Rehabilitation Priorities Research Articles

Operationalising treatment success in aphasia rehabilitation

ABSTRACT Background Treatment success is the desired outcome in aphasia rehabilitation. However, to date, there is a lack of consensus on what defines a 'successful' result on a given aphasia outcome measurement instrument (OMI). Aim In this methodological paper, we present strategies for how to define and measure treatment success on a given OMI at the group-level, as well as for an individual person with aphasia. The latter is particularly important when research findings from group studies are clinically implemented for individuals in rehabilitation. Scope We start by presenting methods to calculate the average statistically significant change across several (group) studies (e.g., standardised mean difference, raw unstandardised mean difference) for a given OMI. Such metrics are useful to summarise the overall effect of the intervention of interest, particularly in meta-analyses. However, benchmarks based on group effects are not feasible for assessing an individual participant’s treatment success and thus for determining the proportion of patients who had a beneficial response to therapy (overall response rate of an intervention). We therefore recommend a distribution-based approach to determine benchmarks of a statistically significant treatment response at the individual level, i.e., the 'smallest detectable change' for a given OMI, which refers to the smallest change that can be detected by the OMI beyond measurement error. However, the statistical significance of an individual treatment effect does not necessarily correspond to its clinical impact. This requires an additional indicator. The benchmark to determine a clinically relevant improvement on a given OMI is the 'minimal important change'. The minimally important change is defined as the smallest OMI change score perceived as important by the relevant stakeholder group (i.e., people with aphasia, their relatives/caregivers, clinicians). It therefore requires relating the individual OMI change scores to 'anchors', i.e., meaningful external criteria, preferably based on patient-perceived therapy success. Currently, there is no consensus regarding the optimal 'anchors' and their respective definition of clinically important change in aphasia outcome research. Conclusions/Recommendations Operationalising individual treatment success based on both statistically significant and (patient-reported) clinically meaningful benchmarks is a key priority in aphasia rehabilitation. Availability of such measures will (a) facilitate estimates of therapy response rate in intervention studies and thus optimise therapeutic decisions and (b) provide stakeholder groups (e.g., the society, the stroke team, people with aphasia, family, clinicians, healthcare professionals) with objective, statistically reliable and meaningful feedback on individual treatment response in the clinical setting.

A Risk-Based Approach in Rehabilitation of Water Distribution Networks.

A risk-based approach to support water utilities in terms of defining pipe rehabilitation priorities is presented. In a risk analysis in the risk management process, the probability that a given event will happen and the consequences if it does happen have to be estimated and combined. In the quantitative risk analysis, numerical values are assigned to both consequence and probability. In this study, the risk event addressed was the inability to supply water due to pipe breaks. Therefore, on the probability side, the probability of pipes breaking was assessed, and on the consequence side, the reduced ability to satisfy the water demand (hydraulic reliability) due to pipe breakage was computed. Random Forest analysis was implemented for the probability side, while the Asset Vulnerability Analysis Toolkit was used to analyse the network’s hydraulic reliability. Pipes could then be ranked based on the corresponding risk magnitude, thereby feeding a risk evaluation step; at this step, decisions are made concerning which risks need treatment, and also concerning the treatment priorities, i.e., rehabilitation priorities. The water distribution network of Trondheim, Norway, was used as a case study area, and this study illustrates how the developed method aids the development of a risk-based rehabilitation plan.

Effects of Rehabilitation Models on Self-Stigma among Persons with Mental Illness.

Social stigma is inevitable for mentally ill patients, but how patients treat themselves is a priority for rehabilitation and an important buffer mechanism. This study thus aimed to measure the effectiveness of rehabilitation models for improving self-stigma. This quasi-experimental research design applied purposeful sampling. The participants (n = 250) were persons with mental illness who received rehabilitation treatment in central Taiwan. They were divided into community- (n = 170) and institution-based (n = 80) rehabilitation groups. The Internalized Stigma of Mental Illness Scale was evaluated at the time of recruitment, and a follow-up was conducted after 1 and 3 months. A generalized estimation equation was used in data analysis to measure whether self-stigma improved with the rehabilitation model and time, and to test the effect of different rehabilitation models on participants’ self-stigma improvement. The study found that the self-stigma of patients receiving CBR improved more than that of those receiving IBR when behavioral problems, education, OT level, sex, and first-time self-stigma were controlled. Returning to the community is the goal of rehabilitation for patients with mental illness, but IBR still dominates the rehabilitation model in Taiwan. Thus, it is necessary to continue promoting CBR plans for future mental health policies.

Person-centered goal setting is feasible in people with Parkinson’s disease who have subjective cognitive decline: a mixed methods study

Purpose Evaluate the feasibility of person-centered goal setting in people with Parkinson’s disease (PD) who have subjective cognitive decline and explore characteristics of the formulated goals. Materials and methods Participants completed person-centered goal setting as a part of two cognitive intervention studies. Participants were guided to develop at least three goals and rate the importance of each goal using a 10-point scale (1: not at all important − 10: extremely important). To evaluate the feasibility of person-centered goal setting, we calculated the mean number of formulated goals per person and the importance level of all goals. To explore goal characteristics, two independent authors coded all goals and synthesized them using deductive content analysis in consultation with the senior author. Results Thirty participants formulated a total of 166 goals. The mean number of formulated goals per participant was 5.53 (SD = 2.22, range = 3 − 10). The mean importance level of all formulated goals was 8.3 (SD = 1.49, range = 4 − 10). Formulated goals ranged across diverse domains and categories. Conclusions Person-centered goal setting is feasible to guide people with PD to formulate personally meaningful goals. Findings highlight the diverse cognitive rehabilitation needs of people with PD, potential cognitive rehabilitation priorities, and future goal setting research directions. Implications for rehabilitation Rehabilitation clinicians and researchers should not assume that people with PD who have subjective cognitive decline are not capable of engaging in their goal setting. Rehabilitation clinicians and researchers should acknowledge and act on our responsibility to enable people with PD who have subjective cognitive decline to engage in goal setting. Rehabilitation clinicians and researchers are encouraged to explore diverse goal domains to optimize goal setting and rehabilitation care among people with PD who have subjective cognitive decline.

Predicting home discharge after inpatient rehabilitation of stroke patients with aphasia

ABSTRACT The early identification of the discharge setting from Inpatient Rehabilitation Facilities is a primary goal in stroke-related research because of its clinical and socio-economic relevance. Several features have been identified as significant predictors of the discharge setting. Within cognitive deficits, aphasia is known to be a common and disabling condition that could influence rehabilitation outcome. However, it is often set as an exclusion criterion in stroke research. This study aims to investigate the predictive power of clinical variables, in particular specific language disturbances and nonlinguistic cognitive deficits, for discharge setting in post-acute stroke patients with aphasia after intensive multidisciplinary rehabilitation. In a sample of 158 patients, demographic, motor, language, and nonverbal cognitive data were retrospectively considered for the prediction of the discharge to home vs. another institutional setting. Univariate analysis identified relevant differences between groups and the significant variables were included in a logistic regression model. The results showed that better functional motor status, absence of dysphagia and unimpaired nonlinguistic cognitive profile independently predict the discharge to home. In particular, nonverbal cognitive functioning seemed to be specifically relevant within the aphasic population. The findings could be helpful for setting up the rehabilitation priorities and an adequate discharge arrangement.

The impact of severe COVID-19 on health-related quality of life and disability: an early follow-up perspective

Objective:To assess early postdischarge health-related quality of life and disability of all survivors of critical COVID-19 admitted for more than 24 hours to na intensive care unit..Methods:Study carried out at the Intensive Care Medicine Department of Centro Hospitalar Universitário São João from 8th October 2020 to 16th February 2021. Approximately 1 month after hospital discharge, an intensive care-trained nurse performed a telephone consultation with 99 survivors already at home applying the EuroQol Five-Dimensional Five-Level questionnaire and the 12-item World Health Organization Disability Assessment Schedule 2.0.Results:The mean age of the population studied was 63 ± 12 years, and 32.5% were submitted to invasive mechanical ventilation. Their mean Simplified Acute Physiologic Score was 35 ± 14, and the Charlson Comorbidity Index was 3 ± 2. Intensive care medicine and hospital lengths of stay were 13 ± 22 and 22 ± 25 days, respectively. The mean EuroQol Visual Analog Scale was 65% (± 21), and only 35.3% had no or slight problems performing their usual activities, most having some degree of pain/discomfort and anxiety/depression. The 12-item World Health Organization Disability Assessment Schedule 2.0 showed marked impairments in terms of reassuring usual work or community activities and mobility. The use of both tools suggested that their health status was worse than their perception of it.Conclusion:This early identification of sequelae may help define flows and priorities for rehabilitation and reinsertion after critical COVID-19.

The impact of severe COVID-19 on health-related quality of life and disability: an early follow-up perspective.

To assess early postdischarge health-related quality of life and disability of all survivors of critical COVID-19 admitted for more than 24 hours to na intensive care unit.. Study carried out at the Intensive Care Medicine Department of Centro Hospitalar Universitário São João from 8th October 2020 to 16th February 2021. Approximately 1 month after hospital discharge, an intensive care-trained nurse performed a telephone consultation with 99 survivors already at home applying the EuroQol Five-Dimensional Five-Level questionnaire and the 12-item World Health Organization Disability Assessment Schedule 2.0. The mean age of the population studied was 63 ± 12 years, and 32.5% were submitted to invasive mechanical ventilation. Their mean Simplified Acute Physiologic Score was 35 ± 14, and the Charlson Comorbidity Index was 3 ± 2. Intensive care medicine and hospital lengths of stay were 13 ± 22 and 22 ± 25 days, respectively. The mean EuroQol Visual Analog Scale was 65% (± 21), and only 35.3% had no or slight problems performing their usual activities, most having some degree of pain/discomfort and anxiety/depression. The 12-item World Health Organization Disability Assessment Schedule 2.0 showed marked impairments in terms of reassuring usual work or community activities and mobility. The use of both tools suggested that their health status was worse than their perception of it. This early identification of sequelae may help define flows and priorities for rehabilitation and reinsertion after critical COVID-19.

FRAMEWORK FOR REHABILITATION OF BUILDINGS TO IMPROVE HEALTH, HYGIENE, AND COMFORT OF OCCUPANTS

The following study outlines a framework that can be applied to the initial stages of the rehabilitation decision making to shortlist and rank alternatives based on their impact on health, hygiene and comfort of occupants. The framework is outlined by applying to three case modules, the initial assessment is based on occupant survey and site data to identify problem areas and form a basis for extent of intervention required. Best Worst Method is applied to work out the weightages of parameters and MCDM is used to finally rank the alternatives based on rehabilitation priorities that could range from cost and time constraints, energy use, etc. The study is concluded by a representative flowchart of the framework.

Aligning Patient's Ideas of a Good Life with Medically Indicated Therapies in Geriatric Rehabilitation Using Smart Sensors.

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of a series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values.

Trunk muscle activity and kinematics during boxing and battle rope exercise in people with motor-complete spinal cord injury

Context Recovery of seated balance is a rehabilitation priority for people with motor-complete spinal cord injury (mcSCI). Previous research has demonstrated that people with mcSCI can voluntarily engage their trunk muscles during different exercise programs that have the potential to improve seated balance control. Boxing and battle rope exercises could offer another opportunity to improve seated balance for people with mcSCI, but it is unknown if this type of exercise engages trunk musculature and challenges seated balance. Objective To describe the movement patterns of people with mcSCI compared to controls by characterizing the muscle activation patterns and kinematics of the trunk and upper-body during boxing and battle rope exercise. Design Cross-sectional study. Participants 4 males with mcSCI between C7-T9, and 4 able-bodied controls. Methods Participants performed different boxing and battle rope exercises while kinematics and electromyography (EMG) from the trunk and arms were recorded. Outcome Measures Trunk EMG amplitude, trunk and arm joint angles, and trunk curvature. Results Boxing and battle ropes elicited higher relative EMG activity in people with mcSCI compared to controls (P < 0.001). Participants with mcSCI had similar upper-limb kinematics during the exercises to controls, but demonstrated reduced trunk rotation and increased trunk curvature. Conclusions These findings suggest that boxing and battle rope can elicit trunk activity in people with mcSCI, though they may adopt increased trunk curvatures. Future research should explore if such exercise programs may improve seated balance in people with mcSCI.

The Rehabilitation Effects of Myoelectric Powered Wearable Orthotics on Improving Upper Extremity Function in Persons with SCI.

Upper extremity (UE) weakness and/or paralysis following spinal cord injury (SCI) can lead to a limited capacity to perform activities of daily living (ADL). Such disability significantly reduces an individual's level of independence. Further, restoration of UE motor function in people with SCI remains a high priority in rehabilitation and the field of assistive technology. The overall goal of this study was to evaluate the effects of a myoelectric-powered wearable orthosis (MPWO) manufactured by MyoMo, Inc. (Boston, MA) for UE movement assistance on ameliorating UE motor function in order to improve ADL and quality of life in people with SCI. Two male participants with chronic incomplete SCI (iSCI), a 75- and a 31-year-old with AIS D and B, respectively, underwent 18 sessions (over 6 weeks) of UE movement rehabilitation using the MPWO. Handgrip strength, active range of motion (AROM) of the hand, response time to initiate a movement, and muscles activations were examined before and after the rehabilitation training using the MPWO. The response time to initiate UE movements decreased, and handgrip strength and AROM improved after training with the MPWO. These preliminary data suggest that rehabilitation with the use of the UE-MPWO device could enhance the participants' UE activities that led to improved function.Clinical Relevance- These preliminary results from two individuals with iSCI suggest that training with UE-MPWO assistive devices may improve UE utilization during ADL for individuals with muscle weakness or paralysis but still possessing residual voluntary muscle activation capabilities.

Analysis of water condition in Dodokan watershed, Lombok, Indonesia

Watershed of Dodokan in Lombok, Indonesia, is one of the strategic watersheds on the island of Lombok, and is a priority for rehabilitation of forest and land. This paper aims to analyse ecological water conditions in Dodokan watershed, Lombok, Indonesia, and recommends policy for improving the ecological conditions of the watershed. The results of this analysis are expected to be useful in implementing policies and programs to improve the ecological condition of this watershed, as well as to provide greater benefits for the communities around or related to this watershed. The watershed analysis focuses on five aspects, including flow regime coefficient, annual flow coefficient, sediment load, flood, and water use index. The results of the analysis show that the ecological condition of water management in the Dodokan watershed is poor, and can threaten the continuity of water resources in the Dodokan watershed. Therefore, rehabilitation activities are urgently needed.

Noninvasive neuromodulation and rehabilitation to promote functional restoration in persons with spinal cord injury.

This review will focus on the use of clinically accessible neuromodulatory approaches for functional restoration in persons with spinal cord injury (SCI). Functional restoration is a primary rehabilitation priority for individuals with SCI. High-tech neuromodulatory modalities have been used in laboratory settings to improve hand and walking function as well as to reduce spasticity and pain in persons with SCI. However, the cost, limited accessibility, and required expertise are prohibitive for clinical applicability of these high-tech modalities. Recent literature indicates that noninvasive and clinically accessible approaches targeting supraspinal, spinal, and peripheral neural structures can modulate neural excitability. Although a limited number of studies have examined the use of these approaches for functional restoration and amelioration of secondary complications in SCI, early evidence investigating their efficacy when combined with training is encouraging. Larger sample studies addressing both biomarker identification and dosing are crucial next steps in the field of neurorehabilitation research before novel noninvasive stimulation approaches can be incorporated into standard clinical practice.

Conception and development of Self-Management indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Context Although self-management is linked to reduced secondary health complications (SHCs) and enhanced overall quality of life post-spinal cord injury or disease (SCI/D), it is poorly integrated into the current rehabilitation process. Promoting self-management and assuring equity in care delivery is critical. Herein, we describe the selection of Self-Management structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods Experts in self-management across Canada completed the following tasks: (1) defined the Self-Management construct; (2) conducted a systematic search of available outcomes and their psychometric properties; and (3) created a Driver diagram summarizing available evidence related to Self-Management. Facilitated meetings allowed development and selection following rapid-cycle evaluations of proposed structure, process and outcome indicators. Results The structure indicator is the proportion of staff with appropriate education and training in self-management principles. The process indicator is the proportion of SCI/D inpatients who have received a self-management assessment related to specific patient self-management goal(s) within 30 days of admission. The outcome indicator is the Skill and Technique Acquisition, and Self-Monitoring and Insight subscores of the modified Health Education Impact Questionnaire. Conclusion The structure indicator will heighten awareness among administrators and policy makers regarding the need to provide staff with ongoing training related to promoting self-management skill acquisition. Successful implementation of the Self-Management process and outcome indicators will promote self-management education and skill acquisition as a rehabilitation priority, allow for personalization of skills related to the individual’s self-management goal(s), and empower individuals with SCI/D to manage their health and daily activities while successfully integrating into the community.

Effect of Task-Oriented Training on Upper Extremity Function for Patients with Spinal Cord and Traumatic Brain Injuries: Systematic Review

Abstract Background: Tetraplegia that results from cervical injury is the most frequent neurologic category after spinal cord injury (SCI) and causes substantial disability. Traumatic Brain injury (TBI) is a shock or a penetrating injury to the head that disrupts the brain function leading to various impairments including upper limb dysfunction. Improving arm and hand function after these injuries is a major priority of rehabilitation due to its reflect on mobility, independency and quality of life. Advances of treatment approaches and technology have been introduced in research work; one of these approaches is task-oriented training (TOT). Aim of Study: This systematic review aims to find out the evidence on the effectiveness of TOT to improve the upper limb functions among patients with SCI and TBI. Material and Methods: This systematic review performed using the PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro) and the Egyptian Knowledge Bank (EKB) search engines and the associated keywords. The methodological quality assessment was done by two reviewers using PEDro scale. Random effect model and standardized mean differences were used for meta-analyses. Results: The search identified 8,424 records, of which only two trials were selected as eligible. Quality appraisal revealed the trials were of good or fair quality. Conclusion: This systematic review suggests moderate level of evidence for non-significant effect of Task-oriented training in improving upper limb function and hand dexterity in patients with spinal cord injuries and further primary research is recommended for both SCI and TBI.

Towards improving an Area of Concern: Main-channel habitat rehabilitation priorities for the Maumee River

The Maumee River watershed in the Laurentian Great Lakes Basin has been impacted by decades of pollution and habitat modification due to human settlement and development. As such, the lower 35 km of the Maumee River and several smaller adjacent watersheds comprising over 2000 km2 were designated the Maumee Area of Concern (AOC) under the revised Great Lakes Water Quality Agreement in 1987. As part of pre-rehabilitation assessments in the Maumee AOC, we assessed fish and invertebrate communities in river km 24–11 of the Maumee River to identify: 1) areas that exhibit the highest biodiversity, 2) habitat characteristics associated with high biodiversity areas, 3) areas in need of protection from further degradation, and 4) areas that could feasibly be rehabilitated to increase biodiversity. Based on benthic trawl data, shallow water habitats surrounding large island complexes had the highest fish diversity and catch per unit effort (CPUE). Electrofishing displayed similar fish diversity and CPUE patterns across habitat types early in the study but yielded no discernable fish diversity or CPUE patterns towards the end of our study. Although highly variable among study sites, macroinvertebrate density was greatest in shallow water habitats <2.5 m and around large island complexes. Our results provide valuable baseline data that could act as a foundation for developing rehabilitation strategies in the lower Maumee River and for assessing the effectiveness of future aquatic habitat rehabilitation projects. In addition to increasing in-channel habitat, watershed-scale improvements of water quality might be necessary to ensure rehabilitation strategies are successful.

Neurological and psychological manifestations and consequences of an acute severe acute respiratory syndrome coronavirus 2 infection

Vital activity restoration in patients with fatigue syndrome after coronavirus disease-2019 and myalgic encephalomyelitis/chronic fatigue syndrome is a priority in the medical rehabilitation of this category of patients. This study aimed to review the literature using Russian and international sources and present data from contemporary studies on symptoms, possible pathophysiology and proposed treatment for neurological manifestations of consequences after an acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The recovery level of vital activity after acute infection with SARS-CoV-2 is low, and neurological symptoms persist in many patients. Chronic fatigue syndrome gradually develops in patients with a history of the disease, which subsequently leads to mental disorders, due to decreased physical activity.

Studi Penilaian Kinerja Irigasi dan Angka Kebutuhan Nyata Operasi dan Pemeliharaan (AKNOP) pada Daerah Irigasi Sumber Mujur Kecamatan Candipuro Kabupaten Lumajang

The Sumber Mujur Irrigation Area is located in Candipuro District with the broncaptering as the main building which is located in Sumber Mujur Subdistrict. In fact, in this Irrigation Area, there are many damages and problems to the assets owned. From the results of the inventory carried out, there were 109 problem points. Damage and problems are found at six points in the main building, 30 points on the carrier channel, and 73 points on the building on the carrier channel. The performance index value of Sumber Mujur Irrigation Area got a score of 81.94% which consists of physical infrastructure is 33.9%, plant productivity is 14.5%, operation and management supporting facilities is 8.5%, personnel organization is 11.7%, documentation 4.18%, water user farmer association is 9.15%. The calculation of priority for rehabilitation in the Sumber Mujur Irrigation Area using the AHP and ANP method, the aspect that requires rehabilitation most is the Physical Infrastructure aspect of the Main Building aspect. For Real Cost Value of Maintaining and Operating Irrigation calculation (AKNOP) for the main building in the Sumber Mujur Irrigation Area, it was obtained IDR 574,871,655.00.

The Impact of Augmented Reality on the Social Skills of Children with High Functioning Autism

The present study determined the effectiveness of augmented reality on the social skills of children with high Functioning autism. The present study was a quasi-experimental study with a posttest test with a control group. The statistical population of the present study included all children with autism with high performance in Andimeshk in 2019. Participants included 20 children with high-functioning autism who were selected by available sampling method and randomly selected in the experimental and control groups. They were evaluated using the Bellini social profile, and then augmented reality was performed on the experimental group in 10 45-minute sessions, while not on the control group. The findings were analyzed using covariance analysis and showed that the augmented reality intervention program had an effect on the social skills of children with high-functioning autism. Based on these results, augmented reality intervention program can be considered as a priority for rehabilitation of children with autism with high performance.

Setting rehabilitation priorities for abandoned mines of similar characteristics according to their visual impact: The case of Milos Island, Greece

Mine rehabilitation is nowadays an essential part of the mine life-cycle. Nevertheless, due to the inadequate legislative framework and the lack of appropriate financial instruments in the past, abandoned mined land is present in almost all regions with a mining history. Especially in times of fiscal and financial belt tightening, where direct funding is almost impossible, the restoration of abandoned mines becomes a difficult task and, consequently, prioritization of the restoration projects is necessitated. So far, several models have been developed for that purpose. The existing models, however, usually underestimate that, especially for non-reclaimed mines located close to populated areas, landscape degradation generated by surface mining is a critical factor. To this end, this paper presents, through an illustrative example, a new approach providing the means for prioritizing mine restoration projects based on the visibility of surface mines with regard to the neighboring areas of interest. The proposed approach can be utilized as an additional module in existing prioritization models, or it can be used standalone when considering a group of surface mines where what distinguishes them from each other is primarily the disturbance of the landscape.