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Ben M, Glinsky JV, Chu J, Spooren AI, Roberts S, Chen LW, Denis S, Lorusso M, Jorgensen V, Gollan EJ, Agostinello J, Van Laake-Geelen CCM, Lincoln C, Stolwijk JM, Bell C, Paddison S, Rainey D, Tranter K, Ilha J, Oostra K, Sherrington C, Harvey LA. Early and intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): description of the intervention. Spinal Cord 2023; 61:600-607. [PMID: 37468607 PMCID: PMC10645584 DOI: 10.1038/s41393-023-00911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
STUDY DESIGN Descriptive. OBJECTIVES The primary objective is to describe the intervention that will be provided in a large multi-centre randomised controlled trial titled: Early and Intensive Motor Training for people with Spinal Cord Injuries (the SCI-MT Trial). The secondary objective is to describe the strategies that will be used to operationalise and standardise the Motor Training provided to participants while keeping the intervention person-centred. METHODS The paper focuses on the rationale and principles of Motor Training for people with spinal cord injuries (SCI). The description of the intervention is based on the Template for Intervention Description and Replication (TIDieR) checklist. Specifically, it addresses the following 6 criteria of the TIDieR checklist: why the effectiveness of Motor Training is being examined; what, how, where and when the Motor Training will be administered; and how much Motor Training will be provided. RESULTS A detailed intervention manual has been developed to help standardise the delivery of the intervention. CONCLUSIONS This paper describes the details of a complex intervention administered as part of a large randomised controlled trial. It will facilitate the subsequent interpretation of the trial results and enable the intervention to be reproduced in clinical practice and future trials.
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Affiliation(s)
- M Ben
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J Chu
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | | | - S Roberts
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | - L W Chen
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - S Denis
- The Prince of Wales Hospital, Wales, NSW, Australia
| | - M Lorusso
- I.R.C.C.S. Foundation Santa Lucia, Rome, Italy
| | - V Jorgensen
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - E J Gollan
- The Princess Alexandra Hospital, Harlow, QLD, Australia
| | - J Agostinello
- The Royal Talbot Rehabilitation Centre, Kew Vic, VIC, Australia
| | - C C M Van Laake-Geelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - C Lincoln
- Queen Elizabeth National Spinal Injures Unit, Glasgow, Scotland
| | - J M Stolwijk
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - C Bell
- Spinal Cord Injury Rehabilitation, Repat Health Precinct, Daw Park, SA, Australia
| | - S Paddison
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital Trust, Middlesex, UK
| | - D Rainey
- Royal Rehab, Ryde, NSW, Australia
| | - K Tranter
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - J Ilha
- Universidade do Estado de Santa Catarina - UDESC, College of Health and Sport Science, Florianopolis, SC, Brazil
| | - K Oostra
- Ghent University Hospital, Ghent, Belgium
| | - C Sherrington
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - L A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia.
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Sidarta A, Lim YC, Wong RA, Tan IO, Kuah CWK, Ang WT. Current clinical practice in managing somatosensory impairments and the use of technology in stroke rehabilitation. PLoS One 2022; 17:e0270693. [PMID: 35951544 PMCID: PMC9371309 DOI: 10.1371/journal.pone.0270693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/15/2022] [Indexed: 11/18/2022] Open
Abstract
Stroke-induced somatosensory impairments seem to be clinically overlooked, despite their prevalence and influence on motor recovery post-stroke. Interest in technology has been gaining traction over the past few decades as a promising method to facilitate stroke rehabilitation. This questionnaire-based cross-sectional study aimed to identify current clinical practice and perspectives on the management of somatosensory impairments post-stroke and the use of technology in assessing outcome measures and providing intervention. Participants were 132 physiotherapists and occupational therapists currently working with stroke patients in public hospitals and rehabilitation centres in Singapore. It was found that the majority (64.4%) of the therapists spent no more than half of the time per week on somatosensory interventions. Functional or task-specific training was the primary form of intervention applied to retrain somatosensory functions in stroke survivors. Standardised assessments (43.2%) were used less frequently than non-standardised assessments (97.7%) in clinical practice, with the sensory subscale of the Fugl-Meyer Assessment being the most popular outcome measure, followed by the Nottingham Sensory Assessment. While the adoption of technology for assessment was relatively scarce, most therapists (87.1%) reported that they have integrated technology into intervention. There was a common agreement that proprioception is an essential component in stroke rehabilitation, and that robotic technology combined with conventional therapy is effective in enhancing stroke rehabilitation, particularly for retraining proprioception. Most therapists identified price, technology usability, and lack of available space as some of the biggest barriers to integrating robotic technology in stroke rehabilitation. Standardised assessments and interventions targeting somatosensory functions should be more clearly delineated in clinical guidelines. Although therapists were positive about technology-based rehabilitation, obstacles that make technology integration challenging ought to be addressed.
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Affiliation(s)
- Ananda Sidarta
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- * E-mail:
| | - Yu Chin Lim
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Russell A. Wong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Isaac O. Tan
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Christopher Wee Keong Kuah
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Centre for Advanced Rehabilitation Therapeutics (CART), Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Tech Ang
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Mechanical & Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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Exercise Training Programs Improve Cardiorespiratory and Functional Fitness in Adults With Asthma: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2022; 42:423-433. [PMID: 35703265 DOI: 10.1097/hcr.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This systematic review aimed to identify the characteristics and determine the effects of exercise interventions on improving health-related physical fitness in adults with asthma. REVIEW METHODS A systematic search was completed in MEDLINE, CINAHL, Embase, and SPORTDiscus for peer-reviewed publications of experimental studies that investigated the effects of an exercise training intervention on performance-based health-related physical fitness outcomes in adults with asthma. Two reviewers independently screened studies for inclusion according to predetermined criteria and performed data extraction and quality assessment of included studies. SUMMARY Forty-five articles were included, in which results for 39 unique studies were reported. Subjects (n = 2135) were aged 22 ± 4 to 71 ± 11 yr with mild-severe asthma. Most exercise programs used aerobic exercise, either alone or in combination with resistance or breathing/stretching exercises. The most common exercise program characteristics were supervised moderate-to-vigorous intensity aerobic exercise performed for 30-45 min 3 d/wk. Meta-analyses revealed significant improvements in cardiorespiratory fitness (V˙o2peak: unstandardized mean difference [MD] 3.1 mL/kg/min, 95% CI, 1.9-4.3), functional fitness (walking distance: MD 41 m, 95% CI, 27-54), and overall health-related physical fitness (standardized mean difference [SMD] 0.67, 95% CI, 0.46-0.89) in favor of groups who underwent experimental exercise training interventions. Aerobic exercise elicited superior improvements in health-related physical fitness compared with breathing/stretching exercise (SMD 0.47, 95% CI, 0.14-0.81).Supervised exercise training programs, particularly those aerobic in nature, are effective in eliciting clinically meaningful improvements in cardiorespiratory and functional fitness in adults with asthma.PROSPERO registration ID number = CRD42018092828.
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Neurophysiological changes accompanying reduction in upper limb motor impairments in response to exercise-based virtual rehabilitation after stroke: systematic review. Physiotherapy 2021; 113:141-152. [PMID: 34625285 DOI: 10.1016/j.physio.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Virtual reality-augmented therapist-delivered exercise-based training has promise for enhancing upper limb motor recovery after stroke. However, the neurophysiological mechanisms are unclear. OBJECTIVE To find if neurophysiological changes are correlated with or accompany a reduction in motor impairment in response to virtual reality-aided exercise-based training. DATA SOURCES Databases searched from inception to August 2020: MEDLINE, AMED, EMBASE, PUBMED, COCHRANE, CINHAL, PROQUEST and OPEN GREY. ELIGIBILITY CRITERIA Studies that investigated virtual reality-augmented exercise-based training for the upper limb in adults with stroke, and, measured motor impairment and neurophysiological outcomes. Studies that combined VR with another technology were excluded. DATA EXTRACTION AND SYNTHESIS Using pre-prepared proformas, three reviewers independently: identified eligible studies, assessed potential risk-of-bias, and extracted data. A critical narrative synthesis was conducted. A meta-analysis was not possible because of heterogeneity in participants, interventions and outcome measures. RESULTS Of 1387 records identified, four studies were eligible and included in the review. Overall, included studies were assessed as having high potential risk-of-bias. The VR equipment, and control interventions varied between studies. Two studies measured motor impairment with the Fugl-Meyer Assessment but there was no commonality in the use of neurophysiological measures. One study found improvement in neurophysiological measures only. The other three studies found a reduction in motor impairment and changes in neurophysiological outcomes, but did not calculate correlation coefficients. CONCLUSION There is insufficient evidence to identify the neurophysiological changes that are correlated with, or accompany, reduction in upper limb motor impairment in response to virtual reality-augmented exercise-based training after stroke. Systematic Review Registration Number PROSPERO 2017 CRD42017071312.
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Grampurohit N, Bell A, Duff SV, Mulcahey MJ, Thielen CC, Kaplan G, Marino RJ. Highlighting gaps in spinal cord injury research in activity-based interventions for the upper extremity: A scoping review. NeuroRehabilitation 2021; 49:23-38. [PMID: 33967071 DOI: 10.3233/nre-210042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited. OBJECTIVE To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI. METHODS The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTSeeker with the criteria: non-invasive activity-based interventions delivered at least three times/week for two weeks, upper extremity functional outcomes, age 13 years or older, English language, and neurological disorders three months post onset/injury. RESULTS The search yielded 172 studies. There were seven studies with SCI, all in adults. Activity-based interventions in SCI included task-specific training and gaming, with and without electrical stimulation, and a robotic exoskeleton. The other populations found in the review included studies in stroke, cerebral palsy, and multiple sclerosis. Thirty-four different interventions were reported in other populations. In comparison to the extensive stroke research, work in SCI was not found for high-intensity interventions using virtual reality, brain stimulation, rehabilitation devices, and applications to the home and telerehab settings. CONCLUSION The results highlight critical gaps within upper extremity high-intensity activity-based research in SCI.
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Affiliation(s)
- Namrata Grampurohit
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alison Bell
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Susan V Duff
- Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA, USA
| | - M J Mulcahey
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Gary Kaplan
- Scott Memorial Library, Academic Commons, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ralph J Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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