Posts Tagged quality of life


via Restoring collagen in menopausal women – HEALTH & SCIENCE – Jerusalem Post



 NOVEMBER 25, 2017 23:29

Jerusalem’s Alyn Hospital recently discussed at its annual conference a variety of modern ways to improve the quality of life of disabled young people.


THE MOST modern wheelchairs are available for children who can even maneuver them with eye movements or joysticks, but robots and virtual reality have joined them.. (photo credit:JUDY SIEGEL-ITZKOVICH)

Rehabilitation of disabled children and teens no longer involves just training in the use of wheelchairs and providing prostheses to replace missing limbs. Ever-advancing technology has added robots, virtual reality, video screens and other assisting devices and ways to improve the youngsters’ quality of life and family cohesion. There are even (highly expensive) drugs that significantly ameliorate diseases that used to be considered hopeless. One powerhouse behind this revolution is Jerusalem’s ALYN Hospital, a national and comprehensive rehabilitation center for physically challenged and disabled children, adolescents and young adults.

The nonprofit facility, which treats all young patients, regardless of religious belief, nationality or ethnic background, was founded in 1932 by American orthopedist Dr. Henry Keller, who dedicated his life to such children. Working out of an old re-purposed monastery in the capital’s Katamon neighborhood, the medical staff cared for children disabled in the polio epidemic that spread through Israel and the rest of the world in the 1940s and 1950s. ALYN served as a treatment center, residence and school for 200 young patients.

In 1971, the voluntary organization was able to build the impressive Woldenberg Family Hospital complex in Jerusalem’s Kiryat Hayovel neighborhood to serve inpatients and outpatients.

Today, it is one of the world’s leading hospitals specializing in the active and intensive rehabilitation of children who have a broad range of physical disabilities caused not only by various congenital and progressive muscle, nerve and bone diseases, but also feeding disorders, severe respiratory problems, road and home accidents, terrorist attacks and severe burns. Patients who underwent orthopedic operations and neurosurgery also recover and are rehabilitated at ALYN.

The center includes a pre-school daycare center for children aged six months to three years, kindergartens, an after-school integration program and school classes. It provides services including occupational therapy, physiotherapy, hydrotherapy, speech therapy and psychological counseling in addition to support by medical specialists and social workers.

Its director-general since 2011, Dr. Maurit Beeri recently opened ALYN’s Third Annual Conference on Rehabilitation at the capital’s Crowne Plaza Hotel. An accompanying exhibition displayed a large variety of equipment available for disabled youngsters from wheelchairs to electronic devices.

Beeri, who graduated from the Hebrew University Medical Faculty and trained as a pediatrician at the Hadassah University Medical Center in Jerusalem, had never heard about ALYN until, as a medical resident, she was sent to work there for a few months. She saw there that children in wheelchairs could be taught to walk.

“I went and felt in love with it. It was a big discovery for me. If you want to create a real change in the life of a child, this is the place you should be.”

Health, she said at the conference attended by some 200 doctors, nurses, physiotherapists, occupational therapists and other, “is not just the absence of disease. It is to grow and develop, to enjoy well-being. Over a billion people in the world – one in seven – suffer from some type of disability. They have three times the risk of the non-disabled to be hurt in the health system, and half lack accessibility to a decent health system.”

While 250 million people around the globe need eyeglasses and don’t have them and many disabled people lack wheelchairs and other basic equipment, humanity is still much better off today than 200 years ago, said Beeri. Medical technology is developing at a rapid pace – faster than the health system does, so not all get the rehabilitation they need.

Over 17% of Israelis have some kind of physical disability, but today’s Israeli medical students “don’t hear the word ‘rehabilitation.’ They aren’t exposed to it in their studies.

They are not told what physiotherapists, occupational therapists, speech pathologists and audiologists do.” Child rehabilitation here is nevertheless more advanced than in many countries, she added, but even so, many significant things are lacking.”

Only recently did the Health Ministry open a rehabilitation division (headed by Dr. Tsaki Ziv-Ner) to coordinate such functions. “The future is very promising. There is more awareness of the rights of disabled; the problem is in the details. Everyone has the right to live with honor and as much independence as they can.”

DR. KEREN Politi, a pediatric neurologist at ALYN, told the participants that only a few decades ago, there was little to do to help children. “But thanks to genetics, we can give treatments, prevent problems and improve their quality of life – even with spinal muscular atrophy (SMA, which affects about 80 Israeli children) and Duchenne muscular dystrophy.

“We can influence gene regulation. We can give treatment with medical cannabis or with blood from the umbilical cord,” she said. “We can insert healthy genes into sick cells using exon skipping [a form of RNA splicing used to cause cells to “skip” over faulty or misaligned sections of genetic code, creating a shorter but still functional protein].”

A new drug approved by the US Food and Drug Administration named Spinraza that costs NIS 2 million a year per patient can help SMA kids hold up their head better, roll over, crawl and even stand. If the child is treated within 13 weeks of diagnosis, said Politi, they do much better. But covering the bill for all SMA children would gobble up a third of the annual increase to the basket of health services. “There are a lot of things we don’t know, such as how early to start. Maybe it could be given to the fetus, but there is a risk that this might cause leukemia.

Another drug, in an earlier stage of development, would be in pill form and threaten the sales of Spinraza if it proves just as effective, but there is as yet no evidence of longterm benefits.”

Medical cannabis for children is controversial.

“There are three types, and they have 60 different chemicals. Cannabis was used even in the 1850s for headaches and seizures, but its medical use declined as drug companies [falsely] claimed it was addictive and caused violence and psychosis. In the last 20 years, however, it has been brought back and used for numerous medical purposes in all ages.”

Every large Israeli pediatrics department tries cannabis oil on some children. “At ALYN,” said Politi, many parents want it for painful spasms and other things, but I dispense it carefully, not for children with normal cognition.”

Umbilical cord blood is being used experimentally to turn regular cells from the bone marrow into stem cells that can produce growth factors and have an anti-inflammatory effect. There is a group at Duke University in North Carolina that is looking at use of umbilical cord blood on cerebral palsy, but it has not brought about a big change.”

One of her young patients who suffered damage due to separation of her mother’s placenta got umbilical cord blood, but it didn’t help with the seizures. But medical cannabis was tried and he was able to sleep at night for the first time without crying.

PROF. TAMAR Weiss, a University of Haifa expert in the use of technology for rehabilitation, noted that there “is huge and accelerating growth in use of technologies. Almost every day there is something new. It took 50 years for half of public to get a telephone, and much less for smartphone. In rehabilitation, we have not yet reached this speed. We have to use ‘disruptive technologies’ – innovation that creates a new market and eventually disrupts an existing market, displacing established firms and products. But not all paradigm shifts mean an improvement in treatment,” she said. More than half of all rehabilitation technologies that came to the market in the last decade are not used today or they are underused because people didn’t know how to use it. Children from Gaza, for example, were given many devices for their disability but when they went home, they were just put in the closet.

A successful item for rehabilitation is video on a screen so disabled children can move. There are relatively cheap virtual reality devices that can benefit them and are easy to use. A company named SenSerum offers a virtual playground that children with autism can use to jump as if they were on a real trampoline.

“There is a need to find a way for robots to copy human movements, and the technology should be inexpensive, small in size and light in weight. They should be adaptable to the intelligence and abilities of each child and be able to document changes and improvements.”

Robots are very good for disabled kids because “they repeat and are consistent. They can provide exact, continuous quantitative feedback through sensors,” Weiss said. Obviously, robots alone are not enough. They must be complemented by human therapists.

ALYN PHYSIOTHERAPIST Orit Bartov presented the benefits of “intelligent wheelchairs” with built-in sensors to prevent collisions and “eye-drivers” that enable steering with one’s eyes. Children can visit the zoo along with the family using a respirator that’s the size of a laptop. There are cheap children’s plastic and metal wheelchairs for the developing countries.”

While physiotherapy in the 1990s was aimed at strengthening one joint at a time, said Bartov, today it involves rehabilitating the whole body, creating balance, control of movement and coordination.

“Muscle tone is not an aim but a means. There is cognitive rehabilitation, not just medical but also biological, psychological and social. We have to learn about the longterm effects of operations on muscle and use new knowledge in engineering, neuroscience and rehabilitation to create new interventions.”

It takes about a decade for knowledge to be translated from development of technology into a product used in the field.

“We used to try to change the patient, but it’s more important to change the patient’s environment to suit him,” she explained.

The physiotherapist’s take-home message is that the disabled patient should always be the focus; we are not technicians but evidence-based clinicians; there is no alternative to using your hands; and don’t be afraid to try something new.”

ALYN RECENTLY set up a program called PELE (Child Solutions) to create individualized products for helping children with special needs identified by therapists or family members. Professionals and volunteers in engineering and other fields donate their time to design what they need, said Dana Hochstein Mann, the director of ALYNnovation to match the innovative products with manufacturers around the world who want, through cooperation, to bring it to the world market.

Mann noted that zippers developed by Under Armor for the disabled to close with one hand have expanded their use to the wider public. “A child asked Nike to make a shoe with a zipper in the back to make it easy to put on. Now they are being made as a fashionable item for the general public. Companies such as ReWalk and OrCam, are talking about accessibility for the disabled all the time.”

Israel became the “Startup Nation,” said Mann, for good reasons.

“We are not satisfied with situations that need improvement. We don’t like failure, but it is acceptable, as it’s better for an entrepreneur to try something than having never tried; one learns from failure. Due to the lack of funds in Israel, creative solutions result.

It’s a minuscule market without neighboring countries where we can sell products, so one can start small and then grow and think global.” In the rehabilitation field, all these conditions are beneficial, she concluded.

PERHAPS THE most inspiring speaker was a young man who reached the stage on his wheelchair via a ramp. Shahar Botzer, who was born with paralyzed legs but whose arms are functional, heads 2B Community, a venture capital group that invests in young, small-to-medium businesses with potential for significant growth and a turnover of over NIS 1 million a year.

It aims not only at making money but also has a social goal and strict standards that examine the business’s ethical conduct in a wide variety of parameters, including fair employment, environmental protection and contribution to the community.

Married and with a family, Botzer clearly exemplifies what ALYN would want all its “graduates” to strive for.

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[Abstract] Sleep Duration, Sedentary Behavior, Physical Activity, and Quality of Life after Inpatient Stroke Rehabilitation 


The aim of this study was to describe accelerometer-derived sleep duration, sedentary behavior, physical activity, and quality of life and their association with demographic and clinical factors within the first month after inpatient stroke rehabilitation.

Materials and Methods

Thirty people with stroke (mean ± standard deviation, age: 63.8 ± 12.3 years, time since stroke: 3.6 ± 1.1 months) wore an activPAL3 Micro accelerometer (PAL Technologies, Glasgow, Scotland) continuously for 7 days to measure whole-day activity behavior. The Stroke Impact Scale and the Functional Independence Measure were used to assess quality of life and function, respectively.


Sleep duration ranged from 6.6 to 11.6 hours/day. Fifteen participants engaged in long sleep greater than 9 hours/day. Participants spent 74.8% of waking hours in sedentary behavior, 17.9% standing, and 7.3% stepping. Of stepping time, only a median of 1.1 (interquartile range: .3-5.8) minutes were spent walking at a moderate-to-vigorous intensity (≥100 steps/minute). The time spent sedentary, the stepping time, and the number of steps differed significantly by the hemiparetic side (P < .05), but not by sex or the type of stroke. There were moderate to strong correlations between the stepping time and the number of steps with gait speed (Spearman r = .49 and .61 respectively, P < .01). Correlations between accelerometer-derived variables and age, time since stroke, and cognition were not significant.


People with stroke sleep for longer than the normal duration, spend about three quarters of their waking hours in sedentary behaviors, and engage in minimal walking following stroke rehabilitation. Our findings provide a rationale for the development of behavior change strategies after stroke.

Source: Sleep Duration, Sedentary Behavior, Physical Activity, and Quality of Life after Inpatient Stroke Rehabilitation – Journal of Stroke and Cerebrovascular Diseases

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[Abstract] Linking of the quality of life in neurological disorders (Neuro-QoL) to the international classification of functioning, disability and health



The quality of life in neurological disorders (Neuro-QoL) is a U.S. National Institutes of Health initiative that produced a set of self-report measures of physical, mental, and social health experienced by adults or children who have a neurological condition or disorder.


To describe the content of the Neuro-QoL at the item level using the World Health Organization’s international classification of functioning, disability and health (ICF).


We assessed the Neuro-QoL for its content coverage of functioning and disability relative to each of the four ICF domains (i.e., body functions, body structures, activities and participation, and environment). We used second-level ICF three-digit codes to classify items into categories within each ICF domain and computed the percentage of categories within each ICF domain that were represented in the Neuro-QoL items.


All items of Neuro-QoL could be mapped to the ICF categories at the second-level classification codes. The activities and participation domain and the mental functions category of the body functions domain were the areas most often represented by Neuro-QoL. Neuro-QoL provides limited coverage of the environmental factors and body structure domains.


Neuro-QoL measures map well to the ICF. The Neuro-QoL–ICF-mapped items provide a blueprint for users to select appropriate measures in ICF-based measurement applications.

Source: Linking of the quality of life in neurological disorders (Neuro-QoL) to the international classification of functioning, disability and health | SpringerLink

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[BOOK + References] Adaptation and Rehabilitation in Patients with Homonymous Visual Field Defects


Hemianopia leads to severe impairment of spatial orientation and mobility. In cases without macular sparing an additional reading disorder occurs. Persistent visual deficits require rehabilitation. The goal is to compensate for the deficits to regain independence and to maintain the patient’s quality of life. Spontaneous adaptive mechanisms, such as shifting the field defect towards the hemianopic side by eye movements or eccentric fixation, are beneficial, but often insufficient. They can be enhanced by training, e.g., saccadic training to utilize the full field of gaze in order to improve mobility and by special training methods to improve reading performance. At present only compensatory interventions are evidence-based.

References (71)

Source: Adaptation and Rehabilitation in Patients with Homonymous Visual Field Defects – Springer

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[ARTICLE] Effects of Virtual Reality Exercise Program on Balance, Emotion and Quality of Life in Patients with Cognitive Decline



In this study, we investigated the effectiveness of a 12-week virtual reality exercise program using the Nintendo Wii console (Wii) in improving balance, emotion, and quality of life among patients with cognitive decline.


The study included 30 patients with cognitive decline (12 female, 18 male) who were randomly assigned to an experimental (n=15) and control groups (n=15). All subjects performed a traditional cognitive rehabilitation program and the experimental group performed additional three 40-minute virtual reality based video game (Wii) sessions per week for 12 weeks. The berg balance scale (BBS) was used to assess balance abilities. The short form geriatric depression scale-Korean (GDS-K) and the Korean version of quality of life-Alzheimer’s disease (KQOL-AD) scale were both used to assess life quality in patients. Statistical significance was tested within and between groups before and after treatment, using Wilcoxon signed rank and Mann-Whitney u-tests.


After 36 training sessions, there were significant beneficial effects of the virtual reality game exercise on balance (BBS), GDS-K, and KQOL-AD in the experimental group when compared to the control group. No significant difference was observed within the control group.


These findings demonstrate that a virtual reality-training program could improve the outcomes in terms of balance, depression, and quality of life in patients with cognitive decline. Long-term follow-ups and further studies of more efficient virtual reality training programs are needed.


Dementia is a degenerative disease of the nervous system, which is prevalent in the elderly population. It involves deterioration in cognitive function and ability to perform everyday activities. As the early diagnosis and treatment of dementia is delayed, its economic costs and burden on families and society are gradually increasing and becoming a social problem.1 Older people with dementia have an increased risk of falls and lower levels of everyday activities being performed due to cognitive decline and decreased muscle mass. This is a result of reduced physical activity, which further deteriorates their quality of life.2 Therapeutic interventions to improve cognitive function and to increase activities of daily living (ADL) in patients with dementia are divided into pharmacological and non-pharmacological treatments. For pharmacological treatment, acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists are the most widely used in clinical practice.3 However, because pharmacological treatment alone cannot prevent the progression of cognitive decline and ADL deterioration in patients with dementia, various non-pharmacological treatments including cognitive therapy or physical exercise are used as additional treatments.4
Recent reports have stated that regular exercise was effective in delaying cognitive impairment in people with dementia.5 In a three-year follow-up study of healthy older people, a combination of cognitive activity and physical activity was found to be effective in reducing the risk for mild cognitive impairment.6 However, physical activity was found to be more important than cognitive activity in order to further reduce the risk for cognitive decline.6 When older people with dementia performed regular physical exercise, there was an improvement in the mini-mental state examination (MMSE) score.7 Physical exercise prevented the deterioration of ADL.8 The mechanism of the benefit of physical exercise on patients with dementia is thought to be that it can facilitate neuroplasticity, promote injury recovery mechanisms at a molecular level and facilitate self-healing of the brain through its neuroprotective effect.9
However, unless individuals perform exercise in the long run, such beneficial effects of exercise may wear off, leading to impaired brain function and worsened disease.10 Therefore, patients with dementia should continue exercise under the supervision of professional physical therapists in order to stop the progression of cognitive impairment for a long time. In order to achieve this, it is required to keep patients interested in the exercise therapy allowing them to maintain adherence. However, it is difficult to execute exercise treatment continuously in patients with dementia because of space, time, and cost issues in Korea. Patients get easily bored and tired of passive and simply repetitive forms of exercise treatment. In general, 20-50% of older people who start an exercise program will stop within six months.11 Patients with dementia are expected to be more likely to discontinue exercise program due to lowered levels of patience and self-regulation abilities. Therefore, exercise programs utilizing media, including games, attempt to keep patients interested in exercise programs and to improve therapeutic effects. With recent advances in scientific technologies and computer programs, exercise and rehabilitation interventions using virtual reality are being introduced in the medical field.12 Virtual reality refers to a computer-generated environment that allows users to have experiences similar to those in the real world. It is an interactive simulation characterized by technology that provides reality through various feedbacks.13 While performing predetermined tasks such as playing a game in virtual reality, users manipulate objects as if they were real and can control their movements by giving and receiving various feedbacks via numerous senses such as sight and hearing.14
The virtual reality-enhanced exercise consisting of exercise with computer-simulated environments and interactive videogame features allows patients to enjoy performing tasks, encourages competition, and creates motivation and interest in their treatment.15 Participation in a virtual reality-enhanced exercise was reported to lead to higher exercise frequency and intensity and enhanced health outcomes when compared with traditional exercise.16
However, despite these advantages, conventional virtual reality systems could not be widely available for patients in clinical settings due to several limitations including high costs and a large size.17 Therefore, it is necessary to develop virtual reality exercise programs that are easy to follow in hospitals and at home. As an alternative, the use of computer-based individual training programmes is becoming increasingly popular due to the low cost, independence and ease of use in the home. One such system that is increasing in popularity for use in exercise training is the Nintendo Wii (Wii; Nintendo Inc., Kyoto, Japan) personal game, which became commercially available. Wii is a video gaming console with a simple method, as its virtual reality system is implemented via a television monitor. It combine physical exercise with computer-simulated environments and interactive videogame features. Because the Wii console is inexpensive and small in size, it is easy to install or move it in hospitals or at home. This gaming console is designed to be controlled using a wireless controller, allowing user to interact with his/her own avatar, which is displayed on the screen through a movement sensing system. The controller is provided with an acceleration sensor that responds to acceleration changes recognizing direction and velocity changes.18 Wii-balance board is being used when playing a Wii Fit game. It is a force plate collecting movement information in the center of pressure of the standing user, enabling reflection of movements in a virtual environment on the monitor and thus constantly resending visual feedback to the user. Through this process, the user can adjust his/her postural responses. Studies have shown that the Wii balance board can be helpful in postural control training.19 Because Wii is a typical example of virtual reality applications and is simple, inexpensive, and easily accessible, Wii is expected to create interest among patients encouraging them to put more efforts in exercise via games and thus augmenting effects of the treatment.
Domestic studies on the use of Wii have reported its effects on the upper extremity function, visual perception and sense of balance in chronic stroke patients,20 spinal cord injury patients,21 Parkinson’s disease patients,22 and multiple sclerosis patients.23 However, there have been only a few controlled research studies about the effects of Wii on patients with cognitive decline. The present study aimed to analyze effects of virtual reality exercise program on balance function, emotions, and quality of life (QOL) in patients with cognitive decline.

Continue —> Effects of Virtual Reality Exercise Program on Balance, Emotion and Quality of Life in Patients with Cognitive Decline – ScienceCentral



Figure 1 The level of satisfaction about Wii game for dementia patients (Number=%).

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[Abstract] The feasibility and impact of a yoga pilot programme on the quality-of-life of adults with acquired brain injury – CNS


OBJECTIVE: This pilot study measured the feasibility and impact of an 8-week yoga programme on the quality-of-life of adults with acquired brain injury (ABI).

METHODS: Thirty-one adults with ABI were allocated to yoga (n = 16) or control (n = 15) groups. Participants completed the Quality of Life After Brain Injury (QOLIBRI) measure pre- and post-intervention; individuals in the yoga group also rated programme satisfaction. Mann-Whitney/Wilcoxon and the Wilcoxon Signed Rank tests were used to evaluate between- and within-group differences for the total and sub-scale QOLIBRI scores, respectively.

RESULTS: No significant differences emerged between groups on the QOLIBRI pre- or post-intervention. However, there were significant improvements on overall quality-of-life and on Emotions and Feeling sub-scales for the intervention group only. The overall QOLIBRI score improved from 1.93 (SD = 0.27) to 2.15 (SD = 0.34, p = 0.01). The mean Emotions sub-scale increased from 1.69 (SD = 0.40) to 2.01 (SD = 0.52, p = 0.01), and the mean Feeling sub-scale from 2.1 (SD = 0.34) to 2.42 (SD = 0.39, p = 0.01).

CONCLUSION: Adults with ABI experienced improvements in overall quality-of-life following an 8-week yoga programme. Specific improvements in self-perception and negative emotions also emerged. High attendance and satisfaction ratings support the feasibility of this type of intervention for people with brain injury.

Source: Traumatic Brain Injury Resource Guide – Research Reports – The feasibility and impact of a yoga pilot programme on the quality-of-life of adults with acquired brain injury

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[ARTICLE] Visual Impairment Following Stroke – The Impact on Quality of Life: A Systematic Review – Full Text PDF


Background: The visual impairments caused by stroke have the potential to affect the ability of an individual to perform activities of daily living. An individual with visual impairment may also have reduced level of independence. The purpose of this review was to investigate the impact on quality of life from stroke related visual impairment, using subjective patient reported outcome measures.

Methods: A systematic search of the literature was performed. The inclusion criteria required studies to have adult participants (aged 18 years or over) with a diagnosis of a visual impairment directly resulting from a stroke. Studies which included visual impairment as a result of other intracranial aetiology, were included if over half of the participants were stroke survivors. Multiple scholarly online databases and registers of published, unpublished and ongoing trials were searched, in addition articles were hand searched. MESH terms and alternatives in relation to stroke and visual conditions were used. Study selection was performed by two authors independently. Data was extracted by one author and verified by a second. The quality of the evidence was assessed using a quality appraisal tool and reporting guidelines.

Results: This review included 11 studies which involved 5646 participants, the studies used a mixture of generic and vision-specific instruments. The seven instruments used by the included studies were the EQ-5D, LIFE-H, SF-36, NEI VFQ-25, VA LV VFQ-48, SRA-VFP and DLTV.

Conclusion: A reduction in quality of life was reported by all studies in stroke survivors with visual impairment. Some studies used generic instruments, therefore making it difficult to extract the specific impact of the visual impairment as opposed to the other deficits caused by stroke. The majority of studies (8/11) primarily had participants with visual field loss. This skew towards visual field loss and no studies investigating the impact ocular motility prevented a comparison of the effects on quality of life due to different visual impairments caused by stroke. In order to fully understand the impact of visual impairment following stroke on quality of life, further studies need to use an appropriate vision-specific outcome measure and include all types of visual impairment which can result from a stroke.

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[Abstract] Caregiver-mediated exercises for improving outcomes after stroke (Cochrane review) [with consumer summary]

BACKGROUND: Stroke is a major cause of long-term disability in adults. Several systematic reviews have shown that a higher intensity of training can lead to better functional outcomes after stroke. Currently, the resources in inpatient settings are not always sufficient and innovative methods are necessary to meet these recommendations without increasing healthcare costs. A resource efficient method to augment intensity of training could be to involve caregivers in exercise training. A caregiver-mediated exercise programme has the potential to improve outcomes in terms of body function, activities, and participation in people with stroke. In addition, caregivers are more actively involved in the rehabilitation process, which may increase feelings of empowerment with reduced levels of caregiver burden and could facilitate the transition from rehabilitation facility (in hospital, rehabilitation centre, or nursing home) to home setting. As a consequence, length of stay might be reduced and early supported discharge could be enhanced.

OBJECTIVES: To determine if caregiver-mediated exercises (CME) improve functional ability and health-related quality of life in people with stroke, and to determine the effect on caregiver burden.

SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (October 2015), CENTRAL (the Cochrane Library, 2015, issue 10), Medline (1946 to October 2015), Embase (1980 to December 2015), CINAHL (1982 to December 2015), SPORTDiscus (1985 to December 2015), three additional databases (two in October 2015, one in December 2015), and six additional trial registers (October 2015). We also screened reference lists of relevant publications and contacted authors in the field.

SELECTION CRITERIA: Randomised controlled trials comparing CME to usual care, no intervention, or another intervention as long as it was not caregiver-mediated, aimed at improving motor function in people who have had a stroke.

DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials. One review author extracted data, and assessed quality and risk of bias, and a second review author cross-checked these data and assessed quality. We determined the quality of the evidence using GRADE. The small number of included studies limited the pre-planned analyses.

MAIN RESULTS: We included nine trials about CME, of which six trials with 333 patient-caregiver couples were included in the meta-analysis. The small number of studies, participants, and a variety of outcome measures rendered summarising and combining of data in meta-analysis difficult. In addition, in some studies, CME was the only intervention (CME-core), whereas in other studies, caregivers provided another, existing intervention, such as constraint-induced movement therapy. For trials in the latter category, it was difficult to separate the effects of CME from the effects of the other intervention. We found no significant effect of CME on basic ADL when pooling all trial data post intervention (4 studies; standardised mean difference (SMD) 0.21, 95% confidence interval (CI) -0.02 to 0.44; p = 0.07; moderate-quality evidence) or at follow-up (2 studies; mean difference (MD) 2.69, 95% CI -8.18 to 13.55; p = 0.63; low-quality evidence). In addition, we found no significant effects of CME on extended ADL at post intervention (two studies; SMD 0.07, 95% CI -0.21 to 0.35; p = 0.64; low-quality evidence) or at follow-up (2 studies; SMD 0.11, 95% CI -0.17 to 0.39; p = 0.45; low-quality evidence). Caregiver burden did not increase at the end of the intervention (2 studies; SMD -0.04, 95% CI -0.45 to 0.37; p = 0.86; moderate-quality evidence) or at follow-up (1 study; MD 0.60, 95% CI -0.71 to 1.91; p = 0.37; very low-quality evidence). At the end of intervention, CME significantly improved the secondary outcomes of standing balance (3 studies; SMD 0.53, 95% CI 0.19 to 0.87; p = 0.002; low-quality evidence) and quality of life (1 study; physical functioning MD 12.40, 95% CI 1.67 to 23.13; p = 0.02; mobility MD 18.20, 95% CI 7.54 to 28.86; p = 0.0008; general recovery MD 15.10, 95% CI 8.44 to 21.76; p < 0.00001; very low-quality evidence). At follow-up, we found a significant effect in favour of CME for Six-Minute Walking Test distance (1 study; MD 109.50 m, 95% CI 17.12 to 201.88; p = 0.02; very low-quality evidence). We also found a significant effect in favour of the control group at the end of intervention, regarding performance time on the Wolf Motor Function test (2 studies; MD -1.72, 95% CI -2.23 to -1.21; p < 0.00001; low-quality evidence). We found no significant effects for the other secondary outcomes (ie, patient: motor impairment, upper limb function, mood, fatigue, length of stay and adverse events; caregiver: mood and quality of life). In contrast to the primary analysis, sensitivity analysis of CME-core showed a significant effect of CME on basic ADL post intervention (2 studies; MD 9.45, 95% CI 2.11 to 16.78; p = 0.01; moderate-quality evidence). The methodological quality of the included trials and variability in interventions (eg, content, timing, and duration), affected the validity and generalisability of these observed results.

AUTHORS’ CONCLUSIONS: There is very low- to moderate-quality evidence that CME may be a valuable intervention to augment the pallet of therapeutic options for stroke rehabilitation. Included studies were small, heterogeneous, and some trials had an unclear or high risk of bias. Future high-quality research should determine whether CME interventions are (cost-)effective.

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Source: PEDro – Search Detailed Search Results

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[ARTICLE] Prediction of quality of life after stroke rehabilitation – Full Text



The purpose of this study was to develop a computational method to identify potential predictors for quality of life (QOL) after post stroke rehabilitation.


Five classifiers were trained by five personal factors and nine functional outcome measures by 10-fold cross-validation. The classifier with the highest cross-validated accuracy was considered to be the optimal classifier for QOL prediction.


Particle Swarm-Optimized Support Vector Machine (PSO-SVM) showed highest accuracy in predicting QOL in stroke patients and was adopted as the optimal classifier. Potential predictors were assessed by PSO-SVM with feature selection. The early outcomes of Quality of Movement scale of the Motor Activity Log (MAL_QOM) and the Stroke Impact Scale (SIS) were identified to be the most predictive outcome predictors for QOL.


The approach provides the medical team another possibility to improve the accuracy in predicting QOL in stroke patients. Therapists could determine the therapies for stroke patients more accurately and efficiently to enhance the quality of life after stroke.


Stroke remains a leading cause of death and disability in the developed world [1]. After stroke, the effects of stroke and post stroke rehabilitation are usually assessed by health professional ratings and performance tests [24]. However, real life of stroke survivors is affected in multiple ways and may not be described completely by only health and functional status. It is possible that a treatment succeeds in enhancing physical function recovery however induces psychosocial problems [5,6]. In this case, quality of life (QOL) may actually be degraded after poststroke rehabilitation. The WHO suggests that a comprehensive view of quality of life includes not only physical health, but also psychological health, social relationships, and environmental quality [4]. Therefore, to obtain a comprehensive view of the effects after stroke, life quality should also be considered when assessing a person’s health and functioning.

In recent years, assessment of QOL in stroke has become increasingly common. Many recent rehabilitation therapies have been reported to be effective in restoring upper limb motor function after stroke but showed varied effects in QOL [710]. Different rehabilitation therapies may benefit different subgroups of the stroke population and cause different effects to QOL. Identifying key predictors of QOL may assist therapists to determine an optimal therapy, which can not only improve physical function but also maximize QOL for a specific subgroup of stroke survivors. Decision making of rehabilitation strategies may be more efficient and complete with identifying predominant predictors of QOL.

Only three studies examined predictors of QOL [5,11,12]. In these three studies, the predictive ability of multiple factors was examined, including demographic factors, vascular risk factors, clinical scales and neuropsychological assessment, and lesion characteristics. However, general predictors of outcomes of QOL were hard to determine because of the heterogeneity among these studies. Both physical and psychological factors were reported to be important in predicting QOL after stroke [5,11,12]. Although stroke rehabilitation gains in QOL are important, the question of which patients may benefit most in QOL from specific therapies has not been widely addressed, and statistical approaches to reveal such associations and predictors may not be optimal [13,14]. However, possible predictors related to QOL performance outcome after rehabilitation remained less discussed. More studies are needed to clarify the predictive ability of diverse QOL predictors in stroke patients.

Practical implementation of outcome predictors in clinical use was also constrained by the complexity of the algorithms. Developing prognostic algorithm based on existing and simple algorithms may reduce the complexity in clinical implementation, increase the use of prognostic model, and further improve the efficiency of rehabilitation therapy. Traditionally, studies examined outcome predictors used regression analysis to discriminate the most predictive factors from others [1518]. However, the results of regression analysis can only explained the variance of the outcome in percentage. Computational methods can provide another aspect of outcome prediction. The results of regression statistical method showed that the factors were predictors for the outcome measure model, and the model only explained how percentage of the variance in the outcome measure scores. However, the results of computational classifier methods can provide accuracy and more application related to the predictors.

It has been applied in predicting clinical outcome in cancer patients and showed high accuracy and efficiency [19,20]. Using classifiers could improve the accuracy in predicting QOL. Hopefully, predominant predictors could also be better identified. That’s why we try to utilize a computational classifier method to identify potential predictors for quality of life (QOL) after post stroke rehabilitation.

Continue —> Prediction of quality of life after stroke rehabilitation

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[ARTICLE] A systematic review of active video games on rehabilitative outcomes among older patients – Full Text


Although current research supports the use of active video games (AVGs) in rehabilitation, the evidence has yet to be systematically reviewed or synthesized. The current project systematically reviewed literature, summarized findings, and evaluated the effectiveness of AVGs as a therapeutic tool in improving physical, psychological, and cognitive rehabilitative outcomes among older adults with chronic diseases.


Seven databases (Academic Search Complete, Communication & Mass Media Complete, ERIC, PsycINFO, PubMed, SPORTDiscus, and Medline) were searched for studies that evaluated the effectiveness of AVG-based rehabilitation among older patients. The initial search yielded 946 articles; after evaluating against inclusion criteria and removing duplicates, 19 studies of AVG-based rehabilitation remained.


Most studies were quasiexperimental in design, with physical functioning the primary outcome investigated with regard to the use of AVGs in rehabilitation. Overall, 9 studies found significant improvements for all study outcomes, whereas 9 studies were mixed, with significant improvements on several study outcomes but no effects observed on other outcomes after AVG-based treatments. One study failed to find any benefits of AVG-based rehabilitation.


Findings indicate AVGs have potential in rehabilitation for older patients, with several randomized clinical trials reporting positive effects on rehabilitative outcomes. However, existing evidence is insufficient to support the advantages of AVGs over standard therapy. Given the limited number of studies and concerns with study design quality, more research is warranted to make more definitive conclusions regarding the ability of AVGs to improve rehabilitative outcomes in older patients.

Continue —> A systematic review of active video games on rehabilitative outcomes among older patients

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