Recommendations For Rehabilitation Research Articles

An Intensive Exercise Program Using a Technology-Enriched Rehabilitation Gym for the Recovery of Function in People With Chronic Stroke: Usability Study.

Rehabilitation improves poststroke recovery with greater effect for many when applied intensively within enriched environments. The failure of health care providers to achieve minimum recommendations for rehabilitation motivated the development of a technology-enriched rehabilitation gym (TERG) that enables individuals under supervision to perform high-intensity self-managed exercises safely in an enriched environment. This study aimed to assess the feasibility of the TERG approach and gather preliminary evidence of its effect for future research. This feasibility study recruited people well enough to exercise but living with motor impairment following a stroke at least 12 months previously. Following assessment, an 8-week exercise program using a TERG (eg, virtual reality treadmills, power-assisted equipment, balance trainers, and upper limb training systems) was structured in partnership with participants. The feasibility was assessed through recruitment, retention, and adherence rates along with participant interviews. Effect sizes were calculated from the mean change in standard outcome measures. In total, 70 individuals registered interest, the first 50 were invited for assessment, 39 attended, and 31 were eligible and consented. Following a pilot study (n=5), 26 individuals (mean age 60.4, SD 13.3 years; mean 39.0, SD 29.2 months post stroke; n=17 males; n=10 with aphasia) were recruited to a feasibility study, which 25 individuals completed. Participants attended an average of 18.7 (SD 6.2) sessions with an 82% attendance rate. Reasons for nonattendance related to personal life, illness, weather, care, and transport. In total, 19 adverse events were reported: muscle or joint pain, fatigue, dizziness, and viral illness, all resolved within a week. Participants found the TERG program to be a positive experience with the equipment highly usable albeit with some need for individual tailoring to accommodate body shape and impairment. The inclusion of performance feedback and gamification was well received. Mean improvements in outcome measures were recorded across all domains with low to medium effect sizes. This study assessed the feasibility of a holistic technology-based solution to the gap between stroke rehabilitation recommendations and provision. The results clearly demonstrate a rehabilitation program delivered through a TERG is feasible in terms of recruitment, retention, adherence, and user acceptability and may lead to considerable improvement in function, even in a chronic stroke population. RR2-doi.org/10.3389/fresc.2021.820929.

Analysis of Physical Characteristics and Soil Degradation Due to Erosion and Rehabilitation Recommendation Based on GIS in Protected Forest Area of Mount Sirimau

Forest areas are designated as protected forests if they function as a provider of clean water reserves, erosion control, city lungs or other functions. Disruption of forest land resources has an impact on changes in the physical properties of the soil and soil degradation due to erosion. Objectives of this study were: 1) to examine the relationship between soil physical properties, 2) to determine soil degradation due to erosion, 3) to examine the relationship between soil physical properties and the level of soil degradation due to erosion, 4) to determine recommendations for land rehabilitation. Research observations were made based on 15 sample areas representing 212 land units. All analyzes were carried out based on Geographic Information Systems (GIS). The physical properties of the soil studied included texture, structure, pore distribution, permeability, particle density and oven dry mass density; whereas soil degradation analysis was based on RUSLE: A=RKLSCP (Renard et al., 1997), and correction of the erosion model A=0.2547RKLSCP (Talakua S.M. and Osok, 2017. The rehabilitation recommendations analyzed were erosion tolerance, potential erosion and CP-maximum. Study results were: 1) The correlation between physical properties was significant (P-value = 0.000*-0.018*) with a positive correlation coefficient (0.163-0.999) and negative one (0.199-0.998); 2) The average erosion rate was: light 3.60 t/ha/year (1425.20 ha), moderate 32.03 t/ha/year (410.28 ha), heavy 108.95 t/ha/year (946 .2 ha), very heavy 426.83 t/ha/year (457.44 ha); 3) There was a significant correlation between the physical properties of the soil and the amount of erosion with a P-value = 0.000*–0.029* with a positive (0.152-0.161) and a negative (0.150-0.151) correlations; 4) Recommendation for rehabilitation are agroforestry patterns combined with tillage and planting of plants according to contour lines on slopes of 0–8%, planting grass in strips, planting low ground cover on high density plantation crops and maintaining secondary and primary forests.

Restoration of Road Pavement Depending on the Degree of Destruction of the Road

Purpose. The main purpose of this work is to develop a methodology for road pavement restoration depending on the degree of road destruction. Methodology. The study is based on the recommendations of the information guide for designers and customers in the development of design solutions for the rehabilitation of public roads and a preliminary assessment of the damage caused by their destruction as a result of the armed aggression of the Russian Federation. To assess the condition of the road and determine the necessary pavement rehabilitation work, indices can be used that take into account different types of defects on the road. Comparison of different road surface options was performed using a «priority matrix». The total score for each type of pavement makes it possible to determine the most rational option. Findings. The study found that when choosing a method for organizing construction work on pavement rehabilitation, the availability of materials, technical equipment, and the timing of rehabilitation should be taken into account. The choice of pavement design and material depends on the degree of road destruction, which is determined by technical and economic indicators, taking into account the life cycle of the road. The cost of repair and maintenance over the life cycle of a pavement is a key aspect of infrastructure planning and management. Estimation of these costs helps to effectively allocate the budget, prioritize and rationally spend resources to maintain road quality. Originality. Methodological approaches to the establishment of the pavement structure by the volume and cost of materials with the adjustment of the decision made by operational indicators, taking into account the service life, resistance to traffic, wear resistance, noise, vibration and, ultimately, vehicle safety, are proposed. Practical value. The provided recommendations for road pavement rehabilitation, depending on the degree of destruction, will contribute to the adoption of effective design solutions and preliminary assessment of the damage caused by the destruction or damage to roads as a result of the armed aggression of the Russian Federation.

Addressing racial bias in parole decisions: A pre-registered study of the Five-Level Risk and Needs System of risk communication

ABSTRACT Indigenous peoples are disproportionately influenced by biases in risk assessment and risk communication. The Five-Level Risk and Needs System (5-levels) is a risk communication strategy that adds standardized definitions to risk categories and incorporates evidence-based recommendations for rehabilitation. The current pre-registered study examined the ability of the 5-levels to mitigate biases in a mock parole case using a 2 (risk communication format: status quo vs. 5-levels) × 2 (race: Indigenous vs. White) between-subjects design. Four hundred and twenty-three community members residing in Canada were asked to make decisions regarding parole and other risk, treatment amenability, and report utility outcomes. Risk communication format had no effect on parole. However, participants in the 5-levels condition did provide more accurate risk information than those in the status quo condition. The 5-levels system was also rated lower in terms of understandability and resulted in lower levels of confidence in decisions. Contrary to expectations, participants assigned to the case involving an Indigenous client were more likely to grant parole and provided more favourable ratings of the client compared to participants assigned the case of a White client. Findings from this study may inform risk communication strategies resulting in more consistent and reliable decision-making.

(384) International Clinical Guidelines for Sexual Health Care in Prostate Cancer Survivorship

Abstract Introduction During the past 20 years, researchers have studied various aspects of the impact of prostate cancer therapies on patients, partners and couples. Patients and partners reported distress and negative consequences for their relationships resulting from treatment-related sexual side-effects of prostate cancer therapies. Research on rehabilitation strategies in prostate cancer survivorship has focused largely on biomedical interventions although psychosexual intervention research is also gaining ground. This research has never been summarized in such a way that clinicians can use the findings to provide evidence-based support for prostate cancer patients and their partners in survivorship. Objective An international panel of experts has developed a guideline that informs clinicians, patients and partners about the impact of prostate cancer therapies on the sexuality of patients and partners, and on their sexual relationships. It provides guidance for biopsychosocial rehabilitation strategies that help patients and partners recover sexual intimacy after prostate cancer therapy. Methods The guideline panel included international, multidisciplinary clinical experts and researchers in prostate cancer, a reference librarian and a guideline methodologist. A systematic review of the literature, using the Ovid MEDLINE, Scopus, CINAHL, PsychINFO, LGBT Life, and Embase databases was conducted (1995-2022). The review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. Study selection is reported, based on PRISMA guidelines. Evidence for each statement was assigned a strength (A-C) and a level of recommendation (strong, moderate, conditional) which was based on benefit/risk balance. Data synthesis included meta-analyses of high-quality studies (determined by the Cochrane Risk of Bias tool). Results The guideline is contextualized within cultural, ethnic and racial diversity. The needs of individuals with diverse sexual orientations and gender identities are also recognized. Forty-seven statements were generated, guided by a theoretical model of sexual recovery after prostate cancer therapies and by principles that promote clinician-initiated discussion of realistic expectations of sexual outcomes and mitigation of sexual side-effects through biopsychosocial rehabilitation. The statements focus on counseling about the impact of prostate cancer therapies on patients’ and partners’ sexuality and couples’ relationships as well as on biomedical and psychosocial treatment strategies for sexual dysfunction. The guideline statements address the assessment of sexual function and distress, and barriers to providing sexual health care in prostate cancer survivorship in globally varied health care systems. Conclusions The guideline documents the distressing sexual sequelae of prostate cancer therapies and makes evidence-based recommendations for sexual rehabilitation in prostate cancer survivorship. Areas for future research are also outlined. The guideline was supported and funded by the Movember Foundation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Author disclosures 1. Capogrosso 2. Northouse 3. Matthew 4. Elliott 5. Mulhall 6. Capellari 7. Incrocci 8. Faraday 9. Loeb 10. Mehta 11. Howell 12. McPhail J 13. McPhail S 14. Brandon 15. Paich 16. Erickson 17. Shifferd 18. Duby 19. Yap 20. Goltz 21. Odiyo 22. Salter 23. Nelson 24. McLeod 25. Trost 26. Wittmann – 10% salary paid by Movember 27. Bober – honorarium from UpToDate 28. Bennett - Endo Pharma - speaker 29. Coloplast - speaker, training grant. 30. Glode – Janssen, Aurora Oncology, Bayer, Exelixis, ProTechSure Scientific, Gonex, Patents, Seattle Genetics 31. Kirby – Lilly, Astra Zeneca, GSK, others 32. Wang – Boston Scientific, Teleflex, Coloplast 33. Pollack – Gilead 34. Burnett - Grant/research support: Endo Pharmaceutical, Boston Scientific, NIH Consultant/advisor: Boston Scientific, Coloplast, Reflexonic, Astellas, Novartis, Futura Medical, Comphya SA, Myriad Genetics Patent Holder: MHN Biotech Boards: UCF, AUA PAC, Mentoring Mae teens in the Hood Editor/editorial board: Urology Practice, Andrology, Canadian Journal of Urology, International Urology and Nephrology, Urology Times Other: UroMissionsWorks Inc (Non-profit) 35. Skolarus – UpToDate 36. Koontz - receives research funding from Janssen Scientific Affairs, Merck Pharmaceuticals, Blue Earth Diagnostics, and has received personal fees (ie advisory board) for Blue Earth Diagnostics.

Post-stroke rehabilitation optimization & recommendation framework using tele-robotic ecosystem: Industry 4.0 readiness approach

Technological development in biomedical procedures has given an upper understanding of the ease of evaluating and handling critical scenarios and diseases. A sustainable model design is required for the post-medical procedures to maintain the consistency of medical treatment. In this article, a telerobotic-based stroke rehabilitation optimization and recommendation technique cum framework is proposed and evaluated. Selecting optimal features for training deep neural networks can help in optimizing the training time and also improve the performance of the model. To achieve this, we have used Whale Optimization Algorithm (WOA) due to its higher convergence accuracy, better stability, stronger global search ability, and faster convergence speed to streamline the dependency matrix of each attribute associated with post-stroke rehabilitation. Deep Neural Networking assures the selection of datasets from training and testing validation. The proposed framework is developed on providing decision support with a recommendation of activities and task flow, these recommendations are independent and have higher feasibility with the scenario of evaluation. The proposed model achieved a precision of 99.6%, recall of 99.5 %, F1-score of 99.7%, and accuracy of 99.9%, which outperform the other considered optimization algorithms such as antlion and gravitational search algorithms. The proposed technique has provided an efficient recommendation model compared to the trivial SVM-based models and techniques.

Impact of Quantitative Videofluoroscopic Swallowing Measures on Clinical Interpretation and Recommendations by Speech-Language Pathologists

Quantitative measures are available for adult videofluoroscopic swallow study (VFSS) analysis but are yet to be seen routinely in clinical practice. This study explores agreement between traditional observational analysis and quantitative analysis, and the impact of analytical approaches on subsequent diagnosis and recommendations. One hundred adults referred for VFSSs with swallowing concerns were administered a standardised VFSS protocol. All VFSSs were analysed using three approaches: (1) a traditional observational analysis typically used by treating speech-language pathologists (SLPs), (2) quantitative analysis by two independent raters, and (3) binary subjective analysis by 11 independent raters. Three metrics were focussed on; pharyngeal constriction (PC), hyoid displacement (Hmax) and pharyngoesophageal segment opening (PESmax). All raters were blinded to others’ ratings. Treating SLPs using traditional observational analysis were provided with no instructions. Quantitative analysis used published Leonard and Kendall digital displacement measures. Binary subjective analysis involved rating each VFSS as normal versus impaired for the three metrics above. Treating SLPs using traditional observational analysis and quantitative analysis raters independently provided diagnostics and treatment plans. PC, Hmax and PESmax achieved fair agreement (Kappa = 0.33–0.36) between binary subjective analysis compared to substantial agreement (ICC = 0.77–0.94) for quantitative analysis. Reports of impairment were significantly lower in the traditional observational and binary subjective analyses compared with studies rated using the quantitative analysis (p < 0.05). Consequently, this resulted in significantly less rehabilitation recommendations when traditional observational analysis was used in comparison to the quantitative analysis. Quantitative measures to analyse VFSSs can be used in clinical practice producing increased inter-rater agreement and supporting more targeted rehabilitation recommendations than using a traditional observational VFSS analysis alone.

Sustainable Cost Optimisation Measures for The Lifecycle of Tolled Highway Projects in Malaysia

The implementation and maintenance of highway infrastructure often requires significant capital throughout its life cycle which affects stakeholders including the government, developers, operators, users, etc. Furthermore, the sustainability aspect and existing toll systems in Malaysia are currently in the midst of being re-evaluated in order to attain a long-term gain that benefits both road users and relevant stakeholders. The objective of this study is to propose a Life Cycle Cost Analysis (LCCA) model for sustainable highway projects in Malaysia which considers certain cost optimisation measures throughout the stages of concept, design, construction, and operation &amp; maintenance. The proposed LCCA model intends to act as a cost optimisation tool that provides sustainability recommendations for toll systems, highway alignments, pavement maintenance and rehabilitation, existing policies, contract and project type, material, equipment, time-cost factor, etc. Additionally, a relationship between the financial efficiency of toll systems and the affect it has on the overall cost of highway projects was established. The significance of cost pertaining to highway infrastructure components and the perception of toll systems was evaluated via a survey questionnaire; distributed to a select group of senior and principal engineers. The survey utilised a 5-point Likert scale which assisted in forming a regression analysis along with determining a correlation between toll systems and the overall cost of highway projects. Secondary data obtained from a reputable consultancy aided in understanding highway components that could potentially undergo further cost optimisation. Lastly, the sustainable and cost optimised LCCA model consists of recommendations and measures intended for a new age of sustainable highway projects in Malaysia.

Social-emotional well-being and adult hearing loss: clinical recommendations

Aim: Best-practice in audiological rehabilitation takes a holistic client- and family-centred approach and considers hearing care in the context of personal well-being. Hearing loss not only impairs the ability to hear, but can also compromise the ability to communicate, thus negatively impacting both social and emotional well-being. Hearing care professionals play a key role in fostering their client’s well-being. This paper aims to provide evidence-based recommendations to ensure inclusion of social-emotional well-being in audiologic rehabilitation clinical practice. Methods: A review of current research and expert opinion. Results: This guide proposes a 5-step plan which includes: identifying the client’s social-emotional well-being; including family members in audiological rehabilitation; incorporating social-emotional needs and goals in an individualized management plan; relating identified hearing needs and goals to rehabilitation recommendations; and using counselling skills and techniques to explore and monitor social-emotional well-being. Each component of the 5-step plan is discussed and clinical considerations are presented. Conclusion: These comprehensive recommendations provide guidance to hearing care professionals looking to ensure clients’ social-emotional well-being are considered throughout the rehabilitation journey.

Rehabilitation after Hip Fracture Surgery: A Survey on Italian Physiotherapists’ Knowledge and Adherence to Evidence-Based Practice

The average life expectancy of the Italian population has increased over the last decades, with a consequent increase in the demand for healthcare. Rehabilitation after hip fracture surgery is essential for autonomy, recovery, and reintegration into the social context. The aim of this study was to determine the level of knowledge and adherence to the recent treatment recommendations of the Italian physiotherapists. A web-based survey, composed of 21 items, was conducted and the frequencies and percentages of the responses were analyzed to evaluate if there was an integration and adherence to the recommendations of greater than 70%, with respect to the desired response. A total of 392 responses were collected and analyzed. Recommendations regarding the multidisciplinary approach, early mobilization, and progressive muscle strength training, achieved the desired value in the inpatient setting. Intensive rehabilitation and full weight bearing did not reach the threshold values. The results of this survey show a partial integration of the recommendations for rehabilitation after hip fracture surgery by Italian physiotherapists. Adherence seems to be better in the inpatient setting and with physiotherapists with higher levels of education.

Persistent Unilateral Force Production Deficits Following Hand Injury in Experienced Climbers: A Reliability and Retrospective Injury Study.

In climbing, research is needed to guide clinical and training advice regarding strength differences between hands. The objectives of this study were to establish test-retest reliability of a field-based apparatus measuring sport-specific unilateral isometric hand strength and to investigate whether these measures detect between-hand differences in climbers with and without a history of unilateral hand injury. A reliability and case-control injury study was carried out. Seventeen intermediate-advanced climbers without and 15 intermediate-advanced climbers with previous unilateral hand injury participated. Unilateral isometric fingertip flexor strength was assessed during maximal voluntary contraction (MVC) and peak rate of force development (RFD) tests in full-crimp overhead position. The magnitude of within-group between-hand differences was calculated using a generalized estimating equation to evaluate if prior injury was associated with lower MVC and RFD outcomes and whether hand dominance influenced the magnitude of these effects. The control group was assessed 1 wk later to determine intraclass correlation coefficients (ICCs) for all measures. The MVC (ICC 0.91-0.93) and the RFD (ICC 0.92-0.83) tests demonstrated moderate-to-high reliability. When accounting for handedness, those with prior injury showed 7% (P=0.004) reduced MVC and 13% (P=0.008) reduced RFD in the injured hand. The nondominant hand was also significantly weaker in MVC (11%, P<0.001) and RFD (12%, P=0.02) outcomes. For uninjured climbers, MVC and RFD were not significantly higher in the dominant hand (differing by 4% and 5%, respectively). Previous climbing injury was associated with persistent weakness in the injured limb and exacerbated handedness effects. Therefore, recommendations for rehabilitation should be considered.

Comparison of Conservative Interventions for Proximal Hamstring Tendinopathy: A Systematic Review and Recommendations for Rehabilitation.

Knowledge of muscular forces and adaptations with hamstring-specific exercises can optimize exercise prescription and tendon remodeling; however, studies investigating the effectiveness of the current conservative management of proximal hamstring tendinopathy (PHT) and outcomes are lacking. The purpose of this review is to provide insights into the efficacy of conservative therapeutic interventions in the management of PHT. In January 2022, databases including PubMed, Web of Science, CINAHL, and Embase were searched for studies assessing the effectiveness of conservative intervention compared with that of a placebo or combination of treatments on functional outcomes and pain. Studies that performed conservative management (exercise therapy and/or physical therapy modalities) in adults 18-65 years were included. Studies that performed surgical interventions or whose subjects had complete hamstring rupture/avulsion greater than a 2 cm displacement were excluded. A total of 13 studies were included: five studies compared exercise interventions, while eight studies investigated a multimodal approach of either shockwave therapy and exercise or a hybrid model incorporating exercise, shockwave therapy, and other modalities, such as ultrasound, trigger point needling, or instrument-assisted soft tissue mobilization. This review supports the notion that the conservative management of PHT may best be optimized through a multimodal approach incorporating a combination of tendon-specific loading at an increased length, lumbopelvic stabilization exercises, and extracorporeal shockwave therapy. With regard to hamstring-specific exercise selection, PHT may be optimally managed by including a progressive loading program at combined angles of the hip flexion at 110 degrees and the knee flexion between 45 and 90 degrees.

Using Mathematical and Statistical Analysis to Investigate the Correlation between Exacerbation of Chronic Obstructive Pulmonary Disease and Risk of Subclinical Atherosclerosis.

Purpose: As the number of patients with chronic obstructive pulmonary disease continues to increase, it is increasingly important to understand the impact of cardiovascular risk on the progression of chronic obstructive pulmonary disease, which can provide guidance for clinical medication and recommendations for patient care and rehabilitation. The purpose of this study was to investigate the relationship between cardiovascular risk and the progression of chronic obstructive pulmonary disease (COPD). Methods: Selected COPD patients admitted to hospital from June 2018 to July 2020 were included in the study for prospective analysis, and patients who showed more than two instances of moderate deterioration or severe deterioration within one year before the consultation were defined as COPD patients, and all participants underwent relevant tests and assessments. Results: Multivariate correction analysis showed that a worsening phenotype improved the risk of carotid artery intima-media thickness exceeding 75% by nearly three times, and it had no relation with the degree of COPD severity and global cardiovascular risk; in addition, the relationship between a worsening phenotype and high carotid intima-media thickness (c-IMT) was more pronounced in patients under 65 years of age. Conclusions: The existence of subclinical atherosclerosis is individually related to the worsening phenotype, and the difference is more obvious in young patients. Therefore, the control of vascular risk factors in these patients should be strengthened.

Vaginal changes, sexual functioning and distress of women with locally advanced cervical cancer treated in the EMBRACE vaginal morbidity substudy

ObjectiveThe EMBRACE-vaginal morbidity substudy prospectively evaluated physician-assessed vaginal changes and patient-reported-outcomes (PRO) on vaginal and sexual functioning problems and distress in the first 2-years after image-guided radio(chemo)therapy and brachytherapy for locally advanced cervical cancer. MethodsEligible patients had stage IB1-IIIB cervical cancer with ≤5 mm vaginal involvement. Assessment of vaginal changes was graded using CTCAE. PRO were assessed using validated Quality-of-Life and sexual questionnaires. Statistical analysis included Generalized-Linear-Mixed-Models and Spearman's rho-correlation coefficients. Results113 eligible patients were included. Mostly mild (grade 1) vaginal changes were reported over time in about 20% (range 11–37%). At 2-years, 47% was not sexually active. Approximately 50% of the sexually active women reported any vaginal and sexual functioning problems and distress over time; more substantial vaginal and sexual problems and distress were reported by up to 14%, 20% and 8%, respectively. Physician-assessed vaginal changes and PRO sexual satisfaction differed significantly (p ≤ .05) between baseline and first follow-up, without further significant changes over time. No or only small associations between physician-assessed vaginal changes and PRO vaginal functioning problems and sexual distress were found. ConclusionsMild vaginal changes were reported after image-guided radio(chemo)therapy and brachytherapy, potentially due to the combination of tumors with limited vaginal involvement, EMBRACE-specific treatment optimization and rehabilitation recommendations. Although vaginal and sexual functioning problems and sexual distress were frequently reported, the rate of substantial problems and distress was low. The lack of association between vaginal changes, vaginal functioning problems and sexual distress shows that sexual functioning is more complex than vaginal morbidity alone.

Sleep-Based Memory Consolidation Stabilizes Perceptual Learning of Noise-Vocoded Speech.

Sleep-based memory consolidation has been shown to facilitate perceptual learning of atypical speech input including nonnative speech sounds, accented speech, and synthetic speech. The current research examined the role of sleep-based memory consolidation on perceptual learning for noise-vocoded speech, including maintenance of learning over a 1-week time interval. Because comprehending noise-vocoded speech requires extensive restructuring of the mapping between the acoustic signal and prelexical representations, sleep consolidation may be critical for this type of adaptation. Thus, the purpose of this study was to investigate the role of sleep-based memory consolidation on adaptation to noise-vocoded speech in listeners without hearing loss as a foundational step toward identifying parameters that can be useful to consider for auditory training with clinical populations. Two groups of normal-hearing listeners completed a transcription training task with feedback for noise-vocoded sentences in either the morning or the evening. Learning was assessed through transcription accuracy before training, immediately after training, 12 hr after training, and 1 week after training for both trained and novel sentences. Both the morning and evening groups showed improved comprehension of noise-vocoded sentences immediately following training. Twelve hours later, the evening group showed stable gains (following a period of sleep), whereas the morning group demonstrated a decline in gains (following a period of wakefulness). One week after training, the morning and evening groups showed equivalent performance for both trained and novel sentences. Sleep-consolidated learning helps stabilize training gains for degraded speech input, which may hold clinical utility for optimizing rehabilitation recommendations.

Expert consensus guidance on respiratory physiotherapy and rehabilitation of patients with rib fractures: An international, multidisciplinary e-Delphi study.

There is limited research supporting optimal respiratory physiotherapy or physical rehabilitation strategies for patients with rib fractures. The aim of this study was to develop key recommendations for the physiotherapy management of patients with rib fractures. A three-round modified e-Delphi survey design, using an international Delphi panel including physiotherapy clinicians, researchers and lecturers, physician associates, trauma surgeons, and intensivists, was used in this study. The draft recommendations were developed by the Steering Group, based on available research. Over three rounds, panelists rated their agreement (using a Likert scale) with regard to recommendation for physiotherapists delivering respiratory physiotherapy and physical rehabilitation to patients following rib fractures. Recommendations were retained if they achieved consensus (defined as ≥70% of panelists ≥5/7) at the end of each round. A total of 121 participants from 18 countries registered to participate in the study, with 87 (72%), 77 (64%), and 79 (65%) registrants completing the three rounds, respectively. The final guidance document included 18 respiratory physiotherapy and rehabilitation recommendations, mapped over seven clinical scenarios for patients (1) not requiring mechanical ventilation, (2) requiring mechanical ventilation, (3) with no concurrent fracture of the shoulder girdle complex, (4) with a concurrent fracture of the shoulder girdle complex, (5) with/without concurrent upper limb orthopedic injuries, (6) undergoing surgical stabilization of rib fractures, and (7) at hospital discharge. This guidance provides key recommendations for respiratory physiotherapy and physical rehabilitation of patients with rib fractures. It could also be used to inform future research priorities in the field. Therapeutic/Care Management; Level IV.

S2k-Guideline SARS-CoV-2, COVID-19 and (early) rehabilitation - a consensus-based guideline for Germany.

The consensus-based guideline "SARS-CoV-2, COVID-19 and (early) rehabilitation" for Germany has two sections: In the first part, the guideline addresses infection protection-related procedures during the COVID-19 pandemic. In the second part, it provides practice recommendations for rehabilitation after COVID-19. The specific recommendations for rehabilitation after COVID-19 as issued by 13 German medical societies and two patient-representative organizations are presented together with general background information for their development.

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: Methods, Overview, and Principles.

Moderate to severe traumatic brain injury (TBI) results in complex cognitive sequelae. Despite hundreds of clinical trials in cognitive rehabilitation, the translation of these findings into clinical practice remains a challenge. Clinical practice guidelines are one solution. The objective of this initiative was to reconvene the international group of cognitive researchers and clinicians (known as INCOG) to develop INCOG 2.0: Guidelines for Cognitive Rehabilitation Following TBI. The guidelines adaptation and development cycle was used to update the recommendations and derive new ones. The team met virtually and reviewed the literature published since the original INCOG (2014) to update the recommendations and decision algorithms. The team then prioritized the recommendations for implementation and modified the audit tool accordingly to allow for the evaluation of adherence to best practices. In total, the INCOG update contains 80 recommendations (25 level A, 15 level B, and 40 level C) of which 27 are new. Recommendations developed for posttraumatic amnesia, attention, memory, executive function and cognitive-communication are outlined in other articles, whereas this article focuses on the overarching principles of care for which there are 38 recommendations pertaining to: assessment (10 recommendations), principles of cognitive rehabilitation (6 recommendations), medications to enhance cognition (10 recommendations), teleassessment (5 recommendations), and telerehabilitation intervention (7 recommendations). One recommendation was supported by level A evidence, 7 by level B evidence, and all remaining recommendations were level C evidence. New to INCOG are recommendations for telehealth-delivered cognitive assessment and rehabilitation. Evidence-based clinical algorithms and audit tools for evaluating the state of current practice are also provided. Evidence-based cognitive rehabilitation guided by these recommendations should be offered to individuals with TBI. Despite the advancements in TBI rehabilitation research, further high-quality studies are needed to better understand the role of cognitive rehabilitation in improving patient outcomes after TBI.

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now?

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now?

Impact of War on Hydroecosystems of Ukraine: Conclusion of the First Year of the Full-Scale Invasion of Russia (a Review)

Paper deals with impact of hostilities on hydroecosystems of Ukraine. The main types of impacts in different river basins and their effects are considered. The algorithm of measures was proposed aimed at development of technologies and recommendations for rehabilitation of the ecological state and biodiversity in the damaged water bodies over the wartime and after-war reconstruction.