Home Training Program Research Articles

Application of LSVT BIG Intervention to Address Gait, Balance, Bed Mobility, and Dexterity in People With Parkinson Disease: A Case Series

Lee Silverman Voice Treatment Big (LSVT BIG) is characterized by intensive exercising of high-amplitude movements to overcome bradykinesia and hypokinesia in patients with Parkinson disease (PD). The aim of the present case series was to explore possible beneficial effects of LSVT BIG training on gait, balance, bed mobility, and dexterity. Three patients with mild to moderate PD (all male; aged 52, 54, and 70 years; Hoehn & Yahr stages I-III) completed a 4-week LSVT BIG training program (16 individual 1-hour sessions) and an intensive home training program in accordance with the LSVT BIG protocol. Two certified LSVT BIG physical therapists delivered the LSVT BIG training sessions. The outcome measures for gait and balance included the Functional Gait Assessment (FGA), Functional Reach Test (FRT), Timed "Up & Go" Test (TUG), Freezing of Gait Questionnaire (FOGQ), and motor score on part III of the Unified Parkinson's Disease Rating Scale (UPDRS III). Bed mobility was addressed using the Lindop Parkinson's Disease Mobility Assessment (LPA). The Nine-Hole Peg Test (9HPT) was used to measure dexterity. The 3 patients performed better on balance and gait assessments, as indicated by increased scores on the FRT and FGA (all 3 patients) and decreased scores on the TUG, FOGQ, and UPDRS III, of which scores of the FRT and UPDRS III achieved the minimal detectable change. Furthermore, the patients were quicker in tasks related to bed mobility (LPA). The patients' dexterity skills did not improve for their dominant (right) hand (9HPT). This case series suggests that the LSVT BIG may be beneficial for gait, balance, and bed mobility. Future work is needed to ascertain the effectiveness by means of randomized controlled trials.

Robotic/virtual reality intervention program individualized to meet the specific sensorimotor impairments of an individual patient: a case study.

A majority of studies examining repetitive task practice facilitated by robots for the treatment of upper extremity paresis utilize standardized protocols applied to large groups. This study will describe a virtually simulated, robot-based intervention customized to match the goals and clinical presentation of a gentleman with upper extremity hemiparesis secondary to stroke. MP, the subject of this case, is an 85-year-old man with left hemiparesis secondary to an intracerebral hemorrhage 5 years prior to examination. Outcomes were measured before and after a 1-month period of home therapy and after a 1-month virtually simulated, robotic intervention. The intervention was designed to address specific impairments identified during his PT examination. When necessary, activities were modified based on MP's response to his first week of treatment. MP's home training program produced a 3-s decline in Wolf Motor Function Test (WMFT) time and a 5-s improvement in Jebsen Test of Hand Function (JTHF) time. He demonstrated an additional 35-s improvement in JTHF and an additional 44-s improvement in WMFT subsequent to the robotic training intervention. A 24-h activity measurement and the Hand and Activities of Daily Living scales of the Stroke Impact Scale improved following the robotic intervention. Based on his responses to training we feel that we have established that a customized program of virtually simulated, robotically facilitated rehabilitation was feasible and resulted in larger improvements than an intensive home training program in several measurements of upper extremity function in our patient with chronic hemiparesis.

Assessment of Virtual Reality Robotic Simulation Performance by Urology Resident Trainees

To examine resident performance on the Mimic dV-Trainer (MdVT; Mimic Technologies, Inc., Seattle, WA) for correlation with resident trainee level (postgraduate year [PGY]), console experience (CE), and simulator exposure in their training program to assess for internal bias with the simulator. Residents from programs of the Southeastern Section of the American Urologic Association participated. Each resident was scored on 4 simulator tasks (peg board, camera targeting, energy dissection [ED], and needle targeting) with 3 different outcomes (final score, economy of motion score, and time to complete exercise) measured for each task. These scores were evaluated for association with PGY, CE, and simulator exposure. Robotic skills training laboratory. A total of 27 residents from 14 programs of the Southeastern Section of the American Urologic Association participated. Time to complete the ED exercise was significantly shorter for residents who had logged live robotic console compared with those who had not (p = 0.003). There were no other associations with live robotic console time that approached significance (all p ≥ 0.21). The only measure that was significantly associated with PGY was time to complete ED exercise (p = 0.009). No associations with previous utilization of a robotic simulator in the resident's home training program were statistically significant. The ED exercise on the MdVT is most associated with CE and PGY compared with other exercises. Exposure of trainees to the MdVT in training programs does not appear to alter performance scores compared with trainees who do not have the simulator.

Development of a wheelchair skills home program for older adults using a participatory action design approach.

Restricted mobility is the most common impairment among older adults and a manual wheelchair is often prescribed to address these limitations. However, limited access to rehabilitation services results in older adults typically receiving little or no mobility training when they receive a wheelchair. As an alternative and novel approach, we developed a therapist-monitored wheelchair skills home training program delivered via a computer tablet. To optimize efficacy and adherence, principles of self-efficacy and adult learning theory were foundational in the program design. A participatory action design approach was used to engage older adult wheelchair users, care providers, and prescribing clinicians in an iterative design and development process. A series of prototypes were fabricated and revised, based on feedback from eight stakeholder focus groups, until a final version was ready for evaluation in a clinical trial. Stakeholder contributions affirmed and enhanced the foundational theoretical principles and provided validation of the final product for the target population.

Is home‐based pelvic floor muscle training effective in treatment of urinary incontinence after birth in primiparous women? A randomized controlled trial

To assess the effect of pelvic floor muscle training (PFMT) on pelvic floor muscle strength and urinary incontinence (UI) in primiparous women who underwent a home training program between three and 9 months after delivery. Randomized controlled trial. One hundred primiparous women were consecutively recruited from four different antenatal clinics in the urban area of Stockholm, Sweden. Women with UI who had undergone normal term singleton vaginal delivery, 10-16 weeks postpartum were randomly allocated to either intervention or control group. Maximally voluntary contraction (MVC) and endurance were measured with a perionometer. The Oxford grading scale was used to manually estimate the strength of the pelvic floor muscle and self-reported symptoms of UI was registered through the Bristol Female Lower Urinary Tract Symptoms Module (ICIQ FLUTS) questionnaire. Maximally voluntary contraction of the pelvic floor muscle measured with a perionometer. Maximally voluntary contraction increased significantly in both groups between baseline and follow up (p < 0.05). The median MVC in cmHg for the intervention and control group was 16.2 and 12.1 at baseline and 26.0 and 18.2 at follow up, respectively. The median endurance, in seconds, for the intervention and control group was 9.6 and 12.0 at baseline and 26.7 and 23.4 at follow up, respectively. Pelvic floor muscle strength measured with the Oxford Scale increased significantly in both groups between baseline and follow up (p < 0.05). The results indicate that home-based PFMT is effective. However, written training instructions were as efficient as home-based training with follow up visits every sixth week.

키넥트 센서를 이용한 자기통제 피드백이 가능한 가정용 훈련프로그램 개발

Almost of stroke patients who experience aftereffects such as motor, sensory and cognitive disorders have to take some rehabilitation therapies. It is known that the consistent training for rehabilitation therapy in their home is more effective than rehabilitation therapy in hospital. A few home training programs were developed but these programs don`t give any appropriate feedback messages to the client. Therefore, we developed a home training program which can provide appropriate feedback message to the clients using the Kinect sensor which can analyze user`s 3-D dimensional motion. With this development, the client can obtain some feedback messages such as the knowledges of performance, results and self-controlled feedback. The program will be more effective than any existing programs.

Feasibility of the Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels) program: study protocol for a randomized controlled trial

BackgroundMany older adults rely on a manual wheelchair for mobility but typically receive little, if any, training on how to use their wheelchair effectively and independently. Standardized skill training is an effective intervention, but limited access to clinician trainers is a substantive barrier. Enhancing Participation in the Community by Improving Wheelchair Skills (EPIC Wheels) is a 1-month monitored home training program for improving mobility skills in older novice manual wheelchair users, integrating principles from andragogy and social cognitive theory. The purpose of this study is to determine whether feasibility indicators and primary clinical outcome measures of the EPIC Wheels program are sufficiently robust to justify conducting a subsequent multi-site randomized controlled trial.MethodsA 2 × 2 factorial randomized controlled trial at two sites will compare improvement in wheelchair mobility skills between an EPIC Wheels treatment group and a computer-game control group, with additional wheelchair use introduced as a second factor. A total of 40 community-dwelling manual wheelchair users at least 55 years old and living in two Canadian metropolitan cities (n = 20 × 2) will be recruited. Feasibility indicators related to study process, resources, management, and treatment issues will be collected during data collection and at the end of the study period, and evaluated against proposed criteria. Clinical outcome measures will be collected at baseline (pre-randomization) and post-intervention. The primary clinical outcome measure is wheelchair skill capacity, as determined by the Wheelchair Skills Test, version 4.1. Secondary clinical outcome measures include wheelchair skill safety, satisfaction with performance, wheelchair confidence, life-space mobility, divided-attention, and health-related quality of life.DiscussionThe EPIC Wheels training program offers several innovative features. The convenient, portable, economical, and adaptable tablet-based, home program model for wheelchair skills training has great potential for clinical uptake and opportunity for future enhancements. Theory-driven design can foster learning and adherence for older adults. Establishing the feasibility of the study protocol and estimating effect size for the primary clinical outcome measure will be used to develop a multi-site randomized controlled trial to test the guiding hypotheses.Trial registrationClinical Trials NCT01740635.

Risks associated with antipsychotic drugs

Nursing and Residential CareVol. 14, No. 8 Clinical ReviewRisks associated with antipsychotic drugsSangita PandyaSangita PandyaSearch for more papers by this authorSangita PandyaPublished Online:16 Aug 2013https://doi.org/10.12968/nrec.2012.14.8.400AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Alzheimer's Society (2011) Antipsychotic drugs. http://bit.ly/HS7IRn (accessed 5 July 2012) Google ScholarAlzheimer's Society (2012a) Focused Intervention Training and Support (FITS) http://alzheimers.org.uk/FITS (accessed 3 July 2012) Google ScholarAlzheimer's Society (2012b) Care home training programme aims to reduce antipsychotic prescriptions. http://alzheimers.org.uk/site/scripts/news_article.php?newsID=1238 (accessed 3 July 2012) Google ScholarBanerjee S (2009) The Use of Antipsychotic Medication for People with Dementia: Time for Action. The Stationary Office, London Google ScholarCooper JE (1994) Pocket Guide to the ICD-10 Classification of Mental and Behavioural Disorders with Glossary and Diagnostic Criteria for Research. Elsevier Health Sciences, Philadelphia Google ScholarGelder M, Mayou R, Cowen P (2001) Shorter Oxford Textbook of Psychiatry. 4th edn, Oxford University Press, Oxford Google ScholarJoint Formulary Committee (2010) British National Formulary 59. BMA and RPS Publishing, London Google ScholarJoint Formulary Committee (2012) British National Formulary 63. BMA and RPS Publishing, London Google ScholarNational Collaborating Centre for Mental Health (2007) A NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care National Clinical Practice Guideline Number 42. http://www.nice.org.uk/nicemedia/live/10998/30320/30320.pdf (accessed 5 July 2012) Google ScholarNational Institute for Health and Clinical Excellence (2006) Bipolar disorder The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. Clinical guideline 38. http://bit.ly/MQm0Yr (accessed 3 July 2012) Google ScholarNHS Institute for Innovation and Improvement (2011) An economic evaluation of alternatives to antipsychotic drugs for individuals living with dementia. NHS Institute for Innovation and Improvement, Coventry Google ScholarRang HP, Dale MM, Ritter JM, Moore PK (2003) Pharmacology. 5th edn. Churchill Livingstone, Edinburgh Google ScholarSoanes C (2006) Compact Oxford English Dictionary for Students. Oxford University Press, Oxford Google ScholarTaylor D, Paton C, Kerwin R (2007) The Maudsley Prescribing Guidelines. 9th edn. Informa Healthcare, London Google ScholarWalker R, Whittlesea C (2007) Clinical Pharmacy and Therapeutics. 4th edn. Churchill Livingstone, Edinburgh Google ScholarWalker K (2009) Metabolic Syndrome and Antipsy-chotics. Graylands Hospital Drug Bulletin. 16(2): 1–4 Google ScholarWestbury JL (2009) How community pharmacists can help reduce antipsychotic use in care homes. Pharmaceutical Journal 283(7582): 653–4 Google Scholar FiguresReferencesRelatedDetails 1 August 2012Volume 14Issue 8ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 16 August 2013 Published in print 1 August 2012 Information© MA Healthcare LimitedThe author would like to acknowledge the help of Dr Peter Rivers and Dr Stephen Bennett, Senior Lecturers, DeMontfort University.PDF download

A survey of advance care planning in care homes following the GSF care homes training

Advance Care Planning has been introduced as an integral part of The Gold Standards Framework (GSF) Care Homes Training Programme in end of life care to over 2000 care homes...

Effectiveness of a Multifaceted Cognitive Training Programme for People with Mild Cognitive Impairment: A One-Group Pre- and Posttest Design

Objectives The effectiveness of a cognitive training programme in enhancing the functional abilities of elderly persons with mild cognitive impairments was tested in an integrated home and institutional training programme focused on performing daily tasks. Methods Twenty elderly participants were taught cognitive stimulation and memory encoding strategies for 10 weeks by an occupational therapist, or by nonprofessionals and community caregivers. The programme consisted of attention and memory stimulation, association-based and imagery-based strategies. Functional assessment (Chinese version of the disability assessment for dementia instrument and the instrumental activities of daily living scale) and neuropsychological tests (digit span forward test, word list memory subtest of the neuropsychological test battery developed by the Consortium to Establish a Registry for Alzheimer's Disease, Cognistat) were administered before and after the programme. Results After the 10-week programme the participants showed significant improvements in average attention and memory. The participants showed improved memory (word list memory: p ≤ .001) and other cognitive function as measured by the naming (p ≤ .001), construction (p ≤ .001), memory (p ≤ .001) and similarities (p ≤ .001) subtests of the Cognistat. Conclusion These results provide initial evidence supporting the use of daily tasks as the context in teaching cognitive stimulation and memory encoding strategies to mildly impaired elderly people.

Lateral epicondylalgia: a structured programme better than corticosteroids and NSAID

Aim: To evaluate whether patients with lateral epicondylalgia had less pain or function loss two years following treatment by a structured programme and if the number of recurrent episodes and sick leave days differed compared with a control group. Subjects: All of the patients were diagnosed by a physician with the diagnosis code M77.1 (lateral epicondylitis). The intervention group (n = 103) was treated by a physiotherapist and an occupational therapist with a home training programme that included ergonomic advice. Wrist supports and/or night bandages were also available. Controls (n = 194) were diversely treated by different professionals. Major findings: In the total study group (n = 297), 54% of the patients experienced pain and 55% experienced function loss after two years. The intervention group had less pain than patients treated with corticosteroid injections (p < 0.0001) or NSAIDs (p = 0.048) and experienced better function than those treated with corticosteroid injections (p = 0.002). The intervention group had a lower recurrence (p < 0.0001) and fewer sick leave days at the time of the visit to the health care centre (p = 0.005). Principal conclusions: A structured treatment programme was more effective than corticosteroid injections and NSAIDs. Patients did not require additional treatment or sick leave and had learned self-treatment of the disorder.

‘Improving Advance Care Planning in Care Homes and other settings, as part of the Gold Standards Framework Training Programme

Advance Care Planning (ACP) is a pivotal aspect of the Gold Standards Framework Care Homes Training Programme used by over 2000 care homes (aged care/long term facilities) in England. The...

Implementation of exercise training programs in a hemodialysis unit: effects on physical performance

Exercise training is beneficial for hemodialysis patients, but it should be tailored to individual abilities and willingness to participate. This study evaluated the effects of different 6-month programs of physical activity in 18 patients of a single hemodialysis unit. Before and after a 12-month control period (T0), and following 3 (T3) and 6 (T6) months of training, the patients underwent the 6-minute walk test (6MWT) and constant treadmill test at 3 km/hour speed and 10% grade; spontaneous physical activity was assessed by pedometers. All patients trained for coordination, flexibility and muscular strengthening for 30 minutes within the first 2 hours of hemodialysis sessions: 9 patients underwent home exercise walking training (advised walking group [AWG]); the other 9 patients underwent the advised home training program plus an additional supervised gym training session, twice weekly (supervised walking group [SWG]). In both AWG and SWG, no changes occurred during the control period (232 ± 204 m and 248 ± 187 m at T0). In contrast, endurance performance at treadmill increased at T3 and T6 in the AWG (377 ± 272 m and 615 ± 413 m; p<0.01) and in the SWG (424 ± 272 m and 890 ± 364 m; p<0.001). No unwanted side effects occurred. This study shows that physical exercise programs can safely increase physical performance in hemodialysis patients. The training program should be continued for at least 6 months to increase muscle strength and endurance. Intradialytic exercise and home-based, pedometer-based regimens may be a useful and easy approach, whereas supervised programs can give additional benefits in motivated, selected patients.

Long‐term effects of coordinative training in degenerative cerebellar disease

Few clinical studies have evaluated physiotherapeutic interventions for patients with degenerative cerebellar disease. In particular, evidence for long-term effects and transfer to activities of daily life is rare. We have recently shown that coordinative training leads to short-term improvements in motor performance. To evaluate long-term benefits and translation to real world function, we here assessed motor performance and achievements in activities of daily life 1 year after a 4 week intensive coordinative training, which was followed by a home training program. Effects were assessed by clinical rating scales, a goal attainment score and quantitative movement analysis. Despite gradual decline of motor performance and gradual increase of ataxia symptoms due to progression of disease after 1 year, improvements in motor performance and achievements in activities of daily life persisted. Thus, also in patients with degenerative cerebellar disease, continuous coordinative training leads to long-term improvements, which translate to real world function.

Reducing hospital admissions from care homes

Evidence indicates that the majority of people would like to die at home. However, only about 35% of people achieve that aim. Most deaths in England occur in acute hospitals. With forward planning some admissions of dying people to hospital are avoidable. Staff in care homes and carers in the home setting need to be supported if the dying person is to be managed at the care home or in their own home. Reducing hospital admissions will help people to die in the place of their choice, improve quality of care and be more cost-effective for the NHS. This article will provide an overview of the problems associated with avoidable hospital admissions. It will describe how the Gold Standards Framework in Care Homes training programme can help achieve people’s wish to die in their home environment. It will also provide practical advice for care staff to manage the dying person at home.

The effect of a computerized visual perception and visual-motor integration training program on improving Chinese handwriting of children with handwriting difficulties

This study aimed to investigate the effect of a computerized visual perception and visual-motor integration training program to enhance Chinese handwriting performance among children with learning difficulties, particularly those with handwriting problems. Participants were 26 primary-one children who were assessed by educational psychologists and occupational therapists to have handwriting difficulties. They were matched according to their age and then randomly assigned into either the control group or the experimental group. Subjects in the experimental group (n=13) would receive eight sessions of computerized visual perception and visual-motor integration training together with a home training program while those in the control group (n=13) would only receive conventional handwriting training by teachers, which focused mainly on remedial handwriting exercises. Results from repeated measure ANOVA revealed that children in the experimental group showed improvements in their visual perception skills as well as in their handwriting time. Both the “On Paper” time and “In Air” time of this group were improved when compared to the control group. However, no significant differences were found in visual-motor integration skill and handwriting legibility between the two groups after the intervention. This computerized training program focusing on visual perception and visual-motor integration training appeared to be effective in enhancing the handwriting time among children with handwriting difficulties. However, the training program did not seem to improve the legibility of children.

Patient information and results of training program in the treatment of plantar fasciitis

The plantar fasciitis is one of the most common causes of heel pain. Several non invasive treatment options exist, but they are often inefficient, followed by steroid infiltration or operative treatment. A complex home-training program handout was developed for our patients. We would evaluate the effect of the training compared with our previous conservative treatment. The training program contains illustrated Achilles and plantar fascia stretching, special massage and cryotherapy and footwear tips. The patients were divided three groups with different treatment strategy. After six weeks, increased ankle and foot range of motions were noted in the training group compared with the iontophoresis group. Lower pain and complaints rate were observed, as well, in the group with the training. Our home-training program is effective and useful for the orthopedic and general practice. Invasive treatment is not allowed in plantar fasciitis before a long-term fair conservative treatment.

Low-Energy Extracorporeal Shock Wave Therapy as a Treatment for Medial Tibial Stress Syndrome

Background Medial tibial stress syndrome (MTSS) is a pain syndrome along the tibial origin of the tibialis posterior or soleus muscle. Extracorporeal shock wave therapy (SWT) is effective in numerous types of insertional pain syndromes. Hypothesis Shock wave therapy is an effective treatment for chronic MTSS. Study Design Cohort study; Level of evidence, 3. Methods Forty-seven consecutive subjects with chronic recalcitrant MTSS underwent a standardized home training program, and received repetitive low-energy radial SWT (2000 shocks; 2.5 bars of pressure, which is equal to 0.1 mJ/mm2; total energy flux density, 200 mJ/mm2; no local anesthesia) (treatment group). Forty-seven subjects with chronic recalcitrant MTSS were not treated with SWT, but underwent a standardized home training program only (control group). Evaluation was by change in numeric rating scale. Degree of recovery was measured on a 6-point Likert scale (subjects with a rating of completely recovered or much improved were rated as treatment success). Results One month, 4 months, and 15 months from baseline, success rates for the control and treatment groups according to the Likert scale were 13% and 30% (P < .001), 30% and 64% (P < .001), and 37% and 76% (P < .001), respectively. One month, 4 months, and 15 months from baseline, the mean numeric rating scale for the control and treatment groups were 7.3 and 5.8 (P < .001), 6.9 and 3.8 (P < .001), and 5.3 and 2.7 (P < .001), respectively. At 15 months from baseline, 40 of the 47 subjects in the treatment group had been able to return to their preferred sport at their preinjury level, as had 22 of the 47 control subjects. Conclusion Radial SWT as applied was an effective treatment for MTSS.

The Comparative Effectiveness of a Multimodal Program Versus Exercise Alone for the Secondary Prevention of Chronic Low Back Pain and Disability

The objective of this study was to examine whether a multimodal, secondary prevention program (MP) is superior to a general physical exercise program (EP) in influencing the process leading to chronic low back pain (LBP) in nurses with a history of back pain. The study was conducted as a randomized controlled parallel-group trial. The interventions were performed in a single center at the Department of Physical and Rehabilitation Medicine at the University of Munich in Germany. A total of 235 nurses from 14 nearby hospitals and nursing homes who experienced at least one episode of back pain during the previous 2 years were invited into the study. Of these, 183 nurses were enrolled and 169 (83 in the MP and 86 in the EP) qualified for the intent-to-treat analysis. The EP consisted of 11 group sessions, each lasting 1 hour. After introductory sessions, subsequent sessions included general physical strengthening and stretching exercises as well as instructions for a home-training program. The MP consisted of 17 group sessions of 1.75 hours and one individual session of 45 minutes. In addition to the full EP, the MP included 5 psychological units, 7 segmental stabilization exercises units, and 8 ergonomic and workplace-specific units. The primary study end-point variable was pain interference, and the secondary study end-point variables were pain intensity and functioning as measured with the West Haven-Yale Multidimensional Pain Inventory and the Short Form-36, respectively. These study end-point variables were defined a priori. There was no statistically significant difference between the 2 groups. Small-to-moderate effects were observed in both intervention programs across all study end-point variables. For pain interference, the effect size at 12 months after intervention was 0.58 in the MP and 0.47 in the EP. A multimodal program is not superior to a general exercise program in influencing the process leading to chronic LBP in a population of nurses with a history of pain. The most likely explanation is a common psychological mechanism leading to improved pain interference that is irrespective of the program used. Considering the lower resources of the general exercise program, the expense for a multimodal program is not justified for the secondary prevention of LBP and disability.

Advance care planning and communication in care homes

The Gold Standards Framework Care Homes (GSFCH) training and accreditation programme is one of the biggest, most comprehensive programmes ever undertaken to enhance end-of-life care in care homes. The programme has been running for almost 6 years and approximately 1000 homes have participated in it. The training programme is based on the GSF’s seven key tasks: communication; coordination; control of systems; continuity out of hours; continued learning; carer support; and care in the dying phase. This article will focus on the first aspect, i.e. communication, and provide an overview of the importance of communication in advance care planning .