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Klaic M, Fong J, Crocher V, Davies K, Brock K, Sutton E, Oetomo D, Tan Y, Galea MP. Application of the extended technology acceptance model to explore clinician likelihood to use robotics in rehabilitation. Disabil Rehabil Assist Technol 2024; 19:52-59. [PMID: 35400278 DOI: 10.1080/17483107.2022.2060356] [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: 11/20/2021] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Evidence suggests that patients with upper limb impairment following a stroke do not receive recommended amounts of motor practice. Robotics provide a potential solution to address this gap, but clinical adoption is low. The aim of this study was to utilize the technology acceptance model as a framework to identify factors influencing clinician adoption of robotic devices into practice. MATERIALS AND METHOD Mixed methods including survey data and focus group discussions with allied health clinicians whose primary caseload was rehabilitation of the neurologically impaired upper limb. Surveys based on the technology acceptance measure were completed pre/post exposure to and use of a robotic device. Focus groups discussions based on the theory of planned behaviour were conducted at the conclusion of the study. RESULTS A total of 34 rehabilitation clinicians completed the surveys with pre-implementation data indicating that rehabilitation clinicians perceive robotic devices as complex to use, which influenced intention to use such devices in practice. The focus groups found that lack of experience and time to learn influenced confidence to implement robotic devices into practice. CONCLUSION This study found that perceived usefulness and perceived ease of use of a robotic device in clinical rehabilitation can be improved through experience, training and embedded technological support. However, training and embedded support are not routinely offered, suggesting there is a discordance between current implementation and the learning needs of rehabilitation clinicians.IMPLICATIONS FOR REHABILITATIONPatients do not receive adequate amounts of upper limb motor practice following a stroke, and although robotic devices have the potential to address this gap, clinical adoption is low.The technology acceptance model identified that clinicians perceive robotic devices to be complex to use with current implementation efforts failing to consider their training needs.Implementation adoption of robotic devices in rehabilitation should be supported with adequate training and technological support if sustainable practice change is to be achieved.
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Affiliation(s)
- Marlena Klaic
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Allied Health Department, The Royal Melbourne Hospital, Melbourne, Australia
| | - Justin Fong
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Vincent Crocher
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Katie Davies
- The Neurological Rehabilitation Group, Melbourne, Australia
| | - Kim Brock
- St Vincent's Hospital, Melbourne, Australia
| | | | - Denny Oetomo
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Ying Tan
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
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Wu Y, Yan Z, Fornah L, Zhao J, Wu S. The mediation effect of social support between stigma and social alienation in patients with stroke. Front Public Health 2023; 11:1290177. [PMID: 38094234 PMCID: PMC10716442 DOI: 10.3389/fpubh.2023.1290177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Background Social alienation is prevalent and causes adverse outcomes in stroke. Previous studies have linked stigma with social alienation. However, little is known about the mechanisms behind this relationship. This study explored the mediation effects of social support between stigma and social alienation. Methods A cross-sectional design was used to study 248 patients with stroke admitted to a tertiary rehabilitation hospital in Beijing, China, from December 2022 to July 2023. Patients were assessed using a general information questionnaire, the Stroke Stigma Scale, the Social Support Rating Scale, and the Generalized Social Alienation Scale. The PROCESS macro in SPSS was used to examine the mediation model. Results The results showed that stigma has a negative effect on social support (β = -0.503, p<0.001); stigma has a positive effect on social alienation (β = 0.768, p<0.001). Social support mediated the relationship between stigma and social alienation, with a mediation effect of 0.131 (95%CI: 0.060, 0.214), and indirect effects accounted for 17.06% of the total effect. Conclusion Social support mediated the relationship between stigma and social alienation. These findings suggest that intervention targeting the enhancement of social support may prevent or reduce social alienation among patients with stroke.
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Affiliation(s)
- Yu Wu
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
- University of Health and Rehabilitation Sciences, Qingdao, Shandong Province, China
- Beijing Boai Hospital, China Rehabilitation Research Center, Capital Medical University, Beijing, China
| | - Zeping Yan
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
- University of Health and Rehabilitation Sciences, Qingdao, Shandong Province, China
- Beijing Boai Hospital, China Rehabilitation Research Center, Capital Medical University, Beijing, China
| | - Lovel Fornah
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Jun Zhao
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Boai Hospital, China Rehabilitation Research Center, Capital Medical University, Beijing, China
| | - Shicai Wu
- Beijing Boai Hospital, China Rehabilitation Research Center, Capital Medical University, Beijing, China
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Li X, Xing X, Yao N. Critical quality appraisal and algorithm development of clinical practice guidelines for management of poststroke sensory loss: a systematic review. BMJ Open 2023; 13:e074082. [PMID: 37977862 PMCID: PMC10660658 DOI: 10.1136/bmjopen-2023-074082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aimed to assess the methodological quality of clinical practice guidelines (CPGs) associated with the management of poststroke sensory loss and develop an algorithm for health professionals. METHODS We conducted a systematic review for relevant CPGs published between 2017 and 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist. Appraisal of Guidelines for Research and Evaluation II instrument was used to assess methodological quality. Recommendations for managing poststroke sensory loss from high and average-quality CPGs were summarised and developed into an algorithm. RESULTS First, 1458 records were identified from the database searches and other sources. Finally, four CPGs were included: three were rated as high quality and one as average quality. Twenty-two recommendations were summarised from these CPGs and used to develop a draft algorithm. Then, we revised the draft algorithm developed by the authors based on expert feedback to form the final version. CONCLUSIONS The four CPGs included in this study had good quality. Based on these CPGs, we developed an algorithm to facilitate health professionals' adherence to CPGs and contribute to evidence-based medicine. In the future, more high-quality CPGs are required to give further scientific and convincing evidence to manage poststroke sensory loss.
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Affiliation(s)
- Xiao Li
- Intensive Care Unit, Nanjing Drum Tower Hospital, Nanjing, China
| | - Xingmin Xing
- Intensive Care Unit, Nanjing Drum Tower Hospital, Nanjing, China
| | - Nannan Yao
- Operating Theatre, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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Chan NH, Ng SSM. Psychometric properties of the Chinese version of the Arm Activity Measure in people with chronic stroke. Front Neurol 2023; 14:1248589. [PMID: 37808490 PMCID: PMC10556664 DOI: 10.3389/fneur.2023.1248589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction The Arm Activity Measure was developed to assess active and passive functions of the upper limb in people with unilateral paresis, but a Chinese version is not available and its psychometric properties have not been specifically tested in people with stroke. This study aimed to translate and culturally adapt the Chinese version of the Arm Activity Measure (ArmA-C) and establish its psychometric properties in people with chronic stroke. Methods The psychometric properties of ArmA-C were determined in 100 people with chronic stroke. Results The ArmA-C had good test-retest reliability (intraclass correlation coefficients [ICC] = 0.87-0.93; quadratic weighted Kappa coefficients = 0.53-1.00). A floor effect was identified in section A of the ArmA-C. The content validity and internal consistency (Cronbach's alpha coefficients = 0.75-0.95) were good. The construct validity of the ArmA-C was supported by acceptable fit to the two-factor structure model and significant correlations with the Fugl-Meyer Assessment for Upper Extremity score, grip strength, the Wolf Motor Function Test score, the Trail Walking Test completion time, and the Oxford Participation and Activities Questionnaire scores. Conclusions The ArmA-C is reliable and valid for assessing active and passive functions in people with chronic stroke.
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Affiliation(s)
- Nga Huen Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Purton J, Sim J, Hunter SM. Stroke survivors' views on their priorities for upper-limb recovery and the availability of therapy services after stroke: a longitudinal, phenomenological study. Disabil Rehabil 2023; 45:3059-3069. [PMID: 36111388 DOI: 10.1080/09638288.2022.2120097] [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: 07/13/2021] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Forty percent of stroke survivors have a persistent lack of function in the upper limb, causing significant disability. Most personal-care tasks and meaningful activities require bi-manual function of both upper limbs. However, lower-limb mobility is often viewed as the priority in stroke services. Perspectives of stroke survivors on priorities for upper-limb recovery and therapy have not been investigated in detail. Therefore, this study aimed to explore their views. MATERIALS AND METHODS Thirteen stroke survivors each engaged in up to four semi-structured interviews over 18 months. A phenomenological approach guided the research. RESULTS Three themes were identified. Priorities change on coming home: recovery of walking is a priority early after stroke but upper-limb recovery becomes equally important over time, particularly once living at home. Limited therapy services: therapy has a short duration, prioritizes lower-limb mobility, and is short-lived in the community; people feel abandoned by services. Active partners in recovery: stroke survivors want intermittent access to review and advice so they can be active partners with therapists to manage their upper-limb recovery. CONCLUSION Therapy services should recognize stroke survivors' changing priorities and work with them as active partners in upper-limb recovery. Intermittent access to review and advice should be included in service design.Implications for rehabilitationStroke survivors' priorities may change over time from recovery of walking toward upper-limb recovery.Post-stroke services can be perceived as insufficient to meet the needs of stroke survivors who want to participate actively in rehabilitation of their upper limb.Stroke survivors may prefer services that are more flexible to provide regular review of their progress, access to guidance and support to self-manage their recovery.
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Affiliation(s)
- Judy Purton
- School of Allied Health Professions, Keele University, Keele, UK
- School of Science, Technology and Health, York St John University, York, UK
| | - Julius Sim
- School of Allied Health Professions, Keele University, Keele, UK
- School of Medicine, Keele University, Keele, UK
| | - Susan M Hunter
- School of Allied Health Professions, Keele University, Keele, UK
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Huynh BP, DiCarlo JA, Vora I, Ranford J, Gochyyev P, Lin DJ, Kimberley TJ. Sensitivity to Change and Responsiveness of the Upper Extremity Fugl-Meyer Assessment in Individuals With Moderate to Severe Acute Stroke. Neurorehabil Neural Repair 2023; 37:545-553. [PMID: 37483132 DOI: 10.1177/15459683231186985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND The Fugl-Meyer Assessment-Upper Extremity (FMA-UE) is a widely used outcome measure for quantifying motor impairment in stroke recovery. Meaningful change (responsiveness) in the acute to subacute phase of stroke recovery has not been determined. OBJECTIVE Determine responsiveness and sensitivity to change of the FMA-UE from 1-week to 6-weeks (subacute) after stroke in individuals with moderate to severe arm impairment who received standard clinical care. METHODS A total of 51 participants with resulting moderate and severe UE hemiparesis after stroke had FMA-UE assessment at baseline (within 2 weeks of stroke) and 6-weeks later. Sensitivity to change was assessed using Glass's delta, standardized response means (SRM), standard error of measure (SEM), and minimal detectable change (MDC). Responsiveness was assessed with the minimal clinically important difference (MCID), estimated using receiver operating characteristic curve analysis with patient-reported global rating of change scales (GROC) and a provider-reported modified Rankin Scale (mRS) as anchors. RESULTS The MCID estimates were 13, 12, and 9 anchored to the GROC Arm Weakness, GROC Recovery, and mRS. Glass's delta and the SRM revealed large effect sizes, indicating high sensitivity to change, (∆ = 1.24, 95% CI [0.64, 1.82], SRM = 1.10). Results for the SEM and MDC were 2.46 and 6.82, respectively. CONCLUSION The estimated MCID for the FMA-UE for individuals with moderate to severe motor impairment from 1 to 6-weeks after stroke is 13. These estimates will provide clinical context for FMA-UE change scores by helping to identify the change in upper-extremity motor impairment that is both beyond measurement error and clinically meaningful.
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Affiliation(s)
- Baothy P Huynh
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Julie A DiCarlo
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI, USA
| | - Isha Vora
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Jessica Ranford
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Perman Gochyyev
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - David J Lin
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI, USA
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Teresa J Kimberley
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
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Moulaei K, Bahaadinbeigy K, Haghdoostd AA, Nezhad MS, Sheikhtaheri A. Overview of the role of robots in upper limb disabilities rehabilitation: a scoping review. Arch Public Health 2023; 81:84. [PMID: 37158979 PMCID: PMC10169358 DOI: 10.1186/s13690-023-01100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Neuromotor rehabilitation and improvement of upper limb functions are necessary to improve the life quality of patients who have experienced injuries or have pathological outcomes. Modern approaches, such as robotic-assisted rehabilitation can help to improve rehabilitation processes and thus improve upper limb functions. Therefore, the aim of this study was to investigate the role of robots in upper limb disability improvement and rehabilitation. METHODS This scoping review was conducted by search in PubMed, Web of Science, Scopus, and IEEE (January 2012- February 2022). Articles related to upper limb rehabilitation robots were selected. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). We used an 18-field data extraction form to extract data from articles and extracted the information such as study year, country, type of study, purpose, illness or accident leading to disability, level of disability, assistive technologies, number of participants in the study, sex, age, rehabilitated part of the upper limb using a robot, duration and frequency of treatment, methods of performing rehabilitation exercises, type of evaluation, number of participants in the evaluation process, duration of intervention, study outcomes, and study conclusions. The selection of articles and data extraction was made by three authors based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth author. Inclusion criteria were articles involving upper limb rehabilitation robots, articles about upper limb disability caused by any illness or injury, and articles published in English. Also, articles involving other than upper limb rehabilitation robots, robots related to rehabilitation of diseases other than upper limb, systematic reviews, reviews, and meta-analyses, books, book chapters, letters to the editor, and conference papers were also excluded. Descriptive statistics methods (frequency and percentage) were used to analyses the data. RESULTS We finally included 55 relevant articles. Most of the studies were done in Italy (33.82%). Most robots were used to rehabilitate stroke patients (80%). About 60.52% of the studies used games and virtual reality rehabilitate the upper limb disabilities using robots. Among the 14 types of applied evaluation methods, "evaluation and measurement of upper limb function and dexterity" was the most applied evaluation method. "Improvement in musculoskeletal functions", "no adverse effect on patients", and "Safe and reliable treatment" were the most cited outcomes, respectively. CONCLUSIONS Our findings show that robots can improve musculoskeletal functions (musculoskeletal strength, sensation, perception, vibration, muscle coordination, less spasticity, flexibility, and range of motion) and empower people by providing a variety of rehabilitation capabilities.
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Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoostd
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour Shahabi Nezhad
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Moulaei K, Sheikhtaheri A, Haghdoost AA, Nezhadd MS, Bahaadinbeigy K. A data set for the design and implementation of the upper limb disability registry. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:130. [PMID: 37397108 PMCID: PMC10312779 DOI: 10.4103/jehp.jehp_721_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/14/2022] [Indexed: 07/04/2023]
Abstract
BACKGROUND If the data elements needed for patient registries are not identified, designing and implementing them can be very challenging. Identifying and introducing a Data Set (DS) can help solve this challenge. The aim of this study was to identify and present a DS for the design and implementation of the upper limb disability registry. MATERIALS AND METHODS This cross-sectional study was conducted in two phases. In the first phase, to identify the administrative and clinical data elements required for registry, a comprehensive study was conducted in PubMed, Web of Science, and Scopus databases. Then, the necessary data elements were extracted from the studies and a questionnaire was designed based on them. In the second phase, in order to confirm the DS, the questionnaire was distributed to 20 orthopedic, physical medicine and rehabilitation physicians and physiotherapists during a two-round Delphi. In order to analyze the data, the frequency and mean score of each data element were calculated. Data elements that received an agreement more than 75% in the first or two-round Delphi were considered for the final DS. RESULTS A total of 81 data elements in five categories of "demographic data", "clinical presentation", "past medical history", "psychological issues", and "pharmacological and non-pharmacological treatments" were extracted from the studies. Finally, 78 data elements were approved by experts as essential data elements for designing a patient registry for upper limb disabilities. CONCLUSION In this study, the data elements necessary for the design and implementation of the upper limb disability registry were suggested. This DS can help registry designers and health data administrators know what data needs to be included in the registry system in order to have a successful design and implementation. Moreover, this standardized DS can be effective for integrating and improving the information management of people with upper limb disabilities and used to accurately gather the upper limb disabilities data for research and policymaking purposes.
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Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali A. Haghdoost
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour S. Nezhadd
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Chan MWM, Lo SHS, Sit JWH, Choi KC, Tao AA. Effects of visual arts-based interventions on physical and psychosocial outcomes of people with stroke: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023. [DOI: 10.1016/j.ijnsa.2023.100126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
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Abdelhafiz MH, Andreasen Struijk LNS, Dosen S, Spaich EG. Biomimetic Tendon-Based Mechanism for Finger Flexion and Extension in a Soft Hand Exoskeleton: Design and Experimental Assessment. SENSORS (BASEL, SWITZERLAND) 2023; 23:2272. [PMID: 36850871 PMCID: PMC9960426 DOI: 10.3390/s23042272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
This study proposes a bioinspired exotendon routing configuration for a tendon-based mechanism to provide finger flexion and extension that utilizes a single motor to reduce the complexity of the system. The configuration was primarily inspired by the extrinsic muscle-tendon units of the human musculoskeletal system. The function of the intrinsic muscle-tendon units was partially compensated by adding a minor modification to the configuration of the extrinsic units. The finger kinematics produced by this solution during flexion and extension were experimentally evaluated on an artificial finger and compared to that obtained using the traditional mechanism, where one exotendon was inserted at the distal phalanx. The experiments were conducted on nine healthy subjects who wore a soft exoskeleton glove equipped with the novel tendon mechanism. Contrary to the traditional approach, the proposed mechanism successfully prevented the hyperextension of the distal interphalangeal (DIP) and the metacarpophalangeal (MCP) joints. During flexion, the DIP joint angles produced by the novel mechanism were smaller than the angles generated by the traditional approach for the same proximal interphalangeal (PIP) joint angles. This provided a flexion trajectory closer to the voluntary flexion motion and avoided straining the interphalangeal coupling between the DIP and PIP joints. Finally, the proposed solution generated similar trajectories when applied to a stiff artificial finger (simulating spasticity). The results, therefore, demonstrate that the proposed approach is indeed an effective solution for the envisioned soft hand exoskeleton system.
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Affiliation(s)
- Mohamed H. Abdelhafiz
- Neurorehabilitation Systems Group, Department of Health Science and Technology, Aalborg University, 9260 Gistrup, Denmark
| | - Lotte N. S. Andreasen Struijk
- Neurorehabilitation Robotics and Engineering Group, Center for Rehabilitation Robotics, Department of Health Science and Technology, Aalborg University, 9260 Gistrup, Denmark
| | - Strahinja Dosen
- Neurorehabilitation Systems Group, Department of Health Science and Technology, Aalborg University, 9260 Gistrup, Denmark
| | - Erika G. Spaich
- Neurorehabilitation Systems Group, Department of Health Science and Technology, Aalborg University, 9260 Gistrup, Denmark
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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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Goldlist S, Wijeyaratnam DO, Edwards T, Pilutti LA, Cressman EK. Assessing proprioceptive acuity in people with multiple sclerosis. Mult Scler J Exp Transl Clin 2022; 8:20552173221111761. [PMID: 35837242 PMCID: PMC9274812 DOI: 10.1177/20552173221111761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background Proprioceptive acuity and impairments in proprioceptively guided reaches have not been comprehensively examined in people with multiple sclerosis (MS). Objective To examine proprioceptive acuity in people with MS who self-report and who do not self-report upper limb (UL) impairment, and to determine how people with MS reach proprioceptive targets. Methods Twenty-four participants with MS were recruited into two groups based on self-reported UL impairment: MS-R (i.e. report UL impairment; n = 12) vs. MS-NR (i.e. do not report UL impairment; n = 12). Proprioception was assessed using ipsilateral and contralateral robotic proprioceptive matching tasks. Results Participants in the MS-R group demonstrated worse proprioceptive acuity compared to the MS-NR group on the ipsilateral and contralateral robotic matching tasks. Analyses of reaches to proprioceptive targets further revealed that participants in the MS-R group exhibited deficits in movement planning, as demonstrated by greater errors at peak velocity in the contralateral matching task in comparison to the MS-NR group. Conclusion Our findings suggest that people with MS who self-report UL impairment demonstrate worse proprioceptive acuity, as well as poorer movement planning in comparison to people with MS who do not report UL impairment.
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Affiliation(s)
| | | | - Thomas Edwards
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Lara A Pilutti
- Interdisciplinary School of Health Science, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin K Cressman
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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13
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Wang Y, Ye M, Tong Y, Xiong L, Wu X, Geng C, Zhang W, Dai Z, Tian W, Rong J. Effects of robot-assisted therapy on upper limb and cognitive function in patients with stroke: study protocol of a randomized controlled study. Trials 2022; 23:538. [PMID: 35765084 PMCID: PMC9238006 DOI: 10.1186/s13063-022-06361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Impairments in upper limb motor function and cognitive ability are major health problems experienced by stroke patients, necessitating the development of novel and effective treatment options in stroke care. The aim of this study is to examine the effects of robot-assisted therapy on improving upper limb and cognitive functions in stroke patients. Methods This will be a single-blinded, 2-arm, parallel design, randomized controlled trial which will include a sample size of 86 acute and subacute stroke patients to be recruited from a single clinical hospital in Shanghai, China. Upon qualifying the study eligibility, participants will be randomly assigned to receive either robot-assisted therapy or conventional therapy with both interventions being conducted over a 6-week period in a clinical rehabilitation setting. In addition to comprehensive rehabilitation, the robot-assisted therapy group will receive a 30-min Armguider robot-assisted therapy intervention 5 days a week. Primary efficacy outcomes will include Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Mini-Mental Status Examination (MMSE). Other secondary outcomes will include Trail Making Test (TMT), Auditory Verbal Learning Test (AVLT), Digit Symbol Substitution Test (DSST), and Rey–Osterrieth Complex Figure Test (ROCFT). All trial outcomes will be assessed at baseline and at 6-week follow-up. Intention-to-treat analyses will be performed to examine changes from baseline in the outcomes. Adverse events will be monitored throughout the trial period. Discussion This will be the first randomized controlled trial aimed at examining the effects of robot-assisted therapy on upper limb and cognitive functions in acute and subacute stroke patients. Findings from the study will contribute to our understanding of using a novel robotic rehabilitation approach to stroke care and rehabilitation. Trial registration Chinese Clinical Trial Registry ChiCTR2100050856. Registered on 5 September 2021.
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Affiliation(s)
- Yana Wang
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China.,Key Laboratory of Exercise and Health Science of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Mingzhu Ye
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Yujie Tong
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Li Xiong
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Xuejiao Wu
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Chao Geng
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Wen Zhang
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Ziqi Dai
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Wei Tian
- The Neurorehabilitation Center, the First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Jifeng Rong
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China.
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14
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Stockley RC, Christian DL. A focus group study of therapists' views on using a novel neuroanimation virtual reality game to deliver intensive upper-limb rehabilitation early after stroke. Arch Physiother 2022; 12:15. [PMID: 35701828 PMCID: PMC9199178 DOI: 10.1186/s40945-022-00139-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Intensive training can significantly reduce upper-limb impairments after stroke but delivering interventions of sufficiently high intensity is extremely difficult in routine practice. The MindPod Dolphin® system is a novel neuroanimation experience which provides motivating and intensive virtual reality based training for the upper-limb. However several studies report that health professionals have reservations about using technology in rehabilitation. Therefore, this study sought to explore the views of therapists who had used this novel neuroanimation therapy (NAT) in a clinical centre to deliver intensive for the upper-limb of people after stroke in a phase 2 trial (SMARTS2). Methods Four therapists (three female, two physical and two occupational therapists) who delivered NAT participated in a focus group conducted by two independent researchers. The theoretical domains framework and COM-B behaviour change models informed the discussion schedule for the focus group. An inductive approach to content analysis was used. Recordings were transcribed, coded and thematically analysed. Generated key themes were cross-checked with participants. Results Whilst therapists had some initial concerns about using NAT, these were reduced by training, reference materials and face-to-face technical support. Therapists noted several significant benefits to using NAT including multi-system involvement, carry-over to functional tasks and high levels of patient engagement. Conclusions These findings illuminate key areas that clinicians, technology developers and researchers should consider when designing, developing and implementing NAT. Specifically, they highlight the importance of planning the implementation of rehabilitation technologies, ensuring technologies are robust and suggest a range of benefits that might be conferred to patients when using intensive NAT as part of rehabilitation for the upper-limb after stroke. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-022-00139-0.
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Affiliation(s)
- Rachel C Stockley
- Stroke Research Team, Faculty of Health and Wellbeing, University of Central Lancashire, PrestonPreston, PR1 2HE, UK.
| | - Danielle L Christian
- Stroke Research Team, Faculty of Health and Wellbeing, University of Central Lancashire, PrestonPreston, PR1 2HE, UK
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15
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Carcello K, McLennon S. “Personal road map for recovery:” examining the therapeutic use of weblogs by stroke survivors with aphasia. Disabil Rehabil 2022; 44:1933-1938. [DOI: 10.1080/09638288.2020.1812122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Karen Carcello
- College of Nursing, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Susan McLennon
- College of Nursing, University of Tennessee-Knoxville, Knoxville, TN, USA
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16
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Gantenbein J, Dittli J, Meyer JT, Gassert R, Lambercy O. Intention Detection Strategies for Robotic Upper-Limb Orthoses: A Scoping Review Considering Usability, Daily Life Application, and User Evaluation. Front Neurorobot 2022; 16:815693. [PMID: 35264940 PMCID: PMC8900616 DOI: 10.3389/fnbot.2022.815693] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Wearable robotic upper limb orthoses (ULO) are promising tools to assist or enhance the upper-limb function of their users. While the functionality of these devices has continuously increased, the robust and reliable detection of the user's intention to control the available degrees of freedom remains a major challenge and a barrier for acceptance. As the information interface between device and user, the intention detection strategy (IDS) has a crucial impact on the usability of the overall device. Yet, this aspect and the impact it has on the device usability is only rarely evaluated with respect to the context of use of ULO. A scoping literature review was conducted to identify non-invasive IDS applied to ULO that have been evaluated with human participants, with a specific focus on evaluation methods and findings related to functionality and usability and their appropriateness for specific contexts of use in daily life. A total of 93 studies were identified, describing 29 different IDS that are summarized and classified according to a four-level classification scheme. The predominant user input signal associated with the described IDS was electromyography (35.6%), followed by manual triggers such as buttons, touchscreens or joysticks (16.7%), as well as isometric force generated by residual movement in upper-limb segments (15.1%). We identify and discuss the strengths and weaknesses of IDS with respect to specific contexts of use and highlight a trade-off between performance and complexity in selecting an optimal IDS. Investigating evaluation practices to study the usability of IDS, the included studies revealed that, primarily, objective and quantitative usability attributes related to effectiveness or efficiency were assessed. Further, it underlined the lack of a systematic way to determine whether the usability of an IDS is sufficiently high to be appropriate for use in daily life applications. This work highlights the importance of a user- and application-specific selection and evaluation of non-invasive IDS for ULO. For technology developers in the field, it further provides recommendations on the selection process of IDS as well as to the design of corresponding evaluation protocols.
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Affiliation(s)
- Jessica Gantenbein
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Jan Dittli
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Jan Thomas Meyer
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
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17
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Wijeyaratnam DO, Edwards T, Pilutti LA, Cressman EK. Assessing visually guided reaching in people with multiple sclerosis with and without self-reported upper limb impairment. PLoS One 2022; 17:e0262480. [PMID: 35061785 PMCID: PMC8782348 DOI: 10.1371/journal.pone.0262480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
The ability to accurately complete goal-directed actions, such as reaching for a glass of water, requires coordination between sensory, cognitive and motor systems. When these systems are impaired, like in people with multiple sclerosis (PwMS), deficits in movement arise. To date, the characterization of upper limb performance in PwMS has typically been limited to results attained from self-reported questionnaires or clinical tools. Our aim was to characterize visually guided reaching performance in PwMS. Thirty-six participants (12 PwMS who reported upper limb impairment (MS-R), 12 PwMS who reported not experiencing upper limb impairment (MS-NR), and 12 age- and sex-matched control participants without MS (CTL)) reached to 8 targets in a virtual environment while seeing a visual representation of their hand in the form of a cursor on the screen. Reaches were completed with both the dominant and non-dominant hands. All participants were able to complete the visually guided reaching task, such that their hand landed on the target. However, PwMS showed noticeably more atypical reaching profiles when compared to control participants. In accordance with these observations, analyses of reaching performance revealed that the MS-R group was more variable with respect to the time it took to initiate and complete their movements compared to the CTL group. While performance of the MS-NR group did not differ significantly from either the CTL or MS-R groups, individuals in the MS-NR group were less consistent in their performance compared to the CTL group. Together these findings suggest that PwMS with and without self-reported upper limb impairment have deficits in the planning and/or control of their movements. We further argue that deficits observed during movement in PwMS who report upper limb impairment may arise due to participants compensating for impaired movement planning processes.
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Affiliation(s)
- Darrin O. Wijeyaratnam
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas Edwards
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lara A. Pilutti
- Interdisciplinary School of Health Science, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin K. Cressman
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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18
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Averell E, Knox D, van Wijck F. A real-time algorithm for the detection of compensatory movements during reaching. J Rehabil Assist Technol Eng 2022; 9:20556683221117085. [PMID: 36082203 PMCID: PMC9445474 DOI: 10.1177/20556683221117085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/15/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: Interactive game systems can motivate stroke survivors to engage with their rehabilitation exercises. However, it is crucial that systems are in place to detect if exercises are performed correctly as stroke survivors often perform compensatory movements which can be detrimental to recovery. Very few game systems integrate motion tracking algorithms to monitor performance and detect such movements. This paper describes the development of algorithms which monitor for compensatory movements during upper limb reaching movements in real-time and provides quantitative metrics for health professionals to monitor performance and progress over time. Methods: A real-time algorithm was developed to analyse reaching motions in real-time through a low-cost depth camera. The algorithm segments cyclical reaching motions into component parts, including compensatory movement, and provides a graphical representation of task performance. Healthy participants (n = 10) performed reaching motions facing the camera. The real-time accuracy of the algorithm was assessed by comparing offline analysis to real-time collection of data. Results: The algorithm’s ability to segment cyclical reaching motions and detect the component parts in real-time was assessed. Results show that movement types can be detected in real time with accuracy, showing a maximum error of 1.71%. Conclusions: Using the methods outlined, the real-time detection and quantification of compensatory movements is feasible for integration within home-based, repetitive task practice game systems for people with stroke.
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Affiliation(s)
| | - Don Knox
- Glasgow Caledonian University, Glasgow, UK
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19
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Tan A, Copley J, Fleming J. Decision-making aids for upper limb interventions in neurological rehabilitation: a scoping review. Disabil Rehabil 2021; 44:5291-5309. [PMID: 34126822 DOI: 10.1080/09638288.2021.1924881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To summarise the range and nature of decision-making aids that guide upper limb (UL) neurorehabilitation. METHODS Our scoping review followed Arksey and O'Malley's 6-step framework. Electronic databases were systematically searched; grey literature was hand-searched. Included papers were: (1) published in English; (2) related to UL rehabilitation for people with upper motor neuron conditions; and (3) provided a description of, or research on, a decision-making aid that guides therapists when choosing between two or more intervention approaches, techniques, or applications of a technique. Levels of evidence were rated. An expert panel of occupational therapists working in UL neurorehabilitation was consulted. RESULTS The 24 included articles described 15 decision-making aids with varying breadth and depth of the assessment process and suggested interventions. Six aids had published research, but lacked high quality evidence. The expert panel identified four key decision-making aids as being clinically useful. Preferred aids either included client-centred goal-setting within a holistic assessment or matched specific intervention options to distinct UL assessment results. Prompts to re-evaluate client performance are desirable. CONCLUSION Few decision-making aids guide therapists to holistically assess and make specific intervention decisions across all domains of UL neurorehabilitation. Their usefulness depends on the purpose, setting, and therapist experience.Implications for rehabilitationConsidering the complexity and heterogeneity of upper limb (UL) neurorehabilitation, a selection of evidence-based and purpose-designed decision-making aids may assist therapists across different experience levels and practice settings to choose individualised interventions.Decision-making aids for UL interventions in neurorehabilitation may be more clinically useful if they include a holistic and client-centred information gathering process that focuses on daily life goals.Decision-making aids should illustrate a clear clinical picture based on UL assessment results, with corresponding UL intervention recommendations provided.Inclusion of a cyclic process to re-evaluate client performance and function could also enhance the usefulness of a decision-making aid.
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Affiliation(s)
- Amelia Tan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | | | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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20
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Secciani N, Topini A, Ridolfi A, Meli E, Allotta B. A Novel Point-in-Polygon-Based sEMG Classifier for Hand Exoskeleton Systems. IEEE Trans Neural Syst Rehabil Eng 2020; 28:3158-3166. [PMID: 33306470 DOI: 10.1109/tnsre.2020.3044113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the early 2000s, data from the latest World Health Organization estimates paint a picture where one-seventh of the world population needs at least one assistive device. Fortunately, these years are also characterized by a marked technological drive which takes the name of the Fourth Industrial Revolution. In this terrain, robotics is making its way through more and more aspects of everyday life, and robotics-based assistance/rehabilitation is considered one of the most encouraging applications. Providing high-intensity rehabilitation sessions or home assistance through low-cost robotic devices can be indeed an effective solution to democratize services otherwise not accessible to everyone. However, the identification of an intuitive and reliable real-time control system does arise as one of the critical issues to unravel for this technology in order to land in homes or clinics. Intention recognition techniques from surface ElectroMyoGraphic (sEMG) signals are referred to as one of the main ways-to-go in literature. Nevertheless, even if widely studied, the implementation of such procedures to real-case scenarios is still rarely addressed. In a previous work, the development and implementation of a novel sEMG-based classification strategy to control a fully-wearable Hand Exoskeleton System (HES) have been qualitatively assessed by the authors. This paper aims to furtherly demonstrate the validity of such a classification strategy by giving quantitative evidence about the favourable comparison to some of the standard machine-learning-based methods. Real-time action, computational lightness, and suitability to embedded electronics will emerge as the major characteristics of all the investigated techniques.
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21
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Meads H, Hunt J, Page A, Withy L, Plowman R, Calder A. Stroke survivors’ experiences of upper limb recovery: a systematic review of qualitative studies. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1832710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Hayley Meads
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Jamie Hunt
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Alister Page
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Lee Withy
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Rose Plowman
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Allyson Calder
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
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22
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Finch T, Alvarado N, Ternent L, Fernandez-Garcia C, Aird L, Andole S, Cohen DL, Dawson J, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Turner DL, Vale L, Wilkes S, Shaw L. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health Technol Assess 2020; 24:1-232. [PMID: 33140719 PMCID: PMC7682262 DOI: 10.3310/hta24540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. OBJECTIVE The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. DESIGN This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. SETTING The trial was set in four NHS trial centres. PARTICIPANTS Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. INTERVENTIONS Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. MAIN OUTCOME MEASURES The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. RESULTS A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. CONCLUSIONS Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. TRIAL REGISTRATION Current Controlled Trials ISRCTN69371850. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hermano I Krebs
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West University Healthcare NHS Trust, London, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK)
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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23
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Purton J, Sim J, Hunter SM. The experience of upper-limb dysfunction after stroke: a phenomenological study. Disabil Rehabil 2020; 43:3377-3386. [PMID: 32223456 DOI: 10.1080/09638288.2020.1743775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Stroke can bring about a profound disruption to people's lives, but what is less understood is the effect that specific dysfunctions can have. The aim of this study was to explore stroke survivors' experiences of upper-limb dysfunction over time. METHODS 13 adult stroke survivors engaged in a series of up to four semi-structured interviews over an 18-month period after stroke. Data were interpreted through a method based on framework analysis. An interpretive phenomenological approach guided the research. RESULTS Upper-limb dysfunction brought substantial challenges for people, identified in a main theme of an altered way of life. Subordinate themes that contributed to this alteration were challenges in personal care, participating in meaningful and valued activities, and managing life roles and relationships. The second main theme was the disrupted self, with subordinate themes of feeling devalued, disrupted self-image and changes in identity. CONCLUSION The impact of upper-limb dysfunction on people's lives after stroke should be understood and acknowledged by rehabilitation professionals. Restoring some functional upper-limb activity could play an important role in enabling a person to regain a meaningful life and a coherent sense of self after stroke.IMPLICATIONS FOR REHABILITATIONUpper-limb dysfunction after stroke, and the loss of bimanual hand function, can profoundly alter a person's life, rendering them unable to manage simple tasks of personal care, participate in valued activities and fulfil important life roles.These functional and social limitations can then disrupt their sense of self, with feelings of low self-worth, and changes in self-image and identity.It is important that these changes in stroke survivors' lives are acknowledged and understood by rehabilitation professionals. More prolonged periods of therapy for recovery of upper-limb function, or for developing compensatory strategies, should be considered so that people can regain some meaning in life and maintain a coherent sense of self.
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Affiliation(s)
- Judy Purton
- School of Science, Technology and Health, York St John University, York, UK.,School of Allied Health Professions, Keele University, Keele, UK
| | - Julius Sim
- School of Allied Health Professions, Keele University, Keele, UK.,School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Susan M Hunter
- School of Allied Health Professions, Keele University, Keele, UK
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Ahmed N, Mauad VAQ, Gomez-Rojas O, Sushea A, Castro-Tejada G, Michel J, Liñares JM, Pedrosa Salles L, Candido Santos L, Shan M, Nassir R, Montañez-Valverde R, Fabiano R, Danyi S, Hassan Hosseyni S, Anand S, Ahmad U, Casteleins WA, Sanchez AT, Fouad A, Jacome A, Moura de Oliveira Paiva MS, Saavedra Ruiz AG, Grochowski RA, Toyama M, Nagi H, Sarvodelli MZ, Halalau A. The Impact of Rehabilitation-oriented Virtual Reality Device in Patients With Ischemic Stroke in the Early Subacute Recovery Phase: Study Protocol for a Phase III, Single-Blinded, Randomized, Controlled Clinical Trial. J Cent Nerv Syst Dis 2020; 12:1179573519899471. [PMID: 32009828 PMCID: PMC6974741 DOI: 10.1177/1179573519899471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 12/08/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND RATIONALE Stroke is considered the most common cause of adult disability. Intensive rehabilitation protocols outperform nonintensive counterparts. The subacute stroke phase represents a potential window to recovery. Virtual reality (VR) has been shown to provide a more stimulating environment, allowing for increased patient compliance. However, the quality of current literature comparing VR with standard therapies is limited. Our aim is to measure the impact of VR versus standard therapy on the recovery of the upper limb motor function in patients with stroke in the early subacute recovery phase. METHOD This is a randomized, controlled trial that will assign 262 patients to tailor-made standard rehabilitation (TMSR) or TMSR plus immersive VR device. The trial will be conducted in an urban rehabilitation clinic in the United States with expertise in the management of poststroke patients. Patients will be 18 to 70 years of age and in the early subacute period (30-90 days post ischemic stroke). The primary outcome will be the change of Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score, measured at baseline and 13 weeks after randomization. The secondary outcome will be the change in the UK Functional Independence Measure and Functional Assessment Measure (UK FIM-FAM) score at the same time points. DISCUSSION If the use of VR in the rehabilitation of patients with stroke proves to have a significant impact on their motor recovery, it will constitute an extremely important step into decreasing the functional impairment associated with stroke and the related health care expense burden.
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Affiliation(s)
- Nima Ahmed
- Neurology Department, Hamad Medical
Corporation, Doha, Qatar
| | | | - Olga Gomez-Rojas
- Occupational Health Department,
Alexander von Humboldt School, Lima, Peru
| | - Ammu Sushea
- Department of Anesthesia and Critical
Care, Harvard Medical School Teaching Hospital, Beth Israel Deaconess Medical
Center, Boston, MA, USA
| | - Gelanys Castro-Tejada
- Regional University Hospital Jose Maria
Cabral y Baez (HRUJMCB), Biomedical and Clinical Research Center (CINBIOCLI),
Santiago, Dominican Republic
| | - Janet Michel
- Health Systems and Policy Department,
University of Basel, Swiss TPH, Basel, Switzerland
| | - Juan Manuel Liñares
- Department of Pediatric Neurosurgery,
SAMIC Pediatric Hospital “Prof. Dr. Juan Pedro Garrahan,” Buenos Aires,
Argentina
| | - Loise Pedrosa Salles
- Dentistry Department, Faculty of Health
Sciences, University of Brasilia, Brasilia, Brazil
| | | | - Ming Shan
- Translational Research &
Development, TESARO, Inc., Waltham, MA, USA
| | - Rami Nassir
- Department of Pathology, School of
Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | | | | | - Sofia Danyi
- Lusíada University Centre’s Medical
School, Santos, Brazil
| | | | - Seerat Anand
- Jawaharlal Nehru Medical College,
Belgaum, India
| | - Usman Ahmad
- Department of Pharmacology &
Therapeutics, Hamdard University, Karachi, Pakistan
| | | | | | - Ahmed Fouad
- Clinical Pharmacy Department, Hamad
Medical Corporation, Doha, Qatar
| | | | | | | | | | - Mayumi Toyama
- School of Public Health, Department of
Health Informatics, Kyoto University, Kyoto, Japan
| | - Hibatalla Nagi
- Neurology Department, Hamad Medical
Corporation, Doha, Qatar
| | | | - Alexandra Halalau
- Internal Medicine Department, Beaumont
Hospital, Royal Oak, MI, USA
- Oakland University William Beaumont
School of Medicine, Rochester, MI, USA
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25
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Salvador PTCDO, Alves KYA, Rodrigues CCFM, Oliveira LVE. Online data collection strategies used in qualitative research of the health field: a scoping review. Rev Gaucha Enferm 2020; 41:e20190297. [DOI: 10.1590/1983-1447.2020.20190297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/21/2020] [Indexed: 01/21/2023] Open
Abstract
ABSTRACT Objective: To identify and map the online data collection strategies used in qualitative researches in the health field. Methods: This is a scoping review guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) from the Joanna Briggs Institute. We analyzed scientific articles, theses and dissertations from 12 databases. The analysis was made by descriptive statistics. Results: The final sample consisted of 121 researches. It was found that the number of publications increased sharply in the last five years, with predominance of studies from the United Kingdom. The highlight fields were psychology (28.1%), medicine (25.6%) and nursing (12.4%). The publications used 10 online data collection strategies: Online questionnaires, online forums, Facebook, websites, blogs, e-mail, online focus group, Twitter, chats, and YouTube. Conclusions: Online data collection strategies are constantly expanding and increasingly used in the health area.
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Sullivan JE, Drogos J, Carmona C, Yao J. The post-stroke upper limb improvement effort survey (IMPETUS): a survey of individuals with chronic stroke. Top Stroke Rehabil 2019; 26:608-620. [PMID: 31386604 DOI: 10.1080/10749357.2019.1647649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is a considerable literature on arm/hand dysfunction post stroke, but little information on the participants' opinions about perceived and desired arm/hand strength, recovery, and function. OBJECTIVE The objective of this study was to examine the perceptions of individuals with stroke about arm/hand function and training devices. METHODS A 69-item survey was developed addressing: activity before and after stroke, involved arm/hand function, willingness to use a training device, and important device characteristics. The survey included items from the Hand Function and Strength Subscales of the Stroke Impact Scale (SIS). Face validity was established by physical therapists and individuals with stroke. The survey was administered via phone and online. RESULTS 852 registry participants were recruited. Ninety-seven responded; 83 completed the survey. Subjects were 51 males, 31 females; mean age: 65 (25-95); meantime since stroke: 13 years (1-34; SD 6.678). There was a statistically significant difference between perceived and desired arm/hand strength, recovery, and function p<0.0001. Impairment factors, such as weakness and spasticity were greater barriers to recovery than socio-economic ones. Most participants (94%) were willing to use a device; functional gains during/following use were the most important characteristics. LIMITATIONS Participants had greater arm impairment and were more chronic than other studies. CONCLUSIONS Participants desired more arm/hand strength, function, and recovery that they perceived they had achieved. Impairment - level factors posed more barriers to arm recovery than socioeconomic ones. Most participants were interested in using arm/hand training devices; the most important device characteristic is functional gain.
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Affiliation(s)
- Jane E Sullivan
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University Chicago, Illinois, USA
| | - Justin Drogos
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University Chicago, Illinois, USA
| | - Carolina Carmona
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University Chicago, Illinois, USA
| | - Jun Yao
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University Chicago, Illinois, USA
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Chatterjee K, Stockley RC, Lane S, Watkins C, Cottrell K, Ankers B, Davies S, Morris MF, Fallon N, Nurmikko T. PULSE-I - Is rePetitive Upper Limb SEnsory stimulation early after stroke feasible and acceptable? A stratified single-blinded randomised controlled feasibility study. Trials 2019; 20:388. [PMID: 31262343 PMCID: PMC6604268 DOI: 10.1186/s13063-019-3428-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 05/11/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Reduction in sensorimotor function of the upper limb is a common and persistent impairment after stroke, and less than half of stroke survivors recover even basic function of the upper limb after a year. Previous work in stroke has shown that repetitive sensory stimulation (RSS) of the upper limb may benefit motor function. As yet, there have been no investigations of RSS in the early-acute period despite this being the time window during which the neuroplastic processes underpinning sensorimotor recovery are likely to occur. METHODS A single-blinded, stratified, randomised controlled feasibility study was undertaken at two NHS acute trusts to determine the recruitment rate, intervention adherence, and safety and acceptability of an RSS intervention in the early period after stroke. Participants were recruited within 2 weeks of index stroke. Stratified on arm function, they were randomised to receive either 45 min of daily RSS and usual care or usual care alone (UC) for 2 weeks. Changes from baseline on the primary outcome of the Action Research Arm Test (ARAT) to measurements taken by a blinded assessor were examined after completion of the intervention (2 weeks) and at 3 months from randomisation. RESULTS Forty patients were recruited and randomised (RSS n = 23; UC n = 17) with a recruitment rate of 9.5% (40/417) of patients admitted with a stroke of which 52 (12.5%) were potentially eligible, with 10 declining to participate for various reasons. Participants found the RSS intervention acceptable and adherence was good. The intervention was safe and there were no serious adverse events. CONCLUSIONS This study indicates that recruitment to a trial of RSS in the acute period after stroke is feasible. The intervention was well tolerated and appeared to provide additional benefit to usual care. In addition to a definitive trial of efficacy, further work is warranted to examine the effects of varying doses of RSS upon arm function and the mechanism by which RSS induces sensorimotor recovery in the acute period after stroke. TRIAL REGISTRATION ISRCTN, registry no: ISRCTN17422343 ; IRAS Project ID: 215137. Registered on October 2016.
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Affiliation(s)
- Kausik Chatterjee
- Countess of Chester Hospital Foundation Trust, Liverpool Rd, Chester, CH2 1UL UK
| | - Rachel C. Stockley
- Stroke Research Team, School of Nursing, University of Central Lancashire, Preston, PR1 2HE UK
| | - Steven Lane
- Department of Biostatistics, University of Liverpool, Liverpool, L69 3GL UK
| | - Caroline Watkins
- Stroke Research Team, School of Nursing, University of Central Lancashire, Preston, PR1 2HE UK
| | - Katy Cottrell
- Countess of Chester Hospital Foundation Trust, Liverpool Rd, Chester, CH2 1UL UK
| | - Brenda Ankers
- Countess of Chester Hospital Foundation Trust, Liverpool Rd, Chester, CH2 1UL UK
| | - Sioned Davies
- Countess of Chester Hospital Foundation Trust, Liverpool Rd, Chester, CH2 1UL UK
| | - Mary Fisher Morris
- MemCheck Memory Clinic, Beehive Healthcare, Northgate Avenue, Chester, CH2 2DX UK
| | - Nick Fallon
- Department of Psychological Sciences, University of Liverpool, Liverpool, L697ZA UK
| | - Turo Nurmikko
- Neuroscience Research Centre, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ UK
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28
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McLaren R, Signal N, Lord S, Taylor S, Henderson J, Taylor D. The volume and timing of upper limb movement in acute stroke rehabilitation: still room for improvement. Disabil Rehabil 2019; 42:3237-3242. [PMID: 30951402 DOI: 10.1080/09638288.2019.1590471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To observe upper limb activity patterns of people with stroke during sub-acute rehabilitation to inform the development of treatment strategies for upper limb rehabilitation. Design: Observational study of upper limb activity. Methods: Twenty participants admitted for sub-acute rehabilitation following stroke were observed during a week day for 1 minute every 10 min between 7 am and 7 pm. Upper limb activity was recorded and categorized into five types of movement. Results: Participants used either one or both upper limbs for 45.8% of the observation time. The affected arm moved 26.4% of the time, with most movement occurring in conjunction with the unaffected arm (18.9% of the time) and only 7.5% of the time being movement of the affected arm by itself. The largest proportion of upper limb activity was observed during mealtimes. Conclusions: Recognition of the need to improve upper limb outcomes after stroke has not yet translated into changes in the amount of upper limb activity undertaken during sub-acute rehabilitation. Opportunities to rehabilitate the hemiplegic upper limb are not fully realized. The dominance of bilateral movement in the early stages after stroke may provide scope for interventions that maximize this aspect of motor control.IMPLICATIONS FOR REHABILITATIONDespite advances in rehabilitation, time spent in upper limb activity following stroke is very low, particularly in the affected arm.Most movement of the affected arm occurs in conjunction with the unaffected arm.There is an urgent need to redress this low level of movement, given the importance of upper limb recovery to quality of life for people following stroke.
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Affiliation(s)
- Ruth McLaren
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Nada Signal
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Sue Lord
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Steve Taylor
- Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Jeanette Henderson
- Assessment, Treatment and Rehabilitation Department, Waitakere Hospital, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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29
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Thomas CM, Allison R, Latour JM. Using blogs to explore the lived-experience of life after stroke: "A journey of discovery I never wanted to take". J Adv Nurs 2017; 74:579-590. [PMID: 28910496 DOI: 10.1111/jan.13457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/29/2022]
Abstract
AIMS To explore the lived-experiences of stroke survivors as expressed in blogs and to discover the role the blogs play in the writers' lives. BACKGROUND Stroke can be a devastating, life changing event. Previous qualitative studies tend to examine one aspect of life after stroke. As stroke often has multiple effects, it is necessary to look widely at its lived-experience. New resources which can enable researchers to explore the lived-experience of stroke are blogs. DESIGN Phenomenological exploration using an interpretive thematic analysis. METHODS The Internet was searched for stroke survivors' blogs (January-March 2016) using pre-set criteria, seeking blogs with entries over an extended time (>1 year). Suitable blogs were identified and codes of meaning were identified and developed into categories, subthemes and themes. FINDINGS Eight blogs were identified for analysis. Of the 40 categories, eight subthemes were assimilated; internal dialogue, emotions, transition, stroke effects, health care, "in the world", relationships, rehabilitation. Two main themes were identified related to perspectives of lived-experience; Internal relationship with "self" and External relationship with "the world". Participants expressed loss and initially strove to regain their "old" lives, their focus being recovery and independence. CONCLUSION Stroke survivors must transition from their previous life to a new and initially unwelcome way of being. Rehabilitation should respect this process and support stroke survivors as they undertake this individual journey.
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Affiliation(s)
- Caroline M Thomas
- Torbay and South Devon NHS Foundation Trust, Torquay, UK.,School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Rhoda Allison
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.,School of Nursing, Midwifery and Paramedicine, Faculty of Human Science, Curtin University, Perth, WA, Australia
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