Posts Tagged self-management

[ARTICLE] A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training – Full Text

Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions.

Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices.

A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover.

On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Neurologic rehabilitation has been testing a motor learning theory for the past quarter century that may be wearing thin in terms of leading to more robust evidence-based practices. The theory has become a mantra for the field that goes like this. Repetitive practice of increasingly challenging task-related activities assisted by a therapist in an adequate dose will lead to gains in motor skills, mostly restricted to what was trained, via mechanisms of activity-dependent induction of molecular, cellular, synaptic, and structural plasticity within spared neural ensembles and networks.

This theory has led to a range of evidence-based therapies, as well as to caricatures of the mantra (eg, a therapist says to patient, “Do those plasticity reps!”). A mantra can become too automatic, no longer apt to be reexamined as a testable theory. A recent Cochrane review of upper extremity stroke rehabilitation found “adequately powered, high-quality randomized clinical trials (RCTs) that confirmed the benefit of constraint-induced therapy paradigms, mental practice, mirror therapy, virtual reality paradigms, and a high dose of repetitive task practice.”1 The review also found positive RCT evidence for other practice protocols. However, they concluded, no one strategy was clearly better than another to improve functional use of the arm and hand. The ICARE trial2 for the upper extremity after stroke found that both a state-of-the-art Accelerated Skill Acquisition Program (motor learning plus motivational and psychological support strategy) compared to motor learning-based occupational therapy for 30 hours over 10 weeks led to a 70% increase in speed on the Wolf Motor Function Test, but so did usual care that averaged only 11 hours of formal but uncharacterized therapy. In this well-designed RCT, the investigators found no apparent effect of either the dose or content of therapy. Did dose and content really differ enough to reveal more than equivalence, or is the motor-learning mantra in need of repair?

Walking trials after stroke and spinal cord injury,38 such as robot-assisted stepping and body weight-supported treadmill training (BWSTT), were conceived as adhering to the task-oriented practice mantra. But they too have not improved outcomes more than conventional over-ground physical therapy. Indeed, the absolute gains in primary outcomes for moderate to severely impaired hemiplegic participants after BWSTT and other therapies have been in the range of only 0.12 to 0.22 m/s for fastest walking speed and 50 to 75 m for 6-minute walking distance after 12 to 36 training sessions over 4 to 12 weeks.3,9 These 15% to 25% increases are just as disappointing when comparing gains in those who start out at a speed of <0.4 m/s compared to >0.4 to 0.8 m/s.3

Has mantra-oriented training reached an unanticipated plateau due to inherent limitations? Clearly, if not enough residual sensorimotor neural substrate is available for training-induced adaptation or for behavioral compensation, more training may only fail. Perhaps, however, investigators need to reconsider the theoretical basis for the mantra, that is, whether they have been offering all of the necessary components of task-related practice, such as enough progressively difficult practice goals, the best context and environment for training, the behavioral training that motivates compliance and carryover of practice beyond the sessions of formal training, and blending in other physical activities such as strengthening and fitness exercise that also augment practice-related neural plasticity? These questions point to new directions for research….

Continue —> A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training – Mar 01, 2017

Figure 1. Components of a Rehabilitation-Internet-of-Things: wireless chargers for sensors (1), ankle accelerometers with gyroscopes (2) and Android phone (3) to monitor walking and cycling, and a force sensor (4) in line with a stretch band (5) to monitor resistance exercises.

 

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[Abstract] An observational study of Australian physiotherapy consultations to explore the prescription of strategies.

Abstract

Objective

The aim of the study was to explore the types of self-management strategies prescribed; the number of strategies and the overall length of time allocated to self-management prescription, by consultation type and by injury location, in physiotherapy consultations.

Methods

A cross-sectional, observational study of 113 physiotherapist–patient consultations was undertaken. Regression analyses were used to determine whether consultation type and injury location were associated with the number of strategies prescribed and the length/fraction of time spent on self-management.

Results

A total of 108 patients (96%) were prescribed at least one self-management strategy – commonly exercise and advice. The mean length of time spent on self-management was 5.80 min. Common injury locations were the neck (n = 40) and lower back (n = 39). No statistically significant associations were observed between consultation type or injury location for either outcome (number of strategies and the length/fraction of time allocated to self-management prescription).

Conclusion

Physiotherapists regularly spend time prescribing self-management strategies such as exercise, advice, and the use of heat or ice to patients receiving treatment linked to a range of injury locations. This suggests that self-management is considered to be an important adjunct to in-clinic physiotherapy. The practice implications of this are that clinicians should reflect on how self-management strategies can be used to maximize patient outcomes, and whether the allocation of consultation time to self-management is likely to optimize patient adherence to each strategy.

Source: An observational study of Australian private practice physiotherapy consultations to explore the prescription of self-management strategies – Peek – 2017 – Musculoskeletal Care – Wiley Online Library

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[Abstract] A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training

Abstract

Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope.

We review some possible explanations, then potential technology-enabled solutions. Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement.

Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover. On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Source: A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training

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[Abstract] A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training

Abstract

Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions. Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover. On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Source: A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training

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[ARTICLE] A Personalized Self-Management Rehabilitation System for Stroke Survivors: A Quantitative Gait Analysis Using a Smart Insole – Full Text HTML

ABSTRACT

Background: In the United Kingdom, stroke is the single largest cause of adult disability and results in a cost to the economy of £8.9 billion per annum. Service needs are currently not being met; therefore, initiatives that focus on patient-centered care that promote long-term self-management for chronic conditions should be at the forefront of service redesign. The use of innovative technologies and the ability to apply these effectively to promote behavior change are paramount in meeting the current challenges.

Objective: Our objective was to gain a deeper insight into the impact of innovative technologies in support of home-based, self-managed rehabilitation for stroke survivors. An intervention of daily walks can assist with improving lower limb motor function, and this can be measured by using technology. This paper focuses on assessing the usage of self-management technologies on poststroke survivors while undergoing rehabilitation at home.

Methods: A realist evaluation of a personalized self-management rehabilitation system was undertaken in the homes of stroke survivors (N=5) over a period of approximately two months. Context, mechanisms, and outcomes were developed and explored using theories relating to motor recovery. Participants were encouraged to self-manage their daily walking activity; this was achieved through goal setting and motivational feedback. Gait data were collected and analyzed to produce metrics such as speed, heel strikes, and symmetry. This was achieved using a “smart insole” to facilitate measurement of walking activities in a free-living, nonrestrictive environment.

Results: Initial findings indicated that 4 out of 5 participants performed better during the second half of the evaluation. Performance increase was evident through improved heel strikes on participants’ affected limb. Additionally, increase in performance in relation to speed was also evident for all 5 participants. A common strategy emerged across all but one participant as symmetry performance was sacrificed in favor of improved heel strikes. This paper evaluates compliance and intensity of use.

Conclusion: Our findings suggested that 4 out of the 5 participants improved their ability to heel strike on their affected limb. All participants showed improvements in their speed of gait measured in steps per minute with an average increase of 9.8% during the rehabilitation program. Performance in relation to symmetry showed an 8.5% average decline across participants, although 1 participant improved by 4%. Context, mechanism, and outcomes indicated that dual motor learning and compensatory strategies were deployed by the participants.

Introduction

The global incidence of stroke is set to escalate from 15.3 million to 23 million by 2030 [1]. In the United Kingdom, stroke is the largest cause of disability [2] resulting in a cost to the economy of £8.9 billion a year [3]. It is estimated that following a stroke, only 15% of people will gain complete recovery for both the upper and lower extremities [4]. Walking and mobility are prominent challenges for many survivors who report the importance of mobility therapy [5]. Nevertheless, rehabilitative service needs cannot always be met and therefore initiatives that focus on patient-centered care promoting long-term self-management remain at the forefront of service redesign [6].

The adoption of technological solutions allows for patient and carer empowerment and a paradigm shift in control and decision-making to one of a shared responsibility. It also has the potential to reduce the burden for care professionals, and support the development of new interventions [7]. Incorporating technology into the daily lives of stroke survivors can be achieved by maintaining high levels of usability, acceptance, engagement, and removing any associated stigma involved with the use of assistive technology [8].

Technological aids for poststroke motor recovery hitherto have required the use of expensive, complex, and cumbersome apparatus that have typically necessitated the therapist to be present during use [9,10]. Recently, inexpensive, wearable, commercially-available sensors have become a more viable option for independent home-based poststroke rehabilitation [11,12]. A systematic review by Powell et al [13] identified a number of wearable lower-limb devices that have been trialed, such as robotics [1416], virtual reality [16], functional electrical stimulation (FES) [17,18], electromyographic biofeedback (EMG-BFB) [19,20], and transcutaneous electrical nerve stimulation [21]. Of the identified trials exploring improvements in the International Classification of Functioning (ICF) domain of activities and participation, only 1 [21] found significant improvements. Studies that adopt a positivist randomized controlled trial paradigm often fail to give sufficient consideration as to how intervention components interact [22]. Indeed, creating and developing technological solutions for complex long-term conditions is challenging and requires multiple stakeholder input [23].

The Self-management supported by Assistive, Rehabilitation and Telecare Technologies consortium explored rehabilitation for stroke survivors focusing initially on the use of wearable sensors to support upper limb feedback on the achievement of functional goals [2430]. User interface design, the practicalities surrounding deployment, and the ability of the participants to interact with the technology were explored [24].

The intervention model for the stroke system was based around a rehabilitation paradigm underpinned by theories of motor relearning and neuroplastic adaptation, motivational feedback, self-efficacy, and knowledge transfer [3134]. In order to enhance and strengthen previous research, a realist evaluation [35] was adopted to evaluate the final personalized self-management rehabilitation system (PSMrS) prototype in order to gain an insight into the value, usability, and potential impact on an individual’s ability to self-manage their rehabilitation following a stroke [36].

The aim of this work was to understand the conditions under which technology-based rehabilitation would have an impact (outcome) on the motor behavior of the user—more specifically what would work for whom, in what context, and in what respect utilizing a realist evaluation framework [35]. This paper addresses this by focusing on the impact smart insole technology has on participants at home. The impacts are assessed by analyzing a participants’ gait over time, which are then presented and discussed.

Futhermore, the rehabilitation system, its architecture, and technical components are presented along with the evaluation of the prototype with regards to the performance and usability of the system in the homes of stroke survivors.

Continue —> JRAT-A Personalized Self-Management Rehabilitation System for Stroke Survivors: A Quantitative Gait Analysis Using a Smart Insole | Davies | JMIR Rehabilitation and Assistive Technologies

Figure 1. Technology infrastructure used to support the realist evaluation consisted of touch screen interactive components: (1) a smart insole produced by Tomorrow Options, (2) used to collect gait information, and (3) a server used to analyze data.

Figure 2. Walkinsense device. Top left: force sensitive resistors showing a typical layout configuration; bottom left: the size of a force sensitive resister in relation to a UK 5 pence piece; and right: attachment of devices to lower limb on a manikin.

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[WEB SITE] Managing Epilepsy – CDC

A support program for parents of teens who have epilepsy

Epilepsy can get in the way of life, mostly when seizures keep happening. Sometimes, seizures make it hard to work, go to school, drive, and take part in social activities. When seizures are not controlled, it increases the risk of

  • Injury.
  • Depression.
  • Anxiety.
  • In some cases, death.

Sometimes even epilepsy treatment can cause problems such as feeling tired.

Self-management is what you do to take care of yourself. You can learn how to manage your epilepsy and have an active and full life.

Successful self-management requires an active partnership between a person with epilepsy, the person’s healthcare provider, and family and friends.

Learn more about self-management and WebEase, a free online epilepsy self-management program:

Brochure for people with epilepsy[PDF-1.4M]
Brochure for people with epilepsy (Spanish)[PDF-1.3M]
Brochure for healthcare providers[PDF-528K]
Brochure for healthcare providers (Spanish) [PDF-1.3M]

What parents or caregivers can do

  • Talk with your child’s heath care provider to make sure your child’s seizures are controlled as much as possible.
  • Find ways to help teens live well with epilepsy with CDC’s You are Not Alone toolkit for parents.
  • Learn more about treatment options for your child with epilepsy, including clinical trials.

The Epilepsy Foundation also has helpful self-management resources for people with epilepsy and their caregivers.

What healthcare professionals can do

Healthcare providers can encourage their patients to participate in self-management programs. Provider support of patient self-management is a key component of effective chronic illness care. A patient is much more likely to participate in proven, free or low-cost, convenient programs with a recommendation from a healthcare provider.

Healthcare professionals can train providers in self-management support. The HHS Education and Training Curriculum on Multiple Chronic Conditions website offers resource for educators across the educational continuum to equip healthcare professionals and paraprofessionals with tools and knowledge on caring for persons living with multiple chronic conditions (PLWMCC) across settings. The Self-Management Support training module outlines self-management and self-management support strategies to use to empower PLWMCC.

Managing Epilepsy Well Network

The Managing Epilepsy Well (MEW) Network is a group of academic Prevention Research Centers that conduct studies related to epilepsy self-management. Read about MEW Network projects and how they are improving health and quality of life through their research, programs, and tools.

Source: Managing Epilepsy | Epilepsy | CDC

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[ARTICLE] Wristband Accelerometers to motiVate arm Exercise after Stroke (WAVES): study protocol for a pilot randomized controlled trial – Full Text

Abstract

Background

Loss of upper limb function affects up to 85 % of acute stroke patients. Recovery of upper limb function requires regular intensive practise of specific upper limb tasks. To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice. Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities. A wrist-worn device has been developed that monitors and provides ‘live’ upper limb activity feedback to remind patients to use their stroke arm in daily activities (The CueS wristband). The aim of this trial is to assess the feasibility of a multi-centre, observer blind, pilot randomised controlled trial of the CueS wristband in clinical stroke services.

Methods/design

This pilot randomised controlled feasibility trial aims to recruit 60 participants over 15 months from North East England. Participants will be within 3 months of stroke which has caused new reduced upper limb function and will still be receiving therapy. Each participant will be randomised to an intervention or control group. Intervention participants will wear a CueS wristband (between 8 am and 8 pm) providing “live” feedback towards pre-set movement goals through a simple visual display and vibration prompts whilst undertaking a 4-week upper limb therapy programme (reviewed twice weekly by an occupational/physiotherapist). Control participants will also complete the 4-week upper limb therapy programme but will wear a ‘sham’ CueS wristband that monitors upper limb activity but provides no feedback. Outcomes will determine study feasibility in terms of recruitment, retention, adverse events, adherence and collection of descriptive clinical and accelerometer motor performance data at baseline, 4 weeks and 8 weeks.

Discussion

The WAVES study will address an important gap in the evidence base by reporting the feasibility of undertaking an evaluation of emerging and affordable technology to encourage impaired upper limb activity after stroke. The study will establish whether the study protocol can be supported by clinical stroke services, thereby informing the design of a future multi-centre randomised controlled trial of clinical and cost-effectiveness.

Continue —> Wristband Accelerometers to motiVate arm Exercise after Stroke (WAVES): study protocol for a pilot randomized controlled trial | Trials | Full Text

Fig. 1 Study flow diagram

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[ARTICLE] Things to Note in Stroke Rehabilitation – Full Text PDF

Abstract

Stroke results in impairment of motor, cognitive and sensory/perceptual functions. As such, activities of daily living (ADL) after stroke can be affected. These affectations can persist for a long time depending on the extent of the affectation in the brain and rehabilitation. In fact, stroke has lately been recognized as a long term condition. Thus, stroke rehabilitation requires intensive time. When stroke occurred, the brain capitalizes heavily on learning to recover function; and the best way to induce such learning is known to be through task specific training.

Effective stroke rehabilitation requires knowledge of the current available evidence base. However, to embrace the current available evidence, skills in information retrieval and critical appraisal of the literature are needed. Unfortunately, the skills of a say, entry level physiotherapists may not be adequate for them to be abreast of the evidence-based practice. Thus, there is a need to summarize the literature for such therapists to help them note some important issues in stroke rehabilitation.

Full Text PDF

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[ARTICLE] Things to Note in Stroke Rehabilitation – OPEN ACCESS

Abstract

Stroke results in impairment of motor, cognitive and sensory/perceptual functions. As such, activities of daily living (ADL) after stroke can be affected. These affectations can persist for a long time depending on the extent of the affectation in the brain and rehabilitation. In fact, stroke has lately been recognized as a long term condition. Thus, stroke rehabilitation requires intensive time.

When stroke occurred, the brain capitalizes heavily on learning to recover function; and the best way to induce such learning is known to be through task specific training. Effective stroke rehabilitation requires knowledge of the current available evidence base. However, to embrace the current available evidence, skills in information retrieval and critical appraisal of the literature are needed.

Unfortunately, the skills of a say, entry level physiotherapists may not be adequate for them to be abreast of the evidence-based practice. Thus, there is a need to summarize the literature for such therapists to help them note some important issues in stroke rehabilitation.

Full Text PDF

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[WEB SITE] Online Patient Platform Improves Epilepsy Self-Management

Patients with epilepsy who participated in an online patient community showed improved ability to manage their condition well by making good medical decisions, according to a new study.

The study, published in the July 14 issue of Neurology, showed that patients with epilepsy taking part in the “Patients Like Me” online platform had improvements in “self-management” and “self-efficacy” of their condition.

Lead author, John D. Hixson, MD, University of California–San Francisco, explained to Medscape Medical News that these endpoints measured whether patients were making good decisions about how they managed their condition.

“Self-efficacy measures whether a patient knows the right thing to do, while self-management measures what the patient actually does. We chose these endpoints as they are validated metrics that reflect well what the online platform is suppose to deliver — helping patients manage their condition themselves.”

He pointed out that “Patients Like Me” is one of several online patient platforms available. These platforms are typically rooted in social media and allow patients to communicate with each other on forums. They also have educational videos and specific tools for tracking frequency and severity of seizures and recording medication side effects.

“This was a real-world study. It is the first study to do a rigorous assessment of this type of platform using validated measures,” Dr Hixson said.

Continue —> Online Patient Platform Improves Epilepsy Self-Management.

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