Clinical Rehabilitation Research Articles

Which Acute Stroke Patients can Walk while Returning Home? Factors Predicting Ambulation.

Regaining gait is the primary goal in stroke rehabilitation. In this study, we aimed to investigate the effect of premorbid features of acute stroke patients on the ambulatory level. The study included 174 patients who applied to our rehabilitation clinic within the first month after the onset of stroke. Demographic characteristics of patients, pre-stroke symptoms, and stroke characteristics were questioned from patient files and historical data. The ambulation levels of patients before and after rehabilitation were evaluated with the functional ambulation category. The relationship between demographic characteristics, pre-stroke symptoms, stroke characteristics, and ambulation levels of patients before and after rehabilitation was examined. The presence of coronary heart diseases, atrial fibrillation, and nausea/vomiting before stroke were independent negative risk factors on both pre- and post-rehabilitation ambulation levels (P < 0.05). Additionally, advanced age, oxygen, and mechanical ventilation requirement were other negative independent risk factors on post-rehabilitation ambulation levels (P < 0.05). Knowing some of the pre-stroke characteristics of patients while applying rehabilitation programs may be useful in estimating the ambulatory levels on returning home.

Post-COVID conditions response: a collaborative approach to -establishing multidisciplinary clinics in Ecuador.

Worldwide, 3.7% (144.7 million) of people diagnosed with COVID-19 developed Post-COVID Conditions (PCC). Therefore, creating and implementing multidisciplinary rehabilitation clinics is important to address the needs of patients and improve overall recovery. This study was made possible with support from the United States Agency for International Development funded RISE program, under the terms of the cooperative agreement 7200AA19CA00003. This case study was conducted in Ecuador and describes the creation and implementation of 21 PCC rehabilitation clinics in primary healthcare centers and secondary level hospitals in 7 provinces across the country. Data was gathered for the identification of partnering health facilities and needs, for the evaluation of knowledge enhancement in health professionals after a specific training program, and for the measurement of key performance indicators. This article emphasizes the organization, educational strategies, and implementation of rehabilitation programs tailored specifically for the management of Post-COVID Conditions in Ecuador. The implementation of PCC rehabilitation clinics involved a collaborative effort between the Ministry of Public Health (MOPH), the private sector and a non-governmental organization (Jhpiego). Twenty-one health facilities from the primary and secondary level of care were selected, and PCC rehabilitation implemented in 7 provinces of Ecuador. Additionally, 133 health providers were trained and a total of 13,846 patients treated, among whom 859 had a diagnosis of PCC. Medical doctors outperformed nurses in both pre- and post-tests scores. However, all healthcare professionals demonstrated comparable improvement in knowledge acquisition. Rehabilitation manuals were developed and adopted by the MOPH, rehabilitation equipment was donated and a mobile application, "RESPIRA", was developed and disseminated free of charge. The establishment of PCC rehabilitation clinics in Ecuador was successful in identifying patients in need of early rehabilitation. The insights of this study can serve as a guide for the development of similar initiatives in other countries. Tailored courses are essential to address disparities and ensure comprehensive skill development and promote equitable healthcare delivery.

The Effect of 12 Weeks Training Program With TheraSuit and Its Durability on Balance Control and Gait Parameters in Children With Cerebral Palsy

Background and Aims The prevalence of spastic cerebral palsy is increasing rapidly among children, with a prevalence of 2-4 per thousand people. This study aimed to investigate the effect of 12 weeks training program with TheraSuit and its durability on balance control and gait parameters in children with cerebral palsy. Methods This quasi-experimental study was performed on children (age range of 6-12 years) with spastic diplegia cerebral palsy referred to occupational therapy and rehabilitation clinics in Hamadan City, Iran, in 2021. Twelve children were selected by convenience sampling. Without random assignment, the patients were divided into two groups: with and without TheraSuits. Before and after the intervention, the balance score and kinematic parameters, including step length, step width, walking speed, ankle, thigh and knee range of motion, were measured in stationary and moving positions in both groups. The exercises were performed for 12 weeks, three sessions every other day for one hour. The Mann-Whitney U and Wilcoxon tests were used to evaluate the effectiveness of the intervention. All statistical analyses were performed in SPSS software, version 24 at a significance level of 5%. Results The results showed a significant improvement in balance score after the intervention in the intervention group compared to the control group (P=0.002), but the speed of walking, hip and knee range of motion significantly decreased compared to the control group (P&lt;0.05). The results showed that 10 weeks and one month later, there was a lasting effect of training in both groups (P&gt;0.05). Conclusion Our results confirmed the effectiveness of corrective exercises in the group with TheraSuit, so its use in a rehabilitation program for cerebral palsy patients is recommended, and the durability of the exercise was seen in both groups.

COMPREHENSIVE EDUCATIONAL-REHABILITATION APPROACH IN A PERSON POST-STROKE: A CASE STUDY

A stroke occurs due to a disruption in brain circulation, leading to partial or complete loss of motor, sensory, perceptual, or cognitive abilities. This can result in disability and reduced rehabilitation potential. Therefore, the approach to working with individuals who have experienced a stroke is crucial, adapting to their individual needs in a holistic manner. In this context, the aim of this study was to present a comprehensive rehabilitation approach for an 88-year-old patient following a stroke through the implementation of educational-rehabilitation treatment, achieving gradual improvements in the recovery process. Tests such as the Mini-Mental State Examination, Motor Evaluation Scalefor Upper Extremity in Stroke patients, The Barthel Index for Activities of Daily Living, Aphasic Depression Rating Scale, and The Modified Rankin Scale were applied to assess the set goal. The educational-rehabilitation treatment was conducted daily for 45 minutes, for two months within clinical rehabilitation and nine months in home conditions. The treatment was based on the principles of brain neuroplasticity and motor learning, involving cognitive training, motor training, adaptive skills training, relaxation, education and counseling, motivational training, and the promotion of metacognitive abilities. The research data underwent analysis through descriptive statistics, and the findings were visually illustrated in graphical representations. Based on the obtained results, it can be concluded that there is noticeable functional progress in the patient across all evaluated areas.Keywords:stroke, rehabilitation, educational-rehabilitation treatment

Eysenck's Personality Questionnaire Scores of Heroin Addicts in Pakistan.

Objective The main objective of the study was to find Eysenck's Personality Questionnaire scores of heroin addicts in Pakistan and to compare the EPQ scores with demographic variables such as age, gender, and duration of addiction. Methodology of the study This cross-sectional study was conducted in Islamabad, Pakistan. Data was collected from 300 participants. The participants were recruited from various drug rehabilitation centers and clinics across Pakistan. Patients diagnosed with heroin addiction by a qualified medical professional and currently undergoing treatment or rehabilitation for heroin addiction were included in the study. Data was collected through a purposive sampling technique. Results Data was collected from 300 participants, including both males and females. The age range included subjects from 18 years to 60 years. Heroin addicts in Pakistan have a mean extraversion score of 12.4 (SD=4.8), with scores ranging from 5 to 20, indicating average levels of sociability. Neuroticism had a mean score of 17.6 (SD=5.2), with a range from 7 to 25, suggesting high emotional instability and anxiety. Psychoticism had a mean score of 8.3 (SD=3.9), with scores between 2 and 15, indicating moderate levels of aggressive and antisocial behavior. Conclusion It is concluded that heroin addicts in Pakistan exhibit high levels of neuroticism, moderate levels of extraversion, and psychoticism. Younger addicts and those with a shorter duration of addiction display higher levels of these traits, indicating a need for personalized and targeted intervention strategies.

How much does clinical prediagnosis correlate with electrophysiological findings?: a retrospective study.

Electrodiagnostic testing (EDX) is important in the diagnosis and follow-up of neuropathic and myopathic diseases. This study aimed to demonstrate the compatibility between clinical prediagnosis and electrophysiological findings. EDX results from 2004 to 2020 at the physical medicine and rehabilitation (PM&R) clinic were screened. Tests with missing data, reevaluation studies, and cases of peripheral facial paralysis were excluded. The clinical prediagnosis and EDX results were recorded, and their compatibility was evaluated. A total of 2,153 tests were included in this study. The mean age was 49.0±13.9 years and 1,533 of them (71.2%) were female. The most frequently referred clinic was the PM&R clinic (90.0%). Numbness (73.6%) was the most common complaint, followed by pain (15.3%) and weakness (13.9%). The most common prediagnosis was entrapment neuropathy (55.3%), radiculopathy (16.1%), and polyneuropathy (15.7%). Carpal tunnel syndrome was the most frequently identified type of entrapment neuropathy (78.3%). Six hundred and seventy EDX results (31.1%) were within normal limits. While the EDX results were consistent with the prediagnosis in 1,328 patients (61.7%), a pathology different from the prediagnosis was detected in 155 patients (7.2%). In the discrepancy group, the most common pathologies were entrapment neuropathy (51.7%), polyneuropathy (17.3%), and radiculopathy (15.1%). The most common neuropathy type was carpal tunnel syndrome (79.3%). After adequate anamnesis and physical and neurological examinations, requesting further appropriate tests will increase the prediagnosis accuracy and prevent unnecessary expenditure of time and labor.

Summary of the best evidence for early exercise rehabilitation in patients with mechanically ventilated ICU-acquired weakness

To integrate the best evidence for early rehabilitation of mechanically ventilated ICU-acquired weakness (ICU-AW) patients using evidence-based methods, providing evidence-based basis for standardized evaluation and intervention of early exercise therapy for mechanically ventilated ICU-AW patients. A systematic search was conducted on the American Thoracic Society (ATS) Clinical Practice Guidelines, Registered Nurses' Association of Ontario (RNAO), Guidelines International Network (GIN), Canadian Medical Association Clinical Practice Guideline Library (CMACPGL), BMJ Clinical Evidence, UpToDate, Scottish Intercollegiate Guidelines Network (SIGN), PubMed, Cochrane Library, National Guideline Clearinghouse (NGC), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), UM-library, Physiotherapy Evidence Database (PEDro), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Chinese Medical Pulse Guidelines Website, CNKI and Wanfang data and other Chinese and English databases, professional team websites, and guideline websites for expert consensus, guidelines, randomized collected trial (RCT), systematic reviews and other evidence on early exercise rehabilitation for mechanically ventilated ICU-AW patients. The search time limit was from the establishment of the database to December 31, 2023. Literature search, screening, evaluation, information extraction was independently conducted by two evaluators with cross checking, and quality evaluation of the included literature was conducted. A total of 21 literatures were enrolled, including 5 guidelines, 5 systematic reviews, 4 expert consensuses, and 7 RCT, all of which with high evidence level and all were enrolled. They were summarized into seven aspects with assessment screening, exercise safety standards, precautions, setting of exercise time, exercise intensity, exercise sequence, and recommended exercise content as the core, and 32 best evidences. The evidence summarized can provide evidence-based basis for standardized assessment and intervention of early exercise rehabilitation in mechanically ventilated ICU-AW patients. ICU medical practitioners need to combine the actual clinical environment, individual differences and rehabilitation goals of patients, to provide targeted health guidance and intervention for the prevention of ICU-AW in mechanically ventilated patients.

Psychophysiological technologies using the biofeedback method: an analytical review

INTRODUCTION. There is high prevalence of post-stroke motor and neuropsychological disorders. However, they are usually considered without interrelation with each other, and rehabilitation methods are also considered in the context of a monodomain effect on specific functions. AIM. To analyze the available scientific evidence on the role of psychophysiological technologies with biofeedback in clinical medicine and medical rehabilitation. MATERIALS. 50 sources were analyzed, 25 of which are high-level evidence-based articles (randomized controlled trials, meta-analyses, systematic reviews) published in databases Elibrary.ru, Medline, Web of Science, PubMed and Scopus for the period of 2009–2024. RESULTS. The complex effect of the BFB method on the physical symptoms and psychological state of patients, as well as the possibility of using physiological indicators for adaptive biofeedback, has been studied. The greatest amount of evidence is available about the positive effect of technology using BFB on the psychoemotional state of patients and the state of the cardiovascular system. Significant results were obtained when using BFB-electromyographic-training in the complex therapy of headache and related emotional disorders. All studies have a high level of reliability of evidence and credibility of recommendations. Great progress has been made in the development of innovative psychophysiological technologies, including the use of hardware and software complexes, electroencephalography and neurointerfaces. CONCLUSION. Psychophysiological technologies with BFB demonstrate effectiveness in the rehabilitation of patients with psychosomatic disorders, borderline conditions and a number of neurological diseases (headache, epilepsy, spinal injury, stroke). Further research is needed to form an evidence base, clarify the mechanisms of action and algorithms of prescriptions, taking into account the physiological and psychological component of the therapeutic or rehabilitation process.

Patients with cancer who will be cured and projections of complete prevalence in Italy from 2018 to 2030

The number and projections of cancer survivors are necessary to meet the healthcare needs of patients, while data on cure prevalence, that is, the percentage of patients who will not die of cancer by time since diagnosis, are lacking. Data from Italian cancer registries (duration of registration ranged from 9 to 40 years, with a median of 22 years) covering 47% of the population were used to calculate the limited-duration prevalence, the complete prevalence in 2018, projections to 2030, and cure prevalence, by cancer type, sex, age, and time since diagnosis. A total of 3 347 809 people were alive in Italy in 2018 after a cancer diagnosis, corresponding to 5.6% of the resident population. They will increase by 1.5% per year to 4 012 376 in 2030, corresponding to 6.9% of the resident population, 7.6% of women and ∼22% after age 75 years. In 2030, more than one-half of all prevalent cases (2million) will have been diagnosed by ≥10 years. Those with breast (1.05 million), prostate (0.56 million), or colorectal cancers (0.47 million) will be 52% of all prevalent patients. Cure prevalence was 86% for all patients alive in 2018 (87% for patients with breast cancer and 99% for patients with thyroid or testicular cancer), increasing with time since diagnosis to 93% for patients alive after 5 years and 96% after 10 years. Among patients who survived at least 5 years, the excess risk of death (1- cure prevalence) was <5% for patients with most cancer types except for those with cancers of the breast (8.3%), lung (11.1%), kidney (13.2%), and bladder (15.5%). Study findings encourage the implementation of evidence-based policies aimed at improving long-term clinical follow-up and rehabilitation of people living after cancer diagnosis throughout the course of the disease. Updated estimates of complete prevalence are important to enhance data-driven cancer control planning.

A Rehabilitation Algorithm After Lateral Ankle Sprains in Professional Football (Soccer): An Approach Based on Clinical Practice Guidelines.

Lateral ankle sprain (LAS) is one of the most common types of injury in professional football (soccer) players with high risk of recurrence. The rehabilitation after LAS in professional football players is often still time-based and relies on anecdotal experience of clinicans. There is still a lack of utilization of criteria-based rehabilitation concepts after LAS in professional football. The aims of this clinical commentary are (1) to critically discuss the need for criteria-based rehabilitation concepts after LAS in professional football players, (2) to highlight the current lack of these approaches and (3) to present a novel clinical guideline-based rehabilitation algorithm. Short time-loss (15 days) and high recurrence rate (17%) raise the question of trivialization of LAS in professional football. Despite consequences for many stakeholders involved (players, teams, clubs, insurers), there is still a lack of of criteria-based, step-by-step approaches. The use of a criteria-based rehabilitation approach might reduce the high recurrence rate after LAS in professional football players and will lead, in turn, to increased long-term player availability. Practical experiences of he authors demonstrate the feasibility of such an approach. The effectiveness of this novel rehabilitation algorithm remains to be evaluated in future studies. Level of Evidence: 5.

Synergistic implications of combinatorial rehabilitation approaches using spinal stimulation on therapeutic outcomes in spinal cord injury

ObjectiveThe objective of this narrative review was to locate and assess recent articles employing a combinatorial approach of transcutaneous spinal cord stimulation or epidural spinal cord stimulation with additional modalities. We sought to provide relevant knowledge of recent literature and advance understanding on outcomes reported, to better equip those working in neurorehabilitation and neuromodulation. MethodsArticles were selected and analyzed based on study approach, stimulation parameters, outcome measures, and presence of neurophysiological data to support findings. ResultsThis narrative review analyzed 44 recent articles employing a combinatorial approach of transcutaneous spinal cord stimulation or epidural spinal cord stimulation with additional modalities. Our findings showed that limited research exists regarding such combinatorial approaches, particularly when considering modalities beyond activity-based training. There is also limited consistency in neurophysiological and quality of life outcomes. ConclusionArticles involving transcutaneous spinal cord stimulation or epidural spinal cord stimulation with other modalities are limited in the current body of literature. Authors noted variety in approach, sample size, and use of participant perspective. Opportunities are present to add high quality research to this body of literature. SignificanceTranscutaneous spinal cord stimulation and epidural spinal cord stimulation are emerging in research as viable avenues for targeting improvement of function after traumatic spinal cord injury, particularly when combined with activity-based training. This body of literature demonstrates viable areas for growth from both neurophysiological and functional perspectives. Further, exploration of novel combinatorial approaches holds potential to offer enhanced contributions to clinical and neurophysiological rehabilitation and research.

Mindfulness in Orthopedic Rehabilitation: Can the Use of a Mindfulness Diary Positively Influence the Therapeutic Outcome of Orthopedic Rehabilitation?

ObjectivesMindfulness is a proven therapeutic practice for reducing anxiety, depression, and chronic pain, which are factors that influence the success of hip/knee replacement surgery. The present study aimed to investigate the effect of mindfulness bibliotherapy in rehabilitation on anxiety, depression, and health status. The objective was to determine whether there is a connection between the level of mindfulness before rehabilitation and the health status after rehabilitation.MethodNinety-three patients (Mage = 63.34, SD = 10.49) from an outpatient rehabilitation clinic participated in the study. Forty-three patients were included in the mindfulness bibliotherapy group, and 45 were included in the waitlist control group. Anxiety, depression (both measured with the Hospital Anxiety and Depression Scale), quality of life (measured with the SF-36), and walking ability (measured with the Timed “Up and Go”-Test), as well as orthopedic measurements and dispositional mindfulness, were measured before and after the intervention. A follow-up measurement was carried out 4 weeks after the end of rehabilitation.ResultsA significant interaction effect between test time (pre- and post-test) and group (mindfulness bibliotherapy and waitlist control group) was detected for the measurement of Anxiety. The Anxiety score decreased in the intervention group from the pre-test to the post-test and the follow-up. In addition, the five subscales of dispositional mindfulness, age, and gender predicted mental health status (measured with the mental health scale of the SF-36) at the end of rehabilitation, F(7, 85) = 2.52, p = 0.021, even though no individual predictor reached significance.ConclusionsMindfulness diary practice can be a helpful therapy approach to support patients and to regain the goal of full capacity for working life and everyday life after surgery. Further studies need to investigate more intensively the relationships between the mode of action of mindfulness interventions in the setting of orthopedic rehabilitation.PreregistrationThis study was preregistered in OSF (https://osf.io/4tmwq/).

Music May Improve Negative Psychology of Stroke Rehabilitation Patients with Dysphagia: A Retrospective Study.

This study aims to explore the effect of music therapy on improving the negative psychology of stroke rehabilitation patients with dysphagia. The medical records of 160 stroke rehabilitation patients with dysphagia admitted to Wuwei People's Hospital from June 2020 to May 2021 were retrospectively analyzed. Based on the different clinical management programs, these patients were divided into the control group (n = 77, receiving routine clinical rehabilitation management) and the research group (n = 83, receiving routine clinical rehabilitation management + music therapy). The scores of the Standard Swallowing Assessment Scale (SSA), Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization Five-item Well-Being Index (WHO-5), as well as the levels of dopamine (DA) and 5-hydroxy tryptamine (5-HT), of the two groups were compared. After treatment, there was no significant difference in SSA scores between the two groups (P > 0.05). After the treatment, the PHQ-9 score of the research group was lower than that of the control group, whereas the WHO-5 score was significantly higher than that of the control group (P < 0.05). After the treatment, the levels of DA and 5-HT in the research group were significantly higher than those in the control group (P < 0.05). Music therapy for stroke rehabilitation patients with dysphagia can improve their negative emotions and quality of life to a certain extent, which may alleviate the condition of patients.

Removable prosthesis with precision attachments for the lower jaw in lateral edentation

Background. In certain cases of lateral edentation, some treatment options are limited due to the patient’s desire or maybe due to the fact that biology could not permit otherwise. Hence, in these scenarios the options to use the implant therapy are limited. Case report. 50-year-old female patient was referred to clinic for a full mandibula rehabilitation. In this case the patient was diagnosed with Kennedy Class I. In this situation, the treatment option was fixed metal-ceramic crowns with precision attachments (keyway attachments) for a removable prothesis. Aim. To emphasize the fact that, from a socio-economic point of view, the patient tends to choose the more accessible treatment option, but also the time component has a major impact on the choice they make, the development time of a treatment plan being very important to the patient. Material and methods. 10 cases of partial edentation were analyzed for the possibility of realizing two treatment plans, namely the version with implants or with removable prosthesis. The clinical implications of various aspects of this area were monitored and displayed as results. Results. Patients were much more receptive to the removable prosthesis with precision attachments treatment compared to the insertion of implants. The former has a similar result to the latter, but in a much shorter time span and with lower costs. Conclusions. From the analyzed it was confirmed that edentulous patients can be successfully treated with fixed prosthodontics associated with a removable partial prosthesis with precision attachments with the same benefits that the implant works might have brought them, the patient being satisfied with the quality of life gained as a result of benefitting from removable prosthesis in a relatively convenient period of time.

Descriptive Study of Earthquake-Related Spinal Cord Injury in Türkiye-Kahramanmaraş

Objective: We aimed to review the epidemiological data of patients who were rescued from under the rubble in the Kahramanmaraş earthquakes on February 6 and developed earthquake-related spinal vertebral fractures. Materials and Methods: Our study included 69 patients with spinal vertebral fractures and/or spinal cord injuries (SCIs) who were admitted to the Physical Medicine and Rehabilitation Clinic of Adana City Training and Research Hospital after the 6 February Kahramanmaraş Pazarcık and Elbistan earthquakes. Patients with peripheral nerve damage or loss of muscle strength due to pelvic and extremity fractures were not included in the study. Results: The mean age of the patients was 40.43±15.24 years (min=8-max=72). The median time of rescue from under the rubble was 15 (1-106) hours. The median visual analogue scale (VAS) pain score was 7 (0-10). 69.6% of the patients were female. Among the patients with a vertebral spinal injury, 72.5% had an incomplete SCI and 27.5% had a complete SCI. 84.5% of the patients underwent surgery, and posterior spinal instrumentation was performed in 56.5% of them. Conclusion: There has been a significant increase in the number of SCI cases after the Kahramanmaraş earthquakes. Rehabilitation centers should be established, patients' access to these centers should be facilitated, and complications should thus be prevented or optimized. Injured people should be helped to return to their social lives. Keywords: February 6th Kahramanmaraş, Earthquake, Spinal Cord Injury

Bacterial Contamination of Environmental Surfaces of Veterinary Rehabilitation Clinics.

The presence of potentially pathogenic bacteria on veterinary clinic surfaces may be problematic. In this study, we collected swab samples (Fisherbrand, double transport swabs with Stuart's liquid medium) and water samples from five veterinary rehabilitation clinics. Swabs and water samples were transported to a microbiology lab for processing. At the lab, swabs were used to inoculate Hardy's Cdiff Banana Broth (for Clostridium difficile [Cdiff]) and five different types of bacterial growth media, including Hardy CHROM MRSA agar (methicillin-resistant Staphylococcus aureus [MRSA] and S. pseudintermedius [SIM]), mannitol salt agar (S. aureus [SA]), eosin methylene blue agar (enterics [ENT]), Pseudomonas isolation agar (Pseudomonas spp. [PS]), and tryptic soy agar [TSA] (non-specific). The most prominent presumptive species cultured was Cdiff (on nearly 55% of swabs). Bacillus spp. and enteric bacteria were encountered on nearly 35% of swabs, with MRSA and SIM on just over 10% of swabs. The most contaminated sample site was harnesses/life jackets used with the underwater treadmill (33% of swabs). The underwater treadmill water had total bacterial counts from 1,600 to 2,800 cfu/mL. Of all presumptive bacterial species detected, SIM tends to be more pathogenic for dogs. Targeted cleaning/disinfecting in these clinics could help reduce risks for both animals and caregivers utilizing these clinics.

Wearable biofeedback device to assess gait features and improve gait pattern in people with parkinson’s disease: a case series

IntroductionPeople with Parkinson’s Disease (PD) show abnormal gait patterns compromising their independence and quality of life. Among all gait alterations due to PD, reduced step length, increased cadence, and decreased ground-reaction force during the loading response and push-off phases are the most common. Wearable biofeedback technologies offer the possibility to provide correlated single or multi-modal stimuli associated with specific gait events or gait performance, hence promoting subjects’ awareness of their gait disturbances. Moreover, the portability and applicability in clinical and home settings for gait rehabilitation increase the efficiency in the management of PD. The Wearable Vibrotactile Bidirectional Interface (BI) is a biofeedback device designed to extract gait features in real-time and deliver a customized vibrotactile stimulus at the waist of PD subjects synchronously with specific gait phases. The aims of this study were to measure the effect of the BI on gait parameters usually compromised by the typical bradykinetic gait and to assess its usability and safety in clinical practice.MethodsIn this case series, seven subjects (age: 70.4 ± 8.1 years; H&Y: 2.7 ± 0.3) used the BI and performed a test on a 10-meter walkway (10mWT) and a two-minute walk test (2MWT) as pre-training (Pre-trn) and post-training (Post-trn) assessments. Gait tests were executed in random order with (Bf) and without (No-Bf) the activation of the biofeedback stimulus. All subjects performed three training sessions of 40 min to familiarize themselves with the BI during walking activities. A descriptive analysis of gait parameters (i.e., gait speed, step length, cadence, walking distance, double-support phase) was carried out. The 2-sided Wilcoxon sign-test was used to assess differences between Bf and No-Bf assessments (p < 0.05).ResultsAfter training subjects improved gait speed (Pre-trn_No-Bf: 0.72(0.59,0.72) m/sec; Post-trn_Bf: 0.95(0.69,0.98) m/sec; p = 0.043) and step length (Pre-trn_No-Bf: 0.87(0.81,0.96) meters; Post-trn_Bf: 1.05(0.96,1.14) meters; p = 0.023) using the biofeedback during the 10mWT. Similarly, subjects’ walking distance improved (Pre-trn_No-Bf: 97.5 (80.3,110.8) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.028) and the duration of the double-support phase decreased (Pre-trn_No-Bf: 29.7(26.8,31.7) %; Post-trn_Bf: 27.2(24.6,28.7) %; p = 0.018) during the 2MWT. An immediate effect of the BI was detected in cadence (Pre-trn_No-Bf: 108(103.8,116.7) step/min; Pre-trn_Bf: 101.4(96.3,111.4) step/min; p = 0.028) at Pre-trn, and in walking distance at Post-trn (Post-trn_No-Bf: 112.5(97.5,124.5) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.043). SUS scores were 77.5 in five subjects and 80.3 in two subjects. In terms of safety, all subjects completed the protocol without any adverse events.ConclusionThe BI seems to be usable and safe for PD users. Temporal gait parameters have been measured during clinical walking tests providing detailed outcomes. A short period of training with the BI suggests improvements in the gait patterns of people with PD. This research serves as preliminary support for future integration of the BI as an instrument for clinical assessment and rehabilitation in people with PD, both in hospital and remote environments.Trial registrationThe study protocol was registered (DGDMF.VI/P/I.5.i.m.2/2019/1297) and approved by the General Directorate of Medical Devices and Pharmaceutical Service of the Italian Ministry of Health and by the ethics committee of the Lombardy region (Milan, Italy).

Responsiveness and Minimal Clinically Important Difference of the Canadian Occupational Performance Measure Among Patients With Frozen Shoulder.

Patient-reported outcome measures provide insights into intervention effects on patients. The Canadian Occupational Performance Measure (COPM) emphasizes identifying priorities in daily activity engagement and evaluating an individual's perception of changes over time. To assess the responsiveness of the COPM and the minimal clinically important difference (MCID) among patients with frozen shoulders. Prospective, single-blind, randomized controlled trial. Two physical medicine and rehabilitation clinics. Ninety-four patients with frozen shoulders enrolled in a previous study. Baseline and 3-mo evaluations of the COPM and other measures. Responsiveness was assessed using effect size (ES) and standardized response mean (SRM). The MCID values were determined through a distribution-based approach, which used the 0.5 standard deviation and ES methods, and an anchor-based approach, which used the receiver operating characteristic curve method. The ES and SRM results indicated that the COPM had high responsiveness. The distribution-based MCID values for COPM Performance and COPM Satisfaction were 1.17 and 1.44, respectively. The anchor-based MCID values were 2.5 (area under the curve [AUC] = 0.78, 95% confidence interval [CI] [0.64-0.91]) and 2.1 (AUC = 0.76, 95% CI [0.60-0.91]), respectively. The findings suggest that the COPM is a responsive outcome measure for patients with frozen shoulder. The established MCID values for the COPM can be valuable for interpreting changes in patient performance and satisfaction, thus aiding clinical interventions and research planning. Plain-Language Summary: This is the first study to review the effectiveness of the Canadian Occupational Performance Measure (COPM) to determine the success of occupational therapy interventions for people with a frozen shoulder. The findings suggest that the COPM is an effective and valuable tool for clients with a frozen shoulder to understand their experiences and treatment priorities and to detect meaningful changes in their performance and satisfaction after an occupational therapy intervention.

A High-Performance, Secure Custom Electronics Circuit for Biopotential Measurement and Processing

Purpose: In this paper, we propose a secure wearable and portable device aiming to (i) monitor physical activity in medical and clinical rehabilitation, (ii) evaluate the subject's movements in sports environments, and (iii) monitor wellness indicators. Materials and Methods: The innovative low-power custom circuit can acquire, pre-process, digitalize, and transmit EMG signals to a Raspberry PI4 device via a low-energy Bluetooth module. The Raspberry PI4 is a hub that sends data to a cloud-based system for remote monitoring and processing. The best cybersecurity practices have been implemented: firewall, anti-DDoS and SELinux. Results: We have assessed the system's vulnerability before and after the system's hardening. SELinux makes the system safer and prevents unauthorized access to patients' data health by tampering with the devices. Conclusion: Adopting IoT systems in telemedicine requires greater attention to cybersecurity. It is necessary to implement security mechanisms to guarantee the privacy of patient's health data.

Effects of Cardiopulmonary Rehabilitation on Cardiorespiratory Fitness and Clinical Symptom Burden in Long COVID: Results from the COVID-Rehab Randomized Controlled Trial.

To investigate the effectiveness of an eight-week cardiopulmonary rehabilitation program on cardiorespiratory fitness (VO2peak) and key cardiopulmonary exercise test measures, quality of life, and symptom burden in individuals with Long COVID. Forty individuals with Long COVID (mean age 53 ± 11 years), were randomized into 2 groups: 1/ Rehabilitation group: centre-based individualized clinical rehabilitation program (8 weeks, 3 sessions per week of aerobic and resistance exercises, and daily inspiratory muscle training) and 2/ Control group: individuals maintained their daily habits during an eight-week period. There was a significant difference between groups in mean VO2peak improvement (p = 0.003). VO2peak improved significantly in the rehab group (+2.7 mL.kg.min 95%IC:+1.6 to +3.8 p < 0.001) compared to the control group (+0.3 mL.kg.min 95%IC:-0.8 to +1.3 p = 0.596), along withVE/VCO2 slope (p = 0.032) (-2.4 95%IC:-4.8 to +0.01 p = 0.049 and + 1.3 95%IC:-1.0 to +3.6 p = 0.272 respectively) and VO2 at first ventilatory threshold (p = 0.045). Furthermore, all symptom impact scales improved significantly in the rehabilitation group compared to the control group (p < 0.05). An individualized and supervised cardiopulmonary rehabilitation program was effective in improving cardiorespiratory fitness, ventilatory efficiency, and symptom burden in individuals with Long COVID. Careful monitoring of symptoms is important to appropriately tailor and adjust rehabilitation sessions.