Home-based Protocol Research Articles

Home-based transcranial direct current stimulation in bipolar depression: an open-label treatment study of clinical outcomes, acceptability and adverse events

BackgroundCurrent treatments for bipolar depression have limited effectiveness, tolerability and acceptability. Transcranial direct current stimulation (tDCS) is a novel non-invasive brain stimulation method that has demonstrated treatment efficacy for major depressive episodes. tDCS is portable, safe, and individuals like having sessions at home. We developed a home-based protocol with real-time remote supervision. In the present study, we have examined the clinical outcomes, acceptability and feasibility of home-based tDCS treatment in bipolar depression.ResultsParticipants were 44 individuals with bipolar disorder (31 women), mean age 47.27 ± 12.89 years, in current depressive episode of at least moderate severity (mean Montgomery Asberg Depression Rating Scale (MADRS) score 24.59 ± 2.64). tDCS was provided in bilateral frontal montage, F3 anode, F4 cathode, 2 mA, for 30 min, in a 6-week trial, for total 21 sessions, a follow up visit was conducted 5 months from baseline. Participants maintained their current treatment (psychotherapy, antidepressant or mood stabilising medication) or maintained being medication-free. A research team member was present by video conference at each session. 93.2% participants (n = 41) completed the 6-week treatment and 72.7% of participants (n = 32) completed the 5 month follow up. There was a significant improvement in depressive symptoms following treatment (mean MADRS 8.77 ± 5.37) which was maintained at the 5 month follow up (mean MADRS 10.86 ± 6.90), rate of clinical response was 77.3% (MADRS improvement of 50% or greater from baseline), and rate of clinical remission was 47.7% (MADRS rating of 9 or less). Acceptability was endorsed as “very acceptable” or “quite acceptable” by all participants. No participants developed mania or hypomania.ConclusionsIn summary, home-based tDCS with real-time supervision was associated with significant clinical improvements and high acceptability in bipolar depression. Due to the open-label design, efficacy findings are preliminary.Trial registrationClinicalTrials.gov number NCT05436613 registered on 23 June 2022 https//www.clinicaltrials.gov/study/NCT05436613.

Home-Based or Supervised Physical Therapy Shows Similar Functional Outcomes and Healing After Massive Rotator Cuff Repair

PurposeThis study aimed to compare postoperative clinical outcomes at the 3-month, 6-month, 12-month, and latest follow-up in patients undergoing supervised physical therapy (PT) or a home-based exercise program after arthroscopic repair (ARCR) of massive rotator cuff tears (MRCTs). MethodsA retrospective review was conducted on a prospectively maintained database of patients who underwent either supervised PT or home-based therapy after ARCR of MRCTs between January 2015 and December 2018 at a single center with a minimum 24-month follow-up. At their 2-week postoperative routine follow-up, patients are allowed to choose between home-based and supervised PT. Patient-reported outcomes (PROs) and range of motion (ROM) were collected and compared between cohorts preoperatively and at the 3-month, 6-month, 12-month, and latest follow-up. The percentage of patients reaching or exceeding the minimal clinically important difference (MCID) and patient accepted symptomatic state (PASS) for visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon score (ASES), and Subjective Shoulder Value (SSV) were recorded for both cohorts at each time point. Complications, healing, satisfaction, and return to work were reported. Healing was evaluated via ultrasound at the latest follow-up. ResultsNinety-nine patients met the study criteria: 61 in the supervised PT cohort, and 38 in the home-based cohort. The supervised PT and home-based cohorts returned to clinic for their most recent follow-up at 53±20 and 55±16 months (p=0.496) after surgery, respectively. There was no difference when comparing tendon involvement (SS, p=0.574; IS, p=0.288; SSc p=0.592), tear retraction (p=0.603), or high-grade fatty infiltration (SS, p=0.684; IS, p-0.397; SSc p=0.473) based on preoperative MRI assessment and surgery-related factors, including anterior (p=0.473) or posterior (p=0.386) slides, fixation constructs (p=0.829), or complete repair (p=0.912). Both cohorts showed similar PROs and ROM at baseline. Postoperative PROs and ROM were similar among groups at the 3-month, 6-month, 12-month, and latest follow-up. However, ASES (71.4 vs 61.2; p = 0.013) and FF (135° vs 118°; p = 0.023) were significantly higher at 3-month follow-up in the home-based cohort. Both groups comparably achieved MCID and PASS for PROs at the 3-month, 6-month, and12-month follow-up. At the latest follow-up, the supervised PT and home-based cohort achieved MCID and PASS for VAS (75% vs 81%, p=0.573; 70% vs 72%, p=0.911), ASES (76% vs 74%, p=0.777; 72% vs 72%, p=0.873), and SSV (82% vs 84%, p=0.734; 72% vs 66%, p=0.489), respectively. Satisfaction, healing, complication, and return to work rates were similar. ConclusionPatients undergoing rehabilitation using a home-based protocol showed largely similar functional scores and healing to those with supervised PT after ARCR of MRCTs at the latest follow-up. Although patients with home-based therapy achieved higher FF and ASES at the 3-month follow-up, these became comparable starting at the 6-month postoperative mark. MCID and PASS were achieved similarly for PROs at each time point.

Antimicrobial photodynamic therapy for dermatological infections: current insights and future prospects

Introduction:Light-based antimicrobial photodynamic therapy (aPDT) shows promise against a wide range of microorganisms, including drug-resistant strains, with low resistance development likelihood. However, its limitations include the need for light exposure, suitability for local infections, and limited industry interest. Relevant studies on aPDT for various infections are discussed.Methods:We conducted an extensive literature review on aPDT encompassing articles published from the year 2000 to the current date. To compile comprehensive data, multiple databases (PubMed, Web of Science, Scopus, and Cochrane Library) were systematically searched for relevant studies in both English and Spanish languages. The search strategy involved a combination of Medical Subject Headings (MeSH) terms and free-text terms. The terms included variations and combinations of “Antimicrobial Photodynamic Therapy,” “aPDT,” “photodynamic inactivation,” “microbial photoinactivation,” among others. To ensure the reliability and quality of the information gathered, articles were screened based on relevance to aPDT in antimicrobial therapy, methodological rigor, and alignment with the objectives of this review.Results:aPDT shows promise in treating various cutaneous infections. It effectively targets fungal infections, including caused by dermatophytes and Malassezia spp., with notable results against dermatophytosis and tinea capitis. New photosensitizers, like nanoencapsulated hypericin, hold potential for treating these infections. In onychomycosis, aminolevulinic acid-aPDT or methylene blue-aPDT offers an alternative to conventional therapies, showing cure rates as high as 90%. For bacterial infections, it presents a solution against antibiotic-resistant strains and infected ulcers, with potential benefits for wound healing. Regarding viral infections, it indirectly targets viruses by impacting host cells’ metabolism, showing efficacy against human papillomavirus and herpes viruses. Lastly, aPDT demonstrates success in treating parasitic infections, particularly leishmaniasis, with cure rates of up to 100%.Discussion:aPDT is increasingly used in dermatological infections, showing efficacy against various microorganisms and stimulating wound healing. It can combat resistant strains and mixed infections, especially in chronic wounds. Combining photodynamic therapy with antimicrobials is a promising strategy to address antimicrobial resistance, but there are practical limitations. Further research is needed for home-based protocols, portable devices, and adapting photosensitizers, as aPDT holds potential as an alternative treatment for recalcitrant infections and immunosuppressed patients, though challenges remain in application.

Outcome of home-based rehabilitation program following arthroscopic anterior cruciate ligament reconstruction in nonathletic patient

Abstract Background: Rehabilitation following anterior cruciate ligament (ACL) reconstruction is thought to be important by almost all surgeons. It has even been considered by some to be as important as surgery itself. As the surgical procedure for these injuries evolved, so has the rehabilitation. A traditional approach to rehabilitation which focused on delayed weight bearing and mobilization is now being replaced by accelerated rehabilitation which advocates early weight bearing and results in early return to sports. Materials and Methods: This is a observational case-control comparative study conducted in our department from September 2019 to February 2021. About 30 cases of more than 20 years of age with comparable matching group are included in our study. Assessment of Lysholm score, International Knee Documentation Committee (IKDC) score, ACL quality of life score, and Tegner activity level is done. Functional assessment was carried out by Carioca test, one leg hop test, and Shuttle test. Assessment of clinical status is done by anterior drawer test, Lachman test, and Pivot shift test. Results: All patients participating in study although nonathletic had complaints of instability and giving away episodes of knee in their day to day activities and therefore were considered as candidates for surgery. Following an arthroscopic ACL reconstruction, they were given written home-based protocols with goals and exercises being explained to them at the time of discharge. All the patients participating in the study were able to return to their preinjury activity level as assessed by the Tegner activity scale at the final follow up. Their functional outcome as measured by Lysholm score, IKDC score, and ACL quality of life score was significantly lower when compared to an age, sex, and activity matched control group. The patients functional performance as assessed by one leg hop test, Carioca test, and Shuttle test was also below the level of what was seen in control groups. More than 90% patients had a stable knee as assessed by the anterior drawer test, Lachman test and pivot shift test (29 patients has anterior drawer of ≤5 mm, 27 patients had Lachmann test ≤5 mm and all 30 patients had pivot shift grades in absent or glide category). Conclusions: Home-based rehabilitation is an effective method of rehabilitation in low demand individuals following ACL reconstruction. In the future, adequately powered randomized controlled trials are needed to assess the usefulness of one rehabilitation protocol over other in these group of low demand patients.

Reliability And Validity Of A Home-Based Protocol To Assess Physical Function: Preliminary Results

Reliability And Validity Of A Home-Based Protocol To Assess Physical Function: Preliminary Results

Effects of home-based exercise programs on physical fitness in cancer patients undergoing active treatment: A systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis aimed to investigate the effects of home-based exercise on physical fitness (cardiorespiratory fitness, muscle strength, and body composition) in cancer patients undergoing active treatment. Systematic review with meta-analysis and Grading Recommendations Assessment, Development, and Evaluation of the evidence. A comprehensive search of existing literature was carried out in four electronic databases: PubMed, Web of Science, Scopus, and PEDro. All databases were searched for randomized controlled trials assessing the effects of home-based exercise on physical fitness outcomes in cancer patients during active treatment. Multicomponent interventions (i.e., exercise plus diet/behavioral therapy) were excluded. The methodological quality of each study was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. Meta-analytical procedures were performed when appropriate and standardized mean differences (SMD) were calculated. Twenty-eight randomized controlled trials (n = 2424 cancer patients) were included. Most of the interventions were conducted in breast cancer patients (n = 13) during the adjuvant treatment period (n = 17); 18 studies included a walking component in their home-based protocol. Home-based exercise was effective at improving the distance of the 6-minute walk test (k = 6; SMD = 0.321, p = 0.010). However, the results were no longer significant when performing sensitivity analysis based on exclusively walking (k = 1) and non-exclusively walking interventions (k = 5; SMD = 0.258; p = 0.072). No effects were found for muscle strength and body composition outcomes (p > 0.05). Regular home-based exercise programs are an effective strategy to improve 6-minutes walk test in cancer patients undergoing active treatment. Conversely, no alterations were found in muscle strength and body composition.

Music.ALS: Clinical Perspectives on a Home-Based Music Therapy Treatment to Improve Breathing, Speech, Swallowing and Cough of Persons with ALS (MND)

Respiratory failure, malnutrition, aspiration pneumonia and dehydration contribute to mortality in ALS / MND, and loss of verbal communication impacts quality of life. There are few interventions that help with the management of these symptoms alongside pharmacological ones. Neurologic music therapy protocols, which are biomedical interventions, have been demonstrated to be effective for the treatment of human neurodegenerative disorders, but less so with ALS. Two case studies from a larger, published ALS study were selected for this new report to provide an insight into the practical aspects of music therapy treatment. The home-based protocol was designed to sustain bulbar and respiratory functions of persons with early and mid-stage onset. It was delivered to all participants twice-weekly for six weeks as a part of a 16-week ABA mixed methods study. Feasibility data (recruitment, retention, adherence, tolerability, self-motivation, personal impressions) and 34 biomedical outcome parameters for bulbar and respiratory changes were collected. The two studies highlight the differences in therapy process between participants – one with a spinal onset, slow progression ALS and another with a bulbar onset, rapid progression. In both cases, music therapy was tolerated well and perceived as pleasant, although moderately challenging. For both participants, developing the sense of agency played an essential role in the therapy process. Minor treatment protocol modifications were needed. Positive changes in the objective measures of respiration, cough, speech and swallowing were observed. Suggested individual adaptations of the experimental music therapy protocol included modifications of sitting posture, breathing technique, consonant changes in singing exercises, additional pauses and stretching, and changes to preferred song therapeutic performance. A pilot study utilising the modified protocol is called for, followed by an RCT to assess the clinical effectiveness of the innovative MT treatment.

3PHASIC SYSTEM: Biostimulation Without Needles

Chemical peeling for skin arose in ancient culture: Egypt, Mesopotamia and Africa. Medical knowledge regarding chemical peeling is a result of centuries of experience and research. Many substances used in peeling have been described, with more or less marked action. In this work we describe the effectiveness of the 3 Phasic System, a system consisting of a peeling (containing various substances) associated with a topical homebased protocol. This protocol also favors the correction of incorrect eating habits also thanks to the integration with vitamins and probiotics. In this protocol a superficial peeling is used and the indications are: skin resurfacing of the face or body even in dark phototypes, outcomes of acne vulgaris, post-inflammatory hyperpigmentation, melasma, scars and photodamage. 3 Phasic System consists of many agents in reduced concentrations, promoting the efficacy of individual agents and reducing adverse effects. However, familiarity with the properties of peels is very important to avoid adverse effects. The possibility of administering 3 Phasic System according to a monthly schedule together with the correction of incorrect eating habits, the integration of deficient factors, the administration of probiotics and the application of correct home cosmetics has proven effective and safe in patients. The evaluation of the efficacy of the 3 Phasic System was evaluated through ANTERA 3D and VISIA in 450 patients.

Blood Flow Restriction Training – An Intervention to Counteract Muscle Loss Caused by the Covid-19 Pandemic

ntroduction: Physical inactivity is a major unintended consequence of the social distancing imposed by the Covid-19 pandemic. Increased physical inactivity and sedentary behaviors have profound physiological impacts on muscular health,leading to muscle and strength losses that are associated with lowerperformance and higher mortality rates. In the so-called “new normal”, exercise routines must find alternative ways to replace high-intensity resistance exercises,since resources are limited in home environments. Blood flow restriction (BFR) is a low-intensity training method involving compressive pressure of the vasculature by use of a tourniquet cuff in the proximal portion of the upper and lower limbs. BFR has been demonstrated to be a safe and efficient training modality to promote muscle and strength gains in different groups, including those under musculoskeletal rehabilitation, young and older adults, and athletes. Objective: This review aims to show that BFR training is an effective intervention for counteracting losses of muscle mass and function caused by Covid-19. Methods: A review of the scientific literature was conducted on electronic databases, such as PubMed, Scielo and Web of Science, covering the period 2000–2020. Results: We advocate the use of BFR training as an urgent counteracting intervention to prevent muscle and strength losses during social distancing and propose a progressive home-based protocol based on wide array of literature. Conclusion: This evidence can help practitioners, personal trainers, physical therapists, and physician assistants to implement an alternative exercise routine that may prevent the deleterious physiological effects of physical inactivity on muscle function during intermittent social distancing.

Adjunctive home-based transcranial direct current stimulation treatment for major depression with real-time remote supervision: An open-label, single-arm feasibility study with long term outcomes

Current treatments for major depressive disorder (MDD) have limited effectiveness and acceptability. Transcranial direct current stimulation (tDCS) is a novel non-invasive brain stimulation method that has demonstrated treatment efficacy in MDD. tDCS requires daily sessions, however clinical trials have been conducted in research centers requiring repeated visits. As tDCS is portable and safe, it could be provided at home. We developed a home-based protocol with real-time supervision, and we examined the clinical outcomes, acceptability and feasibility. Participants were 26 MDD (19 women), mean age 40.9 ± 14.2 years, in current depressive episode of moderate to severe severity (mean 17-item Hamilton Rating Scale for Depression (HAMD) score 19.12 ± 2.12). tDCS was provided in a bilateral frontal montage, F3 anode, F4 cathode, 2 mA, each session 30 min, in a 6-week trial, for a total 21 sessions. Participants maintained their current treatment (antidepressant medication, psychotherapy, or were enrolled in online CBT). Two tDCS device brands were used, and a research team member was present in person or by real-time video call at each session. 92.3% MDD participants (n = 24) completed the 6-week treatment. Attrition rate was 7.7%. There was a significant improvement in depressive symptoms following treatment (mean HAMD 5.33 ± 2.33), which was maintained at 6 months (mean HAMD 5.43 ± 2.73). Acceptability was endorsed as “very acceptable” or “quite acceptable” by all participants. Due to the open-label feasibility design, efficacy findings are preliminary. In summary, home-based tDCS with real-time supervision was associated with significant clinical improvements and high acceptability which were maintained in the long term.

Integrated Cognitive Rehabilitation Home-Based Protocol to Improve Cognitive Functions in Multiple Sclerosis Patients: A Randomized Controlled Study.

Cognitive impairment (CI) occurs in about 40–65% of people with multiple sclerosis (MS) during the disease course. Cognitive rehabilitation has produced non-univocal results in MS patients. Objective: The present study aimed to evaluate whether an Integrated Cognitive Rehabilitation Program (ICRP) in MS patients might significantly improve CI. Methods: Forty patients with three phenotypes of MS were randomly assigned into two groups: the experimental group (EG, n = 20), which participated in the ICRP for 10 weeks of training; and the control group (CG, n = 20). All participants’ cognitive functions were assessed at three timepoints (baseline, post-treatment, and 3-month follow-up) with the California Verbal Learning (CVLT), Brief Visuospatial Memory (BVMTR), Numerical Stroop, and Wisconsin tests. Results: When compared to CG patients, EG patients showed significant improvements in several measures of cognitive performance after ICRP, including verbal learning, visuospatial memory, attention, and executive functions. Conclusions: Home-based ICRP can improve cognitive functions and prevent the deterioration of patients’ cognitive deficits. As an integrated cognitive rehabilitation program aimed at potentiation of restorative and compensatory mechanisms, this approach might suggest an effective role in preserving neuronal flexibility as well as limiting the progression of cognitive dysfunction in MS.

Cortical stimulation for chronic pain: from anecdote to evidence.

Epidural stimulation of the motor cortex (eMCS) was devised in the 1990's, and has now largely supplanted thalamic stimulation for neuropathic pain relief. Its mechanisms of action involve activation of multiple cortico-subcortical areas initiated in the thalamus, with involvement of endogenous opioids and descending inhibition toward the spinal cord. Evidence for clinical efficacy is now supported by at least seven RCTs; benefits may persist up to 10 years, and can be reasonably predicted by preoperative use of non-invasive repetitive magnetic stimulation (rTMS). rTMS first developed as a means of predicting the efficacy of epidural procedures, then as an analgesic method on its own right. Reasonable evidence from at least six well-conducted RCTs favors a significant analgesic effect of high-frequency rTMS of the motor cortex in neuropathic pain (NP), and less consistently in widespread/fibromyalgic pain. Stimulation of the dorsolateral frontal cortex (DLPFC) has not proven efficacious for pain, so far. The posterior operculo-insular cortex is a new and attractive target but evidence remains inconsistent. Transcranial direct current stimulation (tDCS) is applied upon similar targets as rTMS and eMCS; it does not elicit action potentials but modulates the neuronal resting membrane state. tDCS presents practical advantages including low cost, few safety issues, and possibility of home-based protocols; however, the limited quality of most published reports entails a low level of evidence. Patients responsive to tDCS may differ from those improved by rTMS, and in both cases repeated sessions over a long time may be required to achieve clinically significant relief. Both invasive and non-invasive procedures exert their effects through multiple distributed brain networks influencing the sensory, affective and cognitive aspects of chronic pain. Their effects are mainly exerted upon abnormally sensitized pathways, rather than on acute physiological pain. Extending the duration of long-term benefits remains a challenge, for which different strategies are discussed in this review.

The effectiveness of home-based physical activity on osteoporosis: a narrative review of possible intervention

Physical activity plays a key role in prevention and treatment of several chronic conditions. Moreover, exercise seems to induce improvements in the bone turnover of osteopenic and osteoporotic subjects, increasing bone health. Incidence of osteoporosis increases in postmenopausal women due to hormonal factors that lead to an imbalance in bone remodeling. Unfortunately, the COVID-19 pandemic period induced general population to decrease the level of physical activity, increasing the incidence of several diseases, including osteoporosis. During this year, the use of technology has been applied to continue rehabilitation program, as well as the gym session, to reduce the sedentary level both in healthy population and in patients. Therefore, the focus of this review is to verify the effectiveness of home-based protocols, feasible to be performed during confinement situation, on bone health and functional parameters of postmenopausal women, generally at high-risk of osteoporosis. According to the studies analyzed home-based exercises seem effectiveness to maintain bone health in postmenopausal women, despite the protocol attendance seems to decrease over the 12 months.

Collecting Objective Measures of Visual and Auditory Function in a National in-Home Survey of Older Adults

Maintenance of visual and auditory function is important for preventing the onset of activity limitations and preserving quality of life in later life. To date, national panel studies focused on health and aging have mostly collected subjective (self-reported) measures of visual and auditory function. The National Health and Aging Trends Study (NHATS), a study of Medicare beneficiaries ages sixty-five and older, recently developed a protocol for measuring objective visual and auditory function for its annual, in-home data collection conducted by trained interviewers. The protocol includes three vision tests-distance and near acuity and contrast sensitivity-and one hearing test-pure-tone audiometry-conducted using a tablet platform with results recorded in a scannable booklet. To identify operational issues and evaluate data quality for the proposed set of vision and hearing tests, NHATS incorporated a pilot study into its 2019 round (N = 417 participants and N = 9 interviewers). Using these pilot study data, the objectives of this paper are to: (1) describe the NHATS protocols to collect objective measures of visual and auditory function; (2) evaluate the quality of the data collected; and (3) assess whether results are influenced by interviewers. We found that respondents were highly likely to participate, with cooperation rates for each test about 90 percent. Data were high quality, with low rates of missingness, test results significantly associated with age and self-reported items, and percentages with poor vision or hearing consistent with prior population-based studies. Objective measures were more likely than self-reports to classify participants as having visual and auditory impairments and had stronger relationships with demographic correlates. Interviewer effects were small and not statistically significant in this small sample. Results of this study have demonstrated that objective visual and auditory functioning can be successfully incorporated into an interviewer-administered home-based protocol.

Home-Based Stair Climbing as an Intervention for Disease Risk in Adult Females; A Controlled Study.

Cardiovascular disease and the metabolic syndrome are major contributors to health care expenditure. Increased physical activity reduces disease risk. The study compared effects of walking up and down stairs at home with continuous, gym-based stair climbing on the disease risk factors of aerobic fitness, serum lipids, body composition, fasting blood glucose, and resting cardiovascular variables. Sedentary women (31.7 ± 1.4 years) were randomly assigned to home-based (n = 26) or gym-based (n = 24) climbing for five days.week−1 over an eight-week period. Each ascent required a 32.8-m climb, with home-based climbing matching the vertical displacement in the gym. Participants progressed from two ascents.day−1 to five ascents.day−1 in weeks 7 and 8. Relative to controls, stair climbing improved aerobic fitness (O2max +1.63 mL.min−1.kg−1, 95% CI = 1.21–2.05), body composition (weight −0.99 kg, 95% CI = 1.38–0.60), and serum lipids (LDL cholesterol −0.20 mmol.L−1, 95% CI = 0.09–0.31; triglycerides −0.21 mmol.L−1, 95% CI = 0.15–0.27), with similar risk reductions for home and gym-based groups. Only the home-based protocol reduced fasting blood glucose. Discussion focuses on stair climbing bouts as time-efficient exercise and the potential benefits of a home-based intervention. Stair use at home offers a low-cost intervention for disease risk reduction to public health.

BRAINSTORMING: A study protocol for a randomised double-blind clinical trial to assess the impact of concurrent brain stimulation (tDCS) and working memory training on cognitive performance in Acquired Brain Injury (ABI)

BackgroundAcquired Brain Injury (ABI) admissions have an incidence of 385 per 100,000 of the population in the UK, and as brain injury often involves the frontal networks, cognitive domains affected are likely to be executive control, working memory, and problem-solving deficits, resulting in difficulty with everyday activities. The above observations make working memory, and related constructs such as attention and executive functioning attractive targets for neurorehabilitation. We propose a combined home-based rehabilitation protocol involving the concurrent administration of a working memory training program (adaptive N-back task) with non-invasive transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex to promote long-lasting modification of brain areas underlying working memory function.MethodPatients with a working memory deficit will be recruited and assigned to two age-matched groups receiving working memory training for 2 weeks: an active group, receiving tDCS (2 mA for 20 min), and a control group, receiving sham stimulation. After the end of the first 2 weeks, both groups will continue the working memory training for three more weeks. Outcome measures will be recorded at timepoints throughout the intervention, including baseline, after the 2 weeks of stimulation, at the end of the working memory training regimen and 1 month after the completion of the training.DiscussionThe aim of the study is to assess if non-invasive tDCS stimulation has an impact on performance and benefits of a working memory training regimen. Specifically, we will examine the impact of brain stimulation on training gains, if changes in gains would last, and whether changes in training performance transfer to other cognitive domains. Furthermore, we will explore whether training improvements impact on everyday life activities and how the home-based training regimen is received by participants, with the view to develop an effective home healthcare tool that could enhance working memory and daily functioning.Trial registrationThis study was registered with clinicaltrials.gov: NCT04010149 on July 8, 2019.

Feasibility of and Adherence to a Home-Based Video Game Rehabilitation Protocol

Abstract Date Presented 03/28/20 As the population ages and stroke prevalence rises, there will be an increased need for therapeutic interventions in the home that can help improve motor recovery in stroke survivors. A home-based video game protocol can help satisfy this need. This study evaluates the feasibility of and adherence to a home-based video game protocol designed specifically for stroke survivors. This has implications for the field of OT in the home, through telerehabilitation, and in clinics. Primary Author and Speaker: Emerson Hart Additional Authors and Speakers: Michelle Woodbury Contributing Authors: Austen Hayes, Larry Hodges, Kevin Jett, Christian Finetto, Scott Hutchison

Cardiac rehabilitation in the paediatric Fontan population: development of a home-based high-intensity interval training programme.

We evaluated the safety and feasibility of high-intensity interval training via a novel telemedicine ergometer (MedBIKE™) in children with Fontan physiology. The MedBIKE™ is a custom telemedicine ergometer, incorporating a video game platform and live feed of patient video/audio, electrocardiography, pulse oximetry, and power output, for remote medical supervision and modulation of work. There were three study phases: (I) exercise workload comparison between the MedBIKE™ and a standard cardiopulmonary exercise ergometer in 10 healthy adults. (II) In-hospital safety, feasibility, and user experience (via questionnaire) assessment of a MedBIKE™ high-intensity interval training protocol in children with Fontan physiology. (III) Eight-week home-based high-intensity interval trial programme in two participants with Fontan physiology. There was good agreement in oxygen consumption during graded exercise at matched work rates between the cardiopulmonary exercise ergometer and MedBIKE™ (1.1 ± 0.5 L/minute versus 1.1 ± 0.5 L/minute, p = 0.44). Ten youth with Fontan physiology (11.5 ± 1.8 years old) completed a MedBIKE™ high-intensity interval training session with no adverse events. The participants found the MedBIKE™ to be enjoyable and easy to navigate. In two participants, the 8-week home-based protocol was tolerated well with completion of 23/24 (96%) and 24/24 (100%) of sessions, respectively, and no adverse events across the 47 sessions in total. The MedBIKE™ resulted in similar physiological responses as compared to a cardiopulmonary exercise test ergometer and the high-intensity interval training protocol was safe, feasible, and enjoyable in youth with Fontan physiology. A randomised-controlled trial of a home-based high-intensity interval training exercise intervention using the MedBIKE™ will next be undertaken.

Remotely supervised transcranial direct current stimulation: A feasibility study for amyotrophic lateral sclerosis.

Transcranial direct current stimulation (tDCS) has been investigated as a therapeutic neuromodulation tool in several neurological disorders. However, evidence supporting its efficacy in disorders such as amyotrophic lateral sclerosis (ALS) is limited possibly due to limited patient accessibility for research, particularly for individuals with advanced disease progression. Telerehabilitation using home-based protocols allows for remote supervision of tDCS over longer durations, thereby increasing participation, compliance and adherence. In this study, we explored the safety, feasibility and preliminary effects of a remotely supervised tDCS (RS-tDCS) protocol in ALS. In this pre-post case series study, two individuals with ALS completed 24 remotely supervised anodal tDCS sessions (20 minutes, 2 mA). Outcomes included adherence, compliance, disease progression, walking speed, risk of fall, endurance, fatigue and depression. Both participants successfully completed the study without any major adverse effects. Minor side effects included mild sensations of itching and throbbing under the electrodes during stimulation. Clinical outcomes showed minimal to no change for any of the measures. Preliminary findings suggest that the RS-tDCS protocol is safe and feasible in individuals with ALS. Our protocol serves as a model for future long-term studies to evaluate the clinical and neurophysiological effects of tDCS using a telerehabilitation protocol in ALS.

Home-Based Cardiac Rehabilitation in Brazil's Public Health Care: Protocol for a Randomized Controlled Trial.

BackgroundCoronary artery disease (CAD) is among the main causes of hospitalization and death worldwide, therefore, the implementation of programs to reduce its impact is necessary. Supervised cardiac rehabilitation has been shown to have positive effects on CAD control. However, there are barriers to patient participation in the traditional, face-to-face cardiac rehabilitation programs, mainly in low-resource environments.ObjectiveThis study aimed to verify patient compliance to a home-based cardiac rehabilitation program, which includes unsupervised health education and physical exercises, guided by telephone. Moreover, we compare this new method to the traditional supervised cardiac rehabilitation offered in most hospital centers.MethodsWe present here a two-arm, single-blinded, and randomized controlled design protocol, which compares the traditional cardiac rehabilitation (CenterRehab) with the home-based cardiac rehabilitation (Home-Based) in 72 patients affected by CAD. The primary outcome is the compliance to the cardiac rehabilitation sessions. The secondary outcomes (to evaluate effectiveness) include measurable variables such as functional capacity, CAD risk factors (blood pressure, waist circumference, glycemic, cholesterol levels, depressive symptoms, and the level of physical activity), the patient’s quality of life, the disease knowledge, and the morbidity rate. Parameters such as the program cost and the usability will also be evaluated. The programs will last 12 weeks, with a total of 60 rehabilitation and 6 educational sessions. Patients of the CenterRehab program will participate in 24 supervised sessions and 36 home sessions, while the patients of the Home-Based program will participate in 2 supervised sessions and 58 home sessions, guided by telephone. After the 12-week period all participants will be recommended to continue practicing physical exercises at home or at a community center, and they will be invited for re-evaluation after 3 months. The outcomes will be evaluated at baseline, and after 3 and 6 months.ResultsParticipants are currently being recruited for the trial. Data collection is anticipated to be completed by October 2019.ConclusionsThis is the first study in Brazil comparing the traditional cardiac rehabilitation approach with a novel, home-based protocol that uses an accessible and low-cost technology. If positive results are obtained, the study will contribute to establish a new and viable model of cardiac rehabilitation.Trial RegistrationClinicalTrials.gov NCT03605992; https://clinicaltrials.gov/ct2/show/NCT03605992International Registered Report Identifier (IRRID)DERR1-10.2196/13901