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Virtual reality-aided exercise-based training has shown promise for post-stroke upper limb motor recovery in the home. Robust studies are needed to develop evidence-based guidelines and facilitate uptake in clinical practice. Thus, a three-phase mixed methods design was used to (I) identify if VR can drive neural recovery; (II) incorporate end-users into the refinement of a device and (III) provide a robust feasibility trial within the home to inform a future clinical efficacy trial. Phase I was a systematic review that demonstrated there is insufficient robust data to identify neurophysiological changes correlated with or accompanying a reduction in motor impairment, in response to VR. The four included studies reported a varying impact of VR on motor recovery and were of poor quality. Thus, revealing the need for research to address the mechanisms by which VR potentially drives motor recovery, and for more robust initial investigations to guide the development of clinical trials. Phase II incorporated the views of ten stroke survivors, seven informal carers and nine clinicians into the refinement of a virtual reality device. Demonstrations of the Virtualrehab platform and a small home-trial confirmed the need for a low-cost non-immersive VR device that can deliver personalised home-based therapy. The end-users provided key recommendations for the next iteration of the device; in order to facilitate acceptability, usability and uptake of such technology. Phase III investigated the feasibility of delivering upper limb therapy via VR, within the home of eleven stroke survivors. The 12-week intervention demonstrated that this mode of delivery was feasible and acceptable to stroke survivors; of note was the 87.5% therapy adherence. The results identified practical challenges for delivering and investigating VR within the home; particularly recommendations for collecting neural and behavioural outcomes. Thus, providing results to inform a future dose-optimisation study and then a clinical efficacy trial.

“The motivation is that it is at the heart of our work. It’s what matters more than anything, you know, I think EO&D principles, if we get those values, you know, our core values right, as an organisation, if we walk the talk in a sense in all of this, then everything else falls out of it as a consequence. We will build relationships, we will build the right projects, we’ll deliver impact, we’ll scale up, we’ll bring in the income, you know if I get that right. So what motivates me is the feeling that this is the most important thing. The irony is it doesn’t feel like that often, it feels like it’s a kind of added on organisationally. I’m not convinced the organisation sees EO&D that way, but that’s what motivates me. Actually believing, believing in the core values.” GDN Representative N1. The research takes place in the British Council which is the UK’s principal cultural relations organisation and a non departmental public body with offices in 110 countries. The British Council has its headquarters in London, where the researcher is based and in 2009 it marked its 75th anniversary. It therefore has a long history and wide international network. Consistent with the British Council's cultural relations role which concerns itself with building trust and understanding between the UK and other countries, matters of equality and diversity are an important aspect of not only its public face and activities, but its internal workings too. Its geographical spread and consequent diversity raise challenges however. A key challenge with wider resonances, confirmed by the Literature Review, is how to achieve the coherence and cohesion necessary for a shared, organisational identity and an appropriate and viable joined up approach to equality and diversity, whilst also respecting, valuing and managing diversity and cultural difference. In response, the British Council has, amongst other things, established a Global Diversity Network (GDN) of regional representatives who are deemed to be an important resource in this process. However the Diversity Unit which leads and manages the British Council’s equality and diversity agenda and the Global Diversity Network, believe that the Network is not as effective as it could be and the reasons why this is the case need to be explored. As a result the research has focused on the members. In doing so it has interrogated how they perceive they fulfil their role, the difficulties they face, their learning and development needs and explored in greater depth the perceptions of a contrasting group of strong and weak performers. The perceptions and evaluation of wider stakeholders are also incorporated. The ultimate aim, through a case study and action research approach, is to improve the GDN’s effectiveness. What emerges challenges the alleged research problem and highlights a number of things not previously known or considered. This includes the finding that the Network is perceived by its members and its stakeholders as effective but under resourced and there are gaps in how it has been managed and supported by the Diversity Unit. In addition, the research surfaced the existence of 'ideal' GDN members and no concerns of significance about the relevance of equality and diversity within the British Council's varying operating environments. A number of recommendations which are intended to support the GDN to be more effective ,and thereby alleviate pressure on the Diversity Unit, as well as contribute to improved, sustainable organisational performance, are proposed. A key recommendation relates to additional resources and addressing the learning and development needs of GDN members by making use of and building on the British Council’s Diversity Assessment Framework; this being the potent tool that supports and measures efforts to mainstream equality and diversity organisation wide. Recommendations are at various stages of implementation with some that await Executive Board endorsement. Dissemination of the research findings will take place internally and externally and internationally. This is in order to add to the limited body of knowledge about the approaches global organisations adopt in managing equality and diversity, revealed both by the Literature Review and the experiences of the Diversity Unit.