adapt the device to help patients suffering with other long-term conditions better self-manage their illness.

Stroke is the single largest cause of adult disability in the UK, costing nearly £9 billion to the UK economy.

The SMART consortium has been funded by the Engineering and Physical Sciences Research Council and the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for South Yorkshire.