Posts Tagged social participation

[ARTICLE] Use of client-centered virtual reality in rehabilitation after stroke: a feasibility study – Full Text

ABSTRACT

Patient-centered virtual reality (VR) programs could assist in the functional recovery of people after a stroke.

Objectives:

To analyze the feasibility of a rehabilitation protocol using client-centered VR and to evaluate changes in occupational performance and social participation.

Methods:

This was a mixed methods study. Ten subacute and chronic stroke patients participated in the rehabilitation program using games in non-immersive VR for 40 minutes/day, three days/week, for 12 weeks. Sociodemographic information was collected and the outcome variables included were the Canadian Occupational Performance Measure (COPM) and the Participation Scale. A field diary was used to record the frequency of attendance and adherence of participants and an interview was conducted at the end of program.

Results:

There were significant and clinically-relevant statistical improvements in the COPM performance score (p < 0.001; CI = 1.29 − 4.858) and in the COPM satisfaction score (p < 0.001; CI = 1.37 − 5.124), with a difference greater than 4.28 points for performance and 4.58 points for satisfaction. The change in the scores for participation was statistically significant (p = 0.046), but there was no clinical improvement (dcohen = −0.596, CI = −1.862 − 0.671). The majority of participants reported more than 75% consecutive attendance of sessions and there was 100% adherence to the program. In the interviews, the participants described their post-stroke difficulties; how the video game motivated their engagement in rehabilitation; and the improvement of occupational performance and social participation after participating in the program.

Conclusions:

VR is a viable tool for the rehabilitation of stroke patients with functional gains, mainly regarding occupational performance and performance satisfaction.

 

Every year, 16 million people suffer from a stroke, with great economic and social repercussions1. In Brazil, this is the leading cause of disability1,2. A stroke is a sudden syndrome, characterized by sensory, motor, and cognitive-perceptual alterations1. These alterations are associated with disability, limitations in activities of daily life (ADL) and restrictions in social participation, with loss of autonomy and independence3,4.

Different treatment protocols are used in post-stroke rehabilitation, and consist mainly of motor control approaches, and task oriented training5,6,7. Task-based training, mediated by technologies and computerized activities such as virtual reality (VR), has been promising for post-stroke patients8,9. Virtual reality is a technology for interaction between user and operating system using graphic resources that recreate a virtual environment10. One of its advantages is that the environment can be more interesting and pleasant when compared with traditional rehabilitation, increasing motivation, engagement and adherence of patients to the treatment10,11,12.

Recent clinical trials with post-stroke patients demonstrated the effectiveness of VR in the rehabilitation of dynamic balance13,14,15,16; motor function12,17,18,19,20,21; performance and independence in ADL12,14 and quality of life17,19,20,21. However, a systematic review found no significant difference in upper limb function when comparing VR with a conventional therapy8. Differences between groups were found only when VR was added to the usual treatments8. In another review, the VR effects varied from small to moderate for ADL and outcomes for social participation did not change with the intervention9.

Although systematic reviews and meta-analyses on VR effectiveness are growing, they were not conclusive regarding the protocol or intervention parameters, which makes the clinical use of VR difficult8,9,11. Higher frequencies of treatment are preferable; however, these findings were not statistically significant8,9. Personalized VR protocols that consider a specific patient’s requirements seem to offer more benefits. However, it should be noted that these results are also not conclusive and there is no consensus about the issue8,9.

As there is little consistency in the literature indicating better VR protocols to be used in clinical practice, it is fundamental to analyze the viability and the patient response potential regarding the intervention using VR. The studies with better quality methodologies evaluated outcomes related to the body structure and function8,9. To recommend the therapeutic use of VR in post-stroke patients it is essential to develop patient-centered interventions and focus on assessing performance-related outcomes in activity and participation.

A patient-centered practice is an approach that considers the person’s ability to deal with their health condition, to self-manage, to make decisions, to motivate themselves, and adhere to treatment7. In this context, this study aimed to analyze the feasibility of a rehabilitation protocol using patient-centered VR and to evaluate changes in occupational performance and social participation of patients after a stroke. The hypothesis was that VR would increase performance, reduce restrictions in participation, and be a viable tool for outpatient intervention with post-stroke patients.

METHODS

This research was a feasibility study that used mixed methods, including a quantitative and qualitative approach. The quantitative study of the pre- and post-intervention type measured changes in occupational performance and social participation, after a rehabilitation program using VR. The feasibility of the VR was analyzed using qualitative methods. This study was approved by the Institution’s Research Ethics Committee.

Local and participants

The participants were recruited by convenience, at the Rehabilitation Center of the Clinical Hospital of the Federal University of Triângulo Mineiro (HC/UFTM), a public and free rehabilitation service with physical therapy, speech therapy, nutrition, nursing, psychology, and occupational therapy.

We selected participants with primary or recurrent stroke diagnoses, hemiparesis, age 18 or older, of either sex, who were in the rehabilitation program. We excluded participants with strokes older than five years, bilateral hemiparesis, and/or other diseases of the musculoskeletal and central nervous systems, wheelchair users, amputees, visually impaired patients, and those who could not understand or respond to the data collection instruments. The sample was selected from the medical records and by indication of the rehabilitation professionals. A total of 10 patients met the inclusion criteria and agreed to participate in the research.

Evaluation procedures and instruments

The procedures took place between January and August 2017 at the HC/UFTM Rehabilitation Center and was divided into three sequential phases.

Phase 1: Pre-intervention evaluation

The participants responded to a socio-demographic questionnaire and were evaluated according to self-reported occupational performance and social participation.

Occupational performance was measured by the Canadian Occupational Performance Measure (COPM). The patients selected the activities that they needed, but which they had not been able to perform, or were not satisfied with their performance23. The patients assigned a grade of 1-10 to the importance of each activity and selected the five with the most importance. Each activity selected was evaluated for the patient’s performance and satisfaction on a scale from 1-10. The total scores were calculated from the means of the performance and satisfaction. Changes in scores greater than two points indicated a clinically relevant improvement23.

Social participation was measured by the Participation Scale (P-Scale), version 6.0. The participants would compare themselves with a “peer without disability” and respond to how they perceived their own level of participation compared with the “peer”24. The score of any item varied from zero, when the individual did not have restrictions to his participation, to five when the restriction was considered a “big problem”. The total score varied from zero to 90, with smaller values indicating less restriction25.

Phase 2: Intervention

The rehabilitation program using VR was implemented at the HC/UFTM Rehabilitation Center. The literature does not have a standardization of interventions and/or games used in virtual reality programs. Thus, the protocol chosen had the number of sessions and duration following the findings of Aramaki et al26. Therefore, the protocol consisted of three weekly sessions lasting 40 minutes each, developed over 12 weeks, for a total of 36 sessions.

The participants were in an orthostatic position, four meters away from the screen and video game, in a room with natural light. The Xbox 360® was used with Kinect motion sensor technology.

The games were chosen according to the activities indicated in the COPM as difficult to perform in the initial evaluation. These required training in upper-limb and lower-limb motor skills, motor coordination, and cognitive skills. A detailed description of the information for each game and its main effects are shown in the Figure 1.

The sessions began with the game “20,000 Leaks” to familiarize the participant with the video game interface. Each participant played two or three games for 10 minutes each. In order to avoid fatigue, if necessary, a two-minute interval between games took place.

 

[…]

Continue —->  Use of client-centered virtual reality in rehabilitation after stroke: a feasibility study

 

, , , , , ,

Leave a comment

[Infographic] Mental Illness and socializing

, , ,

Leave a comment

[ARTICLE] Course of Social Participation in the First 2 Years After Stroke and Its Associations With Demographic and Stroke-Related Factors – Full text

Background. Many persons with stroke experience physical, cognitive, and emotional problems that contribute to restrictions in social participation. There is, however, a lack of knowledge on the long-term course of participation over time post-stroke.

Objective. To describe the time course of participation up to 2 years post-stroke and to identify which demographic and stroke-related factors are associated with this time course.

Methods. This was a multicenter, prospective cohort study following 390 persons with stroke from hospital admission up to 2 years (at 2, 6, 12, and 24 months). Multilevel modeling with linear and quadratic time effects was used to examine the course of the frequency of vocational and social/leisure activities, experienced restrictions, and satisfaction with participation.

Results. The frequency of vocational activities increased up to 1 year post-stroke and leveled off thereafter. Older and lower-educated persons showed less favorable courses of participation than younger and higher-educated persons, respectively. The frequency of social/leisure activities decreased post-stroke. Participation restrictions declined up to 1 year post-stroke and leveled off thereafter. Persons dependent in activities of daily living (ADL) kept experiencing more restrictions throughout time than independent persons. Satisfaction with participation increased slightly over time.

Conclusions. Changes in participation occurred mostly in the first year post-stroke. Particularly older and lower-educated persons, and those dependent in ADL showed less favorable courses of participation up to 2 years post-stroke. Clinicians can apply these findings in identifying persons most at risk of long-term unfavorable participation outcome and, thus, target rehabilitation programs accordingly.

Stroke can lead to long-lasting physical problems such as mobility limitations,1cognitive problems such as attention or memory deficits,2 and emotional problems such as anxiety,3,4 depressive symptoms,35 and fatigue.4,6 The population of persons surviving a stroke7,8 increases, consistent with major improvements in acute stroke care (eg, stroke units, thrombolysis, and thrombectomy9,10), but this also means that more people have to deal with the long-lasting consequences of stroke.11,12 These consequences contribute to the deterioration of social participation post-stroke.1317 Importantly, persons with stroke view social participation (participation hereafter) as a central aspect of their recovery.18,19

Participation can be defined as involvement in a life situation such as paid work, family, or community life,17 which consists of actual performed activities,20 such as the frequency of observable actions and behaviors,2123 and the subjective experience of persons,20 such as experienced restrictions and satisfaction.2123

In previous studies, it was observed that the frequency of activities decreases in persons with stroke, relative to their premorbid levels.16,2428 This particularly applies to vocational activities (work, unpaid work, and household activities), but social activities decrease after stroke, too.28 Four months after discharge from outpatient rehabilitation, 50% of persons with stroke still experienced participation problems.29Social activity levels have been reported to be lower in persons with stroke at 1 year post-stroke than in healthy controls,30 a level that remained stable up to 3 years.31Past studies showed that only 39% of persons with stroke were satisfied with their lives as a whole after 1 year,16 which might be even lower up to 3 years post-stroke,32 especially in socially inactive persons.33

Although studies have shed some light on the course of participation over time post-stroke, it is difficult to get a good understanding of how levels of participation develop and change over time. This is a result of the use of cross-sectional designs,16,24,26,27,33 longitudinal designs limited to either only the first 6 months13,25,28,29 or only the long-term levels of participation after stroke,31,32,34studies only incorporating 2 time points,35 and many different participation measures, some measuring the frequency of activities and others the subjective experience of participation.36

Research into factors associated with participation post-stroke could lead to identifying possible risk factors of an unfavorable outcome. Earlier studies showed that demographic factors such as older age at stroke onset,14,37 lower levels of education,29,38 and female sex37 were related to a less favorable outcome in terms of participation, along with stroke-related factors such as dependence in activities of daily living (ADL),39,40 more severe stroke,37 and lower levels of cognitive functioning.26,29 However, these factors are yet to be examined in relation to the course of participation over time and as such to be identified as possible risk factors.

To get a more detailed and comprehensive understanding of participation over time, it is necessary to include repeated measurements of objective (ie, frequency of activities) as well as subjective (ie, experienced restrictions and satisfaction) aspects of participation. Furthermore, it is important to identify persons in the early stage after stroke, who are at risk of an unfavorable outcome in the long term. At this point in time, potential risk factors can be easily determined through available information, including demographics and stroke-related information, and rehabilitation care can be provided. Consequently, we studied participation over a 2-year follow-up in a clinical cohort of persons with stroke in order to answer the following research questions: how does participation develop over the first 2 years after stroke in terms of frequency, restrictions, and satisfaction? Moreover, which demographic and stroke-related factors are associated with this time course?[…]

 

Continue —> Course of Social Participation in the First 2 Years After Stroke and Its Associations With Demographic and Stroke-Related Factors – Daan P. J. Verberne, Marcel W. M. Post, Sebastian Köhler, Leeanne M. Carey, Johanna M. A. Visser-Meily, Caroline M. van Heugten, 2018

, , , , , ,

Leave a comment

[Abstract] Does adapted physical activity‑based rehabilitation improve mental and physical functioning? A randomized trial

BACKGROUND: Persons with chronic disabilities face a wide variety of problems with functioning that affect their level of physical activity and participation. We have limited knowledge about the effect of adapted physical activity (APA)-based rehabilitation on perceived mental and physical functioning.
AIM: The main aim of this study was to evaluate the effect of APA‑based rehabilitation compared to waiting‑list on perceived mental and physical functioning. Secondly, we wanted to assess whether improvement in self‑efficacy, motivation, pain and fatigue during rehabilitation was related to the effect of the intervention.
DESIGN: Randomized controlled trial.
SETTING: In‑patient rehabilitation Center.
POPULATION: All subjects above 17 years who were referred by their physician to BHC between July 1, 2010 and August 1, 2012 without major cognitive or language problems were eligible for the study (N.=321).
METHODS: Persons above 17 years (men and women) with chronic disabilities who applied for a rehabilitation stay, were randomized to an adapted physical activity‑based rehabilitation intervention (N.=304) or waiting‑list with delayed rehabilitation. A total of 246 consented and were allocated to four week intervention or a waiting‑list control group. The main outcome was physical and mental functioning evaluated four weeks after rehabilitation using the Medical Outcomes Study 12-Item Short‑Form Health Survey (SF-12).
RESULTS: Compared to waiting‑list the adapted physical activity‑based intervention improved physical and mental functioning. Improvement in physical functioning during rehabilitation was related to reduced pain, improved motivation and self‑efficacy.
CONCLUSIONS: The results indicate that an adapted physical activity‑based rehabilitation program improves functioning. Improved efficacy for managing disability may mediate the improvement in mental functioning.
CLINICAL REHABILITATION IMPACT: Adapted physical activity‑based rehabilitation should be considered during the development of rehabilitation strategies for people with chronic disabilities. Motivational and self‑efficacy aspects must be addressed when organizing and evaluating rehabilitation programs.

via Does adapted physical activity‑based rehabilitation improve mental and physical functioning? A randomized trial – European Journal of Physical and Rehabilitation Medicine 2018 June;54(3):419-27 – Minerva Medica – Journals

, , , , , , ,

Leave a comment

[ARTICLE] Internet and Social Media Use After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study – Full Text

Objectives: To characterize Internet and social media use among adults with moderate to severe traumatic brain injury (TBI) and to compare demographic and socioeconomic factors associated with Internet use between those with and without TBI.

Setting: Ten Traumatic Brain Injury Model Systems centers.

Participants: Persons with moderate to severe TBI (N = 337) enrolled in the TBI Model Systems National Database and eligible for follow-up from April 1, 2014, to March 31, 2015.

Design: Prospective cross-sectional observational cohort study.

Main Measures: Internet usage survey.

Results: The proportion of Internet users with TBI was high (74%) but significantly lower than those in the general population (84%). Smartphones were the most prevalent means of Internet access for persons with TBI. The majority of Internet users with TBI had a profile account on a social networking site (79%), with more than half of the sample reporting multiplatform use of 2 or more social networking sites.

Conclusion: Despite the prevalence of Internet use among persons with TBI, technological disparities remain in comparison with the general population. The extent of social media use among persons with TBI demonstrates the potential of these platforms for social engagement and other purposes. However, further research examining the quality of online activities and identifying potential risk factors of problematic use is recommended.

THE INTERNET AND SOCIAL MEDIA are dominant forces in our lives in this Age of Information. Time spent on the Internet continues to grow steadily in the United States and worldwide, with mobile technology and social media driving much of the expansion.1 , 2 Social media tools, including social networking sites (SNSs) (eg, Facebook), blogs (eg, Tumblr), online content communities (eg, YouTube), and online forums (eg, Google Hangouts), encourage multidimensional communication where users can exchange information, connect to resources, and create social networks based on common interests.3 Such platforms can facilitate opportunities that would otherwise be limited by various barriers. Not only have the Internet and social media transformed the ways that we seek and gather information but they also appear to be changing the perception of communication and of what constitutes social support. For example, among college students, large and seemingly impersonal networks of Facebook friends are associated with greater perceived social support than smaller ones and expressing one’s feelings to such large networks may serve important needs for an evolving type of intimacy.4

People with disabilities may encounter obstacles to keeping up with these social trends and enjoying their advantages. A Pew survey5 in 2011 revealed that Americans with disabilities are less likely to use the Internet than their able-bodied counterparts (54% vs 81%). This remained true even after controlling for factors such as lower income, lower education, and older age. Moreover, people with disabilities were less likely to use online access methods such as broadband service and mobile devices, both of which are advantageous for seeking work, finding health information, and communicating remotely with others. Lack of experience with these technologies creates a vicious cycle, as less experience predicts less favorable outcome in studies using Web-based platforms to help mitigate the effects of disability.6 All of these trends are unfortunate, considering that the Internet and social media may be seen as electronic curb cuts7—resources to help offset the reduced mobility and social isolation that affect many people with disabilities.

Reduced social network size and loneliness are particularly common for persons with traumatic brain injury (TBI).8–11 Social networking through the Internet has the potential to alleviate this isolation. However, cognitive impairments typical after TBI9 , 11 (eg, impaired memory, attention, and organization) may pose an obstacle to learning and utilizing rapidly changing technology. There have been recent studies exploring the use of mobile technology to help people with acquired brain injury compensate for cognitive impairments12–14 and caregivers for such individuals to utilize online resources for support.15 , 16 A few studies have attempted to directly teach Internet access17 or use of social media18 to people with TBI. Others have surveyed people with TBI on their habitual use of the Internet19 or Facebook.20 Such studies quickly become outdated and difficult to generalize as new technologies and online trends emerge. As a result, there is an ongoing need for updated information regarding the use of online technology after TBI that can guide future efforts to narrow the “disability divide,”21 encourage Internet-based social participation, and develop online interventions to facilitate these novel forms of interaction.

In this study, we interviewed a large cohort of people at least 1 year after moderate or severe TBI to examine the current level of online activity among these individuals. Our aims were (1) to examine various aspects of Internet use among adults with TBI, particularly focusing on activities involving communication and social participation through social media platforms; and (2) to compare certain online activities, as well as demographic and socioeconomic factors associated with Internet use, between those with and without TBI, the latter based on published surveys of the general population.22 […]

Continue —>  Internet and Social Media Use After Traumatic Brain Injury:… : The Journal of Head Trauma Rehabilitation

 

, , , , ,

Leave a comment

[ARTICLE] Music Upper Limb Therapy—Integrated: An Enriched Collaborative Approach for Stroke Rehabilitation – Full Text 

Stroke is a leading cause of disability worldwide. It leads to a sudden and overwhelming disruption in one’s physical body, and alters the stroke survivors’ sense of self. Long-term recovery requires that bodily perception, social participation and sense of self are restored; this is challenging to achieve, particularly with a single intervention. However, rhythmic synchronization of movement to external stimuli facilitates sensorimotor coupling for movement recovery, enhances emotional engagement, and has positive effects on interpersonal relationships.

In this proof-of-concept study, we designed a group music-making intervention, Music Upper Limb Therapy-Integrated (MULT-I), to address the physical, psychological and social domains of rehabilitation simultaneously, and investigated its effects on long-term post-stroke upper limb recovery. The study used a mixed-method pre-post design with one-year follow up.

Thirteen subjects completed the 45-minute intervention twice a week for six weeks. The primary outcome was reduced upper limb motor impairment on the Fugl-Meyer Scale. Secondary outcomes included sensory impairment (two-point discrimination test), activity limitation (Modified Rankin scale), well-being (WHO well-being index), and participation (Stroke Impact Scale). Repeated measures ANOVA was used to test for differences between pre- and post-intervention, and one-year follow up scores. Significant improvement was found in upper limb motor impairment, sensory impairment, activity limitation, and well-being immediately post-intervention that persisted at 1 year. Activities of daily living and social participation improved only from post-intervention to one-year follow up. The improvement in upper limb motor impairment was more pronounced in a subset of lower functioning individuals as determined by their pre-intervention wrist range of motion. Qualitatively, subjects reported new feelings of ownership of their impaired limb, more spontaneous movement, and enhanced emotional engagement.

The results suggest that the MULT-I intervention may help stroke survivors re-create their sense of self by integrating sensorimotor, emotional and interoceptive information, and facilitate long-term recovery across multiple domains of disability, even in the chronic stage post-stroke. Randomized controlled trials are warranted to confirm the efficacy of this approach. Clinical Trial Registration: National Institutes of Health, clinicaltrials.gov, NCT01586221.

Continue —> Frontiers | Music Upper Limb Therapy—Integrated: An Enriched Collaborative Approach for Stroke Rehabilitation | Frontiers in Human Neuroscience

, , , , , , , , , , , , ,

Leave a comment

%d bloggers like this: