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Nishiyama M, Koreki A, Isose S, Takeda T, Ishikawa A, Kokubun S, Saito Y, Ito K, Arai K, Takahashi N, Motoda Y, Kuwabara S, Honda K. Factors associated with psychological distress in patients with amyotrophic lateral sclerosis: A retrospective medical records study. J Psychosom Res 2024; 187:111915. [PMID: 39270519 DOI: 10.1016/j.jpsychores.2024.111915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 09/02/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE Although psychological distress is a prevalent issue among patients with amyotrophic lateral sclerosis (ALS) and can impact survival, the risk factors contributing to this distress remain insufficiently understood. METHODS Patients with ALS who completed the Profile of Mood States (POMS) between June 2017 and March 2022 were included. Participants with moderate to severe cognitive decline were excluded, resulting in the recruitment of 121 patients. The associations between POMS profiles and clinical characteristics were analyzed. Physical motor symptoms were evaluated using the Revised ALS Functional Rating Scale (ALSFRS-R) for objective measurement and the 40-item ALS Assessment Questionnaire (ALSAQ-40) for subjective assessment. RESULTS Our model, employing the ALSFRS-R, revealed significant factors associated with overall psychological distress, as assessed by the POMS, including upper limb symptoms, the presence of sleep apnea syndrome, older age at onset, and male sex, with an inverse association with tracheostomy. The POMS subscale scores revealed that anger and depression were significantly associated with upper limb symptoms. The second model, which employed subjective scales, yielded similar results, reinforcing the robustness of our findings. Moreover, subjective bulbar symptoms on the ALSAQ-40 were significantly associated with psychological distress, particularly in female patients. CONCLUSION This study identified the main clinical characteristics significantly associated with psychological distress in patients with ALS. Our findings may be useful in developing individualized psychological management strategies for these patients.
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Affiliation(s)
- Mami Nishiyama
- Department of Psychology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Akihiro Koreki
- Department of Psychiatry, NHO Shimofusa Psychiatric Medical Center, Chiba, Japan; Department of Psychiatry, NHO Chibahigashi National Hospital, Chiba, Japan.
| | - Sagiri Isose
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Takahiro Takeda
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Ai Ishikawa
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Sayuri Kokubun
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Yumiko Saito
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Kimiko Ito
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Kimihito Arai
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Nao Takahashi
- Department of Psychology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Yuka Motoda
- Department of Psychology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhiro Honda
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
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Silva ST, Costa IM, Souza AA, Pondofe K, Melo LP, Resqueti VR, Valentim R, Gonçalves F, Ribeiro TS. Physical therapy for the management of global function, fatigue and quality of life in amyotrophic lateral sclerosis: systematic review and meta-analyses. BMJ Open 2024; 14:e076541. [PMID: 39182937 PMCID: PMC11404137 DOI: 10.1136/bmjopen-2023-076541] [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] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVES To critically evaluate the effectiveness of physical therapy interventions in improving global function, quality of life and fatigue in individuals with amyotrophic lateral sclerosis (ALS). DESIGN Systematic review and meta-analyses. DATA SOURCES MEDLINE, EMBASE, Cochrane Library (CENTRAL) and Physiotherapy Evidence Database (PEDro) were searched through 31 January 2023. ELIGIBILITY CRITERIA We included randomised clinical trials (RCTs) that compared physical therapy interventions that act on global function, fatigue and quality of life in individuals with ALS with any other non-physiotherapeutic methods and techniques, placebo or non-intervention. The primary outcome measure was the evaluation of global function. Secondary outcomes were quality of life, fatigue and adverse events. DATA EXTRACTION AND SYNTHESIS Two independent authors used a researcher-developed extraction form and the Rayyan software to search, screen and code included studies. The risk of bias was assessed using the PEDro scale. Meta-analyses were conducted employing random effects. Outcomes were succinctly presented in Grading of Recommendations, Assessment, Development and Evaluation evidence profiles. RESULTS Our searches identified 39 415 references. After study selection, three studies were included in the review. Such studies involved 62 participants with a mean age of 54.6 years. In the evaluated trials, 40 were male, while 22 participants were female. Regarding the type of onset of the disease, 58 participants had spinal onset of ALS, and four had bulbar. CONCLUSIONS Physical therapy intervention may improve the global function of individuals with ALS in the short term; however, clinically, it was inconclusive. In terms of quality of life and fatigue, physical therapy intervention is not more effective than control in the short term. Adverse events are not increased by physical therapy intervention in the short term. Due to significant methodological flaws, small sample sizes, wide CIs and clinical interpretation, our confidence in the effect estimate is limited. PROSPERO REGISTRATION NUMBER CRD42021251350.
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Affiliation(s)
- Stephano Tomaz Silva
- Department of Physical Therapy and Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Isabela Macedo Costa
- Department of Physical Therapy and Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Aline Alves Souza
- Department of Physical Therapy and Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Karen Pondofe
- Department of Physical Therapy and Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Luciana Protásio Melo
- Department of Physical Therapy and Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Vanessa R Resqueti
- Fisioterapia, Laboratório de Inovação Tecnológica em Reabilitação e PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Ricardo Valentim
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Filipe Gonçalves
- Portuguese Association of Amyotrophic Lateral Sclerosis, Faculty of Health Sciences, University of A Coruna, A Coruna, Spain
| | - Tatiana Souza Ribeiro
- Department of Physical Therapy and Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
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Gonçalves F, Teixeira MI, Magalhães B. The role of spirituality in people with amyotrophic lateral sclerosis and their caregivers: Scoping review. Palliat Support Care 2023; 21:914-924. [PMID: 36464916 DOI: 10.1017/s1478951522001511] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are few studies evaluating the role of spirituality and the role of spiritually integrated interventions in people with amyotrophic lateral sclerosis (PALS) and their caregivers. OBJECTIVES A scoping review was conducted to examine the nature and breadth of peer-reviewed literature on the role of spirituality, interventions integrating spirituality, and outcomes for PALS and their caregivers. METHODS A literature review was performed, following the methods from the Joanna Briggs Institute Reviewers, based on all articles published between January 2006 and April 2022, identified in the CINAHL Complete, MEDLINE Complete, MedicLatina, Psychology and Behavioral Sciences Collection, and SPORTDiscus with full-text databases using key terms. Extracted data included research aims, study design, population and characteristics, theme description, and measures or type of intervention. RESULTS A total of 18 articles were included in this study: 14 qualitative, 3 quantitative, and 1 protocol of a quantitative study. Eight studies were based in Europe. The search identified different main themes related to spirituality for caregivers and patients, 2 spiritual measure scales, and one intervention. However, many studies were limited in sample size, generalizability, and transferability and used less sophisticated research designs. SIGNIFICANCE OF THE RESULTS This scoping review illustrates the importance given to spirituality by caregivers and PALS and reveals a very heterogeneous response. Thus, experimental studies in the area of spirituality are needed to systematically explore the impact of spiritual interventions, and the results of these studies could advance practice and policy by enhancing the quality of life for PALS and their caregivers.
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Affiliation(s)
- Filipe Gonçalves
- APELA - Portuguese Amyotrophic Lateral Sclerosis Association, Porto, Portugal
- Faculty of Health Sciences, University of A Coruña (UdC), A Coruña, Spain
| | - Margarida I Teixeira
- APELA - Portuguese Amyotrophic Lateral Sclerosis Association, Porto, Portugal
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Bruno Magalhães
- Oncology Nursing Research Unit, IPo-Porto Research (CI-POP), Portuguese Oncology Institute of Porto (IPO-Porto)/Porto Comprehensive Cancer Center (Porto. CCC) & Rise@Ci-IPOP (Health Research Network), Porto, Portugal
- School of Health, University of Trás-os-Montes and Alto Douro (ESS-UTAD), Vila Real, Portugal
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Hoxhaj P, Hastings N, Kachhadia MP, Gupta R, Sindhu U, Durve SA, Azam A, Auz Vinueza MJ, Bhuvan, Win SH, Rathod DC, Afsar AP. Exploring Advancements in the Treatment of Amyotrophic Lateral Sclerosis: A Comprehensive Review of Current Modalities and Future Prospects. Cureus 2023; 15:e45489. [PMID: 37868386 PMCID: PMC10585945 DOI: 10.7759/cureus.45489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal and incurable disease requiring a multidisciplinary treatment approach and a collaborative therapeutic effort. A combination of both upper and lower motor neuron degeneration ultimately leads to respiratory failure, similar to other dementia-type neurodegenerative diseases. The aim of this paper is to pioneer current ALS research by carrying out a narrative literature review of the current treatment modalities of the disease. Through these efforts, we hope to condense the most pertinent information regarding current treatments and enhance the management of ALS patients as a whole, giving these patients a better quality of life as the search for a cure continues. We used a Pubmed search strategy and specific MeSH terms for the selection of the literature articles using the keywords "ALS," "new treatment," "treatment," and "symptomatic treatment." A combination of pharmaceutical interventions, psychological support, and physical rehabilitation has been most effective in enhancing the quality of life of patients with ALS (PALS). Among potential pharmacological therapies, only a few have been approved by the US Food and Drug Administration(FDA) to be used to treat ALS and its symptoms. Other treatment modalities being considered include gene therapy, cellular therapy, psychological therapy, physical therapy, and speech therapy, alongside robotics, alternative feeding methods, and communication devices.
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Affiliation(s)
- Pranvera Hoxhaj
- Medicine, University of Medicine, Tirana, Tirana, ALB
- Obstetrics and Gynaecology, Scher & Kerenyi MDS, New York, USA
| | - Natasha Hastings
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Meet Popatbhai Kachhadia
- Internal Medicine, Pandit Dindayal Upadhyay (PDU) Medical College, Civil Hospital Campus, Rajkot, IND
| | - Riya Gupta
- Medicine and Surgery, Shri Atal Bihari Vajpayee Medical College and Research Institute, Bangalore, IND
| | - Udeept Sindhu
- Medicine and Surgery, Kasturba Medical College, Manipal, Manipal, IND
| | - Shreya A Durve
- General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Areeba Azam
- Medicine, Lahore Medical and Dental College, Lahore, PAK
| | - María J Auz Vinueza
- Critical Care, Hospital de Especialidades de las Fuerzas Armadas N1, Quito, ECU
| | - Bhuvan
- Internal Medicine, Government Medical College, Amritsar, Amritsar, IND
| | - Shwe H Win
- Medicine, University of Medicine, Magway, Magway, MMR
| | - Deepak C Rathod
- Medicine, Chandramma Dayanand Sagar Institute of Medical Education and Research, Harohalli, IND
| | - Aiman P Afsar
- Medicine, Maulana Azad Medical College, New Delhi, IND
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Rojas-Valverde D, Bonilla DA, Gómez-Miranda LM, Calleja-Núñez JJ, Arias N, Martínez-Guardado I. Examining the Interaction between Exercise, Gut Microbiota, and Neurodegeneration: Future Research Directions. Biomedicines 2023; 11:2267. [PMID: 37626763 PMCID: PMC10452292 DOI: 10.3390/biomedicines11082267] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Physical activity has been demonstrated to have a significant impact on gut microbial diversity and function. Emerging research has revealed certain aspects of the complex interactions between the gut, exercise, microbiota, and neurodegenerative diseases, suggesting that changes in gut microbial diversity and metabolic function may have an impact on the onset and progression of neurological conditions. This study aimed to review the current literature from several databases until 1 June 2023 (PubMed/MEDLINE, Web of Science, and Google Scholar) on the interplay between the gut, physical exercise, microbiota, and neurodegeneration. We summarized the roles of exercise and gut microbiota on neurodegeneration and identified the ways in which these are all connected. The gut-brain axis is a complex and multifaceted network that has gained considerable attention in recent years. Research indicates that gut microbiota plays vital roles in metabolic shifts during physiological or pathophysiological conditions in neurodegenerative diseases; therefore, they are closely related to maintaining overall health and well-being. Similarly, exercise has shown positive effects on brain health and cognitive function, which may reduce/delay the onset of severe neurological disorders. Exercise has been associated with various neurochemical changes, including alterations in cortisol levels, increased production of endorphins, endocannabinoids like anandamide, as well as higher levels of serotonin and dopamine. These changes have been linked to mood improvements, enhanced sleep quality, better motor control, and cognitive enhancements resulting from exercise-induced effects. However, further clinical research is necessary to evaluate changes in bacteria taxa along with age- and sex-based differences.
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Affiliation(s)
- Daniel Rojas-Valverde
- Nucleus of Studies for High Performance and Health (CIDISAD-NARS), School of Human Movement Sciences and Quality of Life (CIEMHCAVI), National University, Heredia 86-3000, Costa Rica
- Sports Injury Clinic (Rehab & Readapt), School of Human Movement Sciences and Quality of Life (CIEMHCAVI), National University, Heredia 86-3000, Costa Rica
| | - Diego A. Bonilla
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia;
- Research Group in Biochemistry and Molecular Biology, Faculty of Sciences and Education, Universidad Distrital Francisco José de Caldas, Bogotá 110311, Colombia
- Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba, Montería 230002, Colombia
- Sport Genomics Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Luis M. Gómez-Miranda
- Sports Faculty, Autonomous University of Baja California, Tijuana 22615, Mexico; (L.M.G.-M.); (J.J.C.-N.)
| | - Juan J. Calleja-Núñez
- Sports Faculty, Autonomous University of Baja California, Tijuana 22615, Mexico; (L.M.G.-M.); (J.J.C.-N.)
| | - Natalia Arias
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, C/del Hostal, 28248 Madrid, Spain;
| | - Ismael Martínez-Guardado
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, C/del Hostal, 28248 Madrid, Spain;
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Soares DF, Henriques R, Gromicho M, de Carvalho M, Madeira SC. Triclustering-based classification of longitudinal data for prognostic prediction: targeting relevant clinical endpoints in amyotrophic lateral sclerosis. Sci Rep 2023; 13:6182. [PMID: 37061549 PMCID: PMC10105751 DOI: 10.1038/s41598-023-33223-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/10/2023] [Indexed: 04/17/2023] Open
Abstract
This work proposes a new class of explainable prognostic models for longitudinal data classification using triclusters. A new temporally constrained triclustering algorithm, termed TCtriCluster, is proposed to comprehensively find informative temporal patterns common to a subset of patients in a subset of features (triclusters), and use them as discriminative features within a state-of-the-art classifier with guarantees of interpretability. The proposed approach further enhances prediction with the potentialities of model explainability by revealing clinically relevant disease progression patterns underlying prognostics, describing features used for classification. The proposed methodology is used in the Amyotrophic Lateral Sclerosis (ALS) Portuguese cohort (N = 1321), providing the first comprehensive assessment of the prognostic limits of five notable clinical endpoints: need for non-invasive ventilation (NIV); need for an auxiliary communication device; need for percutaneous endoscopic gastrostomy (PEG); need for a caregiver; and need for a wheelchair. Triclustering-based predictors outperform state-of-the-art alternatives, being able to predict the need for auxiliary communication device (within 180 days) and the need for PEG (within 90 days) with an AUC above 90%. The approach was validated in clinical practice, supporting healthcare professionals in understanding the link between the highly heterogeneous patterns of ALS disease progression and the prognosis.
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Affiliation(s)
- Diogo F Soares
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.
| | - Rui Henriques
- INESC-ID and Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Marta Gromicho
- Instituto de Medicina Molecular and Instituto de Fisiologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mamede de Carvalho
- Instituto de Medicina Molecular and Instituto de Fisiologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sara C Madeira
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
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Tabor Gray L, Donohue C, Vasilopoulos T, Wymer JP, Plowman EK. Maximum Phonation Time as a Surrogate Marker for Airway Clearance Physiologic Capacity and Pulmonary Function in Individuals With Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1165-1172. [PMID: 36877985 PMCID: PMC10187964 DOI: 10.1044/2022_jslhr-22-00522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/23/2022] [Accepted: 12/12/2022] [Indexed: 05/18/2023]
Abstract
PURPOSE The increased use of telehealth practices has created a critical need for home-based surrogate markers for prognostic respiratory indicators of disease progression in persons with amyotrophic lateral sclerosis (pALS). Given that phonation relies on the respiratory subsystem of speech production, we aimed to examine the relationships between maximum phonation time (MPT), forced vital capacity, and peak cough flow and to determine the discriminant ability of MPT to detect forced vital capacity and peak cough flow impairments in pALS. METHOD MPT, peak cough flow, forced vital capacity, and ALS Functional Rating Scale scores were obtained from 62 pALS (El-Escorial Revised) every 3 months as part of a longitudinal natural history study. Pearson's correlations, linear regressions, and receiver operator characteristic curve analyses with the area under the curve (AUC), sensitivity, specificity, and likelihood ratios were calculated. RESULTS The mean age of pALS was 63.14 ± 10.95 years, 49% were female, and 43% had bulbar onset. MPT predicted forced vital capacity, F(1, 225) = 117.96, p < .0001, and peak cough flow, F(1, 217) = 98.79, p < .0001. A significant interaction was noted between MPT and ALS Functional Rating Scale-Revised respiratory subscore for forced vital capacity, F(1, 222) = 6.7, p = .010, and peak cough flow, F(1, 215) = 4.37, p = .034. The discriminant ability of MPT was excellent for peak cough flow (AUC = 0.88) and acceptable for forced vital capacity (AUC = 0.78). CONCLUSIONS MPT is a simple clinical test that can be measured via telehealth and represents a potential surrogate marker for important respiratory and airway clearance indices. Further larger studies are required to validate these findings with remote data collection. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22186408.
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Affiliation(s)
- Lauren Tabor Gray
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Center for Collaborative Research, NOVA Southeastern University, Fort Lauderdale, FL
| | - Cara Donohue
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
| | | | - James P. Wymer
- Department of Neurology, University of Florida, Gainesville
| | - Emily K. Plowman
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
- Department of Neurology, University of Florida, Gainesville
- Department of Surgery, University of Florida, Gainesville
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Duan H, Lian Y, Jing Y, Xing J, Li Z. Research progress in extracorporeal shock wave therapy for upper limb spasticity after stroke. Front Neurol 2023; 14:1121026. [PMID: 36846123 PMCID: PMC9947654 DOI: 10.3389/fneur.2023.1121026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Spasticity is one of the most common complications after stroke. With the gradual intensification of spasticity, stroke patients will have a series of problems such as joint ankylosis and movement restriction, which affect the daily activities and increase the burden on patients' families, medical staff and society. There are many ways to treat post-stroke spasticity before, including physical therapy and exercise therapy, drug therapy, surgery and so on, but not satisfied because of a few shortcomings. In recent years, many researchers have applied extracorporeal shock wave therapy (ESWT) for the treatment of post-stroke spasm and achieved good clinical effect, because it is non-invasive, safe, easy to operate, low cost and other advantages compared with other treatment methods. This article reviews the research progress and existing problems of ESWT in the treatment of post-stroke spasticity.
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Affiliation(s)
- Haoyang Duan
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Yawen Lian
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Yuling Jing
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Jingsong Xing
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
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Burke KM, Ellrodt AS, Joslin BC, Sanpitak PP, MacAdam C, Deo P, Ozment K, Shea C, Johnson SA, Ho D, Chu SK, Babu AN, Franz CK, Paganoni S. Ultrasound-guided glenohumeral joint injections for shoulder pain in ALS: A case series. Front Neurol 2023; 13:1067418. [PMID: 36814537 PMCID: PMC9940635 DOI: 10.3389/fneur.2022.1067418] [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: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Shoulder pain is a common secondary impairment for people living with ALS (PALS). Decreased range of motion (ROM) from weakness can lead to shoulder pathology, which can result in debilitating pain. Shoulder pain may limit PALS from participating in activities of daily living and may have a negative impact on their quality of life. This case series explores the efficacy of glenohumeral joint injections for the management of shoulder pain due to adhesive capsulitis in PALS. Methods People living with ALS and shoulder pain were referred to sports medicine-certified physiatrists for diagnostic evaluation and management. They completed the Revised ALS Functional Rating Scale and a questionnaire asking about their pain levels and how it impacts sleep, function, and quality of life at baseline pre-injection, 1-week post-injection, 1 month post-injection, and 3 months post-injection. Results We present five cases of PALS who were diagnosed with adhesive capsulitis and underwent glenohumeral joint injections. Though only one PALS reported complete symptom resolution, all had at least partial symptomatic improvement during the observation period. No complications were observed. Conclusions People living with ALS require a comprehensive plan to manage shoulder pain. Glenohumeral joint injections are safe and effective for adhesive capsulitis in PALS, but alone may not completely resolve shoulder pain. Additional therapies to improve ROM and reduce pain should be considered.
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Affiliation(s)
- Katherine M. Burke
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States,*Correspondence: Katherine M. Burke ✉
| | - Amy S. Ellrodt
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Benjamin C. Joslin
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Pia P. Sanpitak
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Claire MacAdam
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Prabhav Deo
- Shirley Ryan AbilityLab, Chicago, IL, United States,Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kevin Ozment
- Shirley Ryan AbilityLab, Chicago, IL, United States,Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Cristina Shea
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Stephen A. Johnson
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Doreen Ho
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Samuel K. Chu
- Shirley Ryan AbilityLab, Chicago, IL, United States,Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ashwin N. Babu
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States,Massachusetts General Hospital Department of Orthopedics, Sports Medicine, Boston, MA, United States
| | - Colin K. Franz
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States,Shirley Ryan AbilityLab, Chicago, IL, United States,Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sabrina Paganoni
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States,VA Boston Healthcare System, Boston, MA, United States
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Vance D, Blanchard M, Pendleton S, Richardson S, Moran J, Baker J, Benton H. Creating a consumer-friendly resource to assist persons with Amyotrophic Lateral Sclerosis (ALS) in navigating the power wheelchair selection process. Assist Technol 2023; 35:35-40. [PMID: 33909545 DOI: 10.1080/10400435.2021.1915899] [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] Open
Abstract
Persons living with Amyotrophic Lateral Sclerosis (ALS), a fatal neurodegenerative disease, are often asked to make important decisions regarding power wheelchair (PWC) selection soon after receiving a diagnosis. There is currently a paucity of consumer-friendly information to aid clients living with ALS in better understanding the long-term functional implications of decisions made during the PWC selection process. The purpose of this action research project was to identify the specific considerations and choices required during the PWC selection process to use as the basis for creating a concise, educational video tool that emphasizes functional independence and self-advocacy for clients living with ALS. Semi-structured interviews of a panel of expert stakeholders were conducted to isolate important considerations for PWC selection in clients living with ALS. Qualitative data were collected through coded interviews and used to prioritize themes that were incorporated into an educational video. Once the draft video was created, the expert panel was provided time to review and critique the video prior to the creation of a professional quality video. Major themes identified and analyzed included environmental considerations, PWC component options, self-advocacy, and transportation. The video resource aims to be a resource for beginning a conversation about PWC options to make the PWC evaluation and selection process less daunting for clients and their caregivers.
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Affiliation(s)
- Daniel Vance
- Louisiana State University Health Sciences Center, School of Occupational Therapy, New Orleans, Louisiana, USA
| | - Mark Blanchard
- Louisiana State University Health Sciences Center, School of Occupational Therapy, New Orleans, Louisiana, USA
| | - Sara Pendleton
- Louisiana State University Health Sciences Center, School of Occupational Therapy, New Orleans, Louisiana, USA
| | - Sally Richardson
- Louisiana State University Health Sciences Center, School of Occupational Therapy, New Orleans, Louisiana, USA
| | - Jessica Moran
- Louisiana State University Health Sciences Center, School of Occupational Therapy, New Orleans, Louisiana, USA
| | - Jessica Baker
- Louisiana State University Health Sciences Center, School of Occupational Therapy, New Orleans, Louisiana, USA
| | - Hillary Benton
- Louisiana State University Health Sciences Center, School of Occupational Therapy, New Orleans, Louisiana, USA
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11
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Brizzi K. Outpatient neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:29-48. [PMID: 36599513 DOI: 10.1016/b978-0-12-824535-4.00002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Palliative care is an approach to patient care that focuses on enhancing quality of life through relief of physical, emotional, and spiritual sources of distress and patient-tailored discussions about goals of care. The palliative care approach can be delivered by any provider, and can occur alongside disease-modifying therapies. For patients with a serious neurologic illness or a neurodegenerative disease, neuropalliative care is a growing field focused on providing high-quality palliative care to neurology patients. There are three models of neuropalliative care delivery in the outpatient setting: a consultative model with a palliative care specialist, an integrated model with an embedded palliative care provider, and a primary palliative care model with the patient's neurology provider. The main components of an outpatient palliative care visit include symptom assessment and treatment, communication about serious illness, advance care planning, and assessment of caregiver needs. For patients with advanced illness, palliative care can help facilitate timely referral to hospice. Through a palliative care approach, outpatient care for patients with serious neurologic disease or neurodegenerative disease can focus on the issues most important to the patient, promote improved illness understanding and planning, and can improve the overall quality of care.
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Affiliation(s)
- Kate Brizzi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
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12
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Silva ST, Souza AAD, Pondofe K, Melo LPD, Resqueti VR, Valentim RADM, Ribeiro TS. Physical therapy for the management of motor symptoms in amyotrophic lateral sclerosis: protocol for a systematic review. BMJ Open 2022; 12:e063689. [PMID: 36414305 PMCID: PMC9684999 DOI: 10.1136/bmjopen-2022-063689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The prescription of an intervention plan can be challenging for the physical therapist, considering clinical phenotypes, individual prognosis and the rapid, progressive and deteriorating nature of amyotrophic lateral sclerosis (ALS). In this context, therapeutic exercises (eg, resistance and aerobic exercises) for patients with ALS remain controversial and may influence the treatment plan. Therefore, this review aims to critically assess whether physical therapy interventions are effective for improving functional capacity, quality of life and fatigue of individuals with ALS. METHODS AND ANALYSIS Studies will be selected according to eligibility criteria, and language, geographical area or publication date will not be restricted. Four databases will be used: MEDLINE, EMBASE, Cochrane Library (CENTRAL) and Physiotherapy Evidence Database (PEDro). Searches will also be conducted on ClinicalTrials.gov and references from included studies. We plan to conduct the searches between October and December 2022. Two independent authors will examine titles and abstracts and exclude irrelevant studies and duplicates. We will assess the quality of studies and quality of evidence, and disagreements will be resolved with a third researcher. The findings will be presented in the text and tables; if possible, we will perform meta-analyses. ETHICS AND DISSEMINATION No ethical approval is required because this study does not involve human beings. We will publish our findings in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42021251350.
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Affiliation(s)
- Stephano Tomaz Silva
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Aline Alves de Souza
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Karen Pondofe
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Vanessa R Resqueti
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Tatiana Souza Ribeiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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13
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Johnson SA, Fang T, De Marchi F, Neel D, Van Weehaeghe D, Berry JD, Paganoni S. Pharmacotherapy for Amyotrophic Lateral Sclerosis: A Review of Approved and Upcoming Agents. Drugs 2022; 82:1367-1388. [PMID: 36121612 DOI: 10.1007/s40265-022-01769-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/03/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disorder involving loss of upper and lower motor neurons, with most cases ending in death within 3-5 years of onset. Several molecular and cellular pathways have been identified to cause ALS; however, treatments to stop or reverse disease progression are yet to be found. Riluzole, a neuroprotective agent offering only a modest survival benefit, has long been the sole disease-modifying therapy for ALS. Edaravone, which demonstrated statistically significant slowing of ALS disease progression, is gaining approval in an increasing number of countries since its first approval in 2015. Sodium phenylbutyrate and taurursodiol (PB-TURSO) was conditionally approved in Canada in 2022, having shown significant slowing of disease progression and prolonged survival. Most clinical trials have focused on testing small molecules affecting common cellular pathways in ALS: targeting glutamatergic, apoptotic, inflammatory, and oxidative stress mechanisms among others. More recently, clinical trials utilizing stem cell transplantation and other biologics have emerged. This rich and ever-growing pipeline of investigational products, along with innovative clinical trial designs, collaborative trial networks, and an engaged ALS community', provide renewed hope to finding a cure for ALS. This article reviews existing ALS therapies and the current clinical drug development pipeline.
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Affiliation(s)
- Stephen A Johnson
- Neurological Clinical Research Institute (NCRI), Healey & AMG Center for ALS, Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, MA, 02114, USA
| | - Ton Fang
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Fabiola De Marchi
- Department of Neurology, ALS Centre, Maggiore della Carità Hospital, Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale, 28100, Novara, Italy
| | | | - Donatienne Van Weehaeghe
- Nuclear Medicine Subdivision, Department of Imaging and Pathology, University Hospital Leuven, Leuven, Belgium
| | - James D Berry
- Neurological Clinical Research Institute (NCRI), Healey & AMG Center for ALS, Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, MA, 02114, USA
| | - Sabrina Paganoni
- Neurological Clinical Research Institute (NCRI), Healey & AMG Center for ALS, Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, MA, 02114, USA.
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA.
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14
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The Complexities of Prescribing Assistive Equipment at the End of Life—Patient and Caregivers’ Perspectives. Healthcare (Basel) 2022; 10:healthcare10061005. [PMID: 35742056 PMCID: PMC9222988 DOI: 10.3390/healthcare10061005] [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: 03/30/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023] Open
Abstract
Ongoing participation in valued and essential everyday activities remains a priority for people with advanced disease. This study sought to understand factors influencing patients with advanced disease and caregivers’ utilisation of assistive equipment that enable this participation. Employing a pragmatic approach, purposive sampling identified participants who were interviewed in their homes. A semi-structured interview guide was employed to elicit community dwelling patients’ and caregivers’ perspectives about assistive equipment utilisation. Recorded interviews were analysed inductively and themes were constructed from the data. Fourteen interviews were conducted with patients and caregivers. Patients had a range of cancers and COPD. Three empirically developed themes demonstrate the complexities associated with the use of assistive equipment at the end of life: 1. Enabling engagement in everyday activities; 2. Dependency—a two-way street; 3. The pragmatics of choosing, using or declining assistive equipment. Participants were motivated to use assistive equipment when it optimised their function, enabled participation and supported their values, roles and interests. Conversely, use of assistive equipment could be met with ambivalence as it represented deterioration or could cause conflict within relationships. Caregivers found assistive equipment made it easier for them to provide physical care. Skilled proactive assistive equipment prescription and training by allied health professionals enhanced patient and caregiver confidence and capacity to engage in everyday activities.
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15
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Apreleva Kolomeytseva AT, Brylev L, Eshghi M, Bottaeva Z, Zhang J, Fachner JC, Street AJ. Home-Based Music Therapy to Support Bulbar and Respiratory Functions of Persons with Early and Mid-Stage Amyotrophic Lateral Sclerosis-Protocol and Results from a Feasibility Study. Brain Sci 2022; 12:494. [PMID: 35448025 PMCID: PMC9027911 DOI: 10.3390/brainsci12040494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 01/27/2023] Open
Abstract
Respiratory failure, malnutrition, aspiration pneumonia, and dehydration are the precursors to mortality in ALS. Loss of natural communication is considered one of the worst aspects of ALS. This first study to test the feasibility of a music therapy protocol for bulbar and respiratory rehabilitation in ALS employs a mixed-methods case study series design with repeated measures. Newly diagnosed patients meeting the inclusion criteria were invited to participate, until the desired sample size (n = 8) was achieved. The protocol was delivered to participants in their homes twice weekly for six weeks. Individualised exercise sets for independent practice were provided. Feasibility data (recruitment, retention, adherence, tolerability, self-motivation and personal impressions) were collected. Bulbar and respiratory changes were objectively measured. Results. A high recruitment rate (100%), a high retention rate (87.5%) and high mean adherence to treatment (95.4%) provide evidence for the feasibility of the study protocol. The treatment was well tolerated. Mean adherence to the suggested independent exercise routine was 53%. The outcome measurements to evaluate the therapy-induced change in bulbar and respiratory functions were defined. Findings suggest that the protocol is safe to use in early- and mid-stage ALS and that music therapy was beneficial for the participants' bulbar and respiratory functions. Mean trends suggesting that these functions were sustained or improved during the treatment period were observed for most outcome parameters: Maximal Inspiratory Pressure, Maximal Expiratory Pressure, Peak Expiratory Flow, the Center for Neurologic Study-Bulbar Function Scale speech and swallowing subscales, Maximum Phonation Time, Maximum Repetition Rate-Alternating, Maximum Repetition Rate-Sequential, Jitter, Shimmer, NHR, Speaking rate, Speech-pause ratio, Pause frequency, hypernasality level, Time-to-Laryngeal Vestibule Closure, Maximum Pharyngeal Constriction Area, Peak Position of the Hyoid Bone, Total Pharyngeal Residue C24area. Conclusion. The suggested design and protocol are feasible for a larger study, with some modifications, including aerodynamic measure of nasalance, abbreviated voice sampling and psychological screening.
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Affiliation(s)
| | - Lev Brylev
- Bujanov Moscow City Clinical Hospital, 115419 Moscow, Russia;
- Institute of Higher Nervous Activity and Neurophysiology, 115419 Moscow, Russia
- Moscow Research and Clinical Center for Neuropsychiatry, 115419 Moscow, Russia
| | - Marziye Eshghi
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA 02129-4557, USA;
| | - Zhanna Bottaeva
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, 119180 Moscow, Russia;
| | - Jufen Zhang
- Faculty of Health, Education, Medicine & Social Care, School of Medicine, Anglia Ruskin University, Cambridge CM1 1SQ, UK;
| | - Jörg C. Fachner
- Music, Health and the Brain, Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CM1 1SQ, UK;
| | - Alexander J. Street
- Music, Health and the Brain, Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CM1 1SQ, UK;
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16
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Hassan AA, Elkins J, Hassan HY. Case Report: Stem cell therapy in amyotrophic lateral sclerosis. F1000Res 2022; 10:1080. [PMID: 35087666 PMCID: PMC8762680 DOI: 10.12688/f1000research.73967.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/28/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease leading to loss of upper and lower motor neurons at both spinal and bulbar levels.
For patients with ALS rehabilitation is important to maintain functional independence, ensure safety and optimize quality of life but is not curative. Stem cell therapy (SCT) provides a new approach to treat previously incurable diseases although peer reviewed published evidence has shown no benefit in ALS for slowing disease progression or functional loss. This case report presents a patient with ALS who underwent SCT but deteriorated rapidly after the procedure. Whether the deterioration was due to the natural progress of the disease or expedited by SCT remains unknown. The ethical considerations of how marketing influences healthcare and individuals’ decisions in desperate situations along with reasons for taking desperate measures are discussed. Patient education and open communication with ALS patients are imperative in gaining patient satisfaction and overcoming ill effects that marketing could have on unconventional methods of intervention. Raising awareness about the availability and access to multidisciplinary care, the timing of decisions with regards to symptom management and end of life care have proven to enhance the quality of life for such patients.
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Affiliation(s)
- Ala'a A Hassan
- Physiotherapy and Rehabilitation Department, Bahrain Defence Force Hospital, Riffa, Bahrain
| | | | - Hisham Y Hassan
- Banoon ART and Cytogenetics Center, Bahrain Defence Force Hospital, Riffa, Bahrain
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17
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Lazovic M, Nikolic D, Boyer FC, Borg K, Ceravolo MG, Zampolini M, Kiekens C. Evidence-based position paper on Physical and Rehabilitation Medicine practice for people with amyotrophic lateral sclerosis. Eur J Phys Rehabil Med 2022; 58:271-279. [PMID: 34786907 PMCID: PMC9980500 DOI: 10.23736/s1973-9087.21.07120-3] [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: 06/06/2021] [Revised: 10/27/2021] [Accepted: 11/17/2021] [Indexed: 11/08/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease that affects both upper and lower motor neurons and is fatal in its course. This evidence-based position paper represents the official position of the UEMS PRM Section. The aim of the paper is to define the role of the physical and rehabilitation medicine (PRM) physician and PRM professional practice for people with ALS. A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The responsibility of the PRM physician is functional assessment of persons with ALS and delivering the optimal and most effective PRM program of care. The rehabilitation program of patients with ALS should be delivered and monitored by the multiprofessional team, with the PRM physician as principal coordinator.
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Affiliation(s)
- Milica Lazovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia -
- Institute for Rehabilitation, Belgrade, Serbia -
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - François C Boyer
- Department of Physical and Rehabilitation Medicine, Reims Champagne Ardenne University, Sebastopol Hospital, Reims, France
| | - Kristian Borg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, University Hospital of Ancona, Politecnica delle Marche University, Ancona, Italy
| | - Mauro Zampolini
- Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy
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18
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Olesen LK, la Cour K, With H, Handberg C. Reflections of family caregivers and health professionals on the everyday challenges of caring for persons with amyotrophic lateral sclerosis and cognitive impairments: a qualitative study. Palliat Care Soc Pract 2022; 16:26323524221077702. [PMID: 35187490 PMCID: PMC8855464 DOI: 10.1177/26323524221077702] [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: 07/03/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022] Open
Abstract
Aims and objectives: To explore reflections of family caregivers and health professionals
regarding the challenges involved in caring for persons with amyotrophic
lateral sclerosis and cognitive and/or behavioral impairments
(PALS/CIs). Background: Family caregivers of PALS/CIs are highly burdened and at great risk of
psychological sequela. Professionals working with these families can be
negatively affected on their well-being and are at risk of burnout. Design: The design was a qualitative interview study. Methods: One focus group and 10 individual semi-structured interviews were conducted
with seven family caregivers and nine professionals after the death of a
PALS/CIs. The analysis was guided by the interpretive description
methodology and the theory of sense of coherence. This study adheres to the
COREQ guidelines and the ICMJE recommendations. Results: The family caregivers’ challenges regarding coping with everyday needs
related to the sick person were associated with ‘Accepting that nothing else
matters’, ‘Adjusting to new roles while balancing’, and ‘Realizing different
values in relationships’; whereas the professionals’ challenges were related
to ‘Collaboration a balancing act’, ‘Working in a home of sorrow’, and
‘Coordinating threads to tie’. Conclusion: Family caregivers found coping with the complexity of the diseases a
challenge, and their everyday life needed constant adjustment to new roles,
coping with inappropriate behavior, and navigating through the progression
of the diseases of their sick relatives while collaborating with numerous
professionals. The professionals struggled with coordinating and
collaborating with the families and with other colleagues due to the
severeness and complexity of diseases. Relevance to clinical practice: Findings point to the importance of relationships for caregivers and
professionals and a need to provide support through an online palliative
rehabilitation program that encompass coping strategies in relation to the
diseases. Trial registration details: Id no. NCT 04638608.
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Affiliation(s)
- Lene Klem Olesen
- National Rehabilitation Center for Neuromuscular Diseases (RCFM), Kongsvang Allé 23, 8000 Aarhus, Denmark
| | - Karen la Cour
- Research Unit of User Perspectives, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Heidi With
- National Rehabilitation Center for Neuromuscular Diseases (RCFM), Aarhus, Denmark
| | - Charlotte Handberg
- National Rehabilitation Center for Neuromuscular Diseases (RCFM), Aarhus, Denmark
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19
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He X, Wang X, Fu X. The effects of the quality nursing mode intervention on the psychological moods, postoperative complications, and nursing satisfaction of breast cancer surgery patients. Am J Transl Res 2021; 13:11540-11547. [PMID: 34786080 PMCID: PMC8581850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the influence of high-quality care on the psychological well-being, the postoperative complications, and patient satisfaction following a radical mastectomy. METHODS One hundred and eighteen breast cancer patients who underwent radical mastectomies from February, 2017 to May, 2019 in the Cancer Hospital of China Medical University were enrolled. Among them, 56 patients treated with regular care were included in the regular group, while the other 62 patients who underwent high-quality care were included in the high-quality group. The postoperative recoveries and complications were compared between the two groups. The visual analogue scale (VAS), the disabilities of the arm, shoulder and hand (DASH) questionnaire, the self-rating anxiety scale (SAS), the self-rating depression scale (SDS), the quality of life (QOL) assessment scale, and a patient satisfaction questionnaire were used to evaluate the degrees of pain, the upper limb recovery, the negative emotions, the QOL, the patient satisfaction and the two-year survival rate, respectively. RESULTS The ambulation times, the regression times of upper limb swelling, and the hospital stays in the high-quality group were remarkably shorter than they were in the regular group (P<0.05). The postoperative complications were less frequent in the high-quality group (P<0.05). The VAS scores in the high-quality group were lower than they were in the regular group at 1, 3, and 5 days after surgery, and the DASH scores in the high-quality group were lower at 1 month after discharge (P<0.05). The high-quality group showed lower SAS and SDS scores and higher QOL and patient satisfaction than the regular group (all P<0.05). There was no difference in the two-year survival rates between the two groups after the intervention (P>0.05). CONCLUSION High-quality care following a radical mastectomy contributes to postoperative recovery, the relief of negative emotions, the reduction of complications, as well as the enhancement of QOL and patient satisfaction, so it is worthy of clinical promotion.
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Affiliation(s)
- Xiaodan He
- Department of Gynecology and Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & InstituteShenyang 110042, Liaoning Province, China
| | - Xiaoxu Wang
- Department of Breast Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & InstituteShenyang 110042, Liaoning Province, China
| | - Xin Fu
- Department of Breast Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & InstituteShenyang 110042, Liaoning Province, China
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20
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Major ZZ, Vaida C, Major KA, Tucan P, Brusturean E, Gherman B, Birlescu I, Craciunaș R, Ulinici I, Simori G, Banica A, Pop N, Burz A, Carbone G, Pisla D. Comparative Assessment of Robotic versus Classical Physical Therapy Using Muscle Strength and Ranges of Motion Testing in Neurological Diseases. J Pers Med 2021; 11:jpm11100953. [PMID: 34683094 PMCID: PMC8541455 DOI: 10.3390/jpm11100953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023] Open
Abstract
The use of robotic systems in physical rehabilitation protocols has become increasingly attractive and has been given more focus in the last decade as a result of the high prevalence of motor deficits in the population, which is linked to an overburdened healthcare system. In accordance with current trends, three robotic devices have been designed, called ParReEx Elbow, ParReEx Wrist, and ASPIRE, which were designed to improve upper-limb medical recovery (shoulder, elbow, forearm, and wrist). The three automated systems were tested in a hospital setting with 23 patients (12 men and 11 women) suffering from motor deficits caused by various neurological diseases such as stroke, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS). The patients were divided into three groups based on their pathology (vascular, extrapyramidal, and neuromuscular). Objective clinical measures, such as the Medical Research Council (MRC) scale, goniometry, and dynamometry, were used to compare pre- and post-rehabilitation assessments for both robotic-aided and manual physical rehabilitation therapy. The results of these tests showed that, with the exception of a few minor differences in muscular strength recovery, the robotic-assisted rehabilitation methods performed equally as well as the manual techniques, though only minor improvements were validated during short-term rehabilitation. The greatest achievements were obtained in the goniometric analysis where some rehabilitation amplitudes increased by over 40% in the vascular group, but the same analysis returned regressions in the neuromuscular group. The MRC scale analysis returned no significant differences, with most regressions occurring in the neuromuscular group. The dynamometric analysis mostly returned improvements, but the highest value evolution was 19.07%, which also in the vascular group. While the results were encouraging, more research is needed with a larger sample size and a longer study period in order to provide more information regarding the efficacy of both rehabilitation methods in neurological illnesses.
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Affiliation(s)
- Zoltán Zsigmond Major
- Neurophysiology Department, National Center for Spinal Disorders, Királyhágó u. 1, 1126 Budapest, Hungary;
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (E.B.); (R.C.); (G.S.)
| | - Calin Vaida
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
- Correspondence: (C.V.); (D.P.)
| | - Kinga Andrea Major
- Second ICU, Neurosurgery Department, Cluj County Emergency Clinical Hospital, Strada Clinicilor 3-5, 400000 Cluj-Napoca, Romania;
| | - Paul Tucan
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Emanuela Brusturean
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (E.B.); (R.C.); (G.S.)
| | - Bogdan Gherman
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Iosif Birlescu
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Raul Craciunaș
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (E.B.); (R.C.); (G.S.)
| | - Ionut Ulinici
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Gábor Simori
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (E.B.); (R.C.); (G.S.)
| | - Alexandru Banica
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Nicoleta Pop
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Alin Burz
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Giuseppe Carbone
- DIMEG, University of Calabria, Via Pietro Bucci, 87036 Rende, Italy;
| | - Doina Pisla
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
- Correspondence: (C.V.); (D.P.)
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21
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Cleary S, Misiaszek JE, Wheeler S, Kalra S, Genuis SK, Johnston WS. Lung volume recruitment improves volitional airway clearance in amyotrophic lateral sclerosis. Muscle Nerve 2021; 64:676-682. [PMID: 34505708 PMCID: PMC9293446 DOI: 10.1002/mus.27417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/11/2022]
Abstract
Introduction/Aims In this study we evaluated the effects of lung volume recruitment treatment (LVR), a low‐tech, low‐cost, manual “breath‐stacking” technique used to help people cough with enough force to clear their airways, thereby reducing the risk of aspiration and choking, on five volitional airway clearance and protection behaviors used by people living with amyotrophic lateral sclerosis (PwALS). Methods Using a repeated‐measures cross‐over design, 29 PwALS performed five volitional airway clearance and protection behaviors in LVR treatment and in no‐treatment, control conditions. Peak cough flow (PCF) was used to measure maximum expiratory rate during forced expiration, throat clearing, hawking, post‐swallow coughing, and the supraglottic swallowing maneuver. Comparisons were made as a function of condition (treatment or control) and three time‐points (pretreatment, and 15 and 30 minutes posttreatment). Results LVR treatment had a significant positive effect on maximum expiratory rates during all tested airway clearance and protection behaviors. Increased PCF values lasted for up to 30 minutes post‐LVR for all tested behaviors in the treatment condition. Discussion We found that LVR treatment could increase control over airway clearance in PwALS, as well as provide improved airway protection for up to 30 minutes, the duration of a typical meal. This study has implications for patient care. These include offering patients control over some of the most feared symptoms of ALS, particularly choking during activities of daily living, and enhanced ALS respiratory care in low‐resource settings. Findings may have implications for other neurodegenerative disorders in which dysphagia occurs with retained sensory function.
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Affiliation(s)
- Stuart Cleary
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - John E Misiaszek
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sonya Wheeler
- Misericordia Hospital, Covenant Health Group, Edmonton, Alberta, Canada
| | - Sanjay Kalra
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shelagh K Genuis
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy S Johnston
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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22
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Angelini C, Siciliano G. An updated review on the role of prescribed exercise in the management of Amyotrophic lateral sclerosis. Expert Rev Neurother 2021; 21:871-879. [PMID: 34237230 DOI: 10.1080/14737175.2021.1951706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Amyotrophic Lateral Sclerosis is a group of sporadic or familial disorders, characterized by upper and lower motor neuron involvement, with variable progression.Areas covered: The authors present the role of exercise in counteracting muscle disuse, particularly on limb weakness, that might antagonize denervation. The persistence of inactivity can affect many systems and the patient can develop deconditioning, muscle joint tightness, which causes contractures and pain. The main area of the review is the evaluation of the studies done on ALS exercise rehabilitation protocols, this was done by the evaluation of outcome function and patient independence exerting a positive psychological impact on both patients and caregivers. A second target is underlying differences between endurance and resistance exercise protocols, which may throw light on the biological mechanism of skeletal muscle repair, functional performance, and metabolism. The authors present not only exercise trials but also molecular biomarkers that might help define changes induced by physical rehabilitation. Our findings might help to achieve the best rehabilitation program. A standardized rehabilitation protocol is important: the instructed patients may continue therapy at home or be followed by telemedicine.Expert opinion: This review evaluates exercise rehabilitation, a controversial issue, evidence is weak and non-conclusive but represents the art status.
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Affiliation(s)
- Corrado Angelini
- Neuromuscular Lab - Department of Neurosciences, University of Padova, Padova, Italy
| | - Gabriele Siciliano
- Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
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23
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Effects of prolonged interruption of rehabilitation routines in amyotrophic lateral sclerosis patients. Palliat Support Care 2021; 20:369-374. [PMID: 33942709 DOI: 10.1017/s1478951521000584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with amyotrophic lateral sclerosis (ALS) experienced prolonged interruption of their rehabilitation palliative care routines due to restrictive COVID-19 pandemic public health measures. This study assesses the effects of before and after the lockdown on functionality rates and quality of life (QoL) in patients with ALS. METHODS A longitudinal observational study was conducted. Participants were assessed three times - early January (T0), before mandatory lockdown (T1), and during lockdown (T2) - using the ALS Functional Rating Scale-revised (ALSFRS-R), Fatigue Severity Scale (FSS), and the ALS-Specific Quality of Life-Short Form (ALSSQOL-SF). The paired-sample t-test and Wilcoxon signed-rank test were used. RESULTS Thirty-two patients were included with a mean age of 56.9 (SD 14.2) years and mean symptoms onset of 27.1 (SD 14.3) months. ALSFRS-R mean scores decayed significantly over time when comparing T0-T1 (0.26 ± 0.38) and T1-T2 (1.36 ± 1.43) slopes (p < 0.001). Significant differences were observed between T1 and T2 for ALSSQOL-SF scores (115.31 ± 17.06 vs. 104.31 ± 20.65), especially in four specific domains, and FSS scores (34.06 ± 16.84 vs. 40.09 ± 17.63). Negative correlations between negative emotions and physical symptoms assessed by ALSSQOL-SF and FSS were found. SIGNIFICANCE OF THE RESULTS Rehabilitation treatment routines in palliative care, such as physiotherapy and speech therapy, appear to mitigate the ALSFRS-R slope. Prolonged interruption of rehabilitation during the lockdown may have accelerated the functional decline in ALS patients' motor skills with as measured after 2 months by the ALSFRS-R in the limb and bulbar subscores, but not respiratory subscore. Other short-term effects, increased fatigue and negative impact on QoL, were also verified.
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24
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Major ZZ, Vaida C, Major KA, Tucan P, Simori G, Banica A, Brusturean E, Burz A, Craciunas R, Ulinici I, Carbone G, Gherman B, Birlescu I, Pisla D. The Impact of Robotic Rehabilitation on the Motor System in Neurological Diseases. A Multimodal Neurophysiological Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6557. [PMID: 32916890 PMCID: PMC7557539 DOI: 10.3390/ijerph17186557] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 12/13/2022]
Abstract
Motor disability is a key feature of many neurological diseases, influencing the social roles of affected patients and their ability to perform daily life activities. Current rehabilitation capacities are overwhelmed by the age-related increase of motor dysfunctions seen, for example, in stroke, extrapyramidal or neuromuscular diseases. As the patient to rehabilitation personnel ration increases, robotic solutions might establish the possibility to rapidly satisfy the increasing demand for rehabilitation. This paper presents an inaugural exploratory study which investigates the interchangeability of a novel experimental robotic rehabilitation device system with classical physical therapy, using a multimodal neurophysiological assessment of the motor system-quantitative electroencephalogram (EEG), motor conduction times and turn/amplitude analysis. Preliminary results show no significant difference between the two methods; however, a significant effect of the therapy was found on different pathologies (beneficial for vascular and extrapyramidal, or limited, and only on preventing reduction of joint movements in neuromuscular).
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Affiliation(s)
- Zoltán Zsigmond Major
- Research Center for Advanced Medicine “MedFuture”, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, 400000 Cluj-Napoca, Romania;
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (G.S.); (E.B.); (R.C.)
| | - Calin Vaida
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (C.V.); (P.T.); (A.B.); (A.B.); (I.U.); (G.C.); (B.G.); (I.B.)
| | - Kinga Andrea Major
- Second ICU, Neurosurgery Department, Cluj County Emergency Clinical Hospital, Strada Clinicilor 3–5, 400000 Cluj-Napoca, Romania
| | - Paul Tucan
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (C.V.); (P.T.); (A.B.); (A.B.); (I.U.); (G.C.); (B.G.); (I.B.)
| | - Gábor Simori
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (G.S.); (E.B.); (R.C.)
| | - Alexandru Banica
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (C.V.); (P.T.); (A.B.); (A.B.); (I.U.); (G.C.); (B.G.); (I.B.)
| | - Emanuela Brusturean
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (G.S.); (E.B.); (R.C.)
| | - Alin Burz
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (C.V.); (P.T.); (A.B.); (A.B.); (I.U.); (G.C.); (B.G.); (I.B.)
| | - Raul Craciunas
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (G.S.); (E.B.); (R.C.)
| | - Ionut Ulinici
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (C.V.); (P.T.); (A.B.); (A.B.); (I.U.); (G.C.); (B.G.); (I.B.)
| | - Giuseppe Carbone
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (C.V.); (P.T.); (A.B.); (A.B.); (I.U.); (G.C.); (B.G.); (I.B.)
- DIMEG, University of Calabria, Via Pietro Bucci, 87036 Arcavacata, Italy
| | - Bogdan Gherman
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (C.V.); (P.T.); (A.B.); (A.B.); (I.U.); (G.C.); (B.G.); (I.B.)
| | - Iosif Birlescu
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (C.V.); (P.T.); (A.B.); (A.B.); (I.U.); (G.C.); (B.G.); (I.B.)
| | - Doina Pisla
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (C.V.); (P.T.); (A.B.); (A.B.); (I.U.); (G.C.); (B.G.); (I.B.)
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25
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Zhao C, Lange DJ, Wymer JP. Management of Primary Lateral Sclerosis. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00640-6] [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]
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26
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Spencer KR, Foster ZW, Rauf NA, Guilderson L, Collins D, Averill JG, Walker SE, Robey I, Cherry JD, Alvarez VE, Huber BR, McKee AC, Kowall NW, Brady CB, Stein TD. Neuropathological profile of long-duration amyotrophic lateral sclerosis in military Veterans. Brain Pathol 2020; 30:1028-1040. [PMID: 32633852 PMCID: PMC8018169 DOI: 10.1111/bpa.12876] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting both the upper and lower motor neurons. Although ALS typically leads to death within 3 to 5 years after initial symptom onset, approximately 10% of patients with ALS live more than 10 years after symptom onset. We set out to determine similarities and differences in clinical presentation and neuropathology in persons with ALS with long vs. those with standard duration. Participants were United States military Veterans with a pathologically confirmed diagnosis of ALS (n = 179), dichotomized into standard duration (<10 years) and long-duration (≥10 years). The ALS Functional Rating Scale-Revised (ALSFRS-R) was administered at study entry and semi-annually thereafter until death. Microglial density was determined in a subset of participants. long-duration ALS occurred in 76 participants (42%) with a mean disease duration of 16.3 years (min/max = 10.1/42.2). Participants with long-duration ALS were younger at disease onset (P = 0.002), had a slower initial ALS symptom progression on the ALSFRS-R (P < 0.001) and took longer to diagnose (P < 0.002) than standard duration ALS. Pathologically, long-duration ALS was associated with less frequent TDP-43 pathology (P < 0.001). Upper motor neuron degeneration was similar; however, long-duration ALS participants had less severe lower motor neuron degeneration at death (P < 0.001). In addition, the density of microglia was decreased in the corticospinal tract (P = 0.017) and spinal cord anterior horn (P = 0.009) in long-duration ALS. Notably, many neuropathological markers of ALS were similar between the standard and long-duration groups and there was no difference in the frequency of known ALS genetic mutations. These findings suggest that the lower motor neuron system is relatively spared in long-duration ALS and that pathological progression is likely slowed by as yet unknown genetic and environmental modifiers.
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Affiliation(s)
| | | | | | | | | | | | | | - Ian Robey
- Southern Arizona VA Healthcare SystemTucsonAZ
| | - Jonathan D. Cherry
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMA
| | - Victor E. Alvarez
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of NeurologyBoston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
| | - Bertrand R. Huber
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
| | - Ann C. McKee
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of NeurologyBoston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
| | - Neil W. Kowall
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of NeurologyBoston University School of MedicineBostonMA
| | - Christopher B. Brady
- VA Boston Healthcare SystemBostonMA,Department of NeurologyBoston University School of MedicineBostonMA,Division of AgingBrigham and Women's Hospital, Harvard Medical SchoolBostonMA
| | - Thor D. Stein
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
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27
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Burke K, DE Marchi F, Swartz Ellrodt A, Doyle M, Koul M, Comeau O, Adelson E, Walter R, Kusy M, Amaya F, Anderson C, Honda J, Chan J, Berry J, Paganoni S. Exploring the use of educational materials for increasing participation in a stretching program: a quality improvement project in people with motor neuron disease. Eur J Phys Rehabil Med 2020; 57:78-84. [PMID: 32744050 DOI: 10.23736/s1973-9087.20.06245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Decreased range of motion is a common secondary complication of motor neuron disease (MND) that can contribute to functional decline and decreased participation in daily activities. AIM The purpose of this study was to develop and assess the effectiveness of educational brochures and videos aimed at improving knowledge regarding the importance of a regular stretching program. DESIGN This was a quality improvement (QI) project. SETTING Participants were seen in an outpatient multidisciplinary neuromuscular clinic. POPULATION Individuals with motor neuron disease were invited to participate in this QI study. METHODS Individuals were asked to complete surveys asking questions regarding current stretching program, pain levels, and knowledge of benefits of stretching before and after receiving the stretching brochures or videos. RESULTS A total of 53 participants completed the pre-intervention survey, 28 in the brochure group and 25 in the video group. Of those, 86% and 88% completed the post-intervention survey in the brochure and video groups, respectively. The video group increased stretching frequency significantly more than the brochure group (2.04 and 0.62 days/week respectively, P=0.004). Significantly more participants in the video group reported usage of stretches from the educational materials on a regular basis (54% for brochure group and 86% for video group, P=0.024). CONCLUSIONS Educational brochures and videos are two different strategies to improve knowledge of benefits of stretching for individuals with MND. Both groups increased frequency of stretching. Videos may be better able to improve frequency of stretching when compared to brochures. CLINICAL REHABILITATION IMPACT The brochures and videos developed for this study can be used by clinicians treating individuals with MND. By improving knowledge regarding the benefits of stretching, individuals with MND may choose to prioritize stretching as a part of their routine. This in turn may help to prevent or address potential joint or muscle length issues or assist patients to incorporate preventative measures into their treatment plans.
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Affiliation(s)
- Katherine Burke
- Department of Neurology, Harvard Medical School, Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Boston, MA, USA - .,Department of Physical Therapy, Institute of Health Professions, MGH, Boston, MA, USA -
| | - Fabiola DE Marchi
- Department of Neurology, Harvard Medical School, Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Boston, MA, USA
| | - Amy Swartz Ellrodt
- Department of Neurology, Harvard Medical School, Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Boston, MA, USA
| | - Michael Doyle
- Department of Neurology, Harvard Medical School, Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Boston, MA, USA
| | - Megha Koul
- Department of Neurology, Harvard Medical School, Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Boston, MA, USA
| | - Olivia Comeau
- Department of Neurology, Harvard Medical School, Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth Adelson
- Department of Neurology, Harvard Medical School, Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Boston, MA, USA
| | - Rebecca Walter
- Department of Physical Therapy, Institute of Health Professions, MGH, Boston, MA, USA
| | - Melissa Kusy
- Department of Physical Therapy, Institute of Health Professions, MGH, Boston, MA, USA
| | - Flor Amaya
- Department of Physical Therapy, Institute of Health Professions, MGH, Boston, MA, USA
| | - Carissa Anderson
- Department of Physical Therapy, Institute of Health Professions, MGH, Boston, MA, USA
| | - Jennifer Honda
- Department of Physical Therapy, Institute of Health Professions, MGH, Boston, MA, USA
| | - James Chan
- Department of Biostatistics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - James Berry
- Department of Neurology, Harvard Medical School, Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Boston, MA, USA
| | - Sabrina Paganoni
- Department of Neurology, Harvard Medical School, Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
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28
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Sass LR, Khani M, Romm J, Schmid Daners M, McCain K, Freeman T, Carter GT, Weeks DL, Petersen B, Aldred J, Wingett D, Martin BA. Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients. Fluids Barriers CNS 2020; 17:4. [PMID: 31959193 PMCID: PMC6971921 DOI: 10.1186/s12987-019-0164-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background Developing novel therapeutic agents to treat amyotrophic lateral sclerosis (ALS) has been difficult due to multifactorial pathophysiologic processes at work. Intrathecal drug administration shows promise due to close proximity of cerebrospinal fluid (CSF) to affected tissues. Development of effective intrathecal pharmaceuticals will rely on accurate models of how drugs are dispersed in the CSF. Therefore, a method to quantify these dynamics and a characterization of differences across disease states is needed. Methods Complete intrathecal 3D CSF geometry and CSF flow velocities at six axial locations in the spinal canal were collected by T2-weighted and phase-contrast MRI, respectively. Scans were completed for eight people with ALS and ten healthy controls. Manual segmentation of the spinal subarachnoid space was performed and coupled with an interpolated model of CSF flow within the spinal canal. Geometric and hydrodynamic parameters were then generated at 1 mm slice intervals along the entire spine. Temporal analysis of the waveform spectral content and feature points was also completed. Results Comparison of ALS and control groups revealed a reduction in CSF flow magnitude and increased flow propagation velocities in the ALS cohort. Other differences in spectral harmonic content and geometric comparisons may support an overall decrease in intrathecal compliance in the ALS group. Notably, there was a high degree of variability between cases, with one ALS patient displaying nearly zero CSF flow along the entire spinal canal. Conclusion While our sample size limits statistical confidence about the differences observed in this study, it was possible to measure and quantify inter-individual and cohort variability in a non-invasive manner. Our study also shows the potential for MRI based measurements of CSF geometry and flow to provide information about the hydrodynamic environment of the spinal subarachnoid space. These dynamics may be studied further to understand the behavior of CSF solute transport in healthy and diseased states.
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Affiliation(s)
- Lucas R Sass
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Mohammadreza Khani
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Jacob Romm
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA.,University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Kyle McCain
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Tavara Freeman
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Gregory T Carter
- St. Luke's Rehabilitation Institute, 711 South Cowley St., Spokane, WA, 99202, USA
| | - Douglas L Weeks
- St. Luke's Rehabilitation Institute, 711 South Cowley St., Spokane, WA, 99202, USA
| | - Brian Petersen
- Inland Imaging PS and LLC, 801 South Stevens St., Spokane, WA, 99204, USA
| | - Jason Aldred
- Selkirk Neurology, 610 South Sherman St. #201, Spokane, WA, 99202, USA
| | - Dena Wingett
- Inland Imaging LLC, 801 South Stevens St., Spokane, WA, 99204, USA
| | - Bryn A Martin
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA. .,Biological Engineering, University of Idaho, 875 Perimeter Dr. MS0904, Moscow, ID, 83844-0904, USA.
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29
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Paganoni S, van de Rijn M, Drake K, Burke K, Doyle M, Ellrodt AS, Nicholson K, Atassi N, de Marchi F, Babu S, Estrada J, Schwamm LH, Berry JD. Adjusted cost analysis of video televisits for the care of people with amyotrophic lateral sclerosis. Muscle Nerve 2019; 60:147-154. [PMID: 31136007 PMCID: PMC6772103 DOI: 10.1002/mus.26606] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We previously reported our amyotrophic lateral sclerosis (ALS) video televisit experience. Here we report on video televisit versus in-clinic costs, adjusting for perceived medical usefulness (MU). METHODS We take the patient-perspective and a focused institutional-perspective. Costs are adjusted for patient/caregiver and physician perceptions of visit MU. The base-case reflects our outpatient ALS practice. RESULTS In the base-case, from the patient perspective, in-clinic visits cost $1,116 and video televisits cost $89 ($119 after MU-adjustment). From the institutional perspective, clinic visits cost $799, and video televisits cost $354 ($472 after MU-adjustment). Adjusted cost-savings per televisit are $997 (patient) and $327 (institution). Sensitivity analyses on 5 variables accounted for uncertainty in base-case assumptions. CONCLUSIONS Video televisits provide marked adjusted cost-savings for patients and institutions. Adjusted costs are sensitive to perceived MU of video televisits. Future research should explore the ability of video televisits to reduce healthcare resource usage. Muscle Nerve 60: 147-154, 2019.
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Affiliation(s)
- Sabrina Paganoni
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Marc van de Rijn
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Kristin Drake
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine Burke
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael Doyle
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Swartz Ellrodt
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine Nicholson
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nazem Atassi
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fabiola de Marchi
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA
| | - Suma Babu
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juan Estrada
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee H Schwamm
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James D Berry
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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30
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Doughty CT, Guidon AC, Paganoni S, Hedley-Whyte ET. Case 12-2019: A 60-Year-Old Man with Weakness and Difficulty Chewing. N Engl J Med 2019; 380:1566-1574. [PMID: 30995378 DOI: 10.1056/nejmcpc1900141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Christopher T Doughty
- From the Department of Neurology, Brigham and Women's Hospital (C.T.D.), the Departments of Neurology (A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, Spaulding Rehabilitation Hospital (S.P.), and the Departments of Neurology (C.T.D., A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Harvard Medical School - all in Boston
| | - Amanda C Guidon
- From the Department of Neurology, Brigham and Women's Hospital (C.T.D.), the Departments of Neurology (A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, Spaulding Rehabilitation Hospital (S.P.), and the Departments of Neurology (C.T.D., A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Harvard Medical School - all in Boston
| | - Sabrina Paganoni
- From the Department of Neurology, Brigham and Women's Hospital (C.T.D.), the Departments of Neurology (A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, Spaulding Rehabilitation Hospital (S.P.), and the Departments of Neurology (C.T.D., A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Harvard Medical School - all in Boston
| | - E Tessa Hedley-Whyte
- From the Department of Neurology, Brigham and Women's Hospital (C.T.D.), the Departments of Neurology (A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, Spaulding Rehabilitation Hospital (S.P.), and the Departments of Neurology (C.T.D., A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Harvard Medical School - all in Boston
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31
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Exploring the Use of Educational Material About Shoulder Dysfunction: A Quality Improvement Project in People With Amyotrophic Lateral Sclerosis. Am J Phys Med Rehabil 2019; 97:379-382. [PMID: 29303793 PMCID: PMC5903949 DOI: 10.1097/phm.0000000000000885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Supplemental digital content is available in the text. Shoulder pain is a common secondary complication of amyotrophic lateral sclerosis (ALS) that can contribute to functional decline and decreased participation in daily activities. The purpose of this study was to assess the effectiveness of an educational brochure aimed at improving knowledge regarding shoulder pain and dysfunction in people with ALS. Participants completed a preintervention survey with questions regarding their knowledge of how ALS may affect their shoulders. After completing the presurvey, they were mailed a brochure that described shoulder health and range of motion and stretching exercises. Four weeks after receiving the brochure, participants were then asked to determine the effectiveness of the educational materials in terms of impact on shoulder-related knowledge and self-efficacy with regard to prevention of shoulder pain and dysfunction. More than 50% of participants reported pain, decreased range of motion, or weakness in at least one shoulder since being diagnosed with ALS. All participants were interested in receiving educational materials, and all agreed that the brochure was easy to interpret and understand, with most (87%) reporting that it was helpful. Educational brochures are one strategy to improve awareness about shoulder health and to educate patients with ALS about exercises that may help reduce shoulder pain and dysfunction.
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32
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Komata T. A case of amyotrophic lateral sclerosis which was diagnosed with progressive dysphagia and muscle atrophy. J Gen Fam Med 2019; 20:25-27. [PMID: 30631656 PMCID: PMC6321826 DOI: 10.1002/jgf2.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 11/09/2022] Open
Abstract
A 79-year-old man presented to our outpatient clinic with symptoms of dysphagia, dysarthria, and muscle atrophy of the trunk and upper extremities. These symptoms were gradually progressive, and he had lost substantial weight-20 kg in 2 years. One month later, he was admitted due to dehydration and received tube feeding. The presence of "split hand" suggested amyotrophic lateral sclerosis (ALS). Finally, the patient was diagnosed with ALS by two neurologists. When elderly patients present with progressive dysphagia and muscle atrophy, especially with "split hands," ALS should be included as a differential diagnosis.
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Affiliation(s)
- Tadashi Komata
- Department of RehabilitationNiigata Rehabilitation HospitalNiigataJapan
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33
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Ethical challenges in tracheostomy-assisted ventilation in amyotrophic lateral sclerosis. J Neurol 2018; 265:2730-2736. [DOI: 10.1007/s00415-018-9054-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 12/11/2022]
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34
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Bello-Haas VD. Physical therapy for individuals with amyotrophic lateral sclerosis: current insights. Degener Neurol Neuromuscul Dis 2018; 8:45-54. [PMID: 30890895 PMCID: PMC6065609 DOI: 10.2147/dnnd.s146949] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative, and inevitably fatal disease. There is no cure for ALS and life expectancy is typically 2–5 years after symptom onset. Despite the lack of a cure and the rapidly progressive nature of the disease, ALS is considered a “treatable disease” and rehabilitation is integral to optimal, comprehensive care. In addition to the other health care professions making up the health care team, physical therapy provides a critical role in the overall management in individuals with ALS. Physical therapy that is tailored to the individual’s needs and goals and focused on addressing symptoms and maximizing function and participation enables people with ALS to live their lives to the fullest and with quality. The purpose of this paper is to review some of the recent ALS research findings that have implications for physical therapy practice.
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Affiliation(s)
- Vanina Dal Bello-Haas
- Physiotherapy Program, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada,
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35
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Olsson Möller U, Stigmar K, Beck I, Malmström M, Rasmussen BH. Bridging gaps in everyday life - a free-listing approach to explore the variety of activities performed by physiotherapists in specialized palliative care. BMC Palliat Care 2018; 17:20. [PMID: 29378566 PMCID: PMC5789614 DOI: 10.1186/s12904-018-0272-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A growing body of studies indicate benefits of physiotherapy for patients in palliative care, for symptom relief and wellbeing. Though physiotherapists are increasingly acknowledged as important members of palliative care teams, they are still an underutilized source and not fully recognized. The aim of this study was to explore the variety of activities described by physiotherapists in addressing the needs and problems of patients and their families in specialized palliative care settings. METHODS Using a free-listing approach, ten physiotherapists working in eight specialized palliative care settings in Sweden described as precisely and in as much detail as possible different activities in which patients and their families were included (directly or indirectly) during 10 days. The statements were entered into NVivo and analysed using qualitative content analysis. Statements containing more than one activity were categorized per activity. RESULTS In total, 264 statements, containing 504 varied activities, were coded into seven categories: Counteracting a declining physical function; Informing, guiding and educating; Observing, assessing and evaluating; Attending to signs and symptoms; Listening, talking with and understanding; Caring for basic needs; and Organizing, planning and coordinating. In practice, however, the activities were intrinsically interwoven. The activities showed how physiotherapists aimed, through care for the body, to address patients' physical, psychological, social and existential needs, counteracting the decline in a patient's physical function and wellbeing. The activities also revealed a great variation, in relation not only to what they did, but also to their holistic and inseparable nature with regard to why, how, when, where, with whom and for whom the activities were carried out, which points towards a well-adopted person-centred palliative care approach. CONCLUSIONS The study provides hands-on descriptions of how person-centred palliative care is integrated in physiotherapists' everyday activities. Physiotherapists in specialized palliative care help patients and families to bridge the gap between their real and ideal everyday life with the aim to maximize security, autonomy and wellbeing. The concrete examples included can be used in understanding the contribution of physiotherapists to the palliative care team and inform future research interventions and outcomes.
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Affiliation(s)
- U Olsson Möller
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden. .,Faculty of Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - K Stigmar
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| | - I Beck
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Faculty of Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Faculty of Health Science, The Research Platform for Collaboration for Health, Kristianstad University, Kristianstad, Sweden
| | - M Malmström
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Department of Clinical Sciences Lund, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - B H Rasmussen
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
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36
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Madsen LS, Jeppesen J, Handberg C. “Understanding my ALS”. Experiences and reflections of persons with amyotrophic lateral sclerosis and relatives on participation in peer group rehabilitation. Disabil Rehabil 2018; 41:1410-1418. [DOI: 10.1080/09638288.2018.1429499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Louise Sofia Madsen
- Department of Public Health, Faculty of Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Denmark
| | - Jørgen Jeppesen
- The National Rehabilitation Centre for Neuromuscular Diseases, Aarhus, Denmark
| | - Charlotte Handberg
- Department of Public Health, Faculty of Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Denmark
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37
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Motor Neuron Diseases (Amyotrophic Lateral Sclerosis). Neuromuscul Disord 2018. [DOI: 10.1007/978-981-10-5361-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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38
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Dharmadasa T, Matamala JM, Huynh W, Zoing MC, Kiernan MC. Motor neurone disease. HANDBOOK OF CLINICAL NEUROLOGY 2018; 159:345-357. [PMID: 30482326 DOI: 10.1016/b978-0-444-63916-5.00022-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Motor neurone disease (MND) patients exhibit poor gait, balance, and postural control, all of which significantly increases their risk of falling. Falls are frequent in the MND population, and are associated with an increased burden of disease. The complex interplay of both motor and extramotor manifestations in this disease contributes to the heterogeneous and multifactorial causes of such dysfunction. This review highlights the pathophysiologic influence of motor degeneration in gait disturbance, but also the additional influence on postural instability from other inputs such as cognitive impairment, autonomic dysregulation, cerebellar dysfunction, sensory impairment, and extrapyramidal involvement. In various combinations, these impairments are responsible for reduced gait speed and alteration in gait cycle, as well as structurally more variable and disorganized gait patterns. Based on these features, this chapter will also provide disease-specific interventions to assess, manage, and prevent falls in the MND cohort.
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Affiliation(s)
| | | | - William Huynh
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Margaret C Zoing
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
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39
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Van De Rijn M, Paganoni S, Levine-Weinberg M, Campbell K, Swartz Ellrodt A, Estrada J, Cohen AB, Schwamm LH, Berry JD. Experience with telemedicine in a multi-disciplinary ALS clinic. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:143-148. [PMID: 29250986 DOI: 10.1080/21678421.2017.1392577] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Telemedicine using video televisits is emerging as a means to provide care directly to patients. Here we report our experience using video televisits to provide follow-up care as a part of the Massachusetts General Hospital (MGH) Telemedicine for People with ALS (TelePALS) initiative. METHODS This was a retrospective chart review of all video televisit encounters conducted by the MGH ALS clinic between September 2014 and January 2016. RESULTS A total of 97 distinct ALS patients were seen using video televisits. Twenty-four percent of these patients had more than one video televisit. The median distance of the patients' primary residence to MGH was 211 miles. The average video televisit lasted 32 min (±12). About half the patients (54%) were ambulatory at the time of their video televisit. The most commonly addressed issues were medication management (89%), discussion of goals of care (74%), research (55%) and equipment use (50%). Acute care issues were rarely discussed. CONCLUSION Video televisits are feasible and can be a useful tool to supplement traditional clinic-based multidisciplinary ALS care.
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Affiliation(s)
- Marc Van De Rijn
- a Harvard Medical School , Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,b Department of Physical Medicine and Rehabilitation , Spaulding Rehabilitation Hospital , Charlestown , MA , USA
| | - Sabrina Paganoni
- a Harvard Medical School , Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,b Department of Physical Medicine and Rehabilitation , Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,c Department of Neurology , Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital , Boston , MA , USA , and.,d VA Boston Healthcare System , Boston , MA , USA
| | - Mark Levine-Weinberg
- a Harvard Medical School , Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,c Department of Neurology , Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital , Boston , MA , USA , and
| | - Katharine Campbell
- a Harvard Medical School , Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,c Department of Neurology , Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital , Boston , MA , USA , and
| | - Amy Swartz Ellrodt
- a Harvard Medical School , Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,c Department of Neurology , Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital , Boston , MA , USA , and
| | - Juan Estrada
- a Harvard Medical School , Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,c Department of Neurology , Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital , Boston , MA , USA , and
| | - Adam B Cohen
- a Harvard Medical School , Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,c Department of Neurology , Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital , Boston , MA , USA , and
| | - Lee H Schwamm
- a Harvard Medical School , Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,c Department of Neurology , Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital , Boston , MA , USA , and
| | - James D Berry
- a Harvard Medical School , Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,c Department of Neurology , Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital , Boston , MA , USA , and
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40
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Hogden A, Crook A. Patient-centered decision making in amyotrophic lateral sclerosis: where are we? Neurodegener Dis Manag 2017; 7:377-386. [DOI: 10.2217/nmt-2017-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Developments in amyotrophic lateral sclerosis research and care delivery have created new arenas, and new dilemmas, for patients’ decision making. This review explores three aspects of amyotrophic lateral sclerosis patient-centered care and decision making: patient-centered service delivery through the expanding multidisciplinary team; decision making for genetic testing and the implications of undergoing testing; and development of user-designed decision support tools to help patients and families make decisions as their choices become more complex. Until a cure is found, well-timed and effective decision making will rely on patient and family preferences to guide them through an increasingly complicated disease landscape.
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Affiliation(s)
- Anne Hogden
- Australian Institute of Health Innovation, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ashley Crook
- Department of Clinical Medicine, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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41
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Paganoni S, Nicholson K, Leigh F, Swoboda K, Chad D, Drake K, Haley K, Cudkowicz M, Berry JD. Developing multidisciplinary clinics for neuromuscular care and research. Muscle Nerve 2017. [PMID: 28632945 PMCID: PMC5656914 DOI: 10.1002/mus.25725] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Multidisciplinary care is considered the standard of care for both adult and pediatric neuromuscular disorders and has been associated with improved quality of life, resource utilization, and health outcomes. Multidisciplinary care is delivered in multidisciplinary clinics that coordinate care across multiple specialties by reducing travel burden and streamlining care. In addition, the multidisciplinary care setting facilitates the integration of clinical research, patient advocacy, and care innovation (e.g., telehealth). Yet, multidisciplinary care requires substantial commitment of staff time and resources. We calculated personnel costs in our ALS clinic in 2015 and found an average cost per patient visit of $580, of which only 45% was covered by insurance reimbursement. In this review, we will describe classic and emerging concepts in multidisciplinary care models for adult and pediatric neuromuscular disease. We will then explore the financial impact of multidisciplinary care with emphasis on sustainability and metrics to demonstrate quality and value. Muscle Nerve 56: 848-858, 2017.
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Affiliation(s)
- Sabrina Paganoni
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA.,Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Katie Nicholson
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA.,Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fawn Leigh
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
| | - Kathryn Swoboda
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
| | - David Chad
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
| | - Kristin Drake
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA.,Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kellen Haley
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA.,Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Merit Cudkowicz
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA.,Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James D Berry
- Harvard Medical School, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA.,Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, Boston, Massachusetts, USA
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42
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Galvin M, Ryan P, Maguire S, Heverin M, Madden C, Vajda A, Normand C, Hardiman O. The path to specialist multidisciplinary care in amyotrophic lateral sclerosis: A population- based study of consultations, interventions and costs. PLoS One 2017. [PMID: 28640860 PMCID: PMC5480998 DOI: 10.1371/journal.pone.0179796] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Amyotrophic Lateral Sclerosis (ALS) is a devastating neurological condition that requires coordinated, multidisciplinary clinical management. ALS is prone to misdiagnosis as its signs and symptoms may be non-specific, which may prolong patients’ journey to multidisciplinary ALS care. Methods Using chart review and national register data, we have detailed the journey of a national cohort of ALS patients (n = 155) from the time of first symptom to presentation at a multidisciplinary clinic (MDC). Key milestones were analysed, including frequency of consultations, clinical interventions, and associated economic cost. Results A majority of patients was male (60%), 65 years of age and over (54%), and had spinal onset ALS (72%). Time from onset of first symptoms to ALS diagnosis was a mean of 15.1 months (median, 11). There was a mean interval of 17.4 months (median 12.5) from first symptoms to arrival at the MDC, and a mean of 4.09 (median, 4) consultations with health care professionals. Electromyography and nerve conduction studies were among the most common interventions. Direct referral by a general practitioner (GP) to a neurologist was associated with reduced cost, but not reduced diagnostic delay. Bulbar ALS was associated with shorter time from symptom onset to diagnosis. Neurologist consultation in the first three consultations was associated with lower costs prior to the ALS clinic attendance but not a shorter time from first symptom to final diagnosis. Mean cost prior to attending the MDC was €3,486 per patient. Conclusions Expedited referral to the multidisciplinary ALS clinic would have reduced costs by an estimated €2,072 per patient. Development of a standardised pathway with early referral to neurology of patients with suspected symptoms of ALS could limit unnecessary interventions and reduce cost of care.
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Affiliation(s)
- Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- * E-mail:
| | - Padhraig Ryan
- Department of Health Policy and Management, Trinity College Dublin, Ireland
| | - Sinead Maguire
- National ALS ClinicDepartment of Neurology, National Neuroscience Centre Beaumont Hospital, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Caoifa Madden
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Charles Normand
- Department of Health Policy and Management, Trinity College Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- National ALS ClinicDepartment of Neurology, National Neuroscience Centre Beaumont Hospital, Dublin, Ireland
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43
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Hogden A, Foley G, Henderson RD, James N, Aoun SM. Amyotrophic lateral sclerosis: improving care with a multidisciplinary approach. J Multidiscip Healthc 2017; 10:205-215. [PMID: 28579792 PMCID: PMC5446964 DOI: 10.2147/jmdh.s134992] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, leading to death within an average of 2–3 years. A cure is yet to be found, and a single disease-modifying treatment has had a modest effect in slowing disease progression. Specialized multidisciplinary ALS care has been shown to extend survival and improve patients’ quality of life, by providing coordinated interprofessional care that seeks to address the complex needs of this patient group. This review examines the nature of specialized multidisciplinary care in ALS and draws on a broad range of evidence that has shaped current practice. The authors explain how multidisciplinary ALS care is delivered. The existing models of care, the role of palliative care within multidisciplinary ALS care, and the costs of formal and informal care are examined. Critical issues of ALS care are then discussed in the context of the support rendered by multidisciplinary-based care. The authors situate the patient and family as key stakeholders and decision makers in the multidisciplinary care network. Finally, the current challenges to the delivery of coordinated interprofessional care in ALS are explored, and the future of coordinated interprofessional care for people with ALS and their family caregivers is considered.
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Affiliation(s)
- Anne Hogden
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, the University of Dublin, Republic of Ireland
| | | | - Natalie James
- Motor Neurone Disease (MND) Service, Communication and Assistive Technology (CAT) Clinic, St Joseph's Hospital, St Vincent's Health Network, Sydney, NSW
| | - Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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