Recommendations For Rehabilitation Research Articles

STRATEGIES TO MITIGATE THE IMPACT OF POST-COVID-19 SYNDROME ON HIGHER EDUCATION QUALITY

The SARS-CoV-2 pandemic has left a profound impact not only on the physical health of humanity but also on neurological, social, and ecological well-being. Neurological and psychological disorders resulting from the pandemic have negatively affected the quality of learning and significantly worsened learning outcomes among students in higher education institutions. The purpose of this study is to compare the prevalence and evaluate the symptoms of post-COVID syndrome, and to identify their impact on the quality of education among senior students in two higher educational institutions: Poltava State Medical University and Poltava National Pedagogical University named after V.G. Korolenko. It has been observed that damage to the nervous system and the simultaneous appearance of a combination of symptoms including headache, memory impairment, insomnia, anxiety, unmotivated weakness, and excessive fatigue are significantly high among students of both universities. The aforementioned complaints, along with the need for increased time to complete educational tasks post-illness, memory impairment, and sleep disturbances, indicate that the academic performance, psychological state, and psychosomatic background of students are at a low level. Therefore, it is essential to develop recommendations for cognitive rehabilitation tailored to this group of students, considering their significant educational workload (samples were collected from senior students). Moreover, the low and moderate physical activity levels of senior students in higher education may exacerbate symptoms of post-COVID-19 syndrome, necessitating the development of recommendations for physical rehabilitation. Students experiencing weakness, increased fatigue, reduced work capacity, sleep disturbances, and mood instability should consider reviewing the organization of the educational process, especially in distance learning conditions, and making lifestyle changes accordingly. Therefore, thoroughly elaborated healthcare recommendations and rehabilitation measures to enhance the quality of the educational process should be implemented into healthcare practice.

Surgical strategy and complication management of osteotomy around the painful degenerative varus knee: ESSKA Formal Consensus Part II.

The purpose of the European consensus was to provide recommendations for the treatment of patients with a painful degenerative varus knee using a joint preservation approach. Part II focused on surgery, rehabilitation and complications after tibial or femoral correction osteotomy. Ninety-four orthopaedic surgeons from 24 countries across Europe were involved in the consensus, which focused on osteotomies around the knee. The consensus was performed according to the European Society for Sports Traumatology, Knee Surgery and Arthroscopy consensus methodology. The steering group designed the questions and prepared the statements based on the experience of the experts and the evidence of the literature. The statements were evaluated by the ratings of thepeer-review groups before a final consensus was released. The ideal hinge position for medial opening wedge high tibial osteotomy (MOW HTO) should be at the upper level of the proximal tibiofibular joint, and for lateral closing wedge distal femoral osteotomy (LCW DFO) just above the medial femoral condyle. Hinge protection is not mandatory. Biplanar osteotomy cuts provide more stability and quicker bony union for both MOW HTO and LCW DFO and are especially recommended for the latter. Osteotomy gap filling is not mandatory, unless structural augmentation for stabilityis required. Patient-specific instrumentation should be reserved for complex cases by experienced hands. Early full weight-bearing can be adopted after osteotomy, regardless of the technique. However, extra caution should be exercised in DFO patients. Osteotomy patients should return to sports within 6 months. Clear recommendations for surgical strategy, rehabilitation and complications of knee osteotomies for the painful degenerative varus kneewere demonstrated. In Part 2of the consensus, high levels of agreement were reached by experts throughout Europe, under variable working conditions. Where science islimited, the collated expertise of the collaborators aimed at providing guidance for orthopaedic surgeons developing an interest in the fieldand highlighting areas for potential future research. Level II, consensus.

Social Determinants of Health and Health Equity in the Treatment and Rehabilitation of Sport-Related Concussion: A Content Analysis of Intervention Research and Call-To-Action.

This review was designed to (i) determine the extent to which the clinical science on sport-related concussion treatment and rehabilitation has considered social determinants of health (SDoH) or health equity and (ii) offer recommendations to enhance the incorporation of SDoH and health equity in concussion treatment research and clinical care. The Concussion in Sport Group consensus statement (2023) was informed by two systematic reviews examining prescribed rest or exercise following concussion and targeted interventions to facilitate concussion recovery. We examined 31 studies, including 2,698 participants, from those two reviews. Race (k=6; 19.4%) and ethnicity (k=4; 12.9%) were usually not reported. Four studies examined ethnicity (i.e., Hispanic), exclusively as a demographic category. Five studies (16.1%) examined race as a demographic category. Three studies (9.7%) examined socioeconomic status (SES; measured as household income) as a demographic category/sample descriptor and one study (3.2%) examined SES in depth, by testing whether the treatment and control groups differed by SES. Five studies examined a SDoH domain in a descriptive manner and four studies in an inferential/intentional manner. No study mentioned SDoH, health equity, or disparities by name. Many studies (61.3%) excluded participants based on demographic, sociocultural, or health factors, primarily due to language proficiency. The new consensus statement includes recommendations for concussion treatment and rehabilitation that rely on an evidence base that has not included SDoH or studies addressing health equity. Researchers are encouraged to design treatment and rehabilitation studies that focus specifically on under-represented groups to determine if they have specific and unique treatment and rehabilitation needs, whether certain practical modifications to treatment protocols might be necessary, and whether completion rates and treatment adherence and response are similar.

An initiative to implement a triage and referral system to make exercise and rehabilitation referrals standard of care in oncology

BackgroundClinical guidelines suggest that patients should be referred to exercise while undergoing cancer treatment. Oncology clinicians report being supportive of exercise referrals but not having the time to make referrals. Toward the goal of making exercise referrals standard of care, we implemented and evaluated a novel clinical workflow.MethodsFor this QI project, a rehabilitation navigator was inserted in chemotherapy infusion clinics. Patients were offered a validated electronic triage survey. Exercise or rehabilitation recommendations were communicated to patients during a brief counseling visit by the rehabilitation navigator. The implementation approach was guided by the EPIS framework. Acceptability and feasibility were assessed.ResultsInitial meetings with nursing and cancer center leadership ensured buy-in (exploration). The education of medical assistants contributed to the adoption of the triage process (preparation). Audit and feedback ensured leadership was aware of medical assistants’ performance (implementation). 100% of medical assistants participated in implementing the triage tool. A total of 587 patients visited the infusion clinics during the 6-month period when this QI project was conducted. Of these, 501 (85.3%) were offered the triage survey and 391 (78%) completed the survey (acceptability). A total of 176 (45%) of triaged patients accepted a referral to exercise or rehabilitation interventions (feasibility).ConclusionsImplementation of a validated triage tool by medical assistants and brief counseling by a rehabilitation navigator resulted in 45% of infusion patients accepting a referral to exercise or rehabilitation. The triage process showed promise for making exercise referrals standard of care for patients undergoing cancer treatment.

Lessons of the global COVID-19 pandemic in relation to the quality of education

The global COVID-19 pandemic has had a profound impact on humanity, affecting not only physical health but also neurological, social, and ecological well-being. Neurological and psychological disorders can negatively impact learning quality and significantly worsen learning outcomes for higher education students. The aim of this study is to compare the prevalence and evaluate the symptoms of post-COVID-19 syndrome among senior students in two higher educational institutions, Poltava State Medical University and Poltava National Pedagogical University named after V.G. Korolenko. The impact of these symptoms on the quality of education will also be assessed through analysis of the author's questionnaire. Rehabilitation measures will be recommended to improve quality of educational process. It has been determined that there is a high level of damage to the nervous system among students from both universities, which is accompanied by a combination of symptoms including headache, memory impairment, insomnia, anxiety, unmotivated weakness, and excessive fatigue. The aforementioned complaints and the need to increase time for completing educational tasks after illness, along with memory impairment and sleep disturbances, suggest that the academic performance, psychological state, and psychosomatic background of students are at a low level. Therefore, recommendations for cognitive rehabilitation of this category of applicants are necessary, taking into account their significant educational load. The samples were made by senior year students. Physical activity levels among senior higher education students may exacerbate post-COVID-19 syndrome symptoms. Recommendations for the physical rehabilitation of this patient group are necessary. Applicants experiencing weakness, increased fatigue, reduced work capacity, sleep disturbances, and mood instability should review the organization of the educational process in distance learning conditions and make changes to their lifestyle. Keywords: students of higher education institutions, post-COVID-19 syndrome, long COVID-19, trucker syndrome.

Comparative global analysis of stroke rehabilitation recommendations across income levels

ObjectiveSuccessful implementation of stroke rehabilitation guidelines demands high-quality practice standards tailored to targeted sociodemographic contexts. The primary objective is to determine the quality differences in post-stroke rehabilitation practice guidelines (PGs), when comparing high-income countries (HIC) and low or middle-income countries (LMIC). Study Design and SettingWe conducted a scoping review of PGs in English or Spanish, published between 2012 and 2021, and providing recommendations on post-stroke rehabilitation. We used Search engines, databases, guideline libraries, gray literature, and references from previous reviews on post-stroke rehabilitation as sources of evidence. Quality assessment of PGs was performed using 6P’s, ELSE, IOM, and AGREE II instruments. We evaluated each item using a scale between 0 to 3, based on the confidence of adherence to the standard. For AGREE II, we followed the instruction manual for scoring. At least two reviewers were independently involved in every step of the process. A cloud-based spreadsheet was used to chart data. We compared the results of PGs originating from HIC with those from LMIC. ResultsThe inclusion criteria were met by 35 documents, which were subjected to evaluation. The study included 21 documents from HIC and 14 from middle-income countries (MIC). No manuscripts from low-income countries were available for inclusion in the study. The quality of PGs from MIC was found to be lower, in terms of methodological rigor and adherence to international recommendations for guidelines development. PGs from both groups of countries failed to include all target audiences and stakeholders (according to the 6P’s criteria) and integration of ethical, legal, social, and economic considerations. ConclusionThere are gaps in the quality and availability of stroke rehabilitation guidelines worldwide, especially in LMIC. Designing and providing financial support for the implementation of high-quality guidelines will contribute to more effective implementation strategies in stroke rehabilitation programs and lead to improved patient outcomes.

Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction: A Practical Review with Medical Recommendations.

Returning to sport after anterior cruciate ligament reconstruction (ACLR) can be a challenging and complex process for the athlete, with the rate of return to the pre-injury level of sport observed to be less than athlete expectations. Of the athletes that do return to sport (RTS), knee re-injury rates remain high, and multiple studies have observed impaired athletic performance upon RTS after ACLR as well as reduced playing time, productivity, and career lengths. To mitigate re-injury and improve RTS outcomes, multiple RTS after ACLR consensus statements/clinical practice guidelines have recommended objective RTS testing criteria to be met prior to medical clearance for unrestricted sports participation. While the achievement of RTS testing criteria can improve RTS rates after ACLR, current criteria do not appear valid for predicting safe RTS. Therefore, there is a need to review the various factors related to the successful return to the pre-injury level of sport after ACLR, clarify the utility of objective performance testing and RTS criteria, further discuss safe RTS decision-making as well as present strategies to reduce the risk of ACL injury/re-injury upon RTS. This article provides a practical review of the current RTS after ACLR literature, as well as makes medical recommendations for rehabilitation and RTS decision-making after ACLR.

Effect of Adding a Program of Contextualized, Personalized, Remote Physical Activity Support to Conventional Cardiac Rehabilitation.

The objective of this investigation was to conduct a randomized controlled trial to evaluate whether KiActiv Heart alongside usual care (UC) promotes positive physical activity (PA) change versus UC alone. Patients in cardiac rehabilitation (n = 130) undertook an 8-wk intervention with follow-up at wk 8. Both groups attended UC and wore a PA monitor during the intervention. The intervention group accessed the digital service and received weekly one-to-one remote mentor sessions. The primary outcome was change in PA to achieve the Association of Certified Physiotherapists in Cardiac Rehabilitation (ACPICR) recommendations. The secondary outcome was cardiorespiratory fitness (CRF) change, measured using incremental shuttle walk test (ISWT). The probability of meeting ACPICR "Daily Activity" recommendation was statistically significantly greater in the intervention group versus control at wk 8 ( P < .05). No statistically significant differences between groups were found for mean ISWT change (intervention 89 ± 116 m; control 44 ± 124 m). Participation in KiActiv Heart alongside UC was associated with statistically significant improvement in probability of meeting ACPICR recommendation and non-statistically significant but potentially clinically important increases in CRF versus UC alone. This builds on existing evidence for effectiveness.

The knowns and unknowns of long COVID-19: from mechanisms to therapeutical approaches.

The coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has been defined as the greatest global health and socioeconomic crisis of modern times. While most people recover after being infected with the virus, a significant proportion of them continue to experience health issues weeks, months and even years after acute infection with SARS-CoV-2. This persistence of clinical symptoms in infected individuals for at least three months after the onset of the disease or the emergence of new symptoms lasting more than two months, without any other explanation and alternative diagnosis have been named long COVID, long-haul COVID, post-COVID-19 conditions, chronic COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Long COVID has been characterized as a constellation of symptoms and disorders that vary widely in their manifestations. Further, the mechanisms underlying long COVID are not fully understood, which hamper efficient treatment options. This review describes predictors and the most common symptoms related to long COVID's effects on the central and peripheral nervous system and other organs and tissues. Furthermore, the transcriptional markers, molecular signaling pathways and risk factors for long COVID, such as sex, age, pre-existing condition, hospitalization during acute phase of COVID-19, vaccination, and lifestyle are presented. Finally, recommendations for patient rehabilitation and disease management, as well as alternative therapeutical approaches to long COVID sequelae are discussed. Understanding the complexity of this disease, its symptoms across multiple organ systems and overlapping pathologies and its possible mechanisms are paramount in developing diagnostic tools and treatments.

Evidence-based recommendations for the rehabilitation and management of the ageing population with spinal cord injury: a systematic review of clinical practice guidelines.

The intersection of ageing and spinal cord injury (SCI) is of global concern. Two scenarios have been described: 1) "SCI with ageing," an increase in the average age of SCI onset, and 2) "ageing with SCI," an increase in post-injury life expectancy. These scenarios entail complex health care and rehabilitation needs due to the accumulation of comorbidities, ageing-related and SCI-induced physiological changes, and post-SCI secondary health conditions. We systematically reviewed Clinical Practice Guidelines (CPGs) with the objective of identifying the extent to which SCI CPGs include recommendations for the rehabilitation and management of people who are "ageing with SCI" or who have acquired an "SCI with ageing". We termed these as "ageing-related recommendations". We also aimed to describe them and identify gaps. We searched PubMed (NCBI), CINAHL Complete (EBSCOhost) and Embase (Elsevier) for relevant CPGs between 28 December 2022 and 5 January 2023. Included CPGs were evidence-based and had at least one ageing-related recommendation for SCI rehabilitation and management. We used the two core sets of the International Classification of Functioning, Disability and Health (ICF) to identify gaps. Only 16 (30%) of the 52 identified CPGs included ageing-related recommendations. Most were recent US or European publications and lacked specific chapters on ageing. These CPGs included 40 ageing-related recommendations, mostly "strong" but based on "low" to "very low" quality of evidence. The overall quality of the development process was low and did not consider the values and preferences of stakeholders and patients. Common topics included cardiovascular, bone, metabolic, bowel, bladder, and skin health. The recommendations could be linked to 30 ICF categories which represented only 18% of the ICF categories included in the comprehensive versions of two ICF Core Sets. Key gaps were found in mobility, interpersonal interactions, and relationships, neuromusculoskeletal and movement-related, mental, sensory and pain functions. There is a notable lack of high-quality ageing-related recommendations for SCI management and rehabilitation. Future research should prioritize the generation of high-quality evidence to develop age-sensitive CPGs. Future SCI CPGs need to address the complex challenges at the interface of ageing and SCI, considering patient and stakeholder preferences.

Effects of training length on adaptation to noise-vocoded speech.

Listeners show rapid perceptual learning of acoustically degraded speech, though the amount of exposure required to maximize speech adaptation is unspecified. The current work used a single-session design to examine the length of auditory training on perceptual learning for normal hearing listeners exposed to eight-channel noise-vocoded speech. Participants completed short, medium, or long training using a two-alternative forced choice sentence identification task with feedback. To assess learning and generalization, a 40-trial pre-test and post-test transcription task was administered using trained and novel sentences. Training results showed all groups performed near ceiling with no reliable differences. For test data, we evaluated changes in transcription accuracy using separate linear mixed models for trained or novel sentences. In both models, we observed a significant improvement in transcription at post-test relative to pre-test. Critically, the three training groups did not differ in the magnitude of improvement following training. Subsequent Bayes factors analysis evaluating the test by group interaction provided strong evidence in support of the null hypothesis. For these stimuli and procedure, results suggest increased training does not necessarily maximize learning outcomes; both passive and trained experience likely supported adaptation. Findings may contribute to rehabilitation recommendations for listeners adapting to degraded speech signals.

Clinical cases and recommendations for post-traumatic rehabilitation based on EI

Clinical cases and recommendations for post-traumatic rehabilitation based on EI

High variability among surgeons in evaluation, treatment, and rehabilitation of medial ulnar collateral ligament injuries

BackgroundThe incidence of elbow medial ulnar collateral ligament (MUCL) injuries has been increasing, leading to advances in surgical treatments. However, it is not clear that there is consensus among surgeons regarding diagnostic imaging, the indications for acute surgery and postoperative rehabilitation. Hypothesis/PurposeThe purpose of this study is evaluate surgeon variability in the presurgical, surgical, and postsurgical treatment of MUCL injuries regarding the imaging modalities used for diagnosis, indications for acute surgical treatment, and postoperative treatment recommendations for rehabilitation and return to play. Our hypothesis is that indications for acute surgical treatment will be highly variable based on MUCL tear patterns and that agreement on the time to return to play will be consistent for throwing athletes and inconsistent for non-throwing athletes. MethodsA survey developed by six orthopedic surgeon with expertise in throwing athlete elbow injuries was distributed to 31 orthopedic surgeons who routinely treat MUCL injuries. The survey evaluated diagnostic and treatment topics related to MUCL injuries, and responses reaching 75% agreement were considered as high-level agreement. ResultsTwenty-four surgeons responded to the survey, resulting in a 77% response rate. There is 75% or better agreement among surveyed surgeons regarding acute surgical treatment for distal full thickness tears, ulnar nerve transposition in symptomatic patients or with ulnar nerve subluxation, postoperative splinting for 1-2 weeks with initiation of rehabilitation within 2 weeks, the use of bracing after surgery and the initiation of a throwing program at 3 months after MUCL repair with internal brace by surgeons performing 20 or more MUCL surgeries per year. There were a considerable number of survey topics without high-level agreement, particularly regarding the indications for acute surgical treatment, the time to return to throwing and time return to play in both throwing and non-throwing athletes. ConclusionThe study reveals that there is agreement for the indication of acute surgical treatment of distal MUCL tears, duration of bracing after surgery, and the time to initiate physical therapy after surgery. There is not clear agreement on indications for surgical treatment for every MUCL tear pattern, return to play time for throwing, hitting and participation in non-throwing sports.

An Evidence Map of Clinical Practice Guideline Recommendations on Stroke Rehabilitation.

The purpose of this study was to provide an evidence map for explaining research trends and gaps. Four databases and CPGs-related websites were searched up to March 2022. Basic information, methodological quality, reporting quality of CPGs, and similar stroke recommendations were extracted. The methodological and reporting quality of stroke CPGs were evaluated using the AGREE II instrument and the RIGHT checklist. The bubble plot format of the evidence map helped visualize the overall quality. Data management and analysis were performed using Excel 2013 and SPSS 22.0 software. A total of 12 CPGs, published between 1997 and 2020 were included for in-depth analysis. The identified CPGs had a mixed quality and scored poorly in the developmental rigor and applicability domains by AGREE II. According to the RIGHT checklist, field four (clarity of expression) showed the highest (79.2%), and field three (rigor of formulation) secured the lowest (28%) reporting rates. The stroke rehabilitation recommendations primarily focused on organizational management, timing and intensity, rehabilitation and nutritional management of dysphagia, return to work, communication, speech, and language function. This would promote improvement in developing trustworthy CPGs for stroke rehabilitation.

Evidence and Recommendations for Acute Stroke Rehabilitation from the Japan Stroke Society: Abridged Secondary Publication of the Japanese-language Version.

In Japan, acute stroke rehabilitation has been expanding more steadily than previously with the nationwide establishment of primary stroke centers. However, Japan previously had no established guidelines for the rehabilitation. Consequently, rehabilitation programs and the provision systems for acute stroke varied among the facilities. To equalize and standardize acute stroke rehabilitation in Japan, it is necessary to develop clinical recommendations for rehabilitation. Therefore, the rehabilitation project team of the Japan Stroke Society aimed to develop the first recommendations for acute stroke rehabilitation in Japan. The recommendations are based on the results of a survey on the current status of acute stroke rehabilitation at primary stroke centers in Japan, which was completed in 2022, and on a literature review conducted by the rehabilitation project team. The recommendations consist of 19 clinical questions regarding the following topics of acute stroke rehabilitation: (1) head elevation and mobilization training, (2) acute complications, (3) training time and frequency for acute stroke rehabilitation, (4) dysphagia in the acute phase, and (5) acute rehabilitation during pandemics of novel and re-emerging infections, particularly novel coronavirus disease 2019 (COVID-19). The team members agreed on all answers for these 19 clinical questions. These recommendations suggest broad principles of rehabilitative intervention in the acute phase of stroke. In the near future, it is expected that the dissemination of these recommendations will result in an increase in the quality of acute stroke rehabilitation in Japan.

The Role of Artificial Intelligence in Physical Education and Sports: A Review of Current Applications and Future Potential

Artificial Intelligence (AI) has emerged as a groundbreaking technology with great potential to transform various industries, and the realm of physical education and sports is no exception. This research paper aims to explore the role of AI in enhancing performance and personalization in physical education and sports activities. The paper will provide an overview of AI technologies and their applications in this field, highlighting key advancements and their impact on athletes, coaches, and trainers. The use of AI in physical education and sports offers numerous benefits. AI-powered sensors and wearables can provide real-time feedback on biomechanics, technique, and performance, allowing athletes to identify and correct weaknesses. Machine learning algorithms can analyze vast amounts of data, enabling coaches to design personalized training programs tailored to each athlete’s unique characteristics and needs. AI also facilitates the development of virtual coaching platforms and simulators, providing athletes with immersive and dynamic training experiences. Additionally, AI can assist in injury prevention and management. Intelligent systems can assess an athlete’s physical condition, track fatigue levels, and provide recommendations for recovery and injury rehabilitation. Furthermore, AI can analyze historical data to predict potential injuries or evaluate an athlete’s readiness to return to competition. This proactive approach to injury prevention can significantly reduce the risk and impact of sport-related injuries. However, the implementation of AI in physical education and sports comes with challenges and ethical considerations. Privacy and security issues arise with the collection and analysis of athletes’ personal data. Moreover, the reliance on AI can lead to a lack of human connection and intuition in coaching relationships. These concerns need to be addressed to ensure the responsible and effective use of AI in this context. Overall, this research paper presents a comprehensive analysis of the role of AI in physical education and sports. By leveraging AI technologies, athletes can optimize their performance, trainers can provide personalized coaching, and the overall sports ecosystem can be enhanced. Future research will delve into the practical implications, implementation strategies, and potential ethical implications involved in incorporating AI into physical education and sports.

INFLUENCE OF PHYSICAL THERAPY REHABILITATION ON FUNCTIONAL RECOVERY OF OLDER PEOPLE AFTER COVID-19

Abstract Retrospective cohort conducted through an online survey sent to older people (≥60 years) of both sexes, with confirmed diagnosis of Covid-19 registered in the Municipal Health Department of Sao Paulo, Brazil. Individuals with cognitive limitations and those who refused to participate were excluded. Functional capacity was assessed using Katz and Lawton Indices for pre-Covid, immediate post-Covid, and current time points, and characteristics of post-Covid physiotherapeutic rehabilitation were collected. Statistical analysis was performed using JASP-0.17.3 software, and group comparisons were made using repeated measures ANOVA, considering alpha=0.05. From March to August 2023, 86 individuals participated, with median age of 66.5 [62.3-71.0] and 57.0% (n=49) male. Among them, 39.5% (n=34) received recommendations for physiotherapeutic rehabilitation and 88.2% (n=30) of them were rehabilitated, while 11.8% (n=4) did not receive treatment. Older people with recommendation for physiotherapy post-Covid-19 demonstrated worse functional status (p&amp;lt; 0.001). Older people who received treatment were functionally equivalent to those who did not attend physiotherapy rehabilitation (p=1.000 for Katz Index and p=0.812 for Lawton Index). The primary indication for post-Covid-19 physiotherapy was muscular fatigue (70.0%, n=21), and domiciliary care was the predominant modality received (46.7%, n=14). Older people who were recommended for physiotherapy showed worse functional status after Covid-19, but there was no difference in long-term functional capacity. This suggests the potential importance of physiotherapeutic rehabilitation for functional recovery after Covid-19.

Compensatory versus Rehabilitative Dysphagia Management Approaches are More Frequently Recommended in Hospitalized Persons with Alzheimer’s Disease and Related Dementias

AbstractBackgroundPersons with Alzheimer’s disease and Related Dementias (AD/ADRD) frequently develop difficulty swallowing (dysphagia). Two general categories of dysphagia management approaches are initiated by Speech‐Language Pathologists (SLP): compensatory (e.g., modifying fluid/food characteristics) and rehabilitative (exercise‐based). While compensations may improve swallowing safety (no airway invasion) and efficiency (no residue) in the short term, they do not actively target swallowing muscles (e.g. rehabilitative approaches) to induce lasting change in physiology. Additionally, compensatory recommendations are often based on clinical examinations (Desai, 2020) that do not permit visualization of swallowing possible with instrumental assessment (e.g. videofluoroscopic swallow study, ‘VFS’) which may lead to recommendations that are misaligned with swallowing physiology. This study aimed to elucidate whether the frequency of compensatory versus rehabilitative recommendations differs based on VFS findings. Specifically, we sought to characterize: 1) dysphagia management recommendations and 2) VFS findings contributing to these recommendations in a cohort of hospitalized patients with AD/ADRD.MethodThe retrospective sample included all inpatients (n = 122) with AD/ADRD (≥50 years) referred for a VFS at an academic hospital in 2014. AD/ADRD was determined by a diagnosis in the EHR and/or if the patient was taking medication(s) prescribed for AD/ADRD. Dysphagia management recommendations and VFS outcomes including swallowing safety (Penetration‐Aspiration Scale (Rosenbek, 1995) ‘PAS’ scores), efficiency (oropharyngeal residue), and biomechanical impairments (as identified by the SLP) were abstracted from the EHR. The absence (PAS scores 1,2, or 4) or presence (PAS scores 3,5,6, 7, or 8) of airway invasion was further classified (Steele, 2017). Descriptive statistics were calculated to analyze the data.ResultAll recommendations were compensatory with no rehabilitative treatments offered (Table 1). Across recommendations, pharyngeal phase impairments (e.g., pharyngeal delay) and inefficiency (e.g., vallecular residue) on VFS were more common than oral phase impairments/inefficiency. While relatively infrequent, airway invasion was most observed in the pill, solid, and liquid modification groups (Table 2).ConclusionIn this cohort, all dysphagia treatment recommendations were compensatory approaches focused on optimizing swallowing safety and efficiency. While these recommendations were aligned with VFS findings reflecting pharyngeal phase impairments/inefficiency, they highlight a missed opportunity to address swallowing impairments by directly targeting underlying physiology with a rehabilitative approach.

Neurovisual rehabilitation in multiple sclerosis: Why a close integration of low-vision rehabilitation and neuropsychological rehabilitation may be effective for visual complaints

Objective The quality of life of people with multiple sclerosis (MS) is often affected by visual complaints. A previous study suggested that visual complaints are not likely to be related to specific visual functions, but by a global decline of cognitive and visual functioning. In this study, we further explore this hypothesis, by investigating the relation between visual functions and global cognitive functioning, aiming to provide recommendations for rehabilitation for visual complaints. Design Cross-sectional study. Setting A rehabilitation centre for partially sighted and blind people and a MS centre at a university hospital. Participants 102 people with MS. Main measure Correlations between assessments of visual functions (acuity, contrast sensitivity, visual field, smooth pursuit and saccades) and composite scores of a neuropsychological assessment (tests with a visual component and without a visual component). Results All composite scores correlated with visual acuity, contrast sensitivity and the sensitivity of the monocular field, but not with smooth pursuit and saccades. Similar patterns were found in various subgroups. Results showed that visual functions that related to visual complaints correlated with a diffuse decline of global cognitive functioning and that visual and cognitive functioning may decline concurrently in people with MS. Conclusions Visual complaints may occur as a result of a diffuse decline of the integrity of a cerebral network involved in vision and cognition. People with MS with visual complaints may benefit from neurovisual rehabilitation, in which low-vision rehabilitation and neuropsychological rehabilitation are closely intertwined.

20 Examining the Recovery Course of Pediatric Concussion Patients with Protracted Recovery Referred to a Specialty Concussion Clinic

Objective:The purpose of this study was to explore overall recovery time and post-concussive symptoms (PCSS) of pediatric concussion patients who were referred to a specialty concussion clinic after enduring a protracted recovery (&gt;28 days). This included patients who self-deferred care or received management from another provider until recovery became complicated. It was hypothesized that protracted recovery patients, who initiated care within a specialty concussion clinic, would have similar recovery outcomes as typical acute injury concussion patients (i.e., within 3 weeks).Participants and Methods:Retrospective data were gathered from electronic medical records of concussion patients aged 6-19 years. Demographic data were examined based on age, gender, race, concussion history, and comorbid psychiatric diagnosis. Concussion injury data included days from injury to initial clinic visit, total visits, PCSS scores, days from injury to recovery, and days from initiating care with a specialty clinic to recovery. All participants were provided standard return-to-learn and return-to-play protocols, aerobic exercise recommendations, behavioral health recommendations, personalized vestibular/ocular motor rehabilitation exercises, and psychoeducation on the expected recovery trajectory of concussion.Results:52 patients were included in this exploratory analysis (Mean age 14.6, SD ±2.7; 57.7% female; 55.7% White, 21.2% Black or African American, 21.2% Hispanic). Two percent of our sample did not disclose their race or ethnicity. Prior concussion history was present in 36.5% of patients and 23.1% had a comorbid psychiatric diagnosis. The patient referral distribution included emergency departments (36%), local pediatricians (26%), neurologists (10%), other concussion clinics (4%), and self-referrals (24%).Given the nature of our specialty concussion clinic sample, the data was not normally distributed and more likely to be skewed by outliers. As such, the median value and interquartile range were used to describe the results. Regarding recovery variables, the median days to clinic from initial injury was 50.0 (IQR=33.5-75.5) days, the median PCSS score at initial visit was 26.0 (IQR=10.0-53.0), and the median overall recovery time was 81.0 (IQR=57.0-143.3) days.After initiating care within our specialty concussion clinic, the median recovery time was 21.0 (IQR=14.0-58.0) additional days, the median total visits were 2.0 (IQR=2.0-3.0), and the median PCSS score at follow-up visit was 7.0 (IQR=1-17.3).Conclusions:Research has shown that early referral to specialty concussion clinics may reduce recovery time and the risk of protracted recovery. Our results extend these findings to suggest that patients with protracted recovery returned to baseline similarly to those with an acute concussion injury after initiating specialty clinic care. This may be due to the vast number of resources within specialty concussion clinics including tailored return-to-learn and return-to-play protocols, rehabilitation recommendations consistent with research, and home exercises that supplement recovery. Future studies should compare outcomes of protracted recovery patients receiving care from a specialty concussion clinic against those who sought other forms of treatment. Further, evaluating the influence of comorbid factors (e.g., psychiatric and/or concussion history) on pediatric concussion recovery trajectories may be useful for future research.