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Kuo FL, Wu YS, Kuo TY, Lee YS, Huang SW, Lee HC. Effects of 3D-printed assistive device on daily life function in patients with neurological impairment: a pilot study. Disabil Rehabil Assist Technol 2024; 19:1648-1656. [PMID: 37377434 DOI: 10.1080/17483107.2023.2227222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE To explore the effects of customized 3D-printed assistive technology (AT) on functional performance and feasibility in patients with neurological impairment. METHODS Patients with neurological impairment were recruited and randomized into customized 3D-printed assistive device group (group 1; n = 17) or standard device group (group 2; n = 14). The device was designed to assist their writing, spoon using, and typing. Each patient underwent 4-week intervention with the device (30 min per session, twice a week). RESULTS We observed significant differences in shoulder abduction (p = .00), external rotation (p = .01), and internal rotation (p = .02) in group 1. And significant differences in abduction (p = .05) and external rotation (p = .05) between the 2 groups. Group 1 achieved significant improvements in writing without AT (p = .04) and with AT (p = .02), spoon use without AT (p = .02) and with AT (p = .03), and hemiplegia-side typing with AT (p = .00). Group 2 achieved significant improvements in writing without AT (p = .01), hemiplegia-side typing without AT (p = .01), and bil-side typing with AT (P = .05). Moreover, no significant differences were noted in other outcome measures. CONCLUSIONS This study demonstrated that customized 3D-printed AT can improve shoulder active motion for patients with neurological impairment. A positive effect in functional hand tasks after AT intervention. Offering customized AT with specific training could enhance the efficacy of interventions. The feasibility of using 3D printing technology to produce customized AT, which has the potential to be cost-effective and efficient.
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Affiliation(s)
- Fen-Ling Kuo
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yi-Shien Wu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tien-Yu Kuo
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yi-Shan Lee
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Chieh Lee
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Del Lucchese B, Parravicini S, Filogna S, Mangani G, Beani E, Di Lieto MC, Bardoni A, Bertamino M, Papini M, Tacchino C, Fedeli F, Cioni G, Sgandurra G. The wide world of technological telerehabilitation for pediatric neurologic and neurodevelopmental disorders - a systematic review. Front Public Health 2024; 12:1295273. [PMID: 38694988 PMCID: PMC11061864 DOI: 10.3389/fpubh.2024.1295273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/08/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction The use of Information and Communication Technology (ICT) for assessing and treating cognitive and motor disorders is promoting home-based telerehabilitation. This approach involves ongoing monitoring within a motivating context to help patients generalize their skills. It can also reduce healthcare costs and geographic barriers by minimizing hospitalization. This systematic review focuses on investigating key aspects of telerehabilitation protocols for children with neurodevelopmental or neurological disorders, including technology used, outcomes, caregiver involvement, and dosage, to guide clinical practice and future research. Method This systematic review adhered to PRISMA guidelines and was registered in PROSPERO. The PICO framework was followed to define the search strategy for technology-based telerehabilitation interventions targeting the pediatric population (aged 0-18) with neurological or neurodevelopmental disorders. The search encompassed Medline/PubMed, EMBASE, and Web of Science databases. Independent reviewers were responsible for selecting relevant papers and extracting data, while data harmonization and analysis were conducted centrally. Results A heterogeneous and evolving situation emerged from our data. Our findings reported that most of the technologies adopted for telerehabilitation are commercial devices; however, research prototypes and clinical software were also employed with a high potential for personalization and treatment efficacy. The efficacy of these protocols on health or health-related domains was also explored by categorizing the outcome measures according to the International Classification of Functioning, Disability, and Health (ICF). Most studies targeted motor and neuropsychological functions, while only a minority of papers explored language or multi-domain protocols. Finally, although caregivers were rarely the direct target of intervention, their role was diffusely highlighted as a critical element of the home-based rehabilitation setting. Discussion This systematic review offers insights into the integration of technological devices into telerehabilitation programs for pediatric neurologic and neurodevelopmental disorders. It highlights factors contributing to the effectiveness of these interventions and suggests the need for further development, particularly in creating dynamic and multi-domain rehabilitation protocols. Additionally, it emphasizes the importance of promoting home-based and family-centered care, which could involve caregivers more actively in the treatment, potentially leading to improved clinical outcomes for children with neurological or neurodevelopmental conditions. Systematic review registration PROSPERO (CRD42020210663).
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Affiliation(s)
- Benedetta Del Lucchese
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Stefano Parravicini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Pediatric Neuroscience Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Filogna
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Gloria Mangani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Chiara Di Lieto
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | | | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marta Papini
- Scientific Institute, IRCCS E. Medea, Lecco, Italy
| | - Chiara Tacchino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Wu J, Liu Y, Zhao J, Jia Z. Research on a New Rehabilitation Robot for Balance Disorders. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3927-3936. [PMID: 37676800 DOI: 10.1109/tnsre.2023.3312692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The treatment of patients with balance disorders is an urgent problem to be solved by the medical community. The causes of balance disorders are diverse. An aging population, traffic accidents, stroke, genetic diseases and so on are all possible factors. It has brought great pain and inconvenience to patients and their families. At present, there are two main types of assisted rehabilitation training robots for patients with balance disorders: exoskeleton robots and end robots. The exoskeleton robot is generally installed on the outside of the patient's body to follow their movement, which can support the weight of the body and provide power support to help the patient train and recover lower limb ability. The use of end robots is usually to secure the patient's foot to the motion platform and control the pedal to drive the lower limbs to conduct gait training. Such passive training is more suitable for patients with severe disorders. The patient has low awareness of active participation. This paper focuses on research on end rehabilitation training robots for balance disorders. In this paper, a robotic system for rehabilitation training of patients with balance disorders is invented. The robot body is a 9 degree of freedom (DOF) redundant series-parallel hybrid motion platform. Two sets of motion platforms with symmetrical mirror images are used together to simulate different motion modes of the human body and drive the human body to move. Each set of motion platforms is composed of a 6-DOF vestibular parallel device and a 3-DOF proprioception parallel device. It has the advantages of DOF decoupling and fast response, proposing a new structural form for the design of proprioceptive and vestibular simulation platforms. The robot's functional level can be divided into a vestibular sense module and a proprioception module according to the structure. The two modules can work independently to achieve different functions or work together to achieve complex motion and multisensory fusion. This robot is a redundant mechanism device with 9 DOFs. Through a reasonable distribution of DOF and motion, the robot's working space can be increased, and the robot's flexibility and motion performance can be improved. In this paper, a trajectory tracking control algorithm for vestibular and proprioceptive simulation is proposed, which can provide unlimited body sense training for patients within the robot's limited motion range.
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Lyon MF, Mitchell K, Roddey T, Medley A, Gleeson P. Keeping it all in balance: a qualitative analysis of the role of balance outcome measurement in physical therapist decision-making and patient outcomes. Disabil Rehabil 2023; 45:3099-3107. [PMID: 36083016 DOI: 10.1080/09638288.2022.2118872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 07/20/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The use of outcome measures (OMs) is a hallmark of contemporary physical therapy in the USA. The effect of OM utilization on patient care decisions and the results of PT services remain poorly understood. The purpose of this study is to explore PTs perceptions about the relationship between balance OMs and decision-making and how that interaction impacts patient outcomes, particularly for patients with acquired brain injury. MATERIALS AND METHODS This qualitative study used semi-structured phone interviews with an interview guide. Maximum variation sampling was used. Thematic analysis was situated in a priori determined theory-based categories. RESULTS Twenty-three physical therapists (PTs) from diverse geographic areas and practice settings participated. Therapists expressed diverse views on the impact of OM use on patient outcomes, but the majority perceived that using OMs improved rehabilitation outcomes. The use of OMs was related to the selection of optimal intervention type and intensity and justified continued high-frequency rehabilitation services. OMs were important to therapists' decision-making. CONCLUSIONS In the present study, PTs reported that they believe the use of validated, clinically useful OMs may improve patient outcomes.Implications For RehabilitationBalance outcome measures are considered an important tool to the optimal management of the profound impact of balance impairments after brain injury.Most physical therapists in this study believe that using balance outcome measures results in better outcomes for patients with brain injury.In this study, physical therapists reported using outcome measures in wide-ranging ways to guide clinical decisions about balance in those with brain injury.
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Affiliation(s)
- Marissa F Lyon
- Physical Therapy, University of New England, Portland, ME, USA
| | - Katy Mitchell
- Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Toni Roddey
- Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Ann Medley
- Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Peggy Gleeson
- Physical Therapy, Texas Woman's University, Houston, TX, USA
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Owolabi MO, Leonardi M, Bassetti C, Jaarsma J, Hawrot T, Makanjuola AI, Dhamija RK, Feng W, Straub V, Camaradou J, Dodick DW, Sunna R, Menon B, Wright C, Lynch C, Chadha AS, Ferretti MT, Dé A, Catsman-Berrevoets CE, Gichu M, Tassorelli C, Oliver D, Paulus W, Mohammed RK, Charway-Felli A, Rostasy K, Feigin V, Craven A, Cunningham E, Galvin O, Perry AH, Fink EL, Baneke P, Helme A, Laurson-Doube J, Medina MT, Roa JD, Hogl B, O'Bryan A, Trenkwalder C, Wilmshurst J, Akinyemi RO, Yaria JO, Good DC, Hoemberg V, Boon P, Wiebe S, Cross JH, Haas M, Jabalpurwala I, Mojasevic M, DiLuca M, Barbarino P, Clarke S, Zuberi SM, Olowoyo P, Owolabi A, Oyesiku N, Maly-Sundgren PC, Norrving B, Soekadar SR, van Doorn PA, Lewis R, Solomon T, Servadei F. Global synergistic actions to improve brain health for human development. Nat Rev Neurol 2023; 19:371-383. [PMID: 37208496 PMCID: PMC10197060 DOI: 10.1038/s41582-023-00808-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/21/2023]
Abstract
The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.
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Affiliation(s)
- Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- African Stroke Organization, Ibadan, Nigeria.
- World Federation for Neurorehabilitation, North Shields, UK.
- Lebanese American University of Beirut, Beirut, Lebanon.
- Blossom Specialist Medical Center, Ibadan, Nigeria.
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Claudio Bassetti
- Neurology Department Inselspital - University of Bern, Bern, Switzerland
- European Academy of Neurology, Vienna, Austria
| | - Joke Jaarsma
- European Federation of Neurological Associations, Brussels, Belgium
| | - Tadeusz Hawrot
- European Federation of Neurological Associations, Brussels, Belgium
| | | | | | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Volker Straub
- John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle, UK
| | - Jennifer Camaradou
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- One Neurology Initiative, Brussels, Belgium
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
- Atria Academy of Science and Medicine, New York, NY, USA
- American Brain Foundation, Minneapolis, MN, USA
| | - Rosita Sunna
- Tics and Tourette Across the Globe, Hannover, Germany
- Australian Clinical Psychology Association, Sydney, New South Wales, Australia
| | - Bindu Menon
- Department of Neurology, Apollo Specialty Hospitals, Nellore, India
| | | | - Chris Lynch
- Alzheimer's Disease International, London, UK
| | | | | | - Anna Dé
- Women's Brain Project, Guntershausen, Switzerland
| | - Coriene E Catsman-Berrevoets
- Department of Paediatric Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- European Paediatric Neurology Society, Bolton, UK
| | - Muthoni Gichu
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
- Global Brain Health Institute, San Francisco, CA, USA
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences of the University of Pavia, Pavia, Italy
- IRCCS C. Mondino Foundation Neurological Institute, Pavia, Italy
- International Headache Society, London, UK
| | - David Oliver
- University of Kent, Canterbury, UK
- International Neuro-Palliative Care Society, Roseville, MN, USA
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians University Munich, Klinikum Großhadern, Munich, Germany
- International Federation of Clinical Neurophysiology, Milwaukee, WI, USA
| | - Ramla K Mohammed
- Amal Neuro Developmental Centres, Gudalur, India
- Al Ameen Educational Trust, Gudalur, India
| | | | - Kevin Rostasy
- European Paediatric Neurology Society, Bolton, UK
- Department of Paediatric Neurology, Children's Hospital Datteln, University Witten/Herdecke, Witten, Germany
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Orla Galvin
- European Federation of Neurological Associations, Brussels, Belgium
| | | | - Ericka L Fink
- Department of Paediatric Neurology and Critical Care, University of Pittsburgh Medical Centre Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh Medical Centre Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Peer Baneke
- Multiple Sclerosis International Federation, London, UK
| | - Anne Helme
- Multiple Sclerosis International Federation, London, UK
| | | | - Marco T Medina
- National Autonomous University of Honduras, Tegucigalpa, Honduras
- Pan-American Federation of Neurological Societies, Santiago de Chile, Chile
| | - Juan David Roa
- HOMI Fundacion Hospital Paediatrico la Misericordia, Bogota, Colombia
| | - Birgit Hogl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- World Sleep Society, Rochester, MN, USA
| | | | - Claudia Trenkwalder
- Paracelsus-Elena Hospital, Kassel, Department of Neurosurgery, University Medical Centre, Goettingen, Germany
| | - Jo Wilmshurst
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- International Child Neurology Association, London, UK
| | - Rufus O Akinyemi
- African Stroke Organization, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joseph O Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - David C Good
- World Federation for Neurorehabilitation, North Shields, UK
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Volker Hoemberg
- World Federation for Neurorehabilitation, North Shields, UK
- SRH Neurorehabilitation Hospital Bad Wimpfen, Bad Wimpfen, Germany
| | - Paul Boon
- European Academy of Neurology, Vienna, Austria
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- International League Against Epilepsy, Flower Mound, TX, USA
| | - J Helen Cross
- International League Against Epilepsy, Flower Mound, TX, USA
- Clinical Neurosciences Section, UCL Institute of Child Health, University College London, London, UK
| | - Magali Haas
- Cohen Veterans Bioscience, New York, NY, USA
| | | | | | - Monica DiLuca
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- European Brain Council, Brussels, Belgium
| | | | - Stephanie Clarke
- World Federation for Neurorehabilitation, North Shields, UK
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sameer M Zuberi
- European Paediatric Neurology Society, Bolton, UK
- Paediatric Neurosciences Research Group, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Olowoyo
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
- Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Nelson Oyesiku
- Department of Neurosurgery, University of North Carolina at Chapel Hill, North Carolina, NC, USA
- World Federation of Neurosurgical Societies, Prague, Czech Republic
| | - Pia C Maly-Sundgren
- Department of Clinical Sciences/Diagnostic Radiology, Lund University, Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences/Neurology, Lund University, Lund, Sweden
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Peripheral Nerve Society, Roseville, MN, USA
| | - Richard Lewis
- Peripheral Nerve Society, Roseville, MN, USA
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Tom Solomon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Encephalitis Society, Malton, North Yorkshire, UK
| | - Franco Servadei
- World Federation of Neurosurgical Societies, Prague, Czech Republic
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Humanitas University, Milan, Italy
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Capodaglio EM, Cavalagli A, Panigazzi M. Exergame for the functional rehabilitation of adults over 55 with neurological diseases. G Ital Med Lav Ergon 2022; 44:59-76. [PMID: 36346300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 01/01/2022] [Indexed: 05/18/2023]
Abstract
SUMMARY Rehabilitation based on Exergame is showing a rapid evolution, with interesting applications for the recovery of mobility, balance, postural control, coordination and fine motor skills, and including home-based training. At present, there are no precise indications for Exergamebased rehabilitation of people over 55 affected by stroke, Parkinson's disease, or multiple sclerosis. This review examines the proposed modalities and the effectiveness of Exergame-based rehabilitation interventions for adults over 55 with stroke, Parkinson's disease or multiple sclerosis, highlighting the limitations, advantages, controversies and impact of this approach. We examined randomized controlled trials published between 2016-2020, with search in the databases of PubMed, Scopus, Cochrane Library, RehabData, selecting 24 studies. The study of patients with chronic or subacute stroke in outpatient treatment, and with small sample sizes, prevails. Wide variability characterizes the rehabilitation methods, the technological platforms used, the type and dose of exercise administered, the outcome measures. The adequacy and efficacy of Exergames remains uncertain in the neurological elderly, and the functional improvement in the neurological adult patient is not yet attested using this type of approach.
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Affiliation(s)
- Edda Maria Capodaglio
- Istituti Clinici Scientifici Maugeri IRCCS, Occupational therapy and ergonomics unit of Pavia Institute, Italy
| | - Angela Cavalagli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Monica Panigazzi
- Istituti Clinici Scientifici Maugeri IRCCS, Occupational therapy and ergonomics unit of Pavia and Montescano Institutes, Italy
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Koryakina OV, Moskvina EY, Kovtun OP, Kazaeva AV, Safronov AA. [Evaluation the effectiveness of immersive VR-assisted rehabilitation in a child with chemotherapy-induced neurological complication in acute lymphoblastic leukemia]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:85-89. [PMID: 36170105 DOI: 10.17116/jnevro202212209285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Rehabilitation therapy is considered as an actual and complex system of knowledge, in which the main task is the development and implementation of new methods of rehabilitation. In present time, the most perspective rehabilitation program is utilizing virtual reality. A report was made with the utilization of rehabilitation therapy with virtual reality in a child with chemotherapy-induced neurological disorders in acute lymphoblastic leukemia. The child performed a set of exercises using fully immersive virtual reality. Over the course of rehabilitation positive dynamics was observed, namely increased muscle strength in the injured limb from 3 to 5 scores according to the Medical Research Council Weakness Scale. There was improved balance on the Berg Balance Scale from 35 to 42. In addition, there were increased range of active movements, partly restored biomechanics of gait with increased velocity by 2 times. According to the results of testing the psycho-emotional state using the Luscher color test and the graphic technique «Cactus» by M.A. Panfilova, self-esteem, the desire to succeed and independence were improved, the level of auto-aggression was decreased. The results show that rehabilitation using fully immersive virtual reality is probably a perspective tool in addition to traditional rehabilitation. It improves the neurological and psycho-emotional state, raises motivation of patients, which, in turn, helps to increase the effectiveness of rehabilitation therapy and speeds up the rehabilitation process.
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Affiliation(s)
- O V Koryakina
- Ural State Medical University, Yekaterinburg, Russia
- Regional Children Clinical Hospital, Yekaterinburg, Russia
| | - E Yu Moskvina
- Ural State Medical University, Yekaterinburg, Russia
| | - O P Kovtun
- Ural State Medical University, Yekaterinburg, Russia
| | - A V Kazaeva
- The Sverdlovsk Charity Organization Helping Patients with Cancer «Together for life», Yekaterinburg, Russia
| | - A A Safronov
- Regional Children Clinical Hospital, Yekaterinburg, Russia
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Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2021; 396:2006-2017. [PMID: 33275908 PMCID: PMC7811204 DOI: 10.1016/s0140-6736(20)32340-0] [Citation(s) in RCA: 794] [Impact Index Per Article: 264.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/04/2020] [Accepted: 10/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritised in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury. METHODS To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability (YLDs) of 25 diseases, impairments, or bespoke aggregations of sequelae that were selected as amenable to rehabilitation. All analyses were done at the country level and then aggregated to seven regions: World Bank high-income countries and the six WHO regions (ie, Africa, the Americas, Southeast Asia, Europe, Eastern Mediterranean, and Western Pacific). FINDINGS Globally, in 2019, 2·41 billion (95% uncertainty interval 2·34-2·50) individuals had conditions that would benefit from rehabilitation, contributing to 310 million [235-392] YLDs. This number had increased by 63% from 1990 to 2019. Regionally, the Western Pacific had the highest need of rehabilitation services (610 million people [588-636] and 83 million YLDs [62-106]). The disease area that contributed most to prevalence was musculoskeletal disorders (1·71 billion people [1·68-1·80]), with low back pain being the most prevalent condition in 134 of the 204 countries analysed. INTERPRETATION To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Alarcos Cieza
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
| | - Kate Causey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kaloyan Kamenov
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Sarah Wulf Hanson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Somnath Chatterji
- Data and Analytics Department, World Health Organization, Geneva, Switzerland
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Schwab SM, Dugan S, Riley MA. Reciprocal Influence of Mobility and Speech-Language: Advancing Physical Therapy and Speech Therapy Cotreatment and Collaboration for Adults With Neurological Conditions. Phys Ther 2021; 101:pzab196. [PMID: 34403483 PMCID: PMC8801003 DOI: 10.1093/ptj/pzab196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/28/2021] [Indexed: 11/13/2022]
Abstract
Mobility and speech-language impairments and limitations in adults with neurological conditions manifest not in isolated anatomical components but instead in the individual-environment system and are task-dependent. Optimization of function thus requires interprofessional care to promote participation in meaningful life areas within appropriate task and environmental contexts. Cotreatment guidelines (ie, the concurrent intervention of disciplines) were established by the physical therapy, occupational therapy, and speech-language and hearing professional organizations nearly 2 decades ago to facilitate seamless interprofessional care. Despite this, cotreatment between physical therapy and speech therapy remains limited. The purpose of this Perspective article is to encourage physical therapists and speech-language pathologists to increase interprofessional collaboration through cotreatment in the management of adults with neurological conditions. Evidence from pediatrics and basic motor control literature points toward reciprocal interactions between speech-language and mobility. We provide recommendations for clinical practice with an emphasis on the gains each discipline can provide the other. This Perspective is rooted in the International Classification of Functioning, Disability and Health model and ecological theory. IMPACT The goals of speech therapy and physical therapy are complementary and mutually supportive. Enhanced cotreatment, and collaboration more generally, between physical therapists and speech-language pathologists in the management of adults with neurological conditions can augment task-relevant conditions to improve function.
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Affiliation(s)
- Sarah M Schwab
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sarah Dugan
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Rehabilitation, Exercise, & Nutrition Sciences, Health Sciences Building, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael A Riley
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Rehabilitation, Exercise, & Nutrition Sciences, Health Sciences Building, University of Cincinnati, Cincinnati, Ohio, USA
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10
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Abstract
The purpose of the present study was to investigate the effects of transcranial direct current stimulation (tDCS) on motor recovery in adult patients with stroke, taking into account the parameters that could influence the motor recovery responses. The second aim was to identify the best tDCS parameters and recommendations available based on the enhanced motor recovery demonstrated by the analyzed studies. Our systematic review was performed by searching full-text articles published before February 18, 2019 in the PubMed database. Different methods of applying tDCS in association with several complementary therapies were identified. Studies investigating the motor recovery effects of tDCS in adult patients with stroke were considered. Studies investigating different neurologic conditions and psychiatric disorders or those not meeting our methodologic criteria were excluded. The main parameters and outcomes of tDCS treatments are reported. There is not a robust concordance among the study outcomes with regard to the enhancement of motor recovery associated with the clinical application of tDCS. This is mainly due to the heterogeneity of clinical data, tDCS approaches, combined interventions, and outcome measurements. tDCS could be an effective approach to promote adaptive plasticity in the stroke population with significant positive premotor and postmotor rehabilitation effects. Future studies with larger sample sizes and high-quality studies with a better standardization of stimulation protocols are needed to improve the study quality, further corroborate our results, and identify the optimal tDCS protocols.
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Affiliation(s)
- Graziella Orrù
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Ciro Conversano
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Paul Kenneth Hitchcott
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, via Savi, 10, 56126, Pisa, Italy
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Reid JN, Ethans KD, Chan BCF. Outreach physiatry clinics in remote Manitoba communities: an economic cost analysis. CMAJ Open 2021; 9:E818-E825. [PMID: 34446461 PMCID: PMC8412418 DOI: 10.9778/cmajo.20200234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND One in 5 people in Canada have a disability affecting daily activities, and, for rural patients, accessing lifelong physiatry care to improve function and manage symptoms requires complex and expensive travel. We compared the costs of new outreach physiatry clinics with those of conventional urban clinics in Manitoba. METHODS Six outreach clinics were held from January 2018 to September 2019 in the remote communities of St. Theresa Point and Churchill, Manitoba. A general physiatry population was seen in these clinics, including patients with musculoskeletal and neurologic conditions seen in consultation and follow-up. We performed a societal cost-minimization analysis comparing outreach clinic costs to estimated costs of standard care at conventional outpatient clinics in Winnipeg. Outcomes of interest included direct costs to government health services and patients, and indirect opportunity cost of travel time. We calculated total costs, average cost per clinic visit and incremental costs for outreach clinics compared to conventional urban clinics. Costs were inflated to 2020 Canadian dollars. RESULTS Thirty-one patients (48 visits) were seen at the outreach clinics. The total cost of providing outreach clinics, $33 136, was 21% of the estimated cost of standard care, $158 344. When only direct costs were included, outreach clinics cost an estimated 24% of conventional care costs. The average unit cost per outreach visit was $690, compared to $3299 per conventional visit, for an incremental cost of -$2609 per outreach visit. INTERPRETATION An outreach physiatry visit in Manitoba cost an estimated 21% of a conventional urban outpatient visit, or 24% when only direct costs were included, with costs savings largely related to travel. Outreach physiatry care in this model provides substantial cost savings for the public health care system as the primary payer, and can reduce the travel cost burden for patients who do not have public travel funding.
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Affiliation(s)
- Janine N Reid
- Section of Physical Medicine and Rehabilitation (Reid, Ethans), Department of Internal Medicine, University of Manitoba, Winnipeg, Man.; KITE - Toronto Rehabilitation Institute (Chan), University Health Network; Institute of Health Policy, Management and Evaluation (Chan), University of Toronto, Toronto, Ont.
| | - Karen D Ethans
- Section of Physical Medicine and Rehabilitation (Reid, Ethans), Department of Internal Medicine, University of Manitoba, Winnipeg, Man.; KITE - Toronto Rehabilitation Institute (Chan), University Health Network; Institute of Health Policy, Management and Evaluation (Chan), University of Toronto, Toronto, Ont
| | - Brian Chun-Fai Chan
- Section of Physical Medicine and Rehabilitation (Reid, Ethans), Department of Internal Medicine, University of Manitoba, Winnipeg, Man.; KITE - Toronto Rehabilitation Institute (Chan), University Health Network; Institute of Health Policy, Management and Evaluation (Chan), University of Toronto, Toronto, Ont
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Pellicciari L, Agosti M, Goffredo M, Pournajaf S, Le Pera D, De Pisi F, Franceschini M, Damiani C. Factors Influencing Functional Outcome at Discharge: A Retrospective Study on a Large Sample of Patients Admitted to an Intensive Rehabilitation Unit. Am J Phys Med Rehabil 2021; 100:483-491. [PMID: 32889862 DOI: 10.1097/phm.0000000000001582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Functional outcome represents the most central objective of rehabilitation programs. Understanding which factors could affect functional status at discharge is crucial for the planning of appropriate treatments in both neurologic and orthopedic patients. The aim of this study was to investigate which clinical and demographic variables, collected at the patient's admission, could influence the functional outcome, assessed by the modified Barthel Index (mBI), at discharge. DESIGN A retrospective study was conducted on a large cohort (n = 3548) of orthopedic and neurologic patients. Functional, demographic, and clinical records at patient admission and mBI score at discharge were collected. General linear model analysis was performed to assess the influence of these variables on functional outcome at discharge. RESULTS The results reported a significant effect of mBI score at admission (P < 0.0001), age (P < 0.0001), and time from the acute event (P < 0.0001) on mBI score at discharge. Moreover, the disease type (neurologic or orthopedic) adjusted by sex (male or female) and presence of different impairments (cognitive and behavioral impairments) and complications (hypertension and cardiovascular diseases) significantly influenced mBI score at discharge (P < 0.05) (R2 = 0.497). No significant interactions between other factors were found (P > 0.05). CONCLUSION Several prognostic factors should be considered when planning an appropriate tailored rehabilitation program.
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Affiliation(s)
- Leonardo Pellicciari
- From the Neurorehabilitation Research Laboratory, IRCCS San Raffaele Pisana, Rome, Italy (LP, MG, SP, DLP, FDP, MF, CD); Rehabilitation Medicine Service, Rehabilitation Geriatrics Department of the NHS-University Hospital of Parma, Parma, Italy (MA); and San Raffaele University, Rome, Italy (MF)
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Chen Y, Kathirithamby DR, Li J, Candelario-Velazquez C, Bloomfield A, Ambrose AF. Telemedicine in the Coronavirus Disease 2019 Pandemic: A Pediatric Rehabilitation Perspective. Am J Phys Med Rehabil 2021; 100:321-326. [PMID: 33480609 DOI: 10.1097/phm.0000000000001698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
ABSTRACT In the spring of 2020, coronavirus disease 2019 evolved into a worldwide pandemic, forcing traditional face-to-face healthcare to a standstill. Telemedicine was quickly adopted as a major tool for pediatric rehabilitation services. This article describes the national legislative response of the United States to the coronavirus disease 2019 pandemic and the opportunities and challenges of implementing telemedicine in pediatric rehabilitation outpatient settings, consultations, as well as physician and patient education. The feasibility of performing a remote pediatric musculoskeletal and neurological tele-evaluation is also discussed. Although challenges exist, telemedicine has demonstrated its potential and has proven to be a practical system. Future developments in technology and accessibility, in addition to support from government and third-party payers, have the potential to make telemedicine an effective and vital platform in a coordinated healthcare system.
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Affiliation(s)
- Yuxi Chen
- From the Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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14
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Calabrò RS. Teleneurorehabilitation in the COVID-19 Era: What Are We Doing Now and What Will We Do Next? Med Sci (Basel) 2021; 9:medsci9010015. [PMID: 33668321 PMCID: PMC8006037 DOI: 10.3390/medsci9010015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 01/20/2023] Open
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Irons JY, Garip G, Cross AJ, Sheffield D, Bird J. An integrative systematic review of creative arts interventions for older informal caregivers of people with neurological conditions. PLoS One 2020; 15:e0243461. [PMID: 33284840 PMCID: PMC7721165 DOI: 10.1371/journal.pone.0243461] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/21/2020] [Indexed: 12/17/2022] Open
Abstract
Objective We aimed to assess and synthesise the current state of quantitative and qualitative research concerning creative arts interventions for older informal caregivers of people with neurological conditions. Methods A systematic search was employed to identify studies that examined creative arts interventions for older informal caregivers, which were synthesised in this integrative review. We searched the following databases: MEDLINE, PubMed, EBSCO, CINAHL, EMBASE, PsycINFO, Cochrane Library, Scopus, Web of Science, and Google Scholar. We also backwards searched references of all relevant studies and inspected trials registers. Results Of the 516 studies identified, 17 were included: one was quantitative, nine were qualitative and seven used mixed methods. All included quantitative studies were pilot or feasibility studies employing pre- and post-test design with small sample sizes. Studies varied in relation to the type of creative intervention and evaluation methods, which precluded meta-analysis. Large effect sizes were detected in wellbeing measures following singing and art interventions. The qualitative synthesis highlighted that interventions created space for caregivers to make sense of, accept and adapt to their identity as a caregiver. Personal developments, such as learning new skills, were viewed positively by caregivers as well as welcoming the opportunity to gain cognitive and behavioural skills, and having opportunities to unload emotions in a safe space were important to caregivers. Group creative interventions were particularly helpful in creating social connections with their care-recipients and other caregivers. Conclusions The current review revealed all creative interventions focused on caregivers of people living with dementia; subsequently, this identified gaps in the evidence of creative interventions for informal caregivers of other neurological conditions. There are encouraging preliminary data on music and art interventions, however, little data exists on other art forms, e.g., drama, dance. Creative interventions may appeal to many caregivers, offering a range of psycho-social benefits. The findings of the current review open the way for future research to develop appropriate and creative arts programmes and to test their efficacy with robust tools.
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Affiliation(s)
- J. Yoon Irons
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
- * E-mail:
| | - Gulcan Garip
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| | - Ainslea J. Cross
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| | - David Sheffield
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| | - Jamie Bird
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
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Holmes JA, Logan P, Morris R, Radford K. Factors affecting the delivery of complex rehabilitation interventions in research with neurologically impaired adults: a systematic review. Syst Rev 2020; 9:268. [PMID: 33239081 PMCID: PMC7690089 DOI: 10.1186/s13643-020-01508-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rehabilitation research does not always improve patient outcomes because of difficulties implementing complex health interventions. Identifying barriers and facilitators to implementation fidelity is critical. Not reporting implementation issues wastes research resources and risks erroneously attributing effectiveness when interventions are not implemented as planned, particularly progressing from single to multicentre trials. The Consolidated Framework for Implementation Research (CFIR) and Conceptual Framework for Implementation Fidelity (CFIF) facilitate identification of barriers and facilitators. This review sought to identify barriers and facilitators (determinants) affecting implementation in trials of complex rehabilitation interventions for adults with long-term neurological conditions (LTNC) and describe implementation issues. METHODS Implementation, complex health interventions and LTNC search terms were developed. Studies of all designs were eligible. Searches involved 11 databases, trial registries and citations. After screening titles and abstracts, two reviewers independently shortlisted studies. A third resolved discrepancies. One reviewer extracted data in two stages; 1) descriptive study data, 2) units of text describing determinants. Data were synthesised by (1) mapping determinants to CFIF and CFIR and (2) thematic analysis. RESULTS Forty-three studies, from 7434 records, reported implementation determinants; 41 reported both barriers and facilitators. Most implied determinants but five used implementation theory to inform recording. More barriers than facilitators were mapped onto CFIF and CFIR constructs. "Patient needs and resources", "readiness for implementation", "knowledge and beliefs about the intervention", "facilitation strategies", "participant responsiveness" were the most frequently mapped constructs. Constructs relating to the quality of intervention delivery, organisational/contextual aspects and trial-related issues were rarely tapped. Thematic analysis revealed the most frequently reported determinants related to adherence, intervention perceptions and attrition. CONCLUSIONS This review has described the barriers and facilitators identified in studies implementing complex interventions for people with LTNCs. Early adoption of implementation frameworks by trialists can simplify identification and reporting of factors affecting delivery of new complex rehabilitation interventions. It is vital to learn from previous experiences to prevent unnecessary repetitions of implementation failure at both trial and service provision levels. Reported facilitators can provide strategies for overcoming implementation issues. Reporting gaps may be due to the lack of standardised reporting methods, researcher ignorance and historical reporting requirements. SYSTEMIC REVIEW REGISTRATION PROSPERO CRD42015020423.
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Affiliation(s)
- Jain Anne Holmes
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, Univeristy of Nottingham, Nottingham, NG7 2UH UK
| | - Philippa Logan
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, Univeristy of Nottingham, Nottingham, NG7 2UH UK
| | - Richard Morris
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, Univeristy of Nottingham, Nottingham, NG7 2UH UK
| | - Kathryn Radford
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, Univeristy of Nottingham, Nottingham, NG7 2UH UK
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Bodine AJ, Heinemann AW, Carpenter J, Taylor SM, Hansen P, Lieber RL, Sliwa J. Development of a Multidimensional, Multigroup Measure of Self-Care for Inpatient Rehabilitation. Arch Phys Med Rehabil 2020; 102:97-105. [PMID: 33035514 DOI: 10.1016/j.apmr.2020.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/06/2020] [Accepted: 08/22/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To develop and evaluate a measure of clinician-observed and patient-performed self-care function for use during inpatient rehabilitation. DESIGN Retrospective analysis of self-care assessments collected by therapists using confirmatory factor analysis (CFA) followed by multidimensional item response theory (MIRT). SETTING Freestanding inpatient rehabilitation hospital in the Midwestern United States. PARTICIPANTS Inpatients (N=7719) with stroke, traumatic brain injury, spinal cord injury, neurologic disorders, and musculoskeletal conditions. INTERVENTIONS Not applicable MAIN OUTCOME MEASURES: A total of 19 clinician-selected self-care measures including the FIM and patient-performed, clinician-rated measures of balance, upper extremity function, strength, changing body position, and swallowing. Clinicians completed assessments on admission and at least 1 interim assessment. RESULTS CFA was completed for 3 patient groups defined by their highest level of balance (sitting, standing, walking). We reduced the number of items by 47.5% while maintaining acceptable internal consistency; unidimensionality within each item set required development of testlets. A recursive analysis defined a self-care measure with sensitivity (Cohen dmax-min =1.13; Cohen dlast-first.=0.91) greater than the FIM self-care items (dmax-min.=0.94; dlast-first .=0.83). The CFA models provided good to acceptable fit (root mean square error of approximations 0.03-0.06). Most patients with admission FIM self-care ratings of total assistance (88%, 297 of 338) made improvements on the MIRT self-care measure that were undetected by the FIM; the FIM detected no change for 26% of these patients (78 of 297). The remaining 74% (219 of 297) improved on the MIRT-based measure an average of 14 days earlier than was detected by the FIM. CONCLUSIONS This MIRT self-care measure possesses measurement properties that are superior to the FIM, particularly for patients near its floor or ceiling. Methods assure accommodation for multidimensionality and high levels of sensitivity. This self-care measure has the potential to improve monitoring of self-care and manage therapy effectively during inpatient rehabilitation.
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Affiliation(s)
- Andrew J Bodine
- Shirley Ryan AbilityLab, Outcomes Management: Systems & Analytics, Chicago, Illinois.
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Center for Rehabilitation Outcomes Research, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Sally M Taylor
- Shirley Ryan AbilityLab, Chicago, Illinois; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Piper Hansen
- Staff Development, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, Illinois; Physiology and Biomedical Engineering, Northwestern University, Chicago, Illinois
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18
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Zhao J, Chau JPC, Zang Y, Lo SHS, Choi KC, Liang S. The effects of sitting Tai Chi on physical and psychosocial health outcomes among individuals with impaired physical mobility. Medicine (Baltimore) 2020; 99:e21805. [PMID: 32846817 PMCID: PMC7447489 DOI: 10.1097/md.0000000000021805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Impaired physical mobility, most often seen in people with neurological disorders (i.e., stroke and spinal cord injury survivors), musculoskeletal diseases or frailty, is a limitation in independent and purposeful physical movement of the body or one or more extremities. The physical restrictions result in negative consequences on an individual's physical and psychosocial functions. This proposal describes a systematic review protocol to determine the effectiveness and approaches of sitting Tai Chi intervention for individuals with impaired physical mobility. Our review would inform stakeholders' decisions in integrating this complementary therapy into current rehabilitation services. METHODS Randomized controlled trials or quasi-experimental studies that compared an intervention group receiving sitting Tai Chi with a control group among adult participants with impaired physical mobility resulting from any health condition(s) will be included. Outcomes of interest will include physical and psychosocial health outcomes. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, Scopus, Web of Science, AMED, PsycINFO, SPORDiscus, PEDro, WanFang Data and China National Knowledge Infrastructure will be searched from their inception to January 2020. Additional searches will be performed to identify studies that are being refereed, to be published, unpublished or ongoing. Two reviewers will select the trials and extract data independently. The risk of bias of the included studies will be assessed using the Cochrane risk-of-bias tools. The Grading of Recommendations, Assessment, Development and Evaluation will be used to assess evidence quality for each review outcome. Data synthesis will be performed using Review Manager 5.3. When a meta-analysis is possible, we will assess the heterogeneity across the studies by computing the I statistics. RESULTS A high-quality synthesis of current evidence of sitting Tai Chi for impaired physical mobility will be stated from several aspect using subjective reports and objective measures of performance. CONCLUSION This protocol will present the evidence of whether sitting Tai Chi is an effective intervention for impaired physical mobility. PROSPERO REGISTRATION NUMBER CRD 42019142681.
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Affiliation(s)
- Jie Zhao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- School of Nursing, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Yuli Zang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Surui Liang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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Bannwart M, Bayer SL, König Ignasiak N, Bolliger M, Rauter G, Easthope CA. Mediolateral damping of an overhead body weight support system assists stability during treadmill walking. J Neuroeng Rehabil 2020; 17:108. [PMID: 32778127 PMCID: PMC7418206 DOI: 10.1186/s12984-020-00735-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Body weight support systems with three or more degrees of freedom (3-DoF) are permissive and safe environments that provide unloading and allow unrestricted movement in any direction. This enables training of walking and balance control at an early stage in rehabilitation. Transparent systems generate a support force vector that is near vertical at all positions in the workspace to only minimally interfere with natural movement patterns. Patients with impaired balance, however, may benefit from additional mediolateral support that can be adjusted according to their capacity. An elegant solution for providing balance support might be by rendering viscous damping along the mediolateral axis via the software controller. Before use with patients, we evaluated if control-rendered mediolateral damping evokes the desired stability enhancement in able-bodied individuals. METHODS A transparent, cable-driven robotic body weight support system (FLOAT) was used to provide transparent body weight support with and without mediolateral damping to 21 able-bodied volunteers while walking at preferred gait velocity on a treadmill. Stability metrics reflecting resistance to small and large perturbations were derived from walking kinematics and compared between conditions and to free walking. RESULTS Compared to free walking, the application of body weight support per-se resulted in gait alterations typically associated with body weight support, namely increased step length and swing phase. Frontal plane dynamic stability, measured by kinematic variability and nonlinear dynamics of the center of mass, was increased under body weight support, indicating reduced balance requirements in both damped and undamped support conditions. Adding damping to the body weight support resulted in a greater increase of frontal plane stability. CONCLUSION Adding mediolateral damping to 3-DoF body weight support systems is an effective method of increasing frontal plane stability during walking in able-bodied participants. Building on these results, adjustable mediolateral damping could enable therapists to select combinations of unloading and stability specifically for each patient and to adapt this in a task specific manner. This could extend the impact of transparent 3-DoF body weight support systems, enabling training of gait and active balance from an early time point onwards in the rehabilitation process for a wide range of mobility activities of daily life.
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Affiliation(s)
- M. Bannwart
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - S. L. Bayer
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - M. Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - G. Rauter
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
- BIROMED-Laboratory, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - C. A. Easthope
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- cereneo Center for Interdisciplinary Research, Vitznau, Switzerland
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Aslam AR, Altaf MAB. An On-Chip Processor for Chronic Neurological Disorders Assistance Using Negative Affectivity Classification. IEEE Trans Biomed Circuits Syst 2020; 14:838-851. [PMID: 32746354 DOI: 10.1109/tbcas.2020.3008766] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Chronic neurological disorders (CND's) are lifelong diseases and cannot be eradicated, but their severe effects can be alleviated by early preemptive measures. CND's, such as Alzheimer's, Autism Spectrum Disorder (ASD), and Amyotrophic Lateral Sclerosis (ALS), are the chronic ailment of the central nervous system that causes the degradation of emotional and cognitive abilities. Long term continuous monitoring with neuro-feedback of human emotions for patients with CND's is crucial in mitigating its harmful effect. This paper presents hardware efficient and dedicated human emotion classification processor for CND's. Scalp EEG is used for the emotion's classification using the valence and arousal scales. A linear support vector machine classifier is used with power spectral density, logarithmic interhemispheric power spectral ratio, and the interhemispheric power spectral difference of eight EEG channel locations suitable for a wearable non-invasive classification system. A look-up-table based logarithmic division unit (LDU) is to represent the division features in machine learning (ML) applications. The implemented LDU minimizes the cost of integer division by 34% for ML applications. The implemented emotion's classification processor achieved an accuracy of 72.96% and 73.14%, respectively, for the valence and arousal classification on multiple publicly available datasets. The 2 x 3mm2 processor is fabricated using a 0.18 μm 1P6M CMOS process with power and energy utilization of 2.04 mW and 16 μJ/classification, respectively, for 8-channel operation.
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Maritz R, Ehrmann C, Prodinger B, Tennant A, Stucki G. The influence and added value of a Standardized Assessment and Reporting System for functioning outcomes upon national rehabilitation quality reports. Int J Qual Health Care 2020; 32:379-387. [PMID: 32472134 PMCID: PMC7369390 DOI: 10.1093/intqhc/mzaa058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/24/2020] [Accepted: 05/11/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To demonstrate the influence and added value of a Standardized Assessment and Reporting System (StARS) upon the reporting of functioning outcomes for national rehabilitation quality reports. A StARS builds upon an ICF-based (International Classification of Functioning, Disability and Health) and interval-scaled common metric. DESIGN Comparison of current ordinal-scaled Swiss national rehabilitation outcome reports including an expert-consensus-based transformation scale with StARS-based reports through descriptive statistical methods and content exploration of further development areas of the reports with relevant ICF Core Sets. SETTING Swiss national public rehabilitation outcome quality reports on the clinic level. PARTICIPANTS A total of 29 Swiss rehabilitation clinics provided their quality report datasets including 18 047 patients. INTERVENTIONS Neurological or musculoskeletal rehabilitation. MAIN OUTCOME MEASURES Functional Independence Measure™ or Extended Barthel Index. RESULTS Outcomes reported with a StARS tended to be smaller but more precise than in the current ordinal-scaled reports, indicating an overestimation of achieved outcomes in the latter. The comparison of the common metric's content with ICF Core Sets suggests to include 'energy and drive functions' or 'maintaining a basic body position' to enhance the content of functioning as an indicator. CONCLUSIONS A StARS supports the comparison of outcomes assessed with different measures on the same interval-scaled ICF-based common metric. Careful consideration is needed whether an ordinal-scaled or interval-scaled reporting system is applied as the magnitude and precision of reported outcomes is influenced. The StARS' ICF basis brings an added value by informing further development of functioning as a relevant indicator for national outcome quality reports in rehabilitation.
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Affiliation(s)
- Roxanne Maritz
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
| | | | - Birgit Prodinger
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Faculty of Applied Health and Social Sciences, Technical University of Applied Sciences Rosenheim, 83024 Rosenheim, Germany
| | - Alan Tennant
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
| | - Gerold Stucki
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
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Calabrò RS, Manuli A, Naro A, Rao G. How Covid 19 has changed Neurorehabilitation in Italy: a critical appraisal. Acta Biomed 2020; 91:e2020143. [PMID: 33525243 PMCID: PMC7927524 DOI: 10.23750/abm.v91i4.10172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/26/2020] [Indexed: 12/23/2022]
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Morya E, Monte-Silva K, Bikson M, Esmaeilpour Z, Biazoli CE, Fonseca A, Bocci T, Farzan F, Chatterjee R, Hausdorff JM, da Silva Machado DG, Brunoni AR, Mezger E, Moscaleski LA, Pegado R, Sato JR, Caetano MS, Sá KN, Tanaka C, Li LM, Baptista AF, Okano AH. Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes. J Neuroeng Rehabil 2019; 16:141. [PMID: 31730494 PMCID: PMC6858746 DOI: 10.1186/s12984-019-0581-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique used to modulate neural tissue. Neuromodulation apparently improves cognitive functions in several neurologic diseases treatment and sports performance. In this study, we present a comprehensive, integrative review of tDCS for motor rehabilitation and motor learning in healthy individuals, athletes and multiple neurologic and neuropsychiatric conditions. We also report on neuromodulation mechanisms, main applications, current knowledge including areas such as language, embodied cognition, functional and social aspects, and future directions. We present the use and perspectives of new developments in tDCS technology, namely high-definition tDCS (HD-tDCS) which promises to overcome one of the main tDCS limitation (i.e., low focality) and its application for neurological disease, pain relief, and motor learning/rehabilitation. Finally, we provided information regarding the Transcutaneous Spinal Direct Current Stimulation (tsDCS) in clinical applications, Cerebellar tDCS (ctDCS) and its influence on motor learning, and TMS combined with electroencephalography (EEG) as a tool to evaluate tDCS effects on brain function.
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Affiliation(s)
- Edgard Morya
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Rio Grande do Norte Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Kátia Monte-Silva
- Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Claudinei Eduardo Biazoli
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Andre Fonseca
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Tommaso Bocci
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Raaj Chatterjee
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Jeffrey M. Hausdorff
- Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Eva Mezger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Luciane Aparecida Moscaleski
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Rodrigo Pegado
- Graduate Program in Rehabilitation Science, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte Brazil
| | - João Ricardo Sato
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Marcelo Salvador Caetano
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Kátia Nunes Sá
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
| | - Clarice Tanaka
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Li Min Li
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Abrahão Fontes Baptista
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Alexandre Hideki Okano
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Graduate Program in Physical Education. State University of Londrina, Londrina, Paraná, Brazil
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Carnevale A, Longo UG, Schena E, Massaroni C, Lo Presti D, Berton A, Candela V, Denaro V. Wearable systems for shoulder kinematics assessment: a systematic review. BMC Musculoskelet Disord 2019; 20:546. [PMID: 31731893 PMCID: PMC6858749 DOI: 10.1186/s12891-019-2930-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Wearable sensors are acquiring more and more influence in diagnostic and rehabilitation field to assess motor abilities of people with neurological or musculoskeletal impairments. The aim of this systematic literature review is to analyze the wearable systems for monitoring shoulder kinematics and their applicability in clinical settings and rehabilitation. METHODS A comprehensive search of PubMed, Medline, Google Scholar and IEEE Xplore was performed and results were included up to July 2019. All studies concerning wearable sensors to assess shoulder kinematics were retrieved. RESULTS Seventy-three studies were included because they have fulfilled the inclusion criteria. The results showed that magneto and/or inertial sensors are the most used. Wearable sensors measuring upper limb and/or shoulder kinematics have been proposed to be applied in patients with different pathological conditions such as stroke, multiple sclerosis, osteoarthritis, rotator cuff tear. Sensors placement and method of attachment were broadly heterogeneous among the examined studies. CONCLUSIONS Wearable systems are a promising solution to provide quantitative and meaningful clinical information about progress in a rehabilitation pathway and to extrapolate meaningful parameters in the diagnosis of shoulder pathologies. There is a strong need for development of this novel technologies which undeniably serves in shoulder evaluation and therapy.
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Affiliation(s)
- Arianna Carnevale
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Daniela Lo Presti
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128 Rome, Italy
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Proffitt R. Relationships between Occupational Therapy Practitioner Characteristics and Home Exercise Program Prescription for Clients with Neurological Injuries. Occup Ther Health Care 2019; 33:381-393. [PMID: 31411911 PMCID: PMC6868475 DOI: 10.1080/07380577.2019.1649786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 12/25/2022]
Abstract
There are no guidelines for the prescription of home exercise programs (HEPs) for clients with neurological injuries. However, 95% of occupational therapy practitioners prescribe HEPs. Two thousand anonymous surveys were distributed to occupational therapy practitioners. Data from the 352 returned, usable surveys were analyzed to determine trends in HEP prescription across practice settings and provider demographics. Occupational therapy practitioners in community-based settings tended to use more functional activities and the number of years in practice did not influence HEP dosage. These findings suggest a need for clear guidelines for varying practice settings to guide HEP prescription.
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Affiliation(s)
- Rachel Proffitt
- Department of Occupational Therapy, University of Missouri, Columbia, MO
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Santos Ferreira I, Teixeira Costa B, Lima Ramos C, Lucena P, Thibaut A, Fregni F. Searching for the optimal tDCS target for motor rehabilitation. J Neuroeng Rehabil 2019; 16:90. [PMID: 31315679 PMCID: PMC6637619 DOI: 10.1186/s12984-019-0561-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/28/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) has been investigated over the years due to its short and also long-term effects on cortical excitability and neuroplasticity. Although its mechanisms to improve motor function are not fully understood, this technique has been suggested as an alternative therapeutic method for motor rehabilitation, especially those with motor function deficits. When applied to the primary motor cortex, tDCS has shown to improve motor function in healthy individuals, as well as in patients with neurological disorders. Based on its potential effects on motor recovery, identifying optimal targets for tDCS stimulation is essential to improve knowledge regarding neuromodulation as well as to advance the use of tDCS in clinical motor rehabilitation. METHODS AND RESULTS Therefore, this review discusses the existing evidence on the application of four different tDCS montages to promote and enhance motor rehabilitation: (1) anodal ipsilesional and cathodal contralesional primary motor cortex tDCS, (2) combination of central tDCS and peripheral electrical stimulation, (3) prefrontal tDCS montage and (4) cerebellar tDCS stimulation. Although there is a significant amount of data testing primary motor cortex tDCS for motor recovery, other targets and strategies have not been sufficiently tested. This review then presents the potential mechanisms and available evidence of these other tDCS strategies to promote motor recovery. CONCLUSIONS In spite of the large amount of data showing that tDCS is a promising adjuvant tool for motor rehabilitation, the diversity of parameters, associated with different characteristics of the clinical populations, has generated studies with heterogeneous methodologies and controversial results. The ideal montage for motor rehabilitation should be based on a patient-tailored approach that takes into account aspects related to the safety of the technique and the quality of the available evidence.
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Affiliation(s)
- Isadora Santos Ferreira
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Beatriz Teixeira Costa
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Clara Lima Ramos
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Pedro Lucena
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
| | - Felipe Fregni
- Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, 79/96 13th Street, Charlestown, MA, 02129, USA.
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Affiliation(s)
- Manuel A Anaya
- From the Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD (M.A.A.)
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Cousin CA, Rouse CA, Duenas VH, Dixon WE. Controlling the Cadence and Admittance of a Functional Electrical Stimulation Cycle. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1181-1192. [PMID: 31059451 DOI: 10.1109/tnsre.2019.2914579] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
For an individual suffering from a neurological condition, such as spinal cord injury, traumatic brain injury, or stroke, motorized functional electrical stimulation (FES) cycling is a rehabilitation strategy, which offers numerous health benefits. Motorized FES cycling is an example of physical human-robot interaction in which both systems must be controlled; the human is actuated by applying neuromuscular electrical stimulation to the large leg muscle groups, and the cycle is actuated through its onboard electric motor. While the rider is stimulated using a robust sliding-mode controller, the cycle utilizes an admittance controller to preserve rider safety. The admittance controller is shown to be passive with respect to the rider, and the cadence controller is shown to be globally exponentially stable through a Lyapunov-like switched systems stability analysis. Experiments are conducted on three able-bodied participants and four participants with neurological conditions (NCs) to demonstrate the efficacy of the developed controller and investigate the effect of manipulating individual admittance parameters. Results demonstrate an average admittance cadence error of -0.06±1.47 RPM for able-bodied participants and -0.02 ± 0.93 RPM for participants with NCs.
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Springhetti I. [The Digital Gym in the neuromotor rehabilitation field]. G Ital Med Lav Ergon 2019; 41:125-131. [PMID: 31170342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/31/2019] [Indexed: 06/09/2023]
Abstract
The digitization of processes has become a necessity to make health management remain sustainable. Current organizational models do not enable the increasing efficiency in process governance required by the increasing demand for rehabilitation services. Vice versa, new technologies have an innovative potential for compensation of disability and for operations management. This is context in which the concept of a "comprehensive digital rehabilitation" also said "digital gym" is developed: as a governance system for the whole inpatient rehabilitation path. The author describes the fundamentals of the Maugeri clinical model for a "Digital Gym" and examines some methodological, clinical and organizational issue concerning: information technology, machine operation protocols, clinical evaluation, machine operator interaction, patient doctor interaction, personalization of care, operational changes linked to the electronic workschedule, and the important training needs.
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Castronovo G, De Palo A, De Cicco D. [Implementation of the ICD-ICF model in rehabilitation medicine: report of a clinical case in neuromotor rehabilitation]. G Ital Med Lav Ergon 2019; 41:156-161. [PMID: 31170347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/31/2019] [Indexed: 06/09/2023]
Abstract
We present the clinical case of a 17-year-old boy who, after an auto-motorbike collision, suffered of bilateral condylar atlo-occipital dislocation with blood in the medullary canal and contusion of the C1-C3 spinal cord, hemothorax and pneumothorax, multiple costal fractures, fractures processes transverse L1 and right iliac wing and displaced fracture of the middle third of the right femur. In the emergency phase the patient, who was in a coma GCS: 3/15, was immediately intubated and taken to the Emergency Department and subsequently to Intensive Care Unit. He was also immediately subjected to chest drainage, reduction of femoral fracture and placement of external fixator and tracheostomy. Upon stabilization of the clinical picture, the patient was subjected to occipital-cervical stabilization with plates and screws and reduction of the fracture of the right femur with an intramedullary rod. Then the patient in hemodynamically stable and in alert condition, in spontaneous breath, was discharged and transferred to our Operative Unit of Intensive Neurorehabilitation. At the entrance, the doctor's evaluation, with the whole multidisciplinary team, enabled to identify the ICD-9 and ICF codes that best described the severity of the clinical picture: the patient showed tetraplegia, dysphonia and dysphagia, bearing a tracheal cannula in breath spontaneous with O2 supplementation, sequelae of multiple costal fractures and right femur, totally dependent on ADL. The rehabilitation intervention was aimed at promoting motor recovery in the 4 limbs, recovery of standing and walking, acquisition of ability to control daily life activities (ADL), recovery of physiological swallowing and removal of the tracheostomy tube. After long and slow physiotherapeutic training, the patient recovered the active motility at the crural and brachial level mainly at the proximal level, which however is not effective for ADL recovery. On the other hand, speech therapy allowed the passage to oral feeding and removal of the tracheostomy tube. Upon discharge, the re-evaluation of the ICF codes identified at the entrance indicated an improvement in the strength of the trunk muscles (b7305) with the possibility of performing transfers with assistance (d420), of dysphonia (b320) and of swallowing (b510) which led to the removal of the PEG and the tracheostomy tube; unfortunately severe deficiency of the muscular force at the distal brachial and crural level (b730, b7304) persists with severe disability in the activities of daily life (d455, d4551, d465, d429, d230).
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Affiliation(s)
- Gioacchino Castronovo
- Istituti Clinici Scientifici Maugeri IRCCS, UO di Neuroriabilitazione Intensiva/UO Risveglio, Sciacca (AG), Italy
| | - Angela De Palo
- Istituti Clinici Scientifici Maugeri IRCCS, UO di Neuroriabilitazione Intensiva/UO Risveglio, Sciacca (AG), Italy
| | - Domenico De Cicco
- Istituti Clinici Scientifici Maugeri IRCCS, UO di Neuroriabilitazione Intensiva/UO Risveglio, Sciacca (AG), Italy
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Abstract
Brain-machine interfaces (BMIs) have exploded in popularity in the past decade. BMIs, also called brain-computer interfaces, provide a direct link between the brain and a computer, usually to control an external device. BMIs have a wide array of potential clinical applications, ranging from restoring communication to people unable to speak due to amyotrophic lateral sclerosis or a stroke, to restoring movement to people with paralysis from spinal cord injury or motor neuron disease, to restoring memory to people with cognitive impairment. Because BMIs are controlled directly by the activity of prespecified neurons or cortical areas, they also provide a powerful paradigm with which to investigate fundamental questions about brain physiology, including neuronal behavior, learning, and the role of oscillations. This article reviews the clinical and neuroscientific applications of BMIs, with a primary focus on motor BMIs.
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Affiliation(s)
- Marc W Slutzky
- 1 Departments of Neurology, Physiology, and Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
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Villegas JD, Zapata MC, Jaramillo MC, Orozco E, Suárez JC. A case report of fat embolism syndrome: Treatment and neurological and cognitive rehabilitation. Biomedica 2019; 39:22-32. [PMID: 31021544 DOI: 10.7705/biomedica.v39i1.4438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Indexed: 06/09/2023]
Abstract
Se reporta el proceso de recuperación y rehabilitación neurológica y cognitiva de una mujer joven que desarrolló un síndrome de embolia grasa con repercusiones neurológicas, después de sufrir un politraumatismo. La paciente era una mujer de 21 años de edad con fractura cerrada de húmero y fémur izquierdos, que presentó un síndrome de embolia grasa, neumotórax izquierdo e hipertensión pulmonar, en las primeras 24 horas después de un accidente. Estuvo hospitalizada un mes y quedó con varios déficits neurológicos centrales, como infartos 'lacunares' y necrosis cortical laminar occipital, así como limitaciones en la bipedestación, la marcha, la visión y las funciones cognitivas. A partir del primer mes después del alta hospitalaria, se comenzó un proceso integral de rehabilitación neurológica y cognitiva en casa, y posteriormente, en una unidad médica de rehabilitación. Durante los primeros dos años después del accidente, la paciente recibió estimulación sensorial, sensoperceptiva y motora, así como rehabilitación motora y visual intensiva. Una vez se recuperó físicamente, se inició un proceso de rehabilitación neuropsicológica. Seis años después del accidente, la paciente terminó sus estudios universitarios y hoy está laboralmente activa. El proceso de rehabilitación neurológica es complejo, individual y difícil, aunque no imposible, y no se puede estandarizar un patrón de recuperación para todos los pacientes. Si bien existe la recuperación espontánea, la cual se da en los primeros seis meses, el caso aquí reportado demuestra que, en la fase crónica, la recuperación se puede lograr, pero requiere de evaluaciones y técnicas coordinadas de rehabilitación neurológica.
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Affiliation(s)
- José Daniel Villegas
- Línea de Investigación en Discapacidad, Grupo de Investigación en Salud Pública, Facultad de Medicina, Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia.
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Boldrini P, Bonaiuti D, Mazzoleni S, Posteraro F. Rehabilitation assisted by robotic and electromechanical devices for persons with neurological disabilities: an Italian consensus conference. Funct Neurol 2019; 34:123-124. [PMID: 31556393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Sezier A, Mudge S, Kayes N, Kersten P, Payne D, Harwood M, Potter E, Smith G, McPherson KM. Development of a toolkit to enhance care processes for people with a long-term neurological condition: a qualitative descriptive study. BMJ Open 2018; 8:e022038. [PMID: 29961034 PMCID: PMC6042578 DOI: 10.1136/bmjopen-2018-022038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To (A) explore perspectives of people with a long-term neurological condition, and of their family, clinicians and other stakeholders on three key processes: two-way communication, self-management and coordination of long-term care; and (B) use these data to develop a 'Living Well Toolkit', a structural support aiming to enhance the quality of these care processes. DESIGN This qualitative descriptive study drew on the principles of participatory research. Data from interviews and focus groups with participants (n=25) recruited from five hospital, rehabilitation and community settings in New Zealand were analysed using conventional content analysis. Consultation with a knowledge-user group (n=4) and an implementation champion group (n=4) provided additional operational knowledge important to toolkit development and its integration into clinical practice. RESULTS Four main, and one overarching, themes were constructed: (1) tailoring care:referring to getting to know the person and their individual circumstances; (2) involving others: representing the importance of negotiating the involvement of others in the person's long-term management process; (3) exchanging knowledge: referring to acknowledging patient expertise; and (4) enabling: highlighting the importance of empowering relationships and processes. The overarching theme was: assume nothing. These themes informed the development of a toolkit comprising of two parts: one to support the person with the long-term neurological condition, and one targeted at clinicians to guide interaction and support their engagement with patients. CONCLUSION Perspectives of healthcare users, clinicians and other stakeholders were fundamental to the development of the Living Well Toolkit. The findings were used to frame toolkit specifications and highlighted potential operational issues that could prove key to its success. Further research to evaluate its use is now underway.
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Affiliation(s)
- Ann Sezier
- Centre for Person Centred Research, Health & Rehabilitation Research Institute, University of Technology, Auckland, New Zealand
| | - Suzie Mudge
- Centre for Person Centred Research, Health & Rehabilitation Research Institute, University of Technology, Auckland, New Zealand
| | - Nicola Kayes
- Centre for Person Centred Research, Health & Rehabilitation Research Institute, University of Technology, Auckland, New Zealand
| | - Paula Kersten
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Deborah Payne
- Centre for Person Centred Research, Health & Rehabilitation Research Institute, University of Technology, Auckland, New Zealand
| | | | - Eden Potter
- Design for Health and Wellbeing (DHW) Lab, Auckland District Health Board and Auckland University of Technology collaboration, Auckland, New Zealand
| | - Greta Smith
- Centre for Person Centred Research, Health & Rehabilitation Research Institute, University of Technology, Auckland, New Zealand
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Schalet BD, Kallen MA, Heinemann AW, Deutsch A, Cook KF, Foster L, Cella D. Using PROMIS Pain Interference Items to Improve Quality Measurement in Inpatient Rehabilitation Facilities. J Am Med Dir Assoc 2018; 19:846-851.e2. [PMID: 29804893 DOI: 10.1016/j.jamda.2018.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 02/16/2018] [Accepted: 03/10/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference items for use in a quality measure and to compare the resulting quality score, along with internal reliability and validity, to a similar item set in the Minimum Data Set Version 3.0 (MDS). DESIGN Cross-sectional, observational study. SETTING One freestanding inpatient rehabilitation facility (IRF) and one large hospital-based IRF. PARTICIPANTS Patients with neurologic disorders. Of 1055 consecutive admissions, 26% were excluded based on clinician-determined cognitive impairment or emotional distress. Of the remainder, 50% consented and completed the survey near the end of their IRF stay (N = 391). Of these, more than half (57%) reported pain over the last day (n = 224). MEASUREMENTS Psychometric statistics and quality scores were computed from a 55-question survey, including the MDS and PROMIS pain interference items. RESULTS Estimates for internal reliability were higher for the PROMIS 2-item scale compared to the MDS: Cronbach α (0.86 vs 0.48) and interitem correlations (0.75 vs 0.31). The PROMIS-2 items were better able to detect differences in patients with mild and severe pain intensity (Cohen d = 1.57) relative to the corresponding MDS items (Cohen d = 0.81). Two quality scores based on the PROMIS-2 items, reflecting low and high levels of pain interference, showed 46% or 12% of patients meeting these thresholds. This compared to a 30% rate when patients were classified by the MDS as experiencing pain interference. CONCLUSIONS PROMIS pain interference items appear to be more internally consistent than similar MDS items. The graded PROMIS items permit the creation of multiple quality scores, showing predictable overlap with corresponding MDS quality scores. Because PROMIS items provide finer distinctions, they allow greater latitude in reporting quality scores. We recommend further study of pain interference scores across IRFs to improve their reliability and validity.
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Affiliation(s)
- Benjamin D Schalet
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Michael A Kallen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anne Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Quality Measurement and Health Policy Program, eHealth, Quality & Analytics Division, RTI International, Chicago, IL
| | - Karon F Cook
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Linda Foster
- Alexian Brothers Rehabilitation Hospital, Elk Grove Village, IL
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Swanson RL, Hampton S, Green-McKenzie J, Diaz-Arrastia R, Grady MS, Verma R, Biester R, Duda D, Wolf RL, Smith DH. Neurological Manifestations Among US Government Personnel Reporting Directional Audible and Sensory Phenomena in Havana, Cuba. JAMA 2018; 319:1125-1133. [PMID: 29450484 PMCID: PMC5885885 DOI: 10.1001/jama.2018.1742] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE From late 2016 through August 2017, US government personnel serving on diplomatic assignment in Havana, Cuba, reported neurological symptoms associated with exposure to auditory and sensory phenomena. OBJECTIVE To describe the neurological manifestations that followed exposure to an unknown energy source associated with auditory and sensory phenomena. DESIGN, SETTING, AND PARTICIPANTS Preliminary results from a retrospective case series of US government personnel in Havana, Cuba. Following reported exposure to auditory and sensory phenomena in their homes or hotel rooms, the individuals reported a similar constellation of neurological symptoms resembling brain injury. These individuals were referred to an academic brain injury center for multidisciplinary evaluation and treatment. EXPOSURES Report of experiencing audible and sensory phenomena emanating from a distinct direction (directional phenomena) associated with an undetermined source, while serving on US government assignments in Havana, Cuba, since 2016. MAIN OUTCOMES AND MEASURES Descriptions of the exposures and symptoms were obtained from medical record review of multidisciplinary clinical interviews and examinations. Additional objective assessments included clinical tests of vestibular (dynamic and static balance, vestibulo-ocular reflex testing, caloric testing), oculomotor (measurement of convergence, saccadic, and smooth pursuit eye movements), cognitive (comprehensive neuropsychological battery), and audiometric (pure tone and speech audiometry) functioning. Neuroimaging was also obtained. RESULTS Of 24 individuals with suspected exposure identified by the US Department of State, 21 completed multidisciplinary evaluation an average of 203 days after exposure. Persistent symptoms (>3 months after exposure) were reported by these individuals including cognitive (n = 17, 81%), balance (n = 15, 71%), visual (n = 18, 86%), and auditory (n = 15, 68%) dysfunction, sleep impairment (n = 18, 86%), and headaches (n = 16, 76%). Objective findings included cognitive (n = 16, 76%), vestibular (n = 17, 81%), and oculomotor (n = 15, 71%) abnormalities. Moderate to severe sensorineural hearing loss was identified in 3 individuals. Pharmacologic intervention was required for persistent sleep dysfunction (n = 15, 71%) and headache (n = 12, 57%). Fourteen individuals (67%) were held from work at the time of multidisciplinary evaluation. Of those, 7 began graduated return to work with restrictions in place, home exercise programs, and higher-level work-focused cognitive rehabilitation. CONCLUSIONS AND RELEVANCE In this preliminary report of a retrospective case series, persistent cognitive, vestibular, and oculomotor dysfunction, as well as sleep impairment and headaches, were observed among US government personnel in Havana, Cuba, associated with reports of directional audible and/or sensory phenomena of unclear origin. These individuals appeared to have sustained injury to widespread brain networks without an associated history of head trauma.
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Affiliation(s)
- Randel L. Swanson
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
| | - Stephen Hampton
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
| | - Judith Green-McKenzie
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Division of Occupational and Environmental Medicine, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ramon Diaz-Arrastia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - M. Sean Grady
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Ragini Verma
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Rosette Biester
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Perelman School of Medicine, Philadelphia
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
| | - Diana Duda
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Penn Therapy & Fitness, Good Shepherd Penn Partners, University of Pennsylvania, Philadelphia
| | - Ronald L. Wolf
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Douglas H. Smith
- Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia
- Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia
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Moen VP, Drageset J, Eide GE, Gjesdal S. Dimensions and predictors of disability-A baseline study of patients entering somatic rehabilitation in secondary care. PLoS One 2018; 13:e0193761. [PMID: 29499064 PMCID: PMC5834180 DOI: 10.1371/journal.pone.0193761] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 02/17/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate disability among patients who were accepted for admission to a Norwegian rehabilitation center and to identify predictors of disability. MATERIALS AND METHODS In a cross-sectional study including 967 adult participants, the World Health Organization Disability Assessment Schedule version 2.0 36-item version was used for assessing overall and domain-specific disability as outcome variables. Patients completed the Hospital Anxiety and Depression Scale (HADS), EuroQoL EQ-5D-5L and questions about multi-morbidity, smoking and perceived physical fitness. Additionally, the main health condition, sociodemographic and environmental variables obtained from referrals and public registers were used as predictor variables. Descriptive statistics and linear regression analyses were performed. RESULTS The mean (standard error) overall disability score was 30.0 (0.5), domain scores ranged from 11.9 to 44.7. Neurological diseases, multi-morbidity, low education, impaired physical fitness, pain, and higher HADS depressive score increased the overall disability score. A low HADS depressive score predicted a lower disability score in all domains. CONCLUSIONS A moderate overall disability score was found among patients accepted for admission to a rehabilitation center but "life activities" and "participation in society" had the highest domain scores. This should be taken into account when rehabilitation strategies are developed.
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Affiliation(s)
- Vegard Pihl Moen
- Center for Habilitation and Rehabilitation, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- * E-mail:
| | - Jorunn Drageset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Center for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Sturla Gjesdal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Obembe AO, Goldsmith CH, Simpson LA, Sakakibara BM, Eng JJ. Support service utilization and out-of-pocket payments for health services in a population-based sample of adults with neurological conditions. PLoS One 2018; 13:e0192911. [PMID: 29474391 PMCID: PMC5825050 DOI: 10.1371/journal.pone.0192911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 01/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background Social support can help to deal with the consequences of neurological conditions and promote functional independence and quality of life. Our aim was to evaluate the impact of neurological conditions on the use of support and health-care services in a population-based sample of community-dwelling adults with neurological conditions. Methods Data were from the Survey of Living with Neurological Conditions in Canada, which was derived from a representative sample of household residents. Formal and informal support received and out-of-pocket payments were assessed by personal interviews. Logistic regression was used to explore the association between support service utilization and six common neurological conditions (Stroke, Parkinson's disease, Alzheimer's disease/dementias, traumatic brain injury, spinal cord injury and multiple sclerosis) with stroke as the reference category. Results The sample contained 2,410 respondents and equate to an estimated 459,770 when sample weights were used. A larger proportion of people within each of the neurological conditions received informal support than formal support (at least twice as much). Samples with the non-stroke conditions were more likely to receive formal assistance for personal (odds ratios 2.7 to 5.6; P < 0.05) and medical (odds ratios 2.4 to 4.4; P < 0.05) care compared to the stroke group. Also, the non-stroke conditions were more likely to receive informal assistance (odds ratios 2.7 to 17.9; P < 0.05) and less likely to make out-of-pocket payments for rehabilitation therapy (odds ratios 0.2 to 0.3; P < 0.05) than the stroke group. The Alzheimer’s disease/dementia group had the highest proportion who received formal and informal support services. Conclusions Our findings suggest that Canadians with neurological conditions receive more informal assistance than formal assistance. Furthermore, it appears that stroke survivors receive less support services, while those with Alzheimer’s disease/dementia receive the most compared to other adult neurological conditions. Such data can help inform the development of support services in the community.
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Affiliation(s)
- Adebimpe O. Obembe
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Charlie H. Goldsmith
- Adjunct Professor, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Adjunct Professor, Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, Canada
| | - Lisa A. Simpson
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, Canada
| | - Brodie M. Sakakibara
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Janice J. Eng
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
- * E-mail:
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Nardone A, Ferrari EP. [Chronic diseases in neuromotor rehabilitation medicine.]. G Ital Med Lav Ergon 2018; 40:48-55. [PMID: 29916567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/09/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Chronic diseases are a major problem, whose importance is nowadays raising up. Up to 86% of deaths are directly related to chronic diseases in Europe as they represent large amount of total diseases, with a major impact on global health spending. METHODS Patients suffering from heterogeneous disabilities (such as Parkinson's disease, stroke, multiple sclerosis, osteoporosis, osteoarthritis) often show an interaction between the main disease and comorbidity and multimorbidity. RESULTS Therefore, the complicate interaction between all these ailments must be faced following specific care pathways. Within the latter ones, pharmacological, physical/cognitive and other (surgical and non-surgical) treatments should be reconciled in order to produce a synergic effect to counteract patient's clinical problems. CONCLUSIONS Finally, neuromotor rehabilitation medicine should not only be considered as a step following the acute phase but also as an effective tool of secondary and tertiary prevention aimed to avoid relapses and re-hospitalization as well as to improve patient's quality of life.
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Affiliation(s)
- Antonio Nardone
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Pavia
- Unità Neuroriabilitazione e Spinale, ICS Maugeri SPA SB, Istituto di Pavia, IRCCS, Pavia
- Centro Studi Attività Motorie, ICS Maugeri SPA SB, Istituto di Pavia, IRCCS, Pavia
| | - Elena Paola Ferrari
- Scuola di Specializzazione in Medicina Fisica e Riabilitativa, Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Pavia
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Campanini I, Mastrangelo S, Bargellini A, Bassoli A, Bosi G, Lombardi F, Tolomelli S, Lusuardi M, Merlo A. Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study. BMC Health Serv Res 2018; 18:18. [PMID: 29325560 PMCID: PMC5765700 DOI: 10.1186/s12913-017-2815-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study's aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. METHODS A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards. All admitted patients were enrolled and assessed within 24 h of admission by means of the HIIFRM. The occurrence of falls was checked and recorded daily. HIIFRM feasibility was assessed as the percentage of successful administrations at admission. HIIFRM predictive performance was determined in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC), best cutoff, sensitivity, specificity, positive and negative predictive values, along with their asymptotic 95% confidence intervals (95% CI). RESULTS One hundred ninety-one patents were admitted. HIIFRM was feasible in 147 cases (77%), 11 of which suffered a fall (7.5%). Failures in administration were mainly due to bedridden patients (e.g. minimally conscious state, vegetative state). AUC was 0.779(0.685-0.873). The original HIIFRM cutoff of 5 led to a sensitivity of 100% with a mere specificity of 49%(40-57%), thus suggesting using higher cutoffs. Moreover, the median score for non-fallers at rehabilitation units was higher than that reported in literature for geriatric non fallers. The best trade-off between sensitivity and specificity was obtained by using a cutoff of 8. This lead to sensitivity = 73%(46-99%), specificity = 72%(65-80%), positive predictive value = 17% and negative predictive value = 97%. These results support the use of the HIIFRM as a predictive tool. CONCLUSIONS The HIIFRM showed satisfactory feasibility and predictive performances in rehabilitation wards. Based on both available literature and these results, the prediction of falls among all hospital wards, with high risk of falling, could be achieved by means of a unique tool and two different cutoffs: a standard cutoff of 5 in geriatric wards and an adjusted higher cutoff in rehabilitation units, with predictive performances similar to those of the best-preforming pathology specific tools for fall-risk assessment.
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Affiliation(s)
- Isabella Campanini
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | | | - Annalisa Bargellini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Agnese Bassoli
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy
| | - Gabriele Bosi
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy
| | - Francesco Lombardi
- Neurological Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Stefano Tolomelli
- Neurological Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
- Orthopaedic Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Mirco Lusuardi
- Respiratory Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Andrea Merlo
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy
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Raglio A. Music and neurorehabilitation: Yes, we can! Funct Neurol 2018; 33:173-174. [PMID: 30663962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Ackerman SJ. Bradford C. Berk: Picking Good Questions. Circ Res 2017; 121:1309-1311. [PMID: 29217709 DOI: 10.1161/circresaha.117.312322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Raglio A. [Music therapy and Rehabilitation medicine: state of the art and future perspectives. Editorial]. G Ital Med Lav Ergon 2017; 39:271-272. [PMID: 29916574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/09/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Alfredo Raglio
- IRCCS Istituti Clinici Scientifici Maugeri, Istituto di Pavia, U.O.O.M.L., Dipartimento Sanità Pubblica, Medicina Sperimentale e Forense, Università di Pavia, Pavia
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Abstract
BACKGROUND To provide body weight support during walking and balance training, one can employ two distinct embodiments: support through a harness hanging from an overhead system or support through a saddle/seat type. This paper presents a comparison of these two approaches. Ultimately, this comparison determined our selection of the body weight support system employed in the MIT-Skywalker, a robotic device developed for the rehabilitation/habilitation of gait and balance after a neurological injury. METHOD Here we will summarize our results with eight healthy subjects walking on the treadmill without any support, with 30% unloading supported by a harness hanging from an overhead system, and with a saddle/seat-like support system. We compared the center of mass as well as vertical and mediolateral trunk displacements across different walking speeds and support. RESULTS The bicycle/saddle system had the highest values for the mediolateral inclination, while the overhead harness body weight support showed the lowest values at all speeds. The differences were statistically significant. CONCLUSION We selected the bicycle/saddle system for the MIT-Skywalker. It allows faster don-and-doff, better centers the patient to the split treadmill, and allows all forms of training. The overhead harness body weight support might be adequate for rhythmic walking training but limits any potential for balance training.
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Affiliation(s)
- Rogério Sales Gonçalves
- Federal University of Uberlândia/Brazil, School of Mechanical Engineering, Av. João Naves de Ávila 2121 Campus Santa Monica CX 593, Uberlândia, MG CEP 38408-100 Brazil
- Mechanical Engineering Department, The Eric P. and Evelyn E. Newman Laboratory for Biomechanics and Human Rehabilitation, Massachusetts Institute of Technology – MIT, Boston, USA
| | - Hermano Igo Krebs
- Mechanical Engineering Department, Principal Research Scientist & Lecturer MIT, Room 3-137 Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139-4307 USA
- Neurology Department, University of Maryland, School of Medicine, Baltimore, USA
- Mechanical Science and Bioengineering Department, Osaka University, Suita, Japan
- Fujita Health University, School of Medicine, Toyoake, Japan
- Newcastle University, Institute of Neuroscience, Newcastle, UK
- Loughborough University, The Wolfson School of Engineering, Loughborough, UK
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Chan V, Mollayeva T, Ottenbacher KJ, Colantonio A. Clinical profile and comorbidity of traumatic brain injury among younger and older men and women: a brief research notes. BMC Res Notes 2017; 10:371. [PMID: 28789695 PMCID: PMC5549298 DOI: 10.1186/s13104-017-2682-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/22/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Comorbid disorders influence the course and outcomes of rehabilitation following traumatic brain injury (TBI), yet sex- and age-related disparities in the frequency distribution of these disorders remain poorly understood. We aimed to describe comorbid disorders by the International Classification of Diseases in patients with TBI undergoing inpatient rehabilitation in Ontario, Canada over a 3-year period, by sex and age, and discuss their potential impact on rehabilitation outcomes. RESULTS The percentage of TBI patients with one or more comorbid disorder is higher among older (≥65 years) men and women than among those who are younger or middle-aged (<65 years). Among younger and middle-aged patients, multiple injuries and trauma, mental health conditions, and nervous system disorders were the most prevalent comorbidities. In older patients, circulatory, endocrine, nutritional, metabolic, and immune disorders were the most prevalent comorbidities. Our results suggest that a multisystem view of rehabilitation of men and women with TBI across age categories is needed to reflect the complex clinical profile of TBI patients undergoing rehabilitation.
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Affiliation(s)
- Vincy Chan
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Tatyana Mollayeva
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Kenneth J. Ottenbacher
- Division of Rehabilitation Science, Center for Recovery, Physical Activity and Nutrition, School of Health Professions, University of Texas Medical Branch, Galveston, Texas USA
| | - Angela Colantonio
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
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Sandrini G, Binder H, Hömberg V, Saltuari L, Tarkka I, Smania N, Corradini C, Giustini A, Kätterer C, Picari L, Diserens K, Koenig E, Geurts A, Anghelescu A, Opara J, Tonin P, Kwakkel G, Golyk V, Onose G, Pérennou D, Picelli A. European core curriculum in neurorehabilitation. Funct Neurol 2017; 32:63-68. [PMID: 28676138 DOI: 10.11138/fneur/2017.32.2.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To date, medical education lacks Europe-wide standards on neurorehabilitation. To address this, the European Federation of NeuroRehabilitation Societies (EFNR) here proposes a postgraduate neurorehabilitation training scheme. In particular, the European medical core curriculum in neurorehabilitation should include a two-year residency in a neurorehabilitation setting where trainees can gain practical experience. Furthermore, it should comprise six modules of classroom training organized as weekend seminars or summer/winter schools. In conclusion, after defining the European medical core curriculum in neurorehabilitation, the next activities of the EFNR will be to try and reach the largest possible consensus on its content among all national societies across Europe in order to further validate it and try to extend it to the other, non-medical, professionals on the neurorehabilitation team in line with their core curricula defined by each professional association.
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Ballesteros J, Urdiales C, Martinez AB, Tirado M. Automatic Assessment of a Rollator-User's Condition During Rehabilitation Using the i-Walker Platform. IEEE Trans Neural Syst Rehabil Eng 2017; 25:2009-2017. [PMID: 28459694 DOI: 10.1109/tnsre.2017.2698005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patient condition during rehabilitation has been traditionally assessed using clinical scales. These scales typically require the patient and/or the clinician to rate a number of condition-related items to obtain a final score. This is a time-consuming task, specially if a large number of patients are involved. Furthermore, during rehabilitation, user condition is expected to change steadily in time, so assessment may require to run these scales several times to each user. To save time, much effort has been focused on developing clinical scales that require little time to be completed. This is usually achieved by measuring a reduced set of features, i.e., focusing the scales on specific features of a defined target population (Parkinson's disease, Stroke, and so on). However, these scales still require the therapist's intervention and may be tiresome for patients who have to fill them repeatedly. This paper proposes a novel approach to automatically obtain balance scales from the onboard sensors of a robotic rollator. These sensors are used to extract spatiotemporal gait parameters from patients using the rollator for support. These parameters are derived from the user forces on the rollator handles and its odometry. Resulting parameters are used to predict the Tinetti mobility clinical scale on the fly, without therapist intervention. Our approach has been validated with 19 rollator volunteers with a variety of physical and neurological disabilities at Hospital Civil (Malaga) and Fondazione Santa Lucia (Rome). Clinicians provided traditionally obtained Tinetti scores and the proposed system was used to estimate them on the fly. Results show a small root mean squared prediction error. This method can be used for any rollator user anywhere in everyday walking conditions to obtain the Tinetti scores as often as desired and, hence evaluate their progress.
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Wallesch CW. [Neurological early rehabilitation and pallation]. Fortschr Neurol Psychiatr 2017; 85:137-138. [PMID: 28320022 DOI: 10.1055/s-0043-102188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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O'Brien SR, Bulas M, Metcalfe A, Mix Z, Richert T, Wagner R. Meaningful Functional Change Achieved from Physical Therapy Provided in a Student-Run Pro Bono Clinic. J Allied Health 2017; 46:138-142. [PMID: 28889162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/12/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study investigated whether patients with chronic neurologic diagnoses who attended a student-run pro bono physical therapy (PT) clinic achieved the minimum detectable change (MDC) on functional measures and the factors associated with such change. METHODS Retrospective chart review included 71 patients with a primary diagnosis of stroke, traumatic brain injury, or multiple sclerosis from 2010 to 2014. The sample was 45% female, with a mean age of 62 yrs (SD 12.6) and mean 7.9 yrs (10.1) postdiagnosis. Second-year DPT students provided supervised weekly sessions. Meaningful functional change was defined as the achievement of the MDC on one functional outcome measure. Multivariate logistic regression, controlled for semester, was used to analyze factors associated with achievement of MDC. RESULTS MDC was achieved in approximately 70% of cases. Factors associated with MDC achievement were number of visits (OR 1.04, p<0.02) and the Charlson Comorbidity Index (OR 1.06, p<0.02). Factors not associated were age, sex, diagnosis, years post-diagnosis, number of medications, admission functional status, and distance to the clinic. CONCLUSIONS Weekly 60-min PT sessions provided in a student-run neurologic clinic were associated with achieving the MDC on functional measures. Such clinics may be a safety net.
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Affiliation(s)
- Suzanne R O'Brien
- Dep. of Physical Therapy, Nazareth College, 4245 East Avenue, Rochester, NY 14618, USA. Tel 585-389-2904, fax 585-389-2908.
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