Rehabilitation Experts Research Articles

Validation to Brazilian Portuguese of the coma recovery scale-revised.

To improve the diagnostic accuracy of the state of consciousness of patients with severe brain injury, Giacino et al. introduced the Coma Recovery Scale (CRS) in 1991, which underwent revision in 2004, resulting in the revised CRS scale (CRS-R). To determine the concurrent validity, as well as inter- and intrarater agreement of the CRS-R's adaptation to Brazilian Portuguese. This study involved a sample of 30 patients with severe brain injury. Concurrent evaluations were also performed with the Glasgow Coma Scale (GCS) and the Full Outline of UnResponsiveness (FOUR) scale. A total of seven rehabilitation experts were recruited to assess the inter- and intrarater reliability agreement. Interrater reliability was moderate to high for auditory, visual, motor, verbal, communication, and arousal subscales (Cohen weighted kappa = 0.765 to 0.892; p < 0.001). Significant inter and intrarater intraclass correlation coefficients were observed for the total CRS-R scores, all of which were statistically significant (p < 0.001). Also, total CRS-R scores exhibited a high correlation with the total GCS and FOUR scores, indicating acceptable concurrent validity (p < 0.001). The Brazilian Portuguese version of CRS-R can be reliably administered by trained examiners. This study demonstrated substantial to almost perfect interrater agreement for the total score and subscales, as well as high concurrent validity between the Brazilian Portuguese version of CRS-R and the other two standardized behavioral scales.

VR-Aided Ankle Rehabilitation Decision-Making Based on Convolutional Gated Recurrent Neural Network.

Traditional rehabilitation training for stroke patients with ankle joint issues typically relies on the expertise of physicians. However, when confronted with complex challenges, such as online decision-making or assessing rehabilitation progress, even seasoned experts may not anticipate all potential hurdles. A novel approach is necessary-one that effectively addresses these complexities without solely leaning on expert experience. Previous studies have introduced a rehabilitation assessment method based on fuzzy neural networks. This paper proposes a novel approach, which is a VR-aided ankle rehabilitation decision-making model based on a convolutional gated recurrent neural network. This model takes various inputs, including ankle dorsiflexion range of motion, angular velocity, jerk, and motion performance scores, gathered from wearable motion inertial sensors during virtual reality rehabilitation. To overcome the challenge of limited data, data augmentation techniques are employed. This allows for the simulation of five stages of rehabilitation based on the Brunnstrom staging scale, providing tailored control parameters for virtual training scenarios suited to patients at different stages of recovery. Experiments comparing the classification performance of convolutional neural networks and long short-term memory networks were conducted. The results were compelling: the optimized convolutional gated recurrent neural network outperformed both alternatives, boasting an average accuracy of 99.16% and a Macro-F1 score of 0.9786. Importantly, it demonstrated a strong correlation (correlation coefficient r > 0.9) with the assessments made by clinical rehabilitation experts, showing its effectiveness in real-world applications.

OSSEOINTEGRATIVE PROSTHETICS: OPPORTUNITIES, CHALLENGES, AND PROSPECTS FOR ITS APPLICATION IN THE REHABILITATION OF PATIENTS WITH AMPUTATED LIMBS (LITERATURE REVIEW)

Rehabilitation of patients with amputated limbs is a pressing medical and social issue in modern society. A novel method for partial restoration of limb function is osseointegrative prosthetics. Its main advantage lies in the fact that the implant allows mechanical loads and forces to be transmitted directly to the bone, whereas in traditional prostheses, they mainly act on soft tissues. Despite nearly 30 years of experience with osseointegrative implants globally, these technologies have not yet been implemented in either scientific or clinical practice in Ukraine. Objective. To conduct a literature review of the global practical experience with the use of osseointegrative prosthetics in patients with amputations and to identify its main features, advantages, and disadvantages. Methods. The information search was performed in the bibliographic databases PubMed, Scopus, and Google Scholar. Results. The analysis of literature sources allowed us to distinguish the main types of osseointegrative implants, which differ in terms of design, materials, and surgical techniques: either single-stage or two-stage procedures, and fixation by threading or press-fitting. The rehabilitation period ranges from 6 months to 2 years. Within the first two years, certain complications such as bone infections and skin inflammation should be expected. Hфowever, most of these pathological conditions can be effectively managed. Conclusions. Successful fixation of osseointegrative implants requires optimizing the patient’s bone, the prosthetic surfaces, and the ‘skin-implant’ interface. The implementation of these technologies requires multidisciplinary teams of specialists, including physicians, engineers, and rehabilitation experts. Osseointegrative implants significantly enhance patients’ functional abilities and quality of life, opening up greater opportunities for the use of bionic and robotic prosthetics.

The pivotal role of head and neck surgeons in advancing thyroid ablation practices

Thyroid ablation techniques are becoming increasingly popular across various specialties, leading to significant advancements in the treatment of thyroid and head and neck diseases. Head and neck surgeons (HNS) play a pivotal role in advancing thyroid ablation practices due to several key advantages: their detailed understanding of the thyroid and head and neck anatomy, extensive experience with ultrasound and ultrasound-guided interventions, ability to manage post-ablation conditions, capability to perform surgeries if necessary, and expertise in voice assessment, rehabilitation, and management. In this narrative review, we combine a comprehensive literature review with our own decade-long experience in promoting thyroid ablation to demonstrate that HNS are essential in advancing these techniques, ensuring safety, and improving patient quality of life.

A note on using the workability index (WAI) to predict future earnings capacity losses in moderate to severe partial disability cases

Purpose Disability experts are often called upon to analyze the economic impact of an injury. Determining future economic loss in cases of disabilities is difficult, particularly when the disabilities are considered partial in nature, and the individuals have some capacity to mitigate their future income losses. This paper examines one possible approach for examining reduced future income capacity in cases of partial disabilities, the use of the Work Ability Index (WAI) and Work Ability Scale (WAS). Materials and Methods Empirical data from one-hundred six cases is analyzed using a censored tobit regression to determine the relationship between scores on the WAI/WAS and verified long-term income losses for individuals who suffered disabling events. Results The study found a high correlation between the scores obtained on both the WAI and WAS measures, and future economic loss. The results suggest that these scales may be very useful in analyzing reduced future income capacity in situations involving partial disabilities. Conclusions This study assists the rehabilitation and disability expert to better understand the implications of a moderate to severe disability on the future income capacity of an injured person. It also provides additional support for the validity of the WAI/WAS scales.

Environmental information required by individuals with visual impairments who use orientation and mobility aids to navigate indoor places

The objective of the study is to investigate the requirements of individuals with blindness regarding the information to be included in audio-tactile maps and other orientation and mobility aids of indoor places. The research was conducted with the participation of 115 adults with blindness aged from 18 to 64 years. The participants were asked to evaluate each one of the 136 listed environmental information, regarding their usefulness for safety, location of services, and orientation/wayfinding during movement. The study defines the most useful environmental information that should be included in the orientation and mobility aids of indoor places for individuals with blindness. The older the participants, and the more often they move independently without the support of a sighted guide, the less useful they find the inclusion of some environmental information in orientation and mobility aids for indoor places. Although the research focuses on audio-tactile maps, the recorded participants’ preferences on the significant/useful indoor environmental information could be applied in orientation and mobility aids in general. Participants considered more useful the information necessary for safe and independent navigation within indoor places, as well as information relevant to their daily needs coverage and information referring to support provision through auditory or haptic cues. This study holds particular significance for developers of orientation and mobility aids for individuals with blindness. The findings will serve as a valuable point of reference for professionals such as orientation and mobility specialists, rehabilitation experts, and teachers involved in producing aids for students with blindness. While the research concentrates on audio-tactile maps, the preferences of participants recorded in the study regarding crucial indoor environmental information can apply to orientation and mobility aids in a broader context.

Rehab-AMD: co-design of an application for visual rehabilitation and monitoring of Age-related Macular Degeneration

BackgroundThe increasing demand for remote medical care, driven by digital healthcare advancements and the COVID-19 pandemic, necessitates effective solutions tailored to patients and healthcare practitioners. Co-design, involving collaboration between software developers, patients, and healthcare practitioners, prioritizes end-user needs. Research indicates that integrating patient perspectives enhances user experience and usability. However, its application in healthcare has been limited to small projects. This work focuses on co-designing a technological solution to enhance the monitoring and visual rehabilitation of individuals with Age-Related Macular Degeneration (AMD), a condition that significantly impacts the quality of life in people over 60. Current vision rehabilitation systems lack personalization, motivation, and effective progress monitoring. Involving patients and healthcare practitioners in the design process aims to ensure the final product meets their needs.MethodsThe project employs iterative and collaborative principles, involving a vision rehabilitation expert and two AMD patients as active users in the application’s development and validation. The process begins by establishing requirements for user accounts and rehabilitation exercises. It continues with an initial approach extended through user validation. Co-design is facilitated by specific workshops marking each project iteration, totaling four workshops, along with continuous communication sessions between experts and developers to validate design decisions. Initial requirements gathering and constant feedback from end-users, the visual rehabilitator, and patients are crucial for refining the product effectively.ResultsThe workshops produced a prototype featuring a test to monitor changes and progression and 15 visual rehabilitation exercises. Numerous patient and vision rehabilitation-driven software modifications led to a final design that is responsive and adaptive to end-user needs.ConclusionsThe Rehab-AMD pilot project aims to develop a collaborative and adaptive software solution for AMD rehabilitation by actively involving stakeholders and applying iterative design principles. Co-design in the Rehab-AMD solution proves to be a methodology that identifies usability issues and needs from the initial design stages. This approach ensures that software developers create a final product that is genuinely useful and manageable for people with AMD and the targeted vision rehabilitators.

Collaborative wildlife disease outbreak investigation and response at Bells Swamp Victoria, February 2023.

In February 2023, a report of morbidity and mortality in waterbirds triggered a collaborative regional wildlife disease outbreak investigation and response, led by Parks Victoria. Triage, rehabilitation and diagnosis of sick and dead birds were undertaken by Zoos Victoria (ZV), Agriculture Victoria, Vets for Compassion, Wildlife Victoria and Melbourne Veterinary School (MVS). The field response focused on collection of sick and dead birds for wildlife welfare, for diagnosis, and to reduce environmental contamination. Botulism was suspected, based on clinical signs and lack of significant gross pathology, and this diagnosis was confirmed by PCR testing. Low pathogenicity avian influenza (LPAI) viruses non H5 or H7 were detected in two birds and ruled out in all in others tested. These incidental, non-clinical LPAI detections are considered part of the natural wild bird virus community in Australia. A number of elements contributed to the collaborative effort. Regional individuals had the necessary connections for reporting, collecting and transporting birds. There was rapid determination by the Victorian Department of Energy, Environment and Climate Action (DEECA) that Parks Victoria, as the land managers, should lead the response. Zoos Victoria provided capacity and expertise in wildlife triage and rehabilitation, and Agriculture Victoria, ZV and MVS were responsible for veterinary management of the response and diagnosis. Field investigation and response were conducted by Parks Victoria, Agriculture Victoria, MVS and veterinary teams from Vets for Compassion and Wildlife Victoria. Wildlife Health Australia (WHA) provided guidance and information, approved National Significant Disease Investigation Program funding and captured the event in the national wildlife health information database. Communication and media were important for community understanding of the event.

The new hospital discharge form for inpatient rehabilitation in Italy: a step forward to promote the role of rehabilitation in the healthcare system.

In Italy, longstanding limitations in the existing reporting system of the inpatient rehabilitation activities have been reported. The Hospital Discharge form (HDF) primarily uses ICD codes that inadequately capture the functional status and rehabilitation needs of patients, impacting equity of care and service evaluation. Therefore, the Italian Ministry of Health (IMH) launched an initiative aimed at developing a new reporting system to be specifically adopted in the inpatient rehabilitation setting. A working group (WG), lead by representatives of IMH, was established in 2019. It included members of scientific societies and professional associations in rehabilitation, administrators, policy makers, and other experts. Representatives of the Associations of Patients and Families were also consulted. The WG submitted the new version of the HDF to the political decision makers in early 2020. It includes detailed data on patients' functional levels before and after rehabilitation, and the complexity of clinical conditions. In using the ICD codes, priority is given to functional diagnoses. In 2023, after a period of interruption due to the COVID-19 pandemic, a Ministry of Health Decree sanctioned the adoption of the new reporting system nationwide after a one-year trial period, starting on January 2024. The new HDF is expected to improve data collection, reduce local and regional disparities, allow better comparison of the performances of the structures, and ultimately enhance the quality and outcomes of rehabilitation care across the country. The Italian Society of Physical and Rehabilitation Medicine (SIMFER) gave an important contribution in the development of the system.

Co-designing a cardiac rehabilitation program with knowledge users for patients with cardiovascular disease from a remote area

BackgroundCardiovascular disease is the leading cause of death worldwide. Cardiac rehabilitation (CR) programs are recognized as effective in reducing the burden of cardiovascular disease. However, CR programs are offered inequitably across regions and are available in less than 15% of remote areas worldwide. The main goal of this study was to design a CR program adapted to the contexts of remote areas to improve the service offered to patients.MethodsWe used an iterative user-centered design approach to understand the user context and services offered in cardiac rehabilitation in remote areas. We conducted two co-design processes with knowledge users in two remote regions. Two advisory committees were created in each of these regions, comprising managers (n = 6), healthcare professionals (n = 12) and patients (n = 2). We utilized the BACPR guidelines and the Hautes Autorités de santé operational model to support data collection in coding sessions to develop the CR program. We conducted four cycles of co-design with each of the committees to develop the cardiac rehabilitation program. Qualitative data were analyzed iteratively after each cycle.ResultsThe co-design process resulted in developing a prototype cardiac rehabilitation program similar in both regions. It is based on a contextualized six-phase pathway of care designed for remote regions. For each phase 0 to 6 of the care pathway, knowledge users were asked to describe how to offer these phases in remote areas. Participants made structural changes to phases 0, 2, 3 and 4 in order to overcome staffing shortages in remote areas. These changes make it possible to decentralize cardiac rehabilitation expertise away from specialized centers, to ensure equity of service across the territory. Therapeutic patient education was integrated into phase 4 to meet patients' needs. Participants suggested that three follow-up offerings could come from nursing services to increase access to the cardiac rehabilitation program (primary care, home care, special chronic disease programs) in patients' home communities.ConclusionThe co-design process enables us to meet the needs of remote regions in program development. This final program can be the subject of future implementation research.

Does a service provide safe, effective rehabilitation? An evaluation method for providers and purchasers

Background Independent organisations monitor the safety and governance of clinical services but do not assess specialist expertise. Peer review can assess service capability but is resource-intense and infeasible. The problem How can you ensure a service provides safe, effective rehabilitation? You ask them to provide data as evidence that they can be trusted to do so. This article suggests a structured approach to providing data on entrustability. An analogy How is the specialist skill of a doctor in training established? They provide evidence about high-level outcomes (capabilities in practice) related to their speciality. An educational supervisor assesses whether they can be trusted to perform safely and effectively without supervision. The capabilities in practice define their expertise. The solution A service can use seven high-level rehabilitation service capabilities, based on the clinical capabilities associated with medical training, with observable indicative descriptors, to collect evidence of their rehabilitation approach. A service must also select four to eight high-level competencies indicating they can rehabilitate their patient caseload safely and effectively. These competencies also need indicative descriptors as evidence of their performance in the service; 11 examples are given. Capabilities. The seven rehabilitation capabilities are: using the biopsychosocial model, having a multi-professional team, making a person-centred rehabilitation plan, working collaboratively across all boundaries, tailoring treatments to the patient's needs, ensuring staff have specific competencies required for their caseload, and acknowledging and managing uncertainty and complexity. Conclusion. Service providers could use this structured approach to develop and provide users with evidence of their rehabilitation expertise.

Cochlear reimplantation outcomes over 20 years: Expertise in reimplantation surgery and auditory-speech rehabilitation

ObjectivesThe aim of this study was to present an institution's experience with cochlear reimplantation (CRI), to assess surgical challenges and post-operative outcomes and to increase the success rate of CRI. Study designRetrospective single-institution study. SettingTertiary medical center. MethodsWe retrospectively evaluated data from 76 reimplantation cases treated in a tertiary center between 2001 and 2022. Clinical features including etiology of hearing loss, type of failure, surgical issues, and auditory speech performance were analyzed. Categorical Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores were used to evaluate pre- and post-CRI outcomes. ResultsThe CRI population comprises of 7 patients from our institute,69 referred patients from other centers. Device failure was the most common reason (68/76, 89.5 %) for CRI; in addition, there were 7 medical failures and 1 had both soft device failure. Medical failures included flap rupture and device extrusion, magnet migration, auditory neuropathy, leukoencephalopathy, foreign-body residue and meningitis. In 21/76 patients, the electrode technology was upgraded. The mean time to failure was 0.58–13 years, with a mean of 4.97 years. The mean (± SD) CAP and SIR scores before and after CRI were 5.2 ± 1.2 versus 5.5 ± 1.1 and 3.4 ± 1.1 versus 3.5 ± 1.1, respectively. Performance was poor in six patients with severe cochlear malformation, auditory nerve dysplasia, leukoencephalopathy, and epilepsy. ConclusionCRI surgery is a challenging but relatively safe procedure, and most reimplanted patients experience favorable postoperative outcomes. Medical complications and intracochlear damage are the main causes of poor postoperative results. Therefore, adequate preoperative preparation and atraumatic CRI should be carried out for optimal results.

Perceptions of parental involvement in youth handball players, the effects of sport participation stage and sports injury.

Globally, from the age of 14, the dropout rate of young athletes is high in all sports games in Hungary. The reasons for dropping out are complex, however parental support is critical to succeed or continue, especially after failure or injury. The present study explored the main effects of sports injury and sport participation stage on parental involvement in sports. 1,174 parents and 690 athletes completed our questionnaire, which contains questions on young players' sport participation, injury background and Parental Involvement in Sport Questionnaire. Parents' self-perceived level of involvement differed from the parental involvement perceived by their children. The significant predictors were the person who completed, the parent/athlete, the athlete's previous sports injury and the child's current stage of sport participation. In Directive Behavior, the main effect of stages is only seen in parents whose child has been injured. In the sample of injured athletes, the rate of perceived parental Praise and Understanding tends to be lower in the specializing stage. Our findings suggest that these two behaviors could be part of the same parenting style, which requires further investigation. The results expand the existing knowledge of the complexity of parents' involvement in children's sports careers. These findings have implications beyond parental psychoeducation impacting the work of coaches, sports physicians and rehabilitation experts.

A flexible pressure sensor with wide detection range and high sensitivity based on glycerol@phosphoric acid nanofibers for human posture recognition applications

Flexible pressure sensors are widely used in wearable devices, especially in the field of human–computer interaction. Hence, the development of flexible pressure sensors with excellent sensitivity and detection range is essential. This paper introduces a flexible capacitive pressure sensor based on glycerol@phosphoric acid nanofibers, showcasing remarkable properties, including high sensitivity (53.97 kPa−1 at 300–1200 kPa), exceptionally wide detection range (1800 kPa), faster response/recovery time than human skin (14.4/9.6 ms), extremely low detection limit (5 Pa), outstanding stability (>10,000 fatigue tests), and excellent biocompatibility. In addition, the sensor was seamlessly integrated with deep learning algorithms, embedded systems, and internet technologies to develop a comprehensive human posture recognition system, which can adeptly capture and identify intricate human movements with an accuracy rate over 98 %. This system establishes a diagnostic channel between home patients and rehabilitation experts. Owing to its excellent sensitivity and detection range, the developed sensor presents promising prospects for future advancements in human–computer interaction.

Enhancing quality of life in severe post-COVID-19 survivors through multidisciplinary care.

COVID-19 survivors who were hospitalised continue to experience long-term multisystemic sequelae and symptoms, impacting their health-related quality of life (HRQoL). The complexity of post-COVID-19 conditions underscores the importance of adopting a multidisciplinary, patient-centric approach to ensure ongoing care. This study aims to assess HRQoL and post-COVID symptoms in a cohort of severe COVID-19 survivors depending on their participation in a multidisciplinary programme. This prospective study was conducted in a post-COVID clinic staffed by a multidisciplinary team (physical rehabilitator, nutritionist, psychologist, including experts in pulmonary rehabilitation, nutrition, psychology and others). Subjects over 18 years old who were hospitalised due to severe COVID-19 during the acute phase and had attended the post-COVID clinic within the first 3 months following discharge were included. Subjects who were unable or unwilling to provide informed consent to participate in the protocol were excluded. Linear mixed-effect models were employed to examine changes in 12-Item Short-Form Health Survey (SF-12) component scores. The resolution of post-COVID symptom clusters was compared using the Cox model. A total of 730 patients were included, with a mean±sd age of 55.78±15.43 years; 60.55% were male and 90.62% required mechanical ventilation during hospitalisation. Programme attendants demonstrated improved SF-12 physical and mental component scores at 3 and 12 months. A reduction in the prevalence of post-COVID symptoms was observed in both groups, with greater reductions in those attending the programme. Our study showed that patients enrolled on the multidisciplinary programme experienced improvements in fatigue, musculoskeletal, gastrointestinal, neuropsychiatric and respiratory symptoms, along with enhanced SF-12 mental and physical component scores.

Health App Review Tool (HART): content validation through expert panel review

ABSTRACT The Health App Review Tool (HART) is an evaluation tool that is designed to help the users in evaluation of the health apps for Alzheimer’s Disease and Related Dementias (ADRD) population. As the development of the HART continues, the domain items that HART addresses require evaluation to determine if they meet the intended required criteria for the users.To complete content validation of the HART 10 health care professions provided content validation of the HART via a content validation form. Specifically, data collection took place virtually through Microsoft Teams and Qualtrics-based content validity index. Following, revisions were made through a consensus process involving 3 rehabilitation experts, minimizing potential conflicts.Findings indicate 76 of 109 items were considered acceptable, 19 items were in need of review and 14 items in need of revision. In sum 30% of the total HART items required either review or revision to improve HART validity. The changes were implemented through consensus revisions.

Identifying central elements of the therapeutic alliance in the setting of telerehabilitation: A qualitative study.

Therapeutic alliance is a relevant aspect of healthcare and may influence patient outcomes. So far, little is known about the therapeutic alliance in telerehabilitation. To identify and describe central elements of therapeutic alliance in the setting of telerehabilitation and compare it to those in conventional rehabilitation. In this qualitative study, a literature search and in-depth semi-structured interviews with rehabilitation and telerehabilitation experts were conducted from 15.5.-10.8.2020 on elements influencing the therapeutic alliance in rehabilitation and telerehabilitation. Using a combined deductive and inductive approach, qualitative content analysis was used to identify categories and derive central themes. The elements bond, communication, agreement on goals and tasks and external factors were identified in the literature search and informed the development of the interview guide. Twelve purposively sampled experts from the fields of physiotherapy, occupational therapy, speech and language therapy, psychology, general medicine, sports science and telerehabilitation software development participated in the interviews. We identified three central themes: building effective communication; nurturing a mutual relationship of trust and respect; and agreement on goals and tasks and drivers of motivation. In this qualitative study, key elements of therapeutic alliance in rehabilitation confirmed those reported in the literature, with additional elements in telerehabilitation comprising support from others for ensuring physical safety and technical connectedness, caregivers acting as co-therapists and applying professional touch, and promoting patient autonomy and motivation using specific strategies.

Geospatial-based decision support system for prioritizing road segments for maintenance and rehabilitation

Given the growing demand for moving goods and people and the escalating number of vehicles on highways, issues related to road safety have become common concerns. Additionally, the aging of the road infrastructure and the intensification of climatic change effects reinforce the problem of road pavement serviceability. However, accessing funds for road maintenance and having the autonomy for pure technical decisions remain significant challenges for transport authorities. Thus, this paper addresses developing a geospatial-based systematic process for prioritizing highway segment candidates for maintenance and rehabilitation. The investigation was designed to facilitate the decision-making process for the state transportation authority to allocate funds over the 20.315 km of major highways in Minas Gerais, Brazil. The method consisted of ranking the highway segments regarding the geographic context to which each segment belongs, as well as the operational characteristics of the highways. The approach meets the United Nations Sustainable Development Goals by considering socio-economic and demographic perspectives along with other traditional engineering characteristics such as the available transport infrastructure, the traffic volume, the highway capacity, the pavement serviceability and the potential for deterioration, the condition of the surface drainage, and weather-related data. Transportation practitioners with expertise in pavement maintenance and rehabilitation and transportation managers contributed to the development by weighting the factors according to the best possible technical judgment regarding prioritizing funds. The GIS-oriented Delphi framework resulted in a priority index. The index allowed the elaboration of a ranking of priorities, which is vital information regarding public policies and the transparent use of public money for road maintenance and rehabilitation within the State of Minas Gerais. The model is robust and outputs geoinformation and tabular data to feed the decision-making process in an organized and transparent manner. Therefore, the core methodology can be easily transferable to other jurisdictions.

Delivering Multidisciplinary Rehabilitation Care in Parkinson's Disease: An International Consensus Statement.

Parkinson's disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD. The goal of the international Parkinson's Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care. The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions. The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages. Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.

Criteria and Indicators for Centers of Clinical Excellence in Stroke Recovery and Rehabilitation: A Global Consensus Facilitated by ISRRA

Background The aim of the International Stroke Recovery and Rehabilitation Alliance is to create a world where worldwide collaboration brings major breakthroughs for the millions of people living with stroke. A key pillar of this work is to define globally relevant criteria for centers that aspire to deliver excellent clinical rehabilitation and generate exceptional outcomes for patients. Objectives This paper presents consensus work conducted with an international group of expert stroke recovery and rehabilitation researchers, clinicians, and people living with stroke to identify and define criteria and measurable indicators for Centers of Clinical Excellence (CoCE) in stroke recovery and rehabilitation. These were intentionally developed to be ambitious and internationally relevant, regardless of a country’s development or income status, to drive global improvement in stroke services. Methods Criteria and specific measurable indicators for CoCE were collaboratively developed by an international panel of stroke recovery and rehabilitation experts from 10 countries and consumer groups from 5 countries. Results The criteria and associated indicators, ranked in order of importance, focused upon (i) optimal outcome, (ii) research culture, (iii) working collaboratively with people living with stroke, (iv) knowledge exchange, (v) leadership, (vi) education, and (vii) advocacy. Work is currently underway to user-test the criteria and indicators in 14 rehabilitation centers in 10 different countries. Conclusions We anticipate that use of the criteria and indicators could support individual organizations to further develop their services and, more widely, provide a mechanism by which clinical excellence can be articulated and shared to generate global improvements in stroke care.