Posts Tagged REHABILITATION

[Abstract + References] Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study

Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care.

Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI.

Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge.

In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24).

Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.

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via Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study – Louis Jacob, Mélanie Cogné, Olli Tenovuo, Cecilie Røe, Nada Andelic, Marek Majdan, Jukka Ranta, Peter Ylen, Helen Dawes, Philippe Azouvi, 2020

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[ARTICLE] Protocol for the economic evaluation of the InTENSE program for rehabilitation of chronic upper limb spasticity – Full Text

Abstract

Background

Assessment of the costs of care associated with chronic upper-limb spasticity following stroke in Australia and the potential benefits of adding intensive upper limb rehabilitation to botulinum toxin-A are key objectives of the InTENSE randomised controlled trial.

Methods

Recruitment for the trial has been completed. A total of 139 participants from 6 stroke units across 3 Australian states are participating in the trial. A cost utility analysis will be undertaken to compare resource use and costs over 12 months with health-related quality of life outcomes associated with the intervention relative to a usual care comparator. A cost effectiveness analysis with the main clinical measure of outcome, Goal Attainment Scaling, will also be undertaken. The primary outcome measure for the cost utility analysis will be the incremental cost effectiveness ratio (ICER) generated from the incremental cost of the intervention as compared to the incremental benefit, as measured in quality adjusted life years (QALYs) gained. The utility scores generated from the EQ-5D three level instrument (EQ-5D-3 L) measured at baseline, 3 months and 12 months will be utilised to calculate the incremental Quality Adjusted Life Year (QALY) gains for the intervention relative to usual care using area-under the curve methods.

Discussion

The results of the economic evaluation will provide evidence of the total costs of care for patients with chronic upper limb spasticity following stroke. It will also provide evidence for the cost-effectiveness of adding evidence-based movement therapy to botulinum toxin-A as a treatment, providing important information for health system decision makers tasked with the planning and provision of services.

Background

People with spasticity following stroke have significantly higher care costs (particularly direct healthcare costs, and aged care costs) and lower quality of life than those survivors without spasticity [1,2,3]. Therefore, identifying effective therapies to reduce upper-limb spasticity and improve function are an important target for research.

International clinical guidelines support the use of botulinum toxin-A in conjunction with active rehabilitation as the preferred treatment [4]. However, the optimum rehabilitation strategy remains undetermined. There are a lack of adequately powered randomised controlled trials evaluating the effect of botulinum toxin-A injections alone, compared to the injection plus active rehabilitation. However, consideration of the costs of providing care for these patients and ultimately consideration of the cost effectiveness of new therapies (namely, whether they are a worthwhile spend of the constrained resources of the healthcare budget as compared to other potential therapies) is another important factor [5].

There have been few studies of the economic impact of upper-limb spasticity following stroke. Lundström et al. [2] evaluated the healthcare costs for the year following stroke in those with and without spasticity in Sweden, and identified that direct health care costs were four times higher in those with spasticity compared to those without, predominantly due to increased costs of hospital care and post hospital community care (i.e. home help services, residential care etc). However, this study only included hospitalised patients and was based on only 25 participants with spasticity. More recently in the UK, Raluy-Callado [3] evaluated costs of care in over 2900 post-stroke spasticity patients and found that those with spasticity following stroke had double the healthcare costs of those without spasticity with increased hospital care contributing to increased costs in this group, but were not able to include information on home and community care in their estimate. In addition, the potential economic impacts of spasticity following stroke are broad ranging, with loss of workforce productivity among patients and their caregivers which persisit after the event [6]. However, the potential cost-effectiveness of therapies is under-researched, with no economic evaluations to date evaluating the impact of evidence-based movement training combined with botulinum toxin-A injections [178]. Rychlik et al. 2016 evaluated the impact for the health care costs and quality of life of botulinum toxin-A treatment vs usual care without botulinum toxin-A. The study showed a significant improvement in the physical and mental health status of participants over the follow up period. Increased healthcare costs were evident for the participants who received the treatment, but despite higher incremental costs (driven by higher pharmaceutical and nursing home care costs) the study authors concluded the intervention was very likely to be considered cost effective due to the large gains in quality of life attributed to the intervention group compared to usual care. However a key limitation of this study was that it was not randomised and the results may have been influenced by confounding factors in the treatment and usual care groups [1]. Conversely, the BoTULS trial evaluated the clinical and cost effectiveness of treating upper-limb spasticity with botulinum toxin-A plus physical therapy vs physical therapy alone over a 4 week intervention period. The study authors concluded that the intervention had a low probability of cost-effectiveness compared to usual care using the UK reference care willingness to pay threshold of £20,000 for an additional QALY gained [9].

In addition, there is an absence of studies from an Australian perspective. Makino et al. 2018 [8] have published the only Australian based study which evaluated the cost-effectiveness of extending botulinum toxin-A therapy beyond the four treatments currently supported by the Pharmaceutical Benefits Scheme. This study was undertaken from the health-care payer perspective, and therefore included direct healthcare costs in the Markov-state transition model that was developed. It was found that extending the number of treatments beyond four was likely to be considered cost effective. However, the study authors didn’t include costs or benefits from rehabilitation or physical therapy in addition to the botulinum toxin-A in their analysis.

The cost of botulinum toxin-A injections is significant, calculated as $1673 Australian Dollars per treatment cycle and patients may receive multiple cycles of treatment [48]. The InTENSE trial [10] aims to determine the clinical and cost effectiveness of including evidence-based movement training with botulinum toxin-A injections. Therefore, interventions to improve the long-term effect of botulinum toxin-A injections in this group could assist in improving quality of life of patients and reducing their healthcare and broader community care costs. Here we describe in detail the protocol for the economic evaluation to occur alongside the evaluation of clinical effect for the InTENSE trial.[…]

Continue —-> Protocol for the economic evaluation of the InTENSE program for rehabilitation of chronic upper limb spasticity | BMC Health Services Research | Full Text

 

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[ARTICLE] Functional Electrical Stimulation Controlled by Motor Imagery Brain-Computer Interface for Rehabilitation – Full Text HTML

Abstract

Sensorimotor rhythm (SMR)-based brain–computer interface (BCI) controlled Functional Electrical Stimulation (FES) has gained importance in recent years for the rehabilitation of motor deficits. However, there still remain many research questions to be addressed, such as unstructured Motor Imagery (MI) training procedures; a lack of methods to classify different MI tasks in a single hand, such as grasping and opening; and difficulty in decoding voluntary MI-evoked SMRs compared to FES-driven passive-movement-evoked SMRs. To address these issues, a study that is composed of two phases was conducted to develop and validate an SMR-based BCI-FES system with 2-class MI tasks in a single hand (Phase 1), and investigate the feasibility of the system with stroke and traumatic brain injury (TBI) patients (Phase 2). The results of Phase 1 showed that the accuracy of classifying 2-class MIs (approximately 71.25%) was significantly higher than the true chance level, while that of distinguishing voluntary and passive SMRs was not. In Phase 2, where the patients performed goal-oriented tasks in a semi-asynchronous mode, the effects of the FES existence type and adaptive learning on task performance were evaluated. The results showed that adaptive learning significantly increased the accuracy, and the accuracy after applying adaptive learning under the No-FES condition (61.9%) was significantly higher than the true chance level. The outcomes of the present research would provide insight into SMR-based BCI-controlled FES systems that can connect those with motor disabilities (e.g., stroke and TBI patients) to other people by greatly improving their quality of life. Recommendations for future work with a larger sample size and kinesthetic MI were also presented.

1. Introduction

Healthy individuals whose brains and neuromuscular systems enable normal motor functions can naturally perform Activities of Daily Living (ADLs). Nonetheless, for some people who have disabilities in these functions due to injury or disease, simple tasks become very difficult or impossible to do. To assist this population, researchers in many fields, from physical therapy to engineering, have developed various rehabilitation technologies that help them perform ADLs [1,2]. One such technology, Functional Electrical Stimulation (FES), delivers electrical impulses to either paralyzed or impaired limbs to generate artificial muscle contraction [3,4]. In this way, FES helps disabled people perform ADLs such as walking, reaching, and grasping [5,6]. Some FES devices are controlled by brain–computer interfaces (BCIs), sometimes called brain–machine interfaces.
In general, BCIs can help people communicate and control devices and applications without using peripheral nerves and muscle pathways [7]. BCIs are also a potential method to promote the independence of physically disabled people by means of the BCI’s ability to bypass non-functional neural pathways [8]. A sensorimotor rhythm (SMR)-based BCI-controlled FES system is a novel technology that combines the advantages of FES and BCI systems, and allows severely disabled patients to restore motor functions through the FES system by translating voluntary Motor Imagery (MI) to physical action [9]. There are many potential benefits of combining SMR-based BCIs and FES systems, such as the promotion of neuroplasticity [10], the restoration of motor functions by using voluntary motor intentions [9,11], and providing proprioceptive sensory feedback as a result of their intentions [12].
Although SMR-based BCI-controlled FES methods seem promising, current studies still have central issues: (1) ambiguous instruction of MI tasks during training under SMR-based BCI systems, and (2) difficulties in classifying voluntary MI-evoked SMRs and FES-driven passive-movement-evoked SMRs when FES is activated. Moreover, (3) only a few studies have examined the feasibility of classifying two different MI tasks of a single hand, such as grasping and opening, and (4) few studies have examined human factors and ergonomics (HF/E) perspectives such as subjective mental workload and user satisfaction in the use of SMR-based BCI-controlled FES systems. This research that is composed of two phases was conducted to address these issues by developing a new SMR-based BCI system with visual guidance during training to classify a 2-class MI task in a single hand, as well as voluntary and passive SMRs (Phase 1), and evaluating the feasibility of the proposed BCI-controlled FES system by performing sequential goal-oriented tasks with stroke and TBI patients (Phase 2).
The remainder of this article consists of five more sections (this introduction being Section 1): Section 2 describes a survey of current SMR-based BCI studies for FES systems to identify the limitations of current research and clarifies the current state of BCI-controlled FES technologies. Section 3 presents Phase 1, where an SMR-based BCI system to control FES was developed and validated to address the issues on current research studies. Section 4 describes Phase 2, which assessed the feasibility of the proposed BCI-FES system by conducting a sequential task with fixed order under a semi-asynchronous mode. Section 5 discusses the findings of the present research along with implications and future directions.[…]

Continue —-> Brain Sciences | Free Full-Text | Functional Electrical Stimulation Controlled by Motor Imagery Brain-Computer Interface for Rehabilitation | HTML

Figure 1. Schematic illustration of the experiment procedure. Text in the blue box indicates the auditory cue that played at the beginning of each period, and INI is an abbreviation of the Functional Electrical Stimulation (FES) initiation period. MI: Motor Imagery.

 

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[Abstract] DESC glove: Prototyping a novel wearable device for post-stroke hand rehabilitation

Abstract

The human brain integrates tactile sensory information from the fingertips to efficiently manipulate objects. Sensory impairments due to neurological disorders, e.g. stroke, largely reduce hand dexterity and the ability to perform daily living activities. Several feedback augmentation techniques have been investigated for rehabilitative purposes with promising outcomes. However, they often require the use of unpractical, expensive, or complex devices. In this work we propose the delivery of vibrotactile feedback based on the Discrete Event-driven Sensory feedback Control (DESC) to promote motor learning in post stroke rehabilitation. For this purpose, we prototyped a novel wearable device, namely the DESC glove. It consisted of a soft glove instrumented with PolyVinylidene Fluoride (PVDF) sensors at the fingertips and eccentric-mass vibration actuators to be worn on the forearm. We proceeded with the characterization of the device, which resulted in promising outcomes. The DESC glove was tested with ten healthy participants subsequently in a pick and lift timed task. The effects of augmented vibrotactile feedback were assessed comparing it to a baseline, consisting of wearing the device unpowered. The results of this pilot study showed a decrease in the time necessary to perform the task, a reduction in the time delay from load force to grip force activation and a diminishing of the grip force applied on the object, which led to a lower breakage rate in the intervention condition. These promising outcomes encourage further experiments with stroke survivors to validate the effectiveness of the device to improve hand dexterity and promote stroke rehabilitation.

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[ARTICLE] Persons post-stroke improve step length symmetry by walking asymmetrically – Full Text

Abstract

Background and purpose

Restoration of step length symmetry is a common rehabilitation goal after stroke. Persons post-stroke often retain the ability to walk with symmetric step lengths (“symmetric steps”); however, the resulting walking pattern remains effortful. Two key questions with direct implications for rehabilitation have emerged: 1) how do persons post-stroke generate symmetric steps, and 2) why do symmetric steps remain so effortful? Here, we aimed to understand how persons post-stroke generate symmetric steps and explored how the resulting gait pattern may relate to the metabolic cost of transport.

Methods

We recorded kinematic, kinetic, and metabolic data as nine persons post-stroke walked on an instrumented treadmill under two conditions: preferred walking and symmetric stepping (using visual feedback).

Results

Gait kinematics and kinetics remained markedly asymmetric even when persons post-stroke improved step length symmetry. Impaired paretic propulsion and aberrant movement of the center of mass were evident during both preferred walking and symmetric stepping. These deficits contributed to diminished positive work performed by the paretic limb on the center of mass in both conditions. Within each condition, decreased positive paretic work correlated with increased metabolic cost of transport and decreased walking speed across participants.

Conclusions

It is critical to consider the mechanics used to restore symmetric steps when designing interventions to improve walking after stroke. Future research should consider the many dimensions of asymmetry in post-stroke gait, and additional within-participant manipulations of gait parameters are needed to improve our understanding of the elevated metabolic cost of walking after stroke.

Introduction

Gait dysfunction is common after stroke [1]. Persons post-stroke exhibit slow walking speeds [2,3,4], gait asymmetry [45], and an elevated metabolic cost of transport (i.e., energy expended per meter walked) [6,7,8]. Gait training is a key component of stroke rehabilitation, as persons post-stroke frequently list gait improvement among their most desired rehabilitation goals [9].

Many rehabilitation approaches aim to restore step length symmetry [10,11,12,13,14,15,16]. The rationale for restoring step length symmetry is multifaceted: 1) asymmetric stepping increases the cost of transport in healthy adults [17], 2) persons post-stroke who walk with more asymmetric step lengths also tend to exhibit poorer balance [18] and more effortful gait patterns [19], 3) step length asymmetry is a simple metric that manifests from complex kinematic and kinetic asymmetries that can be difficult to treat in isolation, and 4) step length is easy to measure and manipulate in clinical settings (e.g., “step to the lines on the floor”). Consequently, there has been increasing interest in restoring step length symmetry after stroke, especially after recent intervention studies showed that improved step length symmetry coincided with improvements in gait speed [15] and cost of transport [19].

However, it is not clear that restoration of step length symmetry alone should lead to improvements in gait speed or cost of transport. Persons post-stroke often retain the capacity to walk with improved step length symmetry, even within a single testing session [162021]. But unlike the intervention studies mentioned above, single-session studies have shown cost of transport to be similar whether persons post-stroke walk with asymmetric or symmetric step lengths [1621]. These findings suggest that improvements in gait speed and cost of transport likely arise from changes in kinematic or kinetic parameters that more directly influence gait speed or energetics and also affect step length symmetry. From this perspective, interventions that aim to restore step length symmetry but do not affect these critical underlying factors may not result in meaningful gait improvement. The ability to lessen cost of transport with an intervention aiming to restore step length symmetry likely depends on 1) the underlying causes of the asymmetry (which vary among patients [2122]), and 2) the mechanics used to generate the symmetric step lengths.

Here, we aimed to understand how persons post-stroke changed their walking patterns to restore step length symmetry and how these gait mechanics related to the cost of transport. We asked: do persons post-stroke restore step length symmetry by restoring symmetric gait mechanics or by relying on asymmetric compensatory mechanics? We hypothesized that persons post-stroke would restore step length symmetry using asymmetric walking patterns. We then aimed to explain why these asymmetric gait patterns cost so much energy despite improved step length symmetry.

Materials and methods

General methods

Ten persons post-stroke were recruited for the study. Data accrued from nine persons were retained for analysis (6 M/3F, age (mean ± SEM): 54 ± 4 years, lower extremity Fugl-Meyer [23]: 26 ± 1, body mass: 93 ± 6 kg, all > 6 months post-stroke). Inclusion criteria for recruitment included a step length difference of at least 2 cm during over-ground walking. One participant was excluded from analysis because they unexpectedly reduced the asymmetry below 2 cm during treadmill walking. All other participants showed a > 2 cm step length difference during both over-ground and treadmill walking and reduced their step length asymmetry from the preferred walking trial to the symmetric stepping trial. Participants reported no additional neurological, musculoskeletal, or cardiovascular conditions. We determined preferred walking speed as the average speed of three over-ground 10-meter walk tests (0.81 ± 0.09 m/s, range: 0.40–1.25 m/s). Seven participants held onto the treadmill handrails, two wore ankle-foot orthoses, and one received functional electrical stimulation of the tibialis anterior. We asked participants who held onto the handrails to hold onto them as little as possible and avoid gripping the handrail if at all possible. All participants wore a safety harness that did not provide body weight support, provided written informed consent in accordance with the Johns Hopkins Medicine Institutional Review board prior to participation, and received monetary compensation.

We recorded kinematic (100 Hz) and kinetic (1000 Hz) data using a three-dimensional motion capture system (Vicon, Oxford, UK) and instrumented split-belt treadmill (Motek, Amsterdam, NL; Fig. 1a, left). We placed retroreflective markers over the seventh cervical vertebrae, tenth thoracic vertebrae, jugular notch, xiphoid process, and bilaterally over the second and fifth metatarsal heads, calcaneus, medial and lateral malleoli, shank, medial and lateral femoral epicondyles, thigh, greater trochanter, iliac crest, and anterior and posterior superior iliac spines. We filtered marker trajectories and ground reaction forces (GRFs) with fourth order low-pass Butterworth filters (6 Hz and 15 Hz cut-off frequencies, respectively). GRFs were set to zero for vertical GRF magnitudes < 32 N. Participants wore comfortable shoes and form-fitting clothing.

Fig. 1

a Experimental setup (left). Example participant walking with asymmetric step lengths (center) and resulting visual display showing step length feedback bilaterally (right). b Step lengths (mean ± SE curves) for the limbs that took longer (blue) and shorter (red) steps at baseline during preferred walking (left) and symmetric stepping (right). The data shown have been truncated to number of strides for the participant that took the fewest strides for the same duration of the trial. c Step length asymmetry decreases significantly during symmetric stepping (green) as compared to preferred walking (purple). d The net metabolic cost of transport is similar between preferred walking and symmetric stepping

[…]

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[Abstract] Understanding the multidimensional nature of sexuality after traumatic brain injury

Abstract

Objective

To investigate the association of sexuality with sociodemographic (age, sex, education), medical (injury severity, time since injury), physical (fatigue, pain, independence), neuropsychological (memory, attention, executive function), psychological (depression, anxiety, self-esteem), and social participation factors after traumatic brain injury (TBI).

Design

Survey. Individuals with TBI completed measures at a mean average of 2.78 years post-injury (range = 1-10.3 years).

Setting

All participants were community based at the time of data collection.

Participants

Eighty-four individuals with TBI consecutively recruited after discharge from rehabilitation and 88 age-, sex- and education-matched controls recruited from the general community.

Interventions

Not applicable.

Main Outcome Measure

Brain Injury Questionnaire of Sexuality (BIQS).

Results

Individuals with TBI performed significantly worse on sexuality, mood and self-esteem measures compared to the healthy control group, supporting previous findings. Research findings highlighted a range of significant correlations between sociodemographic, physical, neuropsychological, psychological and social participation factors and sexuality outcomes after TBI. In the multiple regression model, older age, greater depression and lower self-esteem were significant predictors of poorer sexuality post-injury. Further analyses indicated that depression mediated the independent relationships between lower social participation and greater fatigue with a decline in sexuality after TBI.

Conclusions

These findings support sexuality changes after TBI as a multidimensional construct, highlighting depression as a key mechanism through which other factors may impact sexual functioning. Further research is needed to target assessment and intervention services for sexuality problems after TBI.

via Understanding the multidimensional nature of sexuality after traumatic brain injury – Archives of Physical Medicine and Rehabilitation

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[Abstract] Robot-assisted gait training promotes brain reorganization after stroke: A randomized controlled pilot study

Abstract

Background: Robot-assisted gait training (RAGT) can improve walking ability after stroke but the underlying mechanisms are unknown.

Objective: We evaluated the changes in the injured brain after RAGT and compared the effects of early start and late start of RAGT.

Methods: Eleven patients with hemiplegia after stroke undergoing inpatient rehabilitation were examined within 3 months of stroke onset and were randomly assigned into two groups. Group 1 started RAGT with conventional physiotherapy immediately after enrollment, whereas Group 2 underwent conventional physiotherapy for 4 weeks before starting RAGT. We acquired diffusion tensor imaging data after enrollment and at 4 and 8 weeks after treatment. Fractional anisotropy (FA) and mean diffusivity (MD) maps were used to analyze the neural changes.

Results: Repeated measures analysis of variance of the data at 4 weeks after treatment showed a significant interaction between time and groups (RAGT versus control) for the FA and MD values in the non-lesioned hemisphere, indicating that the non-lesioned hemisphere was significantly reorganized by RAGT compared with conventional physiotherapy. Analysis of the data at 8 weeks after treatment showed a significant interaction between time and groups (early and late start of RAGT) for the MD values in the motor-related areas bilaterally, indicating that early start of RAGT significantly accelerated bi-hemispheric reorganization as compared with late start of RAGT.

Conclusions: Our findings indicate that RAGT can facilitate reorganization in the intact superior temporal, cingulate, and postcentral gyri. Furthermore, early start of RAGT can accelerate bi-hemispheric reorganization in the motor-related brain regions.

via Robot-assisted gait training promotes brain reorganization after stroke: A randomized controlled pilot study – PubMed

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[Abstract + References] Resistance training in stroke rehabilitation: systematic review and meta-analysis

This systematic review and meta-analysis investigates the effects of resistance training in supporting the recovery in stroke patients.

PubMed, the Cochrane Central Register of Controlled Trials and the PEDro databases were reviewed up to 30 April 2020.

Randomized controlled trials were included, who compared: (i) resistance training with no intervention, (ii) resistance training with other interventions and (iii) different resistance training protocols in stroke rehabilitation.

Overall 30 trials (n = 1051) were enrolled. The parameters evaluated were: (1) gait, (2) muscular force and motor function, (3) mobility, balance and postural control, (4) health related quality of life, independence and reintegration, (5) spasticity and hypertonia, (6) cardiorespiratory fitness, (7) cognitive abilities and emotional state and (8) other health-relevant physiological indicators. The data indicates that: (i) resistance training is beneficial for the majority of parameters observed, (ii) resistance training is superior to other therapies on muscular force and motor function of lower and upper limbs, health related quality of life, independence and reintegration and other health-relevant physiological indicators, not significantly different from other therapies on walking ability, mobility balance and postural control and spasticity and hypertonia, and inferior to ergometer training on cardiorespiratory fitness and (iii) the type of resistance training protocol significantly impacts its effect; leg press is more efficient than knee extension and high intensity training is superior than low intensity training.

Current data indicates that resistance training may be beneficial in supporting the recovery of stroke patients. However, the current evidence is insufficient for evidence-based rehabilitation.

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via Resistance training in stroke rehabilitation: systematic review and meta-analysis – Jitka Veldema, Petra Jansen, 2020

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[Abstract] Understanding the multidimensional nature of sexuality after traumatic brain injury

Abstract

Objective

To investigate the association of sexuality with sociodemographic (age, sex, education), medical (injury severity, time since injury), physical (fatigue, pain, independence), neuropsychological (memory, attention, executive function), psychological (depression, anxiety, self-esteem), and social participation factors after traumatic brain injury (TBI).

Design

Survey. Individuals with TBI completed measures at a mean average of 2.78 years post-injury (range = 1-10.3 years).

Setting

All participants were community based at the time of data collection.

Participants

Eighty-four individuals with TBI consecutively recruited after discharge from rehabilitation and 88 age-, sex- and education-matched controls recruited from the general community.

Interventions

Not applicable.

Main Outcome Measure

Brain Injury Questionnaire of Sexuality (BIQS).

Results

Individuals with TBI performed significantly worse on sexuality, mood and self-esteem measures compared to the healthy control group, supporting previous findings. Research findings highlighted a range of significant correlations between sociodemographic, physical, neuropsychological, psychological and social participation factors and sexuality outcomes after TBI. In the multiple regression model, older age, greater depression and lower self-esteem were significant predictors of poorer sexuality post-injury. Further analyses indicated that depression mediated the independent relationships between lower social participation and greater fatigue with a decline in sexuality after TBI.

Conclusions

These findings support sexuality changes after TBI as a multidimensional construct, highlighting depression as a key mechanism through which other factors may impact sexual functioning. Further research is needed to target assessment and intervention services for sexuality problems after TBI.

via Understanding the multidimensional nature of sexuality after traumatic brain injury – ScienceDirect

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[ARTICLE] In-Home Rehabilitation Using a Smartphone App Coupled With 3D Printed Functional Objects: Single-Subject Design Study – Full Text

ABSTRACT

Background: Stroke is a major cause of long-term disability. While there is potential for improvements long after stroke onset, there is little to support functional recovery across the lifespan. mHealth solutions can help fill this gap. mRehab was designed to guide individuals with stroke through a home program and provide performance feedback.

Objective: To examine if individuals with chronic stroke can use mRehab at home to improve upper limb mobility. The secondary objective was to examine if changes in limb mobility transferred to standardized clinical assessments.

Methods: mRehab consists of a smartphone coupled with 3D printed household items: mug, bowl, key, and doorknob. The smartphone custom app guides task-oriented activities and measures both time to complete an activity and quality of movement (smoothness/accuracy). It also provides performance-based feedback to aid the user in self-monitoring their performance. Task-oriented activities were categorized as (1) object transportation, (2) prehensile grip with supination/pronation, (3) fractionated finger movement, and (4) walking with object. A total of 18 individuals with stroke enrolled in the single-subject experimental design study consisting of pretesting, a 6-week mRehab home program, and posttesting. Pre- and posttesting included both in-laboratory clinical assessments and in-home mRehab recorded samples of task performance. During the home program, mRehab recorded performance data. A System Usability Scale assessed user’s perception of mRehab.

Results: A total of 16 participants completed the study and their data are presented in the results. The average days of exercise for each mRehab activity ranged from 15.93 to 21.19 days. This level of adherence was sufficient for improvements in time (t15=2.555, P=.02) and smoothness (t15=3.483, P=.003) in object transportation. Clinical assessments indicated improvements in functional performance (t15=2.675, P=.02) and hand dexterity (t15=2.629, P=.02). Participant’s perception of mRehab was positive.

Conclusions: Despite heterogeneity in participants’ use of mRehab, there were improvements in upper limb mobility. Smartphone-based portable technology can support home rehabilitation programs in chronic conditions such as stroke. The ability to record performance data from home rehabilitation offers new insights into the impact of home programs on outcomes.

Introduction

Background

Stroke is a major cause of disability, leading to restriction of occupational performance for stroke survivors [1,2]. It is estimated that 30%-60% of stroke survivors continue to have residual limitations in upper extremity movements after traditional rehabilitation services [3]. At the end of rehabilitation services, survivors are commonly given a written home exercise program to guide recovery in chronic stages of stroke [4]. Shortcomings of the written home exercise program include complaints of being unengaging and patients not continuing the program [4]. Knowing that upper limb motor deficits can reduce quality of life [5], it is important to support survivors to recover as much function as possible. Upper limb recovery after stroke is identified as a research priority by survivors of stroke, caregivers, and health professionals [6].

Research demonstrates that individuals with chronic stroke are capable of making gains in performance with continued practice. The research so far has focused on interventions led by therapists [7,8]. It is improbable that direct oversight by a therapist is a feasible solution for long-term recovery. For chronic conditions such as stroke, better supporting the individual’s ability to self-manage their long-term recovery could offer a more sustainable approach. Use of mHealth (ie, mobile technology to manage health) offers the opportunity for individuals to engage in rehabilitative activities while monitoring their performance and managing their health behaviors [9,10]. mHealth apps can assist users in meeting basic needs, thereby giving a sense of autonomy and competence [11]. In addition, participants have reported that it is enjoyable to use apps [12]. Smart devices are equipped with interactive components (eg, sensors, cameras, speakers, and vibrators) capable of measuring human movement and providing feedback [13]. Readily available smartphone technology can be the basis of a home rehabilitation system.

There has been an increase in app development for stroke rehabilitation. A review of apps designed for stroke survivors or their caregivers found that 62% of apps addressed language or communication [14]. Other apps addressed stroke risk calculation, identifying acute stroke, atrial fibrillation, direction to emergency room or nearest certified stroke center, visual attention therapy, and a mere 4% addressed physical rehabilitation [14]. Importantly, apps for rehabilitation did not focus on upper limb function [14]. Use of technology to guide and measure performance in task-specific training of the upper extremity after stroke has primarily included clinical or laboratory-based interventions [15,16]. Task-specific programs are function based, with practice of tasks relevant to activities of daily life, and have been shown to be efficacious [17,18]. Use of instrumented objects in a laboratory setting has resulted in patients reporting they enjoyed the experience [15]. There has been less research on the use of portable technology for upper limb rehabilitation in a home setting for individuals with chronic arm/hand deficits after stroke.

Previous Work

mRehab (mobile Rehab) was created to better support in-home upper limb rehabilitation programs (Figure 1) [13]. It incorporates a task-oriented approach and immediate performance-based feedback. Exercise programs that include feedback have resulted in better outcomes compared with programs without feedback [19,20]. mRehab consists of 3D printed household objects (a mug, bowl, key, and doorknob) integrated with a smartphone and an app. The app guides participants through practice of activities of daily living, for example, sipping from a mug. It can also consistently measure time to complete an activity and quality of movement (smoothness/accuracy) during the performance of activities of daily living. The system is described in more detail in previous articles that have evaluated it in primarily laboratory-based settings [13,21].

Figure 1. In-home use of mRehab: (A) selecting an activity in mRehab; (B) turning key activity; and (C) vertical mug transfer activity.

There is little information on in-home use of technology for rehabilitation in chronic stroke. While technology-based systems designed for rehabilitation have been developed, they have typically been examined in laboratory or clinical settings [22,23]. The results of this study will provide much needed evidence of the ability of individuals with chronic stroke to use technology in a home-based program with oversight only upon request. This mimics clinical practice, in which patients are discharged from rehabilitation with a home program and then need to self-manage their recovery. We examine the individual’s adherence to exercise and if they required support with the technology. The impact of the home-based mRehab program on functional mobility was also examined. While individuals with chronic stroke were selected for the first examination of mRehab in a home-based setting, the system has the potential to be used by individuals that have arm/hand deficits due to other underlying pathology.[…]

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