Functional Recovery In Individuals Research Articles

Functional recovery of individuals with serious mental illnesses: Development and testing of a new short instrument for routine outcome monitoring.

This article describes the development and testing of the Functional Recovery tool (FR tool), a short instrument for assessing functional recovery during routine outcome monitoring of people living with serious mental illnesses. To assess functional recovery, mental health professionals conducted semistructured interviews with people living with serious mental illnesses on three areas of social functioning: daily living and self-care, work and study, and social contacts. Functioning in each of these areas over the past 6 months was rated on a 3-point scale: 0 (independent), 1 (partially independent), and 2 (dependent). The dichotomous overall outcome of the tool is defined as independent functioning in all areas. We analyzed interrater and test-retest reliability, sensitivity to change, and correlations with constructs that are assumed to be similar to the FR tool (quality of life in daily living, work, and social contacts) or divergent from it (symptomatic functioning). The FR tool was administered to 840 individuals with serious mental illnesses in Dutch mental health care services, 523 of whom were followed up for 1 year (response rate 62%). The tool was easy to complete and was appropriate for policy evaluation and practice. However, when it was combined with more elaborate instruments, it added little extra clinical information. Interrater and test-retest reliability, convergent and discriminant validity, and sensitivity to change were rated sufficient to good. The FR tool could be a useful measure of functional recovery in addition to current measures of symptomatic remission and personal recovery in routine outcome monitoring. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Impact of expectations on functional recovery in individuals with chronic shoulder pain

Study DesignRetrospective cohortObjectivesTo examine general expectations for treatment by physical therapists and specific expectations for common interventions in patients with shoulder pain. A secondary objective was to assess the extent to which patients’ general and specific expectations for treatment affect clinical outcomes.MethodsWe performed a secondary analysis of data from a clinical trial of interventions for shoulder pain. Prior to beginning treatment for shoulder pain, 140 patients were asked their general expectations of benefit and their specific expectations for individual interventions. Next we examined how these expectations related to the patients’ ratings of the success of treatment at one and six months after treatment.ResultsPatients had positive general expectations for treatment by a physical therapist. Specific manual therapy interventions of range of motion and strengthening had the highest proportion of patients who expected these interventions to significantly improve shoulder pain. Seventy-two patients (58%) reported themselves to be improved using the global rating of change (GROC) at one month and six months. In the full model predicting one-month GROC, only the expectation of moderate relief (p = 0.012) and body mass index (BMI) (p = 0.013) had significant effects. Overall, the Shoulder Pain and Disability Index (SPADI) significantly decreased over time (p = 0.004); however, a significant interaction did occur between time and BMI (p = 0.021).DiscussionPatients expect common interventions used by physical therapists to be effective to manage shoulder pain. In conclusion, patients with shoulder pain had high general expectations for physical therapy.Level of Evidence: Prognosis, level 2b

Supplemental Material for Functional Recovery of Individuals With Serious Mental Illnesses: Development and Testing of a New Short Instrument for Routine Outcome Monitoring

Supplemental Material for Functional Recovery of Individuals With Serious Mental Illnesses: Development and Testing of a New Short Instrument for Routine Outcome Monitoring

A small, portable, battery-powered brain-computer interface system for motor rehabilitation.

Motor rehabilitation using brain-computer interface (BCI) systems may facilitate functional recovery in individuals after stroke or spinal cord injury. Nevertheless, these systems are typically ill-suited for widespread adoption due to their size, cost, and complexity. In this paper, a small, portable, and extremely cost-efficient (<;$200) BCI system has been developed using a custom electroencephalographic (EEG) amplifier array, and a commercial microcontroller and touchscreen. The system's performance was tested using a movement-related BCI task in 3 able-bodied subjects with minimal previous BCI experience. Specifically, subjects were instructed to alternate between relaxing and dorsiflexing their right foot, while their EEG was acquired and analyzed in real-time by the BCI system to decode their underlying movement state. The EEG signals acquired by the custom amplifier array were similar to those acquired by a commercial amplifier (maximum correlation coefficient ρ=0.85). During real-time BCI operation, the average correlation between instructional cues and decoded BCI states across all subjects (ρ=0.70) was comparable to that of full-size BCI systems. Small, portable, and inexpensive BCI systems such as the one reported here may promote a widespread adoption of BCI-based movement rehabilitation devices in stroke and spinal cord injury populations.

Disorders of Consciousness: Outcomes, Comorbidities, and Care Needs

Over the last decade, research on patients with disorders of consciousness (DOC) has suggested that their prognosis for functional recovery early after injury is surprisingly positive, particularly for those with traumatic etiologies; that meaningful recovery proceeds for longer intervals than previously appreciated; and that such individuals are often medically complex and challenging to manage. However, access to intensive specialty rehabilitation is limited for most individuals with DOC in the United States. The evolving understanding of DOC calls for a reconsideration of appropriate models of care. This collection of articles provides insight into the functional recovery of individuals with DOC, new tools for assessing prognosis, and the patterns of comorbidity that complicate the recovery process. In addition, models of care from the United States and Europe that attempt to address the needs of patients as well as their caregivers are presented.

Stroke survivors talk while doing: Development of a therapeutic framework for continued rehabilitation of hand function post stroke

Study designQualitative study to identify themes and explore mechanisms underlying recovery of hand function post stroke for individuals discharged from rehabilitation services. Purpose of the studyPost-stroke hemiparesis frequently results in persistent hand dysfunction; the mechanisms of functional recovery are however poorly understood. We assessed the perspectives of community-dwelling individuals with chronic stroke on their hand function limitations and recovery to explore the feasibility of developing a theoretical framework for understanding the process of continued post-stroke recovery. MethodsEight subjects with chronic post-stroke hemiparesis were interviewed and videotaped while they performed a battery of 20 upper limb tasks. Qualitative analysis consisted of two investigators independently reviewing the videotapes and reading the transcribed conversations, identifying significant issues and then comparing their observations to determine common themes and develop emerging concepts. ResultsFour core themes pertaining to impairment and recovery of task-specific ability emerged: 1) spasticity can be overcome actively through task-specific attempts to use the affected arm and hand; 2) use of the affected arm can be facilitated by adopting positions that reduce the effect of gravity on the arm or enable gravity to act as a natural assist in the movement; 3) task-specific skill can be attained by repeatedly attempting specific component movements of tasks in the context of a variety of different tasks; and 4) frustration impedes task performance but a mental state of ‘detached focus’ can improve the motivation to use the affected arm. ConclusionsThese themes suggest a therapeutic framework for continued upper limb rehabilitation in patients' own environment to maximize functional recovery in individuals long after their stroke, and generate hypotheses which may lead to the development of new therapeutic protocols. Level of evidenceNA

Neuromodulation of lower limb motor control in restorative neurology

One consequence of central nervous system injury or disease is the impairment of neural control of movement, resulting in spasticity and paralysis. To enhance recovery, restorative neurology procedures modify altered, yet preserved nervous system function. This review focuses on functional electrical stimulation (FES) and spinal cord stimulation (SCS) that utilize remaining capabilities of the distal apparatus of spinal cord, peripheral nerves and muscles in upper motor neuron dysfunctions. FES for the immediate generation of lower limb movement along with current rehabilitative techniques is reviewed. The potential of SCS for controlling spinal spasticity and enhancing lower limb function in multiple sclerosis and spinal cord injury is discussed. The necessity for precise electrode placement and appropriate stimulation parameter settings to achieve therapeutic specificity is elaborated. This will lead to our human work of epidural and transcutaneous stimulation targeting the lumbar spinal cord for enhancing motor functions in spinal cord injured people, supplemented by pertinent human research of other investigators. We conclude that the concept of restorative neurology recently received new appreciation by accumulated evidence for locomotor circuits residing in the human spinal cord. Technological and clinical advancements need to follow for a major impact on the functional recovery in individuals with severe damage to their motor system.

Beyond dreams: do sleep-related movements contribute to brain development?

Conventional wisdom has long held that the twitches of sleeping infants and adults are by-products of a dreaming brain. With the discovery of active (or REM) sleep in the 1950s and the recognition soon thereafter that active sleep is characterized by inhibition of motor outflow, researchers elaborated on conventional wisdom and concluded that sleep-related twitches are epiphenomena that result from incomplete blockade of dream-related cortical activity. This view persists despite the fact that twitching is unaffected in infants and adults when the cortex is disconnected from the brainstem. In 1966, Roffwarg and colleagues introduced the ontogenetic hypothesis, which addressed the preponderance of active sleep in early infancy. This hypothesis posited that the brainstem mechanisms that produce active sleep provide direct ascending stimulation to the forebrain and descending stimulation to the musculature, thereby promoting brain and neuromuscular development. However, this hypothesis and the subsequent work that tested it did not directly address the developmental significance of twitching or sensory feedback as a contributor to activity-dependent development. Here I review recent findings that have inspired an elaboration of the ontogenetic hypothesis. Specifically, in addition to direct brainstem activation of cortex during active sleep, sensory feedback arising from limb twitches produces discrete and substantial activation of somatosensory cortex and, beyond that, of hippocampus. Delineating how twitching during active sleep contributes to the establishment, refinement, and maintenance of neural circuits may aid our understanding of the early developmental events that make sensorimotor integration possible. In addition, twitches may prove to be sensitive and powerful tools for assessing somatosensory function in humans across the lifespan as well as functional recovery in individuals with injuries or conditions that affect sensorimotor function.

Team Focus: Occupational Therapist

Occupational therapists (OTs) have a unique and valued role in the health and functional recovery of individuals with multiple sclerosis (MS). To maximize the benefit of occupational therapy by both health care professionals who refer patients and the patients who use the services, an understanding of the scope of services that OTs offer is essential. This article describes the breadth of the OT evaluation and intervention specific to the treatment of individuals who have MS. As an overriding goal, the OT assists clients in processing the implications of physical, cognitive, and emotional changes and creatively developing strategies to cope with and, when appropriate, minimize the effects of these changes. The occupational therapy process is described, beginning with evaluation and providing guidelines and resources for appropriate client-centered goal setting. The OT and client then discuss intervention that ensures optimal functional outcome and includes symptomatic management, according to the specific functional difficulties and implications and the particular symptoms of each patient. Through discussion, the OT helps each client achieve health and well-being with remedial and compensatory techniques that enable participation in meaningful activities and roles in the home, work, and community. OT services are essential to the appropriate and optimal delivery of comprehensive care and support to individuals with MS.

Measurement of functional recovery in individuals with acute anterior cruciate ligament rupture

Objectives: To measure functional recovery following acute anterior cruciate ligament (ACL) rupture using a simple and reliable clinical movement analysis system. Clinic based methods that simultaneously quantify different aspects of...