Studying the Research-Practice Gap in Physical Therapies for Cerebral Palsy: Preliminary Outcomes Based on a Survey of Spanish Clinicians

The purpose of this work is to study the gap between the research evidence and the clinical practice in the physical rehabilitation of people with cerebral palsy. A review process was performed to (1) identify physical therapies to improve postural control in children with cerebral palsy and (2) determine the scientific evidence supporting the effectiveness of those therapies. A Likert-based survey addressing a total of 43 healthcare professionals involved in pediatric physical therapy departments in Spain was carried out. The discussion was mainly supported by studies of level I or II evidence (according to the Oxford scale). The search process yielded 50 studies reporting 16 therapies. A strong positive correlation between the most used treatments and elevated levels of satisfaction was found. Some well-known but not often used techniques, such as hippotherapy, were identified. The treatment with the highest degree of use and satisfaction-neurodevelopment therapy (Bobath)-and some emerging techniques, such as virtual reality, were also identified. The fact that there is a meaningful gap between clinical practice and the scientific evidence was confirmed. The identified gap brings a certain degree of controversy. While some classic and well-known therapies had poor levels of supporting evidence, other relatively new approaches showed promising results.

A novel virtual reality application for autonomous assessment of cervical range of motion: development and reliability study

Background

Neck pain, one of the most common musculoskeletal diseases, affects 222 million people worldwide. The cervical range of motion (CROM) is a tool used to assess the neck's state across three movement axes: flexo-extension, rotation, and lateral flexion. People with neck pain often have a reduced CROM, and they feel pain at the end-range and/or accompany neck movements with compensatory trunk movements. Virtual reality (VR) setups can track the movement of the head and other body parts in order to create the sensation of immersion in the virtual environment. Using this tracking position information, a CROM assessment can be performed using a VR setup that may be carried out autonomously from the user's home. The objectives of this study were to develop a VR experience that could be used to perform a CROM assessment, and to evaluate the intra-rater and inter-rater reliability of the CROM measures guided by this VR experience. To the best of our knowledge, a study of this type has not been carried out before.

Materials & Methods

A total of 30 asymptomatic adults were assessed using a VR device (HTC Vive Pro Eye™). Two raters provided support with the VR setup, and the participants were guided by the VR experience as they performed the movements. Each rater tested each subject twice, in random order. In addition to a head-mounted display (HMD), a tracker located on the subject's back was used to measure trunk compensatory movements. The CROM was estimated using only the HMD position and this measurement was corrected using the tracker data. The mean and standard deviation were calculated to characterize the CROM. To evaluate the reliability, the interclass correlation coefficients (ICC) were calculated for intra-rater and inter-rater analysis. The standard error of measurement and minimum detectable change were also calculated. The usability of the VR system was measured using the Spanish version of the System Usability Scale.

Results

The mean CROM values in each axis of movement were compatible with those described in the literature. ICC values ranged between 0.86 and 0.96 in the intra-rater analysis and between 0.83 and 0.97 in the inter-rater analysis; these values were between good and excellent. When applying the correction of the trunk movements, both the intra-rater and inter-rater ICC values slightly worsened except in the case of the lateral flexion movement, where they slightly improved. The usability score of the CROM assessment/VR system was 86 points, which is an excellent usability score.

Conclusion

The reliability of the measurements and the usability of the system indicate that a VR setup can be used to assess CROM. The reliability of the VR setup can be affected by slippage of the HMD or tracker. Both slippage errors are additive, i.e., only when the sum of these two errors is less than the compensatory movement do the measurements improve when considering the tracker data.

Evaluation of Child-Computer Interaction Using Fitts' Law: A Comparison between a Standard Computer Mouse and a Head Mouse

This study evaluates and compares the suitability for child-computer interaction (CCI, the branch within human-computer interaction focused on interactive computer systems for children) of two devices: a standard computer mouse and the ENLAZA interface, a head mouse that measures the user's head posture using an inertial sensor. A multidirectional pointing task was used to assess the motor performance and the users' ability to learn such a task. The evaluation was based on the interpretation of the metrics derived from Fitts' law. Ten children aged between 6 and 8 participated in this study. Participants performed a series of pre- and post-training tests for both input devices. After the experiments, data were analyzed and statistically compared. The results show that Fitts' law can be used to detect changes in the learning process and assess the level of psychomotor development (by comparing the performance of adults and children). In addition, meaningful differences between the fine motor control (hand) and the gross motor control (head) were found by comparing the results of the interaction using the two devices. These findings suggest that Fitts' law metrics offer a reliable and objective way of measuring the progress of physical training or therapy.

CEU Mass Mediator 3.0: A Metabolite Annotation Tool

CEU Mass Mediator (CMM, http://ceumass.eps.uspceu.es ) is an online tool that has evolved from a simple interface to query different metabolomic databases (CMM 1.0) to a tool that unifies the compounds from these databases and, using an expert system with knowledge about the experimental setup and the compounds properties, filters and scores the query results (CMM 2.0). Since this last major revision, CMM has continued to grow, expanding the knowledge base of its expert system and including new services to support researchers in the metabolite annotation and identification process. The information from external databases has been refreshed, and an in-house library with oxidized lipids not present in other sources has been added. This has increased the number of experimental metabolites up 332,665 and the number of predicted metabolites to 681,198. Furthermore, new taxonomy and ontology metadata have been included. CMM has expanded its functionalities with a service for the annotation of oxidized glycerophosphocholines, a service for spectral comparison from MS² data, and a spectral quality-assessment service to determine the reliability of a spectrum for compound identification purposes. To facilitate the collaboration and integration of CMM with external tools and metabolomic platforms, a RESTful API has been created, and it has already been integrated into the HMDB (Human Metabolome Database). This paper will present the novel functionalities incorporated into version 3.0 of CMM.

An Inexpensive and Easy to Use Cervical Range of Motion Measurement Solution Using Inertial Sensors

Neck injuries and the related pain have a high prevalence and represent an important health problem. To properly diagnose and treat them, practitioners need an accurate system for measuring Cervical Range Of Motion (CROM). This article describes the development and validation of an inexpensive, small (4 cm × 4 cm × 8 cm), light (< 200 g) and easy to use solution for measuring CROM using wearable inertial sensors. The proposed solution has been designed with the clinical practice in mind, after consulting with practitioners. It is composed of: (a) two wearable wireless MEMS-based inertial devices, (b) a recording and report generation software application and (c) a measurement protocol for assessing CROM. The solution provides accurate (none of our results is outside the ROM ranges when compared with previously published results based on an optical tracking device) and reliable measurements (ICC = 0.93 for interrater reliability when compared with an optical tracking device and ICC > 0.90 for test-retest reliability), surpassing the popular CROM instrument's capabilities and precision. It also fulfills the needs for clinical practice attending to effectiveness, efficiency (4 min from setup to final report) and user's satisfaction (as reported by practitioners). The solution has been certified for mass-production and use in medical environments.

Iterative reconstruction for pet scanners with continuous scintillators

Several technical developments have led to a comeback of the continuous scintillators in positron emission tomography (PET). Important differences exist between the resurgent continuous scintillators and the prevailing pixelated devices, which can translate into certain advantages of the former over the latter. However, if the peculiarities of the continuous scintillators are not considered in the iterative reconstruction in which the measured data is converted to images, these advantages will not be fully exploited. In this paper, we review which those peculiarities are and how they have been considered in the literature of PET reconstruction. In light of this review, we propose a new method to compute one of the key elements of the iterative schemes, the system matrix. Specifically, we substitute the traditional Gaussian approach to the so-called uncertainty term by a more general Monte Carlo estimation, and account for the effect of the optical photons, which cannot be neglected in continuous-scintillators devices. Finally, we gather in a single scheme all the elements of the iterative reconstruction that have been individually reformulated, in this or previous works, for continuous scintillators, providing the first reconstruction framework fully adapted to this type of detectors. The preliminary images obtained for a commercially available PET scanner show the benefits of adjusting the reconstruction to the nature of the scintillators.

Correlations between physiological parameters related with kidney function and minute-by-minute urine output

AIM

Recently, devices capable of measuring minute-by-minute urine output (UOm) have become available. It is not known how UOm correlates with physiological parameters in normal conditions and in disease states characterized by vascular dysfunction. This paper analyzes correlations between UOm and physiological parameters related to kidney perfusion to provide some insight about UOm pathophysiological interpretation and its relationship with renal blood flow.

METHODS

We studied 14 male pigs were anesthetized, tracheostomized, and mechanically ventilated. Mean systemic blood pressure (P_ART ), mean pulmonary artery blood pressure (P_PA ), carotid artery blood flow (Q_CA ), as well as total (Q_REN ), cortical (Q_COR ) and medullary (Q_MED ) renal blood flows, and the renal resistive index (RRI) were measured or calculated. Animals received an intravenous dose of live E. coli for the induction of sepsis (septic group), or an equivalent amount of normal saline (nonseptic group). Three groups were studied: nonseptic (n = 6) and septic (n = 4), both receiving for resuscitation NaCl 0.9% at 4 mL/kg per h; and septic (n = 4), receiving for resuscitation NaCl 0.9% at 17 mL/kg per h. Animals were monitored for 5 h after the induction of sepsis.

RESULTS

In septic animals, UOm was strongly positively correlated with Q_REN (Kendall's τ = 0.770, P < 0.05), Q_COR (τ = -0.566, P < 0.05) and Q_MED (τ = 0.632, P < 0.05); and negatively correlated with P_PA (τ = -0.524, P < 0.05) and RRI (τ = -0.672, P < 0.05). Control animals exhibited weaker correlations.

CONCLUSION

UOm is a good physiological surrogate marker of total and regional renal blood flows and vascular resistance, particularly under septic conditions, probably reflecting glomerulo-tubular dysfunction in sepsis.