Archive for February, 2015
To better inform coverage of traumatic brain injury (TBI) in news and social media, CDC developed the Guide to Writing about Traumatic Brain Injury in News and Social Media.
The Guide is designed for media writers, editors, and bloggers. It includes:
- Statistics, most frequent causes, and signs and symptoms of TBI;
- Descriptions of who is at greatest risk for TBI;
- Sample press content and story ideas;
- Information for sports writers about how to broaden the content and impact of TBI stories; and
- Tips on TBI prevention that can be included in stories.
Telemedicine has become one of the hot trends in healthcare, with more and more patients and doctors using smartphones and tablets to exchange medical information. The convenience of not having to travel to the doctor’s office or clinic is a big part of the appeal—as is the relief of not wasting valuable time thumbing through outdated waiting-room magazines when an appointment runs late. And for patients living in isolated or underserved areas, telemedicine offers care that might otherwise be unattainable. Despite these advantages, telemedicine can be coldly impersonal, lacking the comfort of interacting with another human being.
Silicon Valley-based Sense.ly is working to bring a human face to telemedicine. The company’s Kinect-powered “nurse avatar” provides personalized patient monitoring and follow-up care—not to mention a friendly, smiling face that converses with patients in an incredibly lifelike manner. The nurse avatar, affectionately nicknamed Molly, has access to a patient’s records and asks appropriate questions related directly to the patient’s past history or present complaints. She has a pleasant, caring demeanor that puts patients at ease. Interacting with her seems surprisingly natural, which, of course, is the goal.
By using Kinect for Windows technology, Sense.ly enables Molly to recognize and respond to her patient’s visual and spoken inputs. The patient stands or sits in from of a Kinect sensor, which captures his or her image and sends it to Molly. Does the patient have knee pain? She can show Molly exactly where it hurts. Is the patient undergoing treatment for bursitis that limits his range of motion? He can raise his affected arm and show Molly whether his therapy is achieving results. In fact, the Kinect sensor’s skeletal tracking capabilities allow Sense.ly to measure the patient’s range of motion and to calculate how it has changed from his last session. What’s more, with Kinect providing a clear view of the patient, Molly can help guide him or her through therapeutic exercises.
A growing number doctors and hospitals are recognizing the value of applications such as Sense.ly. In fact, the San Mateo Medical Center is one of several major hospitals that have recently added Molly to their staff, so to speak. The value of such solutions is particularly striking in handling patients who suffer from long-term conditions that require frequent monitoring, such high blood pressure or diabetes.
Solutions like Sense.ly also provide a clear cost benefit for providers and insurers, as treating a patient remotely is less costly and generally more efficient than onsite care. In a recent pilot program, the use of Sense.ly reduced patient calls by 28 percent and freed up nearly a fifth of their day for the clinicians involved in the program.
Most importantly, Sense.ly’s Kinect-powered nurse avatar offers the promise of better health outcomes, the result of more frequent medical monitoring and of patients’ increased involvement in their own care. Something to think about the next time you’re stuck in the doctor’s waiting room.
After traumatic brain injury (TBI), many couples find that their relationship with each other changes dramatically. These changes are very personal and can be very emotional for both people in the relationship. This factsheet will help couples understand some of the common changes they may notice in their relationship after TBI. Also, suggestions are given for ways that couples can address some of the more difficult changes they are experiencing.
Although some of the relationship changes after TBI are difficult and can be painful, there are many things that couples can do in order to enjoy each other and their relationship in new, positive, and meaningful ways.
Couples’ Relationships and TBI
A TBI can significantly change a couple’s relationship. There are different degrees of brain injury severity, and milder injuries such as concussions do not always result in significant or long-term relationship changes. However, after severe, moderate, or complicated-mild brain injury, both survivors and their spouses or partners must often change many parts of their lives. The following life changes typically affect intimate relationships:
- Changes in responsibilities
- Changes in relationship roles
- Changes and challenges in communication
Brain injury survivors often have new personality traits, challenges, fears, and limitations. Survivors are often surprised by how these changes also mean that they will feel and behave differently in their relationships. These changes have led many spouses to say they feel like they are “married to a stranger.”
The intimate partners of survivors may have new concerns or fears related to both the incident that caused the injury and the new behavior traits of the survivor. Also, partners often change the focus in their lives in order to manage the multiple challenges that arise for their family after an injury.
These changes in the survivor’s personality and the life focus of both partners often result in a feeling that partners do not know what to expect from one another. Uncertainty can increase stress and anxiety within the home.
How Are Relationships Typically Affected?
Continue –> Relationships After Traumatic Brain Injury.
[ARTICLE] Color Doppler ultrasound-guided botulinum toxin type A injection combined with an ankle foot brace for treating lower limb spasticity after a stroke – Full Text PDF
OBJECTIVE: To explore the effectiveness of the color Doppler ultrasound-guided botulinum toxin type A (BTX-A) injection combined with an ankle foot brace (AFO) for treating lower limb spasticity after a stroke.
PATIENTS AND METHODS: A total of 103 post-stroke patients with lower limb spasticity were divided into three groups: the control group treated with conventional therapy and rehabilitation training, the observation group treated with conventional therapy, rehabilitation training and botulinum toxin type A injection, the treatment group treated with AFO plus the same treatment received by the observation group. The muscle spasms were evaluated using the Clinic Spasticity Influx (CSI), movement with the Fugl-Meyer Assessment (FMA), dynamic and static balance with the Berg Balance Scale (BBS), and daily life activities with the Functional Independence Measure (FIM), respectively.
RESULTS: Compared the first month after treatment with the prior treatment, there were significant differences in CSI, FMA and FIM scores in both control group and the observation group (p < 0.05). However, no differences were noticed in the control group (p > 0.05). Compared the third and sixth month after treatment with prior treatment, there were significant differences in these three groups (p < 0.05). In terms of treatment time, the BBS scores were always higher in all three groups after one month, three months and six months treatment than prior treatment (p < 0.05), and there were significant differences in third month and sixth month after treatment compared with the first month treatment (p < 0.05). Compared the third month after treatment with the sixth month, there were significant differences in all three groups (p < 0.05).
CONCLUSIONS: The color Doppler ultrasound-guided BTX-A injection combined with AFO can effectively promote patients with poststroke lower limb spasticity in lower limb muscle spasm, movement, balance and daily life activities.
Purpose: To identify and appraise the literature on clinical measures of spasticity that has been investigated in people after stroke.
Methods: The literature search involved four databases (PubMed, CINAHL, Embase and The Cochrane Library) up to February 2014. The selected studies included those that aimed to measure spasticity using a clinical assessment tool among adult patients post-stroke. Two independent raters reviewed the included articles using a critical appraisal scale and a structured data extraction form.
Results: A total of 40 studies examining 15 spasticity assessment tools in patients post-stroke were reviewed. None of the reviewed measurement tools demonstrated satisfactory results for all psychometric properties evaluated, and the majority lacked evidence concerning validity and absolute reliability.
Conclusion: This systematic review found limited evidence to support the use of most of clinical measures of spasticity for people post-stroke. Future research examining the application and psychometric properties of these measures is warranted.Implications for Rehabilitation
There is a need for objective clinical tools for measuring spasticity that are clinically feasible and easily interpreted by clinicians.
This review identified various clinical measures of spasticity that have been investigated in people after stroke.
Insufficient evidence of psychometric properties precludes recommending one tool over the others.
Future research should focus on investigating the psychometric properties of clinical measures of spasticity.
[ARTICLE] Effect of forced use of the lower extremity on gait performance and mobility of post-acute stroke patients – Full Text PDF
[Purpose] The purpose of this study was to investigate the effects of a forced-use training program on gait, mobility and quality of life of post-acute stroke patients.
[Subjects] Twenty-one individuals with unilateral stroke participated in this study. All participants had suffered from first-ever stroke with time since onset of at least 3 months.
[Methods] A single-blinded, non-equivalent, pre-post controlled design with 1-month follow-up was adopted. Participants received either a forced-use or a conventional physical therapy program for 2 weeks. The main outcomes assessed were preferred and fastest walking velocities, spatial and temporal symmetry indexes of gait, the timed up and go test, the Rivermead Mobility Index, and the Stroke-Specific Quality of Life Scale (Taiwan version).
[Results] Forced-use training induced greater improvements in gait and mobility than conventional physical therapy. In addition, compared to pre-training, patients in the conventional physical therapy group walked faster but more asymmetrically after training. However, neither program effectively improved in-hospital quality of life.
[Conclusion] The forced-use approach can be successfully applied to the lower extremities of stroke patients to improve mobility, walking speeds and symmetry of gait.
[ARTICE] Effects of brain-computer interface-based functional electrical stimulation on balance and gait function in patients with stroke: preliminary results – Full Text PDF
[Purpose] The purpose of this study was to determine the effects of brain-computer interface (BCI)- based functional electrical stimulation (FES) on balance and gait function in patients with stroke.
[Subjects] Subjects were randomly allocated to a BCI-FES group (n=5) and a FES group (n=5).
[Methods] The BCI-FES group received ankle dorsiflexion training with FES according to a BCI-based program for 30 minutes per day for 5 days. The FES group received ankle dorsiflexion training with FES for the same duration.
[Results] Following the intervention, the BCI-FES group showed significant differences in Timed Up and Go test value, cadence, and step length on the affected side. The FES group showed no significant differences after the intervention. However, there were no significant differences between the 2 groups after the intervention.
[Conclusion] The results of this study suggest that BCI-based FES training is a more effective exercise for balance and gait function than FES training alone in patients with stroke.
- Post stroke motor impairments involving force control capabilities are devastating.
- Bimanual motor synergies provide robust data on coordinating forces between hands.
- Low-force frequency patterns reveal fine motor control strategies in paretic hands.
- Analyzing both novel approaches advance understanding of post stroke force control.
Force control deficits are common dysfunctions after a stroke. This review concentrates on various force control variables associated with motor impairments and suggests new approaches to quantifying force control production and modulation. Moreover, related neurophysiological mechanisms were addressed to determine variables that affect force control capabilities. Typically, post stroke force control impairments include:
(a) decreased force magnitude and asymmetrical forces between hands,
(b) higher task error,
(c) greater force variability,
(d) increased force regularity, and
(e) greater time-lag between muscular forces.
Recent advances in force control analyses post stroke indicated less bimanual motor synergies and impaired low-force frequency structure.Brain imaging studies demonstrate possible neurophysiological mechanisms underlying force control impairments:
(a) decreased activation in motor areas of the ipsilesional hemisphere,
(b) increased activation in secondary motor areas between hemispheres,
(c) cerebellum involvement absence, and
(d) relatively greater interhemispheric inhibition from the contralesional hemisphere.
Consistent with identifying neurophysiological mechanisms, analyzing bimanual motor synergies as well as low-force frequency structure will advance our understanding of post stroke force control.