Posts Tagged therapy

[WEB PAGE] Virtual Rehabilitation Programs for Stroke have many Benefits, says Study!!!

 By Nilanjana Roy 

Virtual Rehabilitation Programs for Stroke have many Benefits, says Study!!!

A study shows the benefits of virtual stroke Of rehabilitation. In a recent review paper by Brodie Sakakibara with the center for chronic disease prevention and management has determined that virtual appointment in the form of telerehabilitation also works for people recovering from a stroke.

After a stroke a client provided with a therapy program to regain the loss of skills or motion this can range from speech and memory, strength,  balance, and endurance.  Sakakibara a UBCO assistant professor says research shows remote therapy can be effective during stroke recovery. Telerehabilitation has promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those who attend conventional therapy.

These services can be provided to remote locations through information and communication technology and can be accessed by the patients from their homes.  To learn effective telerehabilitation six different clinical trials have been launched across Canada as a part of the heart and stroke foundation initiated. People who recovered from strokes were given intervention ranging from lifestyle vouching to. Memory speech skills and physical exercise training.

Research for every six trials came together to write a review paper to describe the experience of conducting a telerehabilitation study. And reports on the facilitators and barriers to implementing the telerehabilitation services.

Going with telerehabilitation As a new reality, the study determines there are important lessons to learn from. Each of the six trials.  Most importantly the efficiency and cost of telerehabilitation are similar to the face to face management. Patients have mostly reported satisfaction from the telerehabilitation when therapists have trained appropriately and with some social interaction. Clinicians prefer face to face interaction but will use telerehabilitation when face to face is not feasible.

Source: https://gizmoposts24.com/technology/virtual-rehabilitation-programs-for-stroke-have-many-benefits-says-study-146427/

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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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[Editorial] What is rehabilitation? An empirical investigation leading to an evidence-based description – Full Text

There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect.

This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition.

The evidence shows that rehabilitation may benefit any person with a long-lasting disability, arising from any cause, may do so at any stage of the illness, at any age, and may be delivered in any setting. Effective rehabilitation depends on an expert multidisciplinary team, working within the biopsychosocial model of illness and working collaboratively towards agreed goals. The effective general interventions include exercise, practice of tasks, education of and self-management by the patient, and psychosocial support. In addition, a huge range of other interventions may be needed, making rehabilitation an extremely complex process; specific actions must be tailored to the needs, goals, and wishes of the individual patient, but the consequences of any action are unpredictable and may not even be those anticipated.

Effective rehabilitation is a person-centred process, with treatment tailored to the individual patient’s needs and, importantly, personalized monitoring of changes associated with intervention, with further changes in goals and actions if needed.

What constitutes rehabilitation? Physiotherapy? Exercises? Something you receive ‘to get you better’? Many healthcare staff, when referring someone to rehabilitation, have little idea, maybe saying ‘they’ll sort out your problems for you’, or sometimes ‘they’ll work you really hard’. Commissioners, similarly, rarely understand what they are paying for; at most they expect a certain number of contact hours between a patient and a therapist and/or setting goals. Patients do not know what to expect.

Searching dictionaries or the Internet does not help much because the answers are imprecise and lack detail. Commissioners (for example) still would not know what they are paying for, how to assess its quality, or how to quantify it if depending on published definitions, such as one in a recent commissioning guide1 (Box 1), or others.24 Most definitions are not based on evidence.

Table

Table

Box 1.

An empirical investigation into the phenomenon of rehabilitation might clarify the matter. This editorial reviews studies reporting that rehabilitation has a beneficial effect and asks: what aspects of the intervention being studied, rehabilitation, are common between the various studies investigating successful rehabilitation?

This approach is not new. It was used to investigate the nature of ‘stroke unit rehabilitation’ in 2002,5 and the 2013 review6 stated:

In summary, organised inpatient (stroke unit) care was characterised by: (1) co-ordinated multidisciplinary rehabilitation, (2) staff with a specialist interest in stroke or rehabilitation, (3) routine involvement of carers in the rehabilitation process and (4) regular programmes of education and training.

This editorial, based on systematic reviews and larger individual trials, identifies the features of rehabilitation found in studies showing that patients benefit. Its aim is to discover the main characteristics of effective ‘rehabilitation’. The results are presented in three domains:

  • Context: who may benefit, and does location matter?
  • Process: what are the common features of the process?
  • Interventions: what interventions are used?

It develops an evidence-based description of effective rehabilitation.

[…]

Continue —> What is rehabilitation? An empirical investigation leading to an evidence-based description – Derick T Wade, 2020

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[ARTICLE] What is rehabilitation? An empirical investigation leading to an evidence-based description – Full Text

There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect.

This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition.

The evidence shows that rehabilitation may benefit any person with a long-lasting disability, arising from any cause, may do so at any stage of the illness, at any age, and may be delivered in any setting. Effective rehabilitation depends on an expert multidisciplinary team, working within the biopsychosocial model of illness and working collaboratively towards agreed goals. The effective general interventions include exercise, practice of tasks, education of and self-management by the patient, and psychosocial support. In addition, a huge range of other interventions may be needed, making rehabilitation an extremely complex process; specific actions must be tailored to the needs, goals, and wishes of the individual patient, but the consequences of any action are unpredictable and may not even be those anticipated.

Effective rehabilitation is a person-centred process, with treatment tailored to the individual patient’s needs and, importantly, personalized monitoring of changes associated with intervention, with further changes in goals and actions if needed.

What constitutes rehabilitation? Physiotherapy? Exercises? Something you receive ‘to get you better’? Many healthcare staff, when referring someone to rehabilitation, have little idea, maybe saying ‘they’ll sort out your problems for you’, or sometimes ‘they’ll work you really hard’. Commissioners, similarly, rarely understand what they are paying for; at most they expect a certain number of contact hours between a patient and a therapist and/or setting goals. Patients do not know what to expect.

Searching dictionaries or the Internet does not help much because the answers are imprecise and lack detail. Commissioners (for example) still would not know what they are paying for, how to assess its quality, or how to quantify it if depending on published definitions, such as one in a recent commissioning guide1 (Box 1), or others.24 Most definitions are not based on evidence.[…]

Continue —-> What is rehabilitation? An empirical investigation leading to an evidence-based description – Derick T Wade, 2020

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[ARTICLE] Optogenetic Modulation for the Treatment of Traumatic Brain Injury – Full Text

Abstract

Although research involving traumatic brain injury (TBI) has traditionally focused on the acute clinical manifestations, new studies provide evidence for chronic and progressive neurological sequelae associated with TBI, highlighting the risk of persistent, and sometimes life-long, consequences for affected patients. Several treatment modalities to date have demonstrated efficacy in experimental models. However, there is currently no effective treatment to improve neural structure repair and functional recovery of TBI patients. Optogenetics represents a potential molecular tool for neuromodulation and monitoring cellular activity with unprecedented spatial resolution and millisecond temporal precision. In this review, we discuss the conceptual background and preclinical evidence of optogenetics for neuromodulation, and translational applications for TBI treatment are considered.

Introduction

Traumatic brain injury (TBI) is a significant public health issue worldwide and is predicted to be the third largest contributor to the global disease burden by 2020 [1,2]. The multifaceted and heterogeneous pathological aspects of this disease, which occur within days to months postinjury, cause significant neurological sequelae in TBI patients. Current empirical evidence provides new insight into these pathological mechanisms that lead to both focal neurological, as well as cognitive, deficits [3–5].

Recovery following TBI is complex and incompletely understood, yet studies have begun to elucidate important aspects of endogenously activated mechanisms that facilitate the process. Much of this research has been conducted to understand the fundamental concept of plasticity. Although neurogenesis within the mature brain continues, it is limited primarily to the subventricular zone (SVZ) surrounding the lateral ventricles and the subgranular zone (SGZ) of the hippocampal dentate gyrus (DG) [6–8]. A distinct subpopulation of cells from these regions migrate through adult white matter and differentiate into neurons in several cortical locations. Recent evidence suggests these cells may be involved in cell repair or renewal mechanisms [9,10].

Exploitation of this endogenous population of stem cells is of particular interest with regard to TBI. Following both diffuse and focal injury, a significant increase in proliferation within the SVZ and DG has been demonstrated in both mouse and rat TBI models alike [11,12]. Importantly, newly generated and injury-induced granular cells are able to integrate into the existing hippocampal circuitry, a phenomenon thought to facilitate innate cognitive recovery following injury [13,14]. A more recent study of human TBI models found proliferation of cells expressing markers of neural stem cells (NSCs) and neural progenitor cells in the perilesion cortex, thus representing an intrinsic effort by the injured brain to repair and regenerate damaged tissue [15].

This observed endogenous plasticity can be further investigated and manipulated using precise electrical modulation. To date, several methods have been explored to induce or accelerate functional and adaptive recovery in TBI patients, including both invasive (eg, electrical cortical stimulation [ECS]) and noninvasive (eg, transcranial magnetic stimulation [TMS], transcranial direct current stimulation, and pharmacologic) methods, each mediating an upregulation in plasticity following TBI [16–20]. However, animal studies and clinical trials involving the use of these interventions are scarce, and such approaches are often cell type indiscriminate, invasive, and render surrounding tissues susceptible to damage [21,22]. Due to a universal understanding that newer therapeutic approaches must circumvent these limitations, recent developments have successfully incorporated precision and cell type specificity into the treatment modality. Optogenetics builds upon previous research through the use of genetically encoded channels and receptors that serve to selectively activate or inhibit neuronal subpopulations with unprecedented spatial resolution and millisecond temporal precision. In this review, we discuss optogenetics as a means to evaluate and modulate neural circuits in the context of recovery following TBI.

Fundamentals of Optogenetics

Optogenetics is a modern advancement incorporating the fields of bioengineering, optics, and genetics for the purpose of modulating and monitoring cellular activity at the level of molecularly defined neuronal classes. This innovation involves the artificial introduction of light-sensitive proteins (eg, opsins) into cell membranes [23,24]. Neuronal plasma membranes themselves are thus made sensitive to light, permitting direct activation and inhibition of specified, targeted neurons within intact neuronal circuits [25]. In addition, optical monitoring of neuronal activity is achieved using genetically encoded sensors that respond to changes in ion concentration (eg, calcium) or membrane voltage. By utilizing tools with the ability to utilize light energy, neuronal imaging can achieve both high spatial and high temporal resolution [26,27].

While previous approaches typically fall short with respect to temporal and spatial accuracy, optogenetics expands the capability for optical imaging and genetic targeting by simultaneously controlling or monitoring either the activity of many neurons within a circuit or certain regions within a single neuron. Single-cell optogenetics is able to map neural circuits with excellent accuracy and zero-spike crosstalk [28]. Expression of certain light-sensitive proteins can also behave as actuators and switch neurons on and off, inducing either depolarizations or hyperpolarizations for varying periods of time with exquisite precision. This capability allows the opsins to probe neural activity at the resolution of single spikes, raising the possibility that this method can one day mimic natural neural code [29]. Since its inception, optogenetic tools have been developed to further map complex neural circuits and target specific neurons to facilitate behavior modulation, which are significant ambitions of current research in the field of neuroscience.[…]

 

Continue —-> Optogenetic Modulation for the Treatment of Traumatic Brain Injury | Stem Cells and Development

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[WEB PAGE] How to Treat Neurological Conditions with Physical Therapy

PHYSICAL THERAPY HELPS people improve their movement. You may think of physical therapy as something you use after a sports injury or after certain types of surgery. However, physical therapy helps with a variety of health issues. For example, breast cancer patients who have had their lymph nodes removed often get physical therapy to help with lymphedema. Physical therapy can also help with neurological disorders.

(GETTY IMAGES)

Neurological disorders (also called neurological diseases or conditions) affect the brain, spinal cord or nervous system. There are more than 1,000 neurological diseases. Some examples include:

Nearly 100 million Americans were affected by neurological disorders in 2011, according to a report in the Annals of Neurology. This number will likely increase as the population ages. Stroke and Alzheimer’s disease were the fourth- and fifth-highest killers in the U.S. in 2017, according to the Centers for Disease Control and Prevention.

 

Physical therapists are trained, licensed professionals who focus on evaluating and treating problems that affect any type of movement, says Anne Aldrich, a board-certified clinical specialist in pediatric physical therapy at CHOC Children’s, a pediatric health care system in Orange, California.

 

Physical therapists help to improve movement, so people can more easily do the things they want to do, says physical therapist Julie A. Blank, owner of On the Go Therapy Services in Sarasota, Florida.

 

Physical therapy is a good fit for many people with neurological disorders because they may have problems with their movement. These problems are often caused by the disorder. Depending on the type of neurological condition someone has, movement problems can get worse as the disease progresses. This is the case with conditions like Alzheimer’s disease, Parkinson’s disease and ALS.

How Physical Therapy Can Help

“These impairments can be small or large and can have a varying impact on an individual’s ability to move,” Aldrich says. Here are a few examples of how movement problems affect people with neurological disorders – and how physical therapy can help:

  • A man had a stroke eight years earlier. The stroke caused him to walk abnormally. Now his knee hurts due to the way he walks. He wants his knee pain to get better.
  • A child with a neurological disorder may need to learn to walk with a cane. Before doing this, she needs to practice sitting and standing. Then eventually, she can learn to walk with the cane.
  • A woman has a traumatic brain injury. Now her feet and hands aren’t moving together when she walks.
  • A man with ALS wants to learn some simple exercises to help avoid joint pain and stiffness.
  • Caregivers for a woman with Alzheimer’s disease want to help prevent her from falling. A physical therapist practices balance exercises with her to reduce her fall risk.
  • A physical therapist helps a woman with migraines by performing manual therapy, which is a manipulation of the muscles used by physical therapists and other health professionals. These movements help to decrease pain and expand mobility in the head and neck.
  • An older man with Parkinson’s disease has physical therapy to help with repetitive twisting of the foot, which can happen with Parkinson’s. The exercises done in physical therapy help to strengthen his foot.

Physical therapists tailor their care to each patient. They work with patients to create realistic goals. This means the therapy that one person receives will be very different from the therapy someone else gets. For instance, a person who needs a little training with the mobility equipment he or she uses will have very different needs than someone who has just had a stroke and needs to get back to work in a couple of months, says American Physical Therapy Association spokeswoman Alison M. Lichy. She is also the owner of Neurological Physical Therapy in Falls Church, Virginia.

What to Expect

Goals for physical therapy also are tailored for each person, and so are the frequency of physical therapy sessions. A person in the hospital due to a recent stroke or other major neurological injury may receive physical therapy and other types of therapy at the hospital a couple of times a day to help speed up progress.

Other patients may see a physical therapist a couple of times a week at a physical therapist’s office, although some therapists will come to a person’s home.

 

Sessions also can be done:

  • In a gym.
  • At hospice.
  • In a classroom or on a playground, which would be options for children.

It’s important to start physical therapy for neurological conditions as early as possible. Physical therapy can’t stop these conditions or their effects on movement entirely, but it can help slow down their progression, Blank says. “We can help to maintain things like good posture, balance and strength,” Blank notes. It’s harder to get good results if physical therapy starts later on.

Physical therapists help their patients get better with regular, repetitive exercises. Depending on a person’s goals, this can include practice with:

  • Balance.
  • Strengthening.
  • Stretching.

Even if the movements done during those exercises aren’t perfect, they help retrain the muscles and the brain to work together – something they may not have done for a long time.

 

Physical therapy for children with neurological disorders is a little different because sessions can be set up as playtime. For example, a therapist may have a child reach for a toy to help get them to practice rolling over or balance on one foot while playing ring toss in a pool. “This can make pediatric physical therapy both fun and satisfying for children and their parents,” Aldrich says.

 

An important part of physical therapy is the practice done outside of therapy sessions. Lichy says, “(Patients) need to know how to do activities at home and do them safely to maximize what they do outside of physical therapy.”

 

Patients who are motivated to progress tend to do better than those who want to be left alone. Blank says, “Our main job isn’t to provide therapy. It’s to teach and equip you to help you succeed moving forward. We give you the tools to help you get better or maintain what you have.”

Getting the Most Out of Physical Therapy for Neurological Disorders

If you or someone you care for needs physical therapy to help with a neurological condition, there are a few tips to keep in mind to get the best care possible:

 

1. Find out about the therapist’s experience with neurological disorders. There are physical therapists who have a designation called neurologic clinical specialist, or NCS. Although physical therapists all have some knowledge of neurological disorders, those with the NCS designation have passed a special test to expand their expertise in this area. The American Physical Therapy Association can help people find a physical therapist and allows users to specialize if they want someone with neurological expertise.

 

2. Clearly communicate about your problem. If your movement problem isn’t something that can’t be recreated when you first see a physical therapist, then try to take pictures or videos at home, and bring them with you, Aldrich advises.

 

3. Speak up if you need more care. Many patients in today’s health care system feel their care is limited by what their insurance is willing to pay, Blank says. This can leave them feeling frustrated, especially if they still feel they need more care. Let your physical therapist know if that’s your situation. Some will work with you to file additional paperwork for more sessions or to offer additional care, Blank says.

 

4. Practice your assigned exercises at home. This can’t be stressed enough. Doing designated exercises outside of physical therapy sessions can make a big difference in rebuilding your strength or preventing a further loss of movement if you have a worsening condition.

Vanessa Caceres, Contributor

Sources: Anne Aldrich, PT, DPT, PCSJulie A. Blank, PTAlison Lichy, PT, DPT, NCS

via How to Treat Neurological Conditions with Physical Therapy | U.S. News

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[VIDEO] Managing Fatigue After A Brain Injury – YouTube

via Managing Fatigue After A Brain Injury – YouTube

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[Abstract] Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomised controlled trial.

Abstract

BACKGROUND/AIM:

Task-specific repetitive training, a usual care in occupational therapy practice, and robotic-aided rehabilitation with bilateral practice are used to improve upper limb motor and task performance. The difference in effects of two strategies requires exploration. This study compared the impact of robotic-assisted therapy with bilateral practice (RTBP) and usual task-specific training facilitated by therapists on task and motor performance for stroke survivors.

METHODS:

Forty-three community-dwelling stroke survivors (20 males; 23 females; 53.3 ± 13.1 years; post-stroke duration 14.2 ± 10.9 months) were randomised into RTBP and usual care. All participants received a 10-minute per-protocol sensorimotor stimulation session prior to interventions as part of usual care. Primary outcome was different in the amount of use (AOU) and quality of movement (QOM) on the Motor Activity Log (MAL) scale at endpoint. Secondary outcomes were AOU and QOM scores at follow-up, and pre-post and follow-up score differences on the Fugl-Meyer Assessment (FMA) and surface electromyography (sEMG). Friedman and Mann-Whitney U tests were used to calculate difference.

RESULTS:

There were no baseline differences between groups. Both conditions demonstrated significant within-group improvements in AOU-MAL and FMA scores following treatment (P < 0.05) and improvements in FMA scores at follow-up (P < 0.05). The training-induced improvement in AOU (30.0%) following treatment was greater than the minimal detectable change (16.8%) in the RTBP group. RTBP demonstrated better outcomes in FMA wrist score (P = 0.003) and sEMG of wrist extensor (P = 0.043) following treatment and in AOU (P < 0.001), FMA total score (P = 0.006), FMA wrist score (P < 0.001) and sEMG of wrist extensor (P = 0.017) at follow-up compared to the control group. Control group boost more beneficial effects on FMA hand score (P = 0.049) following treatment.

CONCLUSIONS:

RTBP demonstrated superior upper limb motor and task performance outcomes compared to therapists-facilitated task training when both were preceded by a 10-minute sensorimotor stimulation session.

 

via Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomi… – PubMed – NCBI

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[Review] Ketogenic Diet and Epilepsy – Full Text PDF

Abstract

Currently available pharmacological treatment of epilepsy has limited effectiveness.
In epileptic patients, pharmacological treatment with available anticonvulsants leads to seizure control in <70% of cases. Surgical intervention can lead to control in a selected subset of patients, but still leaves a significant number of patients with uncontrolled seizures. Therefore, in drug-resistant epilepsy, the ketogenic diet proves to be useful. The purpose of this review was to provide a comprehensive overview of what was published about the benefits of ketogenic diet treatment in patients with epilepsy. Clinical data on the benefits of ketogenic diet treatment in terms of clinical symptoms and adverse reactions in patients with epilepsy have been reviewed. Variables that could have influenced the interpretation of the data were also discussed (e.g., gut microbiota). The data in this review contributes to a better understanding of the potential benefits of a ketogenic diet in the treatment of epilepsy and informs scientists, clinicians, and patients—as well as their families and caregivers—about the possibilities of such treatment. Since 1990, the number of publications on attempts to treat drug-resistant epilepsy with a ketogenic diet has grown so rapidly that it has become a challenge to see the overall trajectory and major milestones achieved in this field. In this review, we hope to provide the latest data from randomized clinical trials, practice guidelines, and new research areas over the past 2 years.

[…]

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[Abstract] Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology

Highlights

  • Virtual reality technology improves cognitive function post-traumatic brain injury.
  • Optimal treatment protocol is; 10–12 sessions, 20–40 min in duration with 2–4 sessions per week.
  • There was weak evidence for positive effect of virtual reality on attention.

Abstract

Background

Traumatic brain injury (TBI) can causes numerous cognitive impairments usually in the aspects of problem-solving, executive function, memory, and attention. Several studies has suggested that rehabilitation treatment interventions can be effective in treating cognitive symptoms of brain injury. Virtual reality (VR) technology potential as a useful tool for the assessment and rehabilitation of cognitive processes.

Objectives

The aims of present systematic review are to examine effects of VR training intervention on cognitive function, and to identify effective VR treatment protocol in patients with TBI.

Methods

PubMed, Scopus, PEDro, REHABDATA, EMBASE, web of science, and MEDLINE were searched for studies investigated effect of VR on cognitive functions post TBI. The methodological quality were evaluated using PEDro scale. The results of selected studies were summarized.

Results

Nine studies were included in present study. Four were randomized clinical trials, case studies (n = 3), prospective study (n = 1), and pilot study (n = 1). The scores on the PEDro ranged from 0 to 7 with a mean score of 3. The results showed improvement in various cognitive function aspects such as; memory, executive function, and attention in patients with TBI after VR training.

Conclusion

Using different VR tools with following treatment protocol; 10–12 sessions, 20–40 min in duration with 2–4 sessions per week may improves cognitive function in patients with TBI. There was weak evidence for effects of VR training on attention post TBI.

via Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology – Journal of Clinical Neuroscience

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