[BLOG POST] Reducing stress and anxiety through actions to increase optimism and resilience

Many studies over many years have explored the correlation between an individual’s optimistic or pessimistic outlook and the impact on stress, anxiety, health and well- being. Consistent consensus has been made that optimism is positively correlated with improved psychological health whereas a pessimistic outlook may increase vulnerabilities for poor psychological health.

There are also strong associations between optimism and resilience.

“A resilient person works through challenges by using personal resources, strengths, and other positive capacities of psychological capital like hope, optimism, and self-efficacy.”

Pennock, 2020

positivepsychology.com

“The results indicated that psychological well-being is influenced by personal characteristics such as resilience, and the individual’s optimism regardless of his/her degree of resilience can to some extent provide for psychological well-being.”

Souri and Hasanirad, 2011

https://www.sciencedirect.com/science/article/pii/S1877042811021240

I recently explored this with a friend who had a performance review planned with her Manager. Her last performance review (with a different company) left her feeling deflated and unsupported as the poor feedback from her Manager was unexpected, and unwanted. She was expecting the worst from her upcoming review as well, and the only ‘qualifier’ for this pessimistic view was her last performance review. Jill had been working for this company for over a year, and over our coffee catch ups, I recalled events and stories that appeared to indicate a positive work environment and signs that she was a strong performer in the workplace, so I queried her negative outlook.

– “So, what about that quality assurance project you lead, with great outcomes?” “Yeah, that went well, but the team did most of the work.”

– “Who delegated the work?”

– “I did.”

– “So, you collaborated with the team, as their project manager, provided them with direction, agreed to task roles and ultimately guided the team to a successful outcome?”

Jill’s experience with predicting future outcomes in a negative framework, based on experience is not uncommon. To help Jill feel more confident going into her review, we brainstormed all the positive outcomes she contributed to or was personally responsible for. This included achievement of KPI’s, positive reviews from customers, and her contribution to positive team culture. By challenging her low expectations of the review, she was able to develop a plan to go into the meeting feeling confident, positive and adequately prepared if her Manager did happen to raise any issues. This would also help to put any criticisms that may be raised, into context. After all, none of us are perfect, but if the positive outcomes outweigh the ‘room for improvement’ results, we are winning!

Your current way of thinking may be keeping you where you are, but is that where you want to be? Are your current actions moving you closer to your goals or further away from them? If you would like to improve your current situation, it is likely that you need to start by changing your mindset.

Developing a positive mindset, if you are not already manifesting this, will take a conscious effort. Included below are some tips on helping to manifest a positive outlook in your own life:

• You may have heard about practising gratitude. This is a simple and reflective process you can add into your routine at the end of each day, to reflect on something positive that happened during your day. It may be as simple as receiving a friendly smile from a stranger or feeling gratitude for the comfortable roof over your head. Many studies have found that expressing gratitude increases optimism.

• Reframing your thought processes: This can start with challenging your own negative thoughts e.g., ‘My life is not going the way I would like it to’. To challenge this, you might break it down by looking at one aspect of your life – “I have a great social life.” In the words of author Martin Seligman (2019), “The key to learning optimism is learning how to recognise and then dispute unrealistic catastrophic thoughts.”

• There are numerous studies regarding the practice of meditation and how the regular practice of meditation can improve your mindset, improve your memory, help you manage stress more effectively and many other health benefits. Meditation is a form of brain training. There are multiple studies which show that meditation can actually change your brain.

• Try to surround yourself with positive people. When you seek out positive people, you will be around solution-focused thinking and can-do attitudes. Being in such company can influence your own thinking. These types of people are often found in groups which are focused on goal achievements such as business networking groups. You may already know someone who has a ‘glass half full’ attitude. Meeting up with them more frequently will be a start to increasing your network of positive people.

• If you can join a gym or any type of exercise class, such as yoga, you can meet people trying to improve their lives, well-being and fitness through exercise. Any group that focuses on personal development and growth is likely to include positive people. There is significant evidence that exercise is also good for the mind.

My own personal experience with embracing optimism was best reflected in my journey after a severe traumatic brain injury, and waking up from my coma unable to walk, talk, see or have control over any of my bodily functions. Medical opinion was negative about my outlook. Prognosis predictions included life in a vegetative state, an inability to finish school or achieve the goals I had set, little hope of ever being able to participate in meaningful work, and more. My story of using those negative predictions as a powerful motivator to prove those doctors wrong, to lead a full, productive and meaningful life is documented in my new book, Holding on to Hope, Finding the ‘New You’ after a Traumatic Brain Injury.

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[NEWS] ‘The Virtual Brain’: A new tool for epilepsy surgery planning

Reviewed by Emily Henderson, B.Sc. Feb 20 2021

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Epilepsy is one of the most common neurological disorders, affecting over 50 Million people worldwide. Patients suffer from seizures caused by sudden neuronal activity engaging at times large networks of the brain. In a third of all cases the disease is resistant to drugs. The most common treatment option for these patients is surgical removal of the “epileptogenic zone”, the areas of the brain, where the seizures emerge.

“Surgery success depends on locating these areas as precisely as possible. But in clinical practice, this often proves very difficult, and the average surgery success rate remains at only around 60%”, says Viktor Jirsa. Any improvement would have major impact for many patients”.

The scientist has developed a computational tool, called “The Virtual Brain” (TVB), to model and predict activity in an individual patient brain. In collaboration with the neurologist Fabrice Bartolomei, they adapted the model to epilepsy, simulating the spread of individual seizure activity. The model thus can become an additional advisory tool for neurosurgeons to help target surgeries more precisely.

A clinical trial is currently underway to evaluate the personalized brain models of TVB as a new tool for epilepsy surgery planning, with promising first results. It is important to underscore that the Virtual Brain tool is still at clinical investigating stage and is therefore not yet available to patients.

The team now works on the next generation of The Virtual Brain, which boosts the accuracy of the model further using the EBRAINS research infrastructure. The objective is to significantly scale up the potential for personalized brain representation with the help of large brain data sets from the EBRAINS Brain Atlas. This includes the most detailed 3D representation of the brain’s anatomy, the BigBrain, at a resolution of 20 micrometers.

“Only EBRAINS allows to go to this massive scale and resolution”, Jirsa says. “Here brain data resources are made compatible and integrated with high-performance computing and informatics tools. EBRAINS enables the application of deep learning and other methods to find the configuration that most closely matches the patient’s own recordings of brain dynamics. This is an important step towards pinpointing the epileptogenic zone with greater precision.”

Katrin Amunts, Scientific Research Director of the HBP says: “The HBP’s multidisciplinary approach, gaining neuroscientific insight from the analysis of big data and neuroimaging studies, supported by brain modeling and advanced computing is a highly impactful way to advance brain research and bring innovation to patients and society.”

Pawel Swieboda, CEO of EBRAINS and Director General of the HBP, comments: “Prof Jirsa’s Virtual Brain computing tool is one of the many breakthrough achievements resulting from the cutting-edge scientific expertise of the Human Brain Project scientists and from the state-of-the art research infrastructure EBRAINS. We’re looking forward to sharing more brain health advances enabled by EBRAINS in the future. Meanwhile we invite researchers in different fields, such as neuroscience, neuroengineering, or neurotechnology – to list a few – to explore how the EBRAINS platform can enhance their own research.”

Source: Human Brain Project

[ARTICLE] The activity assessment instruments of the upper limbs do contemplate the most accomplished tasks at home by people with hemiparesis? – Full Text

ABSTRACT

Introduction: There is still no consensus on the recommendation of instruments for evaluation of the upper limb (UL) after Stroke.

Objective: Identify the tasks most performed at home by people after stroke, and among these, which are contemplated in the instruments of assessments of UL activity identified in the literature.

Method: Direct observation during four hours at the home of 40 participants (57,2±13,0 years old) with hemiparesis, the basic activities of daily life (BADL) and instrumental (IADL) were recorded, identifying those performed by a larger number of participants.

Results: From the 247 observed tasks, 70,5% were related to IADL. In the literature we identified six instruments of capacity evaluation: Arm Motor Ability Test (AMAT); Action Research Arm Test (ARAT); Chedoke Arm and Hand Activity Inventory (CAHAI); JEBSEN-TAYLOR; Test d’Evaluation des Membres Supérieurs de Personnes Agées (TEMPA) and Wolf Motor Function Test (WMFT) and four Performance: Motor Activity Log (MAL); Manual Ability Measure (MAM-16 and MAM-36) and ABILHAND. Of the 64 tasks performed by a larger number of participants, the capacity instrument that contemplated the largest number of these was CAHAI (15%) and performance was MAL (33%). The instruments with the greater proportion of tasks observed at home in relation to the total number of the instrument were the TEMPA (all eight) and the MAL (21/30) tasks.

Conclusion: Performance instruments contemplate greater proportion of tasks observed directly at home, however the capacity instruments assess distinct tasks. The combination of capacity and performance tools for UL assessment in this population is recommended.

1 INTRODUCTION

Appropriate outcome measures are essential components to choose the best intervention and depend on the quality of the measurement properties of an assessment tool (^{GADOTTI; VIEIRA; MAGEE, 2006}). The assessment instruments of upper limb (UL) activity, that is, the execution of a task or action by an individual, can be distinguished in capacity and performance. The capacity instrument measures what the individual is capable of doing in a controlled and standardized environment and the performance instrument is spontaneously performed in his daily life in a real situation, as at home (^{LEMMENS et al., 2012}).

A systematic review study by ^{Alt Murphy et al. (2015)} on measurement properties and clinical usefulness of outcomes of UL-related interventions in post-stroke patients concluded that there is still no common thinking about which instruments should be used to assess UL after a stroke. According to the International Classification of Functioning, Disability and Health constructs (ICF) (^{ORGANIZAÇÃO…, 2003}) one aspect that has been debated in the literature is that the activity level assessments specifically the capacity of what paretic UL is capable of doing in a controlled environment as in the clinic, do not represent what the individual actually performs in everyday activities in the real environment, such as what he or she does at home (^{WINSTEIN et al., 2016}).

The Consensus-based Standards for Health Measurement Instruments (COSMIN) recommends the evaluation of the relevance to the target population of the items present in the assessment instrument as a necessary item to the content validity in the process of instrument construction (^{MOKKINK et al., 2009}). Although most instruments have adequate measurement properties, the content validity is poorly reported in the validation studies of the assessment instruments identified by ^{Alt Murphy et al. (2015)}. Also, few instruments provide information about their construction and development process, or how the tasks used in each instrument have been selected (^{LEMMENS et al., 2012}).

The relevance of the items assessed in the instruments of UL activity can be verified by asking the target population to judge the importance of the tasks (^{BARRECA et al., 1999}) or by identifying the main tasks actually performed by an individual in a real-life situation, that is, at home (^{KILBREATH; HEARD, 2005}). Due to the great variety of tasks performed in activities of daily living that require the use of the upper limbs and to better contemplate this range of tasks, the assessment instruments of UL activity after a stroke include assessing a multiplicity of daily tasks (BARRECA et al., 2006; ^{HACKEL et al., 1992}; ^{MICHAELSEN et al., 2008}; ^{PAZ; BORGES, 2007}; ^{PENTA et al., 2001}; ^{PEREIRA et al., 2011}).

The current trend in post-stroke rehabilitation is the task-oriented therapy or repetitive task practice (^{POLLOCK et al., 2014}; ^{TIMMERMANS et al., 2009}), although there is no consensus about the superiority of any intervention for the treatment of paretic UL after a stroke, as already mentioned (POLLOCK et al., 2014). A systematic literature review concludes that through repetitive practice of the task, the therapy has shown the improvement of independence in daily life activities. However, this treatment strategy has limited effects on the specific improvement of the level of activity of paretic UL, that is, improvement in the execution of tasks with these limbs (^{FRENCH et al., 2010}). The lack of evidence in the literature on therapeutic interventions that improve the level of UL activity may be related to the lack of relevance of the tasks evaluated in the instruments currently available in the literature or to the difficulty in choosing the tasks to be used in the therapy.

Thus, it is believed that the direct observation of people with hemiparesis in a real-life situation at their home can provide a valuable resource to broaden the therapist’s view regarding the reality experienced by the patients and support the selection of tasks more relevant to therapy of repetitive practice in the rehabilitation of people who have suffered stroke and have the affected UL, and could guide the selection of instruments of outcome more relevant to this population. There is not enough data available on what tasks the paretic and non-paretic UL are involved during the activities performed at home. Therefore, this study aimed to explore which are the unilateral and bilateral tasks most commonly performed with paretic and non-paretic UL by post-stroke people through direct observation at home, besides identifying, among these tasks, those that are contemplated in the assessment instruments of upper limbs activity after a stroke.[…]

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[NEWS] Waterford researchers developing brain implant to treat epilepsy seizures before they happen

The project was awarded funding of €4.4m under the EU’s Future and Emerging Technologies (FET) programme, making it the first ever FET programme project awarded to an Irish Institute of Technology.

FRI, 19 FEB, 2021, NICOLE GLENNON

Waterford-based researchers have been awarded €4.4m in EU funding to develop a ‘living brain implant’ that can sense and treat impending epilepsy seizures.

The PRIME (Personalised Living Cell Synthetic Computing Circuit for Sensing and Treating Neurodegenerative Disorders) project, based at Waterford Institute of Technology (WIT), are developing technology that could suppress chronic and recurring seizures.

This would allow people with epilepsy to perform jobs that some are currently restricted from doing, such as operating machinery, driving a car, or working near open water or at heights.

Unlike previous implanted devices to treat neurological diseases, which offered ways to interrupt seizures in drug-resistant epilepsy patients only after they began, researchers say this pioneering treatment holds the potential to transform the lives of people with epilepsy “to the point where they won’t even be aware that they were in danger of having a seizure.” 

The team at WIT’s Technology’s Telecommunications Software & Systems Group (TSSG) will collaborate with six other partners, including FutureNeuro, the SFI Research Centre for chronic and rare neurological disease hosted at the Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences.

During the four-year project, the research team will capitalise on a significant breakthrough discovery by FutureNeuro collaborators Professor Jochen Prehn and Professor David Henshall, who discovered that increases in transfer RNA (tRNA) fragments – a type of molecule found in the blood of epilepsy sufferers – precede seizure onset in some patients.

By understanding the role of tRNA in predicting seizure onset, the multidisciplinary team will aim to develop a biological brain implant that will detect spikes in tRNA and then respond with a seizure-suppressing treatment.

Prof David Henshall, Director of FutureNeuro and Professor of Molecular Physiology and Neuroscience at the RCSI, said the PRIME project represents the “very best of FutureNeuro research” taking a discovery in patients and working with world-leading multi-disciplinary teams in Ireland and abroad to develop what could be “a transformative new technology to provide better seizures control.”

The project was awarded funding of €4.4m under the EU’s Future and Emerging Technologies (FET) programme, making it the first ever FET programme project awarded to an Irish Institute of Technology.

Dr Sasitharan Balasubramaniam said the project has the potential to treat other neurological disorders too.

Winning this funding is a significant result for TSSG and will allow the PRIME research team, which is made up of Dr. Sasitharan Balasubramaniam, Dr. Deirdre Kilbane, Frances Cleary and Dr. Hamdan Awan, along with consortium members, to build on their expertise in molecular communications and computing by applying it to future generation bio-implantables.

Dr. Sasitharan Balasubramaniam, Director of Research in TSSG, FutureNeuro investigator and PRIME project co-ordinator said the initial focus of the research team will be the detection and treatment of epilepsy, “though the project does offer the potential to also treat other neurological disorders, including Parkinson’s Disease and also certain types of cancer, going forward.”

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[Abstract] Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis

Abstract

Objective

To summarize the effectiveness of physical therapy interventions to reduce fear of falling (FOF) among individuals living with neurologic diseases.

Data Sources

PubMed, Physiotherapy Evidence Database, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, and SportDiscuss were searched from inception until December 2019.

Study Selection

Clinical trials with either the primary or secondary aim to reduce FOF among adults with neurologic diseases were selected.

Data Extraction

Potential articles were screened for eligibility, and data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized controlled trials and the National Institutes of Health Quality Assessment Tool for pre-post studies. A meta-analysis was performed among trials presenting with similar clinical characteristics. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the overall quality of evidence.

Results

Sixty-one trials with 3954 participants were included in the review and 53 trials with 3524 participants in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. A combination of gait and balance training was significantly more effective compared with gait training alone in reducing FOF among individuals with Parkinson disease (PD) (mean difference [MD]=11.80; 95% CI, 8.22-15.38; P<.001). Home-based exercise and leisure exercise demonstrated significant improvement in reducing FOF over usual care in multiple sclerosis (MS) (MD=15.27; 95% CI, 6.15-24.38; P=.001). No statistically significant between-groups differences were reported among individuals with stroke and spinal cord injury. The overall quality of evidence presented in this review ranges from very low to moderate according to the assessment with the GRADE approach.

Conclusions

Gait with lower limb training combined with balance training is effective in reducing FOF in individuals with PD. Also, home-based or leisure exercise is effective among individuals with MS. However, because of several limitations of the included studies, further research is needed to examine the effectiveness of FOF intervention among individuals with neurologic diseases

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[Abstract] Developing a Thermally Actuated Soft Robot for Finger Rehabilitation – Proceedings Paper

Abstract

As more Americans suffered from mobility impairments, rehabilitation becomes more and more important. Using robots for rehabilitation could potentially lower the barriers of rehabilitation for patients in need and increase the effectiveness of rehabilitation. This paper presented a proof-of-concept soft robot that could be used for finger rehabilitation. This soft robot can bend with heat-induced actuation without many external components. In this soft robot design, a phase changing material (PCM) is sealed in reservoirs inside an elastomer structure. As heat applied, the PCM begins to change phase from solid to liquid and the pressure inside the sealed reservoirs increases and “pushes” the elastomer structure to a different shape to create a “movement” of the robot. Depending on the locations of the reservoirs and methods the heat applied, the movements of the soft robot can be controlled with precision. Preliminary results successfully demonstrated a basic bending motion of this soft robot that mimics the human finger movement.

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[ARTICLE] A gravity balancing assistant arm design in 3-D for rehabilitation of stroke patients – Full Text PDF

Abstract

A gravity balancing assistant arm design in 3-D is a mechanical mechanism consisted of springs, rigid rods, joints and sliders, which can be modified to the geometry and inertia of the arm of stroke patients. This mechanism is designed without any controllers and motors, based solely on mechanical principles, to achieve a relative balance of gravitational potential energy and elastic potential energy, thereby reducing the burden on the arm of a stroke patient to facilitate rehabilitation. To achieve this function, first, the center of gravity of the patient’s arm will be positioned, and then the mounting position of the spring on the assistant arm will be determined. In this paper, the following objectives will be achieved: (i) the calculation of the gravitational potential energy and the elastic potential energy in the mechanism (ii) the simplification of the potential energy equation and the elimination of the coefficient of the items related to the angle. (iii) The comparison between 2-D and 3-D cases of the mechanism. (iv) The motion process of simulating the mechanism using MATLAB (v) Using MATLAB to create the energy plots (vi) Using SolidWorks to construct the prototype of the mechanism (vii) Describe the practical application and future extensions of this mechanism.[…]

Full Text PDF

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[BLOG POST] Let’s talk about sex… – Headway

Let’s talk about sex…

“Sex after a stroke is tricky, but you don’t have to just do the missionary position.”

Let’s talk about sex…

It’s one of the most natural things in the world, yet intimacy and sex are still seen as taboo subjects that many of us don’t feel comfortable talking about.

Throw disability into the mix and there seems to be a stony silence pervading the scene. There also appears to be an implicit reluctance, including among the professional world, to acknowledge and address the fact that having a disability does not stop feelings of wanting romance, intimacy and sex.

Brain injury, as we well know, affects people both physically and in ‘hidden’ ways such as cognitively, psychologically, emotionally and behaviourally. All of these effects can have an impact on the brain injury survivor and their sexual partner’s feelings towards sex.

Here, we discuss the challenges that having a brain injury can pose when it comes to having a healthy sex life, as well as how to address the issues head-on and work towards ending the myths around brain injury and sex.

Okay, so we all know that sex is the rumpy-pumpy hanky-panky business that typically takes place between the bed sheets. But sex isn’t just about the physical act.

Sex has different elements that make it a much more intimate and psychologically fulfilling process, while also having a basic reproductive purpose that comes down to pure biology. So all in all, what is sex?

Sex is sometimes divided into two aspects of sexual functioning: the physical aspect of sex (such as sexual arousal, intercourse and orgasm…the ‘rumpy-pumpy’ stuff, if you will), and sexual well-being, which relates to the emotional and psychological aspect of sex such as sexual satisfaction. It also includes acts of intimacy such as touching and kissing.

But sex refers to more than just physicality. Complex emotional, psychological and social customs, such as forming romantic relationships in the first instance, are often involved in both initiating and having sex. The act of sexual intercourse itself is both physical and emotional.

Finally, there is no single definition of the word sex – it can mean different things to different people, depending on personal experience, values, personality and preferences.

Sex and the brain

So what does the brain have to do with sex? Actually, a lot! The brain is responsible for processing the feelings and sensations that are a core part of a sexual experience.

Different parts of the brain are involved in things such as the behaviour and social skills we use to meet and interact with a sexual partner, and our personality and overall interest in sex. These aspects can all be affected by a brain injury.

Sexual relationships after brain injury

Anna Smith-Higgs

Couples who already shared a sex life before the occurrence of a brain injury commonly find that the injury affects one or both party’s interest or ability to have sex.

This in turn can cause difficulties in the relationship such as feelings of loss and a lack of fulfilment. But in some circumstances, can fear play a part?

Anna Smith-Higgs suffered a life changing stroke aged 24, just one month after her son was born. She was left partially paralysed down her right-hand side, has mobility issues and is partially sighted.

Anna, now 38, said following her stroke sex was the last thing on her mind.

“I couldn’t accept what I’d become,” said Anna. “I’d gone from being a fit 24 year old with everything to look forward to, to struggling to change my child’s nappy.

“Before my stroke I had a very active sex life, but afterwards I spent months in bed and was scared to move, terrified that I’d have another stroke. At that point I was battling depression and I didn’t want to know or partake in sex at all.”

‘Communication is the key’

Anna said sex after having a stroke can be extremely scary and fill you full of doubts.

“My stroke was due to hormones from child birth so I was scared of sex as getting pregnant again was my biggest fear.

“I would also worry in case an orgasm increased my blood pressure. I worried that with only half of my body working to its full capacity, the sex wouldn’t be the same as it was before. I doubted that I wouldn’t be able to perform the way I once did.

“These fears got so bad that my partner and I just didn’t do it. This left both of us frustrated. It just wasn’t a very nice way to live.

“But with time I realised that all these worries were not worth thinking about. I realised that no, my blood pressure won’t increase; no, I won’t be able to perform like I did before. But that doesn’t mean my sex life is over.”

Anna said communicating with her partner about how she was feeling was the key.

“You have to try and not feel self conscious, you need talk to your partner, no matter how uncomfortable you may be feeling,” said Anna.

“It not only helps bring you closer as a couple but you will probably find your partner is feeling the same. A strong relationship can survive anything. It turned out my partner was just as scared as me the first time we had sex after my stroke.”

Anna said sex after a brain injury can still be fulfilling.

“Sex after a stroke is tricky but you don’t have to just do the missionary position. Why would I just lay there and get no pleasure at all. You need to experiment and find positions that work for the both of you.”

Taking up burlesque dancing was a massive help to build up Anna’s confidence

Anna said taking up burlesque dancing was also a massive help to build up her confidence and feel sexy again.

She said: “I found my confidence through burlesque. I now perform as a disabled performer. I don’t care that I am disabled and overweight – I embrace it.

Anna said her biggest advice about sex after brain injury is not to be put off.

“Talk to your partner and try to keep things relaxed. Things are going to fail but that shouldn’t put you off, try again. Oh and most importantly, have fun.”

Top tips for managing sexual relationships after brain injury

• Try to identify if a particular effect of brain injury is causing the sexual issues, such as fatigue, pain or psychological effects. Read up on ways of coping with these effects and seeking professional support for them, for instance from Headway’s booklets and factsheets at www.headway.org.uk/information-library 
  
• Both your body and your brain need time to prepare for sexual activity, so don’t rush into having sex. Instead, set time aside and make sure there are no distractions in the environment, and start off by engaging in activity such as touching and kissing to create a sense of intimacy.
  
• Seek support from professionals, such as your GP, a sex and relationship therapist, a neuropsychologist or the Headway helpline.
  
• Be adventurous! Having a disability, physical or otherwise, does not mean that you cannot try out new things and explore other ways of having sex.

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[Abstract] Effectiveness of telerehabilitation in physical therapy: A rapid overview – Full Text PDF

Abstract

Objective

The purpose of this article was to summarize the available evidence from systematic reviews on telerehabilitation in physical therapy.

Methods

Medline/Pubmed, EMBASE and Cochrane Library databases. In addition, the records in PROSPERO and Epistemonikos and PEDro were consulted. Systematic reviews of different conditions, populations and contexts, where the intervention to be evaluated is telerehabilitation by physical therapy were included. The outcomes were clinical effectiveness depending on specific condition, functionality, quality of life, satisfaction, adherence and safety. Data extraction and risk of bias assessment were carried out by a reviewer with non-independent verification by a second reviewer. The findings are reported qualitatively by tables and figures.

Results

Fifty-three systematic reviews were included of which 17 were assessed as having low risk of bias. Fifteen reviews were on cardiorespiratory rehabilitation, 14 on musculoskeletal conditions and 13 on neurorehabilitation. Other 11 reviews addressed other types of conditions and rehabilitation. Thirteen reviews evaluated with low risk of bias showed results in favor of telerehabilitation versus in-person rehabilitation or no-rehabilitation, while 17 reported no differences between the groups. Thirty-five reviews with unclear or high risk of bias showed mixed results.

Conclusions

Despite the contradictory results, telerehabilitation in physical therapy could be comparable to in-person rehabilitation or better than no-rehabilitation for conditions such as osteoarthritis, low back pain, hip and knee replacement, multiple sclerosis, and also in the context of cardiac and pulmonary rehabilitation. It is imperative to conduct better quality clinical trials and systematic reviews.

Impact

Providing with the best available evidence on the effectiveness of telerehabilitation to professionals, mainly physical therapists, will impact the decision-making process and therefore better clinical outcomes for patients, both in these times of covid-19 pandemic and in the future. The identification of research gaps will also contribute to the generation of relevant and novel research questions.

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[ARTICLE] Effect of Rigid Ankle Foot Orthosis on Postural Control and Functional mobility in Chronic Ambulatory Stroke Patients – Full Text

Abstract

Stroke is the leading cause of long-term disability in adults. Damage to the motor cortex or corticospinal tract often results in contralateral hemiplegia with significant persistent distal weakness. Gait impairments are common in stroke patients and are mainly attributed to motor control deficits. Majority of the stroke patients exhibit a spastic equinus foot. This is usually related to spasticity of triceps surae or contracture of this muscle or tendon, resulting in reduced active ankle dorsiflexion both during stance and swing phases, which is referred to as drop foot. Another common finding in the gait of stroke patients is varus deformity of the foot, which is frequently caused by spasticity of the posterior tibial muscle.

Introduction

Equinovarus foot shifts the weight support of the heel to the lateral plantar surface of the foot, and may cause a loss of balance and a reduction in stride security. Insufficient dorsiflexion during the swing phase, ankle instability, and poor lift during the last phase of walking all disturb the normal walking pattern [1,2]. Patients are unable to successfully transfer weight in the frontal plane during the transition to single-limb stance [3]. This gait impairment can result in compensatory movement patterns, slowed gait velocity, limited functional mobility, and increased risk of falls [4]. Postural control is also affected and causes problems with static and dynamic balance, thus increasing the risk of falls and secondary injuries [5].

An ankle-foot orthosis (AFO) is typically used as an adjunct to physical therapy to compensate for the effects of impairments on walking, in particular in cases of equinus and/or varus foot for inadequate dorsiflexion in swing and mediolateral subtalar instability during stance [6,7,8]. It is presumed that bracing with the AFO compensates for the weakness of muscles around the affected foot and improve peripheral stability preventing foot drop during swing phase ensuring toe clearance and proper contact with the heel. Such approach is found to be effective for improvement in gait parameters such as velocity, cadence, and step length. Few studies have also reported a positive effect on the patient’s self-confidence during functional activities [9,10].

Evidence regarding biomechanical effects of AFOs on balance post stroke is inconclusive and less strong than for the effects of AFOs on gait [11,12]. Currently available clinical evidence consists of just a few articles with small sample sizes and poor methodological quality [9,13–16]. There is a lack of insight into the influence of orthoses on the underlying impairments and there are no evidence based guidelines for AFO prescription. AFOs are routinely prescribed to stroke patients in the acute stage which the patient continues to use even in the chronic stage which can lead to certain negative effects on postural control. The “ traditional ” ankle-foot orthoses are rigid and designed to immobilize the ankle joint at a right angle or in one or more planes. Given that balance may be compromised when joint range of motion is restricted, an understanding of the relative effects of AFOs on balance performance is clinically relevant. Previous literature is controversial and the value of orthoses used in stroke patients is still a matter of debate. Few studies indicate that the use of such an orthosis may force adaptive behavior on the individual by interfering with the ankle plantarflexion that occurs at the balance activity. Some researchers hold the view that an AFO can prolong dependence on a mechanical device, leading to an increase in muscle disuse, especially the dorsiflexors of the ankle, with a consequent delay in functional recovery [4]. Methodological limitations exist as most studies are based on evaluation in acute phase and very few studies have addressed the effects of an AFO on the balance activities of chronic hemiplegic patients. Moreover, we could not find any published information on the effects of AFOs on balance performance of stroke survivors using quantitative balance measures.

Thus, this study aimed to determine the effect of rigid AFO on postural control and functional mobility of chronic ambulatory stroke patients. Results of this study will enhance our understanding of the effects of AFO on postural control and provide better basis for prescription of AFOs in ambulatory patients with stroke.[…]

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