Evidence Synthesis and Clinical Recommendations for Supporting School Students With Sensory Processing Challenges: A Rapid Review.

IMPORTANCE: Children with sensory processing challenges often need supports to access, participate in, and achieve at school. However, research on best practice is varied, presenting difficulty for practitioners to assess the appropriateness of each support. OBJECTIVE: To provide evidence-informed recommendations regarding best practices in school-based supports for students with sensory processing challenges via a Rapid Evidence Assessment of current literature. DATA SOURCES: Searches were run in CINAHL Complete, Education Research Complete, ERIC, MEDLINE, PsycINFO, and Scopus (for articles published 2010 to 2023). Informed by a 2010 review, articles citing publications identified in the prior review were also included. STUDY SELECTION AND DATA COLLECTION: A reviewer screened the title and abstract of each article for inclusion, and another screened the full texts, with 10% of each reviewer's articles assessed by the other. Interrater reliability was excellent. FINDINGS: The review included 61 articles, with only 15% constituting good evidence (38% provided adequate evidence, 31% provided poor evidence, and 16% were reviews). No support could be wholly recommended without caveats, but there was some evidence that sound amplification systems, alternate seating, and multisensory environments may be beneficial in certain conditions or with certain populations. The use of weighted vests is not recommended. CONCLUSIONS AND RELEVANCE: Most research had small sample sizes and inconsistent protocols, highlighting the importance of ongoing research. Evidence-informed practitioners should review research findings carefully and integrate evidence from comprehensive clinical assessment and understanding of the child, school, and family contexts when assessing the appropriateness of a support for each student. Plain-Language Summary: Children with sensory processing challenges often need supports to access, participate in, and achieve at school. Occupational therapists provide school-based supports for children with sensory processing challenges with the goal of enabling access, participation, and achievement. It is difficult, however, for practitioners to assess the appropriateness of each support because research on best practice varies. This review of the current literature provides practitioners with evidence on supports for school children with sensory processing challenges to inform decision-making and the selection of appropriate supports for their clients. When assessing the appropriateness of a support for a student, practitioners should carefully review current research findings and integrate evidence from comprehensive clinical assessments along with an understanding of the student, school, and family contexts.

Long-Term Impact of an Occupational Therapy Intervention for Children With Challenges in Sensory Processing and Integration.

IMPORTANCE: Research is limited regarding parent-caregiver perspectives of occupational therapy (OT) intervention for children with challenges in sensory processing and integration and whether changes immediately following OT intervention are sustained over time. OBJECTIVE: To evaluate whether changes in identified goals are maintained following OT intervention and to determine what aspects of OT intervention parents-caregivers perceive to be most valuable. DESIGN: A mixed-methods research design. SETTING: A large midwestern pediatric hospital, with follow-up telephone interviews with parents-caregivers. PARTICIPANTS: Sixteen children with sensory challenges and their parents-caregivers. INTERVENTION: Children participated in 1-hr OT intervention sessions, 3 days per wk, for 6 to 7 wk. Parents-caregivers of children who completed OT intervention were interviewed via the telephone 6 to 12 mo after the intervention. OUTCOMES AND MEASURES: The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were used to determine whether changes were made and sustained over time. Qualitative data on caregiver perceptions of OT intervention were collected via open-ended questions during phone interviews. COPM and GAS scores before intervention were statistically significant compared with scores immediately following intervention and at 6- to 12-mo follow-up. Five themes emerged from the qualitative data. CONCLUSIONS AND RELEVANCE: Children with sensory challenges made significant changes related to occupational performance following OT intervention, and goal achievement was sustained over time. Parents-caregivers valued many aspects of the OT program, including the increased frequency of therapy services, the occupational therapist's advanced knowledge and skills, and the education and information provided during the program. Plain-Language Summary: This study supports the results of previous studies on OT intervention for children with challenges in sensory processing and integration. The study also adds to the body of knowledge that shows that changes and progress toward goals that result from skilled OT intervention can be sustained over time. The study showed that children participating in OT intervention made statistically significant changes while receiving OT services and maintained progress after intervention ended; however, the children did not continue to make significant progress toward goals once skilled OT services ended. Parents and caregivers of children with sensory challenges reported that they found OT intervention to be beneficial. Other important factors influencing the effectiveness of OT intervention that were identified by parents-caregivers included the education provided by the occupational therapist, the increased frequency of therapy services, and the increased knowledge and skills of the occupational therapists who provided the intervention.

Effect of acupuncture combined with rehabilitation training on sensory impairment of patients with stroke: a network meta-analysis.

BACKGROUND: The refractory and disabling nature of sensory disorders after stroke seriously affects patients' daily lives and reduces hospital turnover. Acupuncture, as an alternative therapy, is commonly used in combination with rehabilitation training to improve sensory disorders. To compare the effects of different acupuncture-related treatments combined with rehabilitation training on sensory impairment and the daily living ability of patients with stroke, we conducted a network meta-analysis to provide evidence-based findings for clinical practice. METHODS: Randomized controlled trials on the treatment of sensory disorders in patients with stroke were systematically retrieved from several databases, including China National Knowledge Infrastructure (CNKI), China Science and Technology Journal(VIP), Wanfang Database, Chinese Biological Medical (CBM), PubMed, Embase, Web of Science, Cochrane Library, and Clinical trials. The retrieval period ranged from January 2012 to December 2023. Two independent reviewers screened the included literature, extracted the data, and assessed the risk quality using Cochrane Handbook 5.1.0 and ReviewManager 5.4.1. Stata16.0 software was employed for data analysis. The study protocol was registered in PROSPERO: CRD42023389180. RESULTS: After screening, 20 studies were included, involving a total of 1999 subjects. The network meta-analysis results indicate that, compared to standard rehabilitation, acupuncture plus massage plus rehabilitation showed the most significant reduction in Numbness Syndrome Scores (MD = -0.71(-1.11,-0.31)). Acupuncture combined with rehabilitation demonstrated the most substantial improvement in Sensory Impairment Scores (MD = -0.59,(-0.68,-0.51)) and daily living ability of patients (MD = 17.16,(12.20,22.12)). CONCLUSIONS: In comparison to standard rehabilitation, the combination of acupuncture-related treatments and modern rehabilitation training not only improves the symptoms of sensory impairment and numbness after stroke but also enhances the daily living ability of patients, especially when acupuncture is combined with rehabilitation. However, further demonstration is required to strengthen these conclusions.

Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury.

BACKGROUND: People with spatial neglect after stroke or other brain injury have difficulty attending to one side of space. Various rehabilitation interventions have been used, but evidence of their benefit is unclear. OBJECTIVES: The main objective was to determine the effects of non-pharmacological interventions for people with spatial neglect after stroke and other adult-acquired non-progressive brain injury. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (last searched October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL; last searched October 2020), MEDLINE (1966 to October 2020), Embase (1980 to October 2020), the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1983 to October 2020), and PsycINFO (1974 to October 2020). We also searched ongoing trials registers and screened reference lists. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of any non-pharmacological intervention specifically aimed at spatial neglect. We excluded studies of general rehabilitation and studies with mixed participant groups, unless separate neglect data were available. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Review authors categorised the interventions into eight broad types deemed to be applicable to clinical practice through iterative discussion: visual interventions, prism adaptation, body awareness interventions, mental function interventions, movement interventions, non-invasive brain stimulation, electrical stimulation, and acupuncture. We assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS: We included 65 RCTs with 1951 participants, all of which included people with spatial neglect following stroke. Most studies measured outcomes using standardised neglect assessments. Fifty-one studies measured effects on ADL immediately after completion of the intervention period; only 16 reported persisting effects on ADL (our primary outcome). One study (30 participants) reported discharge destination, and one (24 participants) reported depression. No studies reported falls, balance, or quality of life. Only two studies were judged to be entirely at low risk of bias, and all were small, with fewer than 50 participants per group. We found no definitive (phase 3) clinical trials. None of the studies reported any patient or public involvement. Visual interventions versus any control: evidence is very uncertain about the effects of visual interventions for spatial neglect based on measures of persisting functional ability in ADL (2 studies, 55 participants) (standardised mean difference (SMD) -0.04, 95% confidence interval (CI) -0.57 to 0.49); measures of immediate functional ability in ADL; persisting standardised neglect assessments; and immediate neglect assessments. Prism adaptation versus any control: evidence is very uncertain about the effects of prism adaptation for spatial neglect based on measures of persisting functional ability in ADL (2 studies, 39 participants) (SMD -0.29, 95% CI -0.93 to 0.35); measures of immediate functional ability in ADL; persisting standardised neglect assessments; and immediate neglect assessments. Body awareness interventions versus any control: evidence is very uncertain about the effects of body awareness interventions for spatial neglect based on measures of persisting functional ability in ADL (5 studies, 125 participants) (SMD 0.61, 95% CI 0.24 to 0.97); measures of immediate functional ability in ADL; persisting standardised neglect assessments; immediate neglect assessments; and adverse events. Mental function interventions versus any control: we found no trials of mental function interventions for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of mental function interventions on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. Movement interventions versus any control: we found no trials of movement interventions for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of body awareness interventions on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. Non-invasive brain stimulation (NIBS) versus any control: evidence is very uncertain about the effects of NIBS on spatial neglect based on measures of persisting functional ability in ADL (3 studies, 92 participants) (SMD 0.35, 95% CI -0.08 to 0.77); measures of immediate functional ability in ADL; persisting standardised neglect assessments; immediate neglect assessments; and adverse events. Electrical stimulation versus any control: we found no trials of electrical stimulation for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of electrical stimulation on spatial neglect based on immediate neglect assessments. Acupuncture versus any control: we found no trials of acupuncture for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of acupuncture on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. AUTHORS' CONCLUSIONS: The effectiveness of non-pharmacological interventions for spatial neglect in improving functional ability in ADL and increasing independence remains unproven. Many strategies have been proposed to aid rehabilitation of spatial neglect, but none has yet been sufficiently researched through high-quality fully powered randomised trials to establish potential or adverse effects. As a consequence, no rehabilitation approach can be supported or refuted based on current evidence from RCTs. As recommended by a number of national clinical guidelines, clinicians should continue to provide rehabilitation for neglect that enables people to meet their rehabilitation goals. Clinicians and stroke survivors should have the opportunity, and are strongly encouraged, to participate in research. Future studies need to have appropriate high-quality methodological design, delivery, and reporting to enable appraisal and interpretation of results. Future studies also must evaluate outcomes of importance to patients, such as persisting functional ability in ADL. One way to improve the quality of research is to involve people with experience with the condition in designing and running trials.

Rehabilitation in multiple sclerosis in 2021.

Patients with multiple sclerosis, despite advances in therapy, often suffer from locomotor impairment that limits their mobility and affect quality of life. Rehabilitation is part of the treatment of MS and has shown its beneficial effects in numerous studies. While traditional rehabilitation techniques remain in the limelight, new technologies are emerging and make it possible to improve the management of disabling symptoms. The aim of this update is to synthesize the new therapy techniques proposed in rehabilitation for patients with multiple sclerosis according to the symptoms as balance, gait, upper limb disorders, fatigue, spasticity and disease progression published over the past 5 years. With regard to balance and walking disorders, neuromotor rehabilitation, physical exercise, rhythmic auditory stimulation, gait robot training and exergaming are effective. Only physical exercise has shown a positive effect on fatigue management. Spasticity is improved by classic rehabilitation techniques however non-invasive brain stimulation are promising. The rehabilitation of upper limb dysfunctions uses various effective techniques such as the repetition of functional tasks in real or virtual situations. In case of a more severe disability, arm robots can be used to relearn the impaired movement. Action observation training in real or virtual situations is also effective. Finally, under certain conditions the constraint induced movement therapy is proposed. The effects of rehabilitation are not only positive on the pyramidal symptoms and fatigue but also increase neuroplasticity and perhaps a neuroprotective effect as shown in some studies.

Effects of a robot-aided somatosensory training on proprioception and motor function in stroke survivors.

BACKGROUND: Proprioceptive deficits after stroke are associated with poor upper limb function, slower motor recovery, and decreased self-care ability. Improving proprioception should enhance motor control in stroke survivors, but current evidence is inconclusive. Thus, this study examined whether a robot-aided somatosensory-based training requiring increasingly accurate active wrist movements improves proprioceptive acuity as well as motor performance in chronic stroke. METHODS: Twelve adults with chronic stroke completed a 2-day training (age range: 42-74 years; median time-after-stroke: 12 months; median Fugl-Meyer UE: 65). Retention was assessed at Day 5. Grasping the handle of a wrist-robotic exoskeleton, participants trained to roll a virtual ball to a target through continuous wrist adduction/abduction movements. During training vision was occluded, but participants received real-time, vibro-tactile feedback on their forearm about ball position and speed. Primary outcome was the just-noticeable-difference (JND) wrist position sense threshold as a measure of proprioceptive acuity. Secondary outcomes were spatial error in an untrained wrist tracing task and somatosensory-evoked potentials (SEP) as a neural correlate of proprioceptive function. Ten neurologically-intact adults were recruited to serve as non-stroke controls for matched age, gender and hand dominance (age range: 44 to 79 years; 6 women, 4 men). RESULTS: Participants significantly reduced JND thresholds at posttest and retention (Stroke group: pretest: mean: 1.77° [SD: 0.54°] to posttest mean: 1.38° [0.34°]; Control group: 1.50° [0.46°] to posttest mean: 1.45° [SD: 0.54°]; F[2,37] = 4.54, p = 0.017, ηp2 = 0.20) in both groups. A higher pretest JND threshold was associated with a higher threshold reduction at posttest and retention (r = - 0.86, - 0.90, p ≤ 0.001) among the stroke participants. Error in the untrained tracing task was reduced by 22 % at posttest, yielding an effect size of w = 0.13. Stroke participants exhibited significantly reduced P27-N30 peak-to-peak SEP amplitude at pretest (U = 11, p = 0.03) compared to the non-stroke group. SEP measures did not change systematically with training. CONCLUSIONS: This study provides proof-of-concept that non-visual, proprioceptive training can induce fast, measurable improvements in proprioceptive function in chronic stroke survivors. There is encouraging but inconclusive evidence that such somatosensory learning transfers to untrained motor tasks. Trial registration Clinicaltrials.gov; Registration ID: NCT02565407; Date of registration: 01/10/2015; URL: https://clinicaltrials.gov/ct2/show/NCT02565407 .

Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study.

BACKGROUND: Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation. METHODS: In this prospective case-control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category. RESULTS: Comparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70). CONCLUSION: The Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke. Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.

Exploration of Sensory Processing Difficulties among Children Attending Primary School in Denmark.

Current research shows that children with sensory processing (SP) difficulties have limited participation and enjoyment in their daily activities at school. The aim of this study was to explore the prevalence of SP difficulties among Danish children and to explore possible associated factors. Since SP difficulties can affect children's prerequisites for participation in school activities and learning possibilities, this study focused on primary school children. Method. The study was designed as a cross-sectional survey. The sample consisted of 1723 children age 5 to 11 years, who were attending Danish public school (45.5% girls, 53.2% boys). The parents or caregivers of the child completed a Short Sensory Profile (SSP) questionnaire and a demographic questionnaire. One-way ANOVA was used to examine differences between girls and boys regarding sports, geographic area, and parental level of education. Chi-square analysis was used to explore the relationship between sex and SPP scores in the different behavioral sections. Logistic regression analysis was used to investigate possible associations between SP difficulties and sex and the included demographics. Results. A total of 21.3% of the children had SSP scores suggesting SP difficulties. Boys had a higher probability of having SP difficulties than girls (odds ratio (OR) = 1.55, confidence level (Cl): 1.22, 1.97). An association was found between participating in sports outside of school and SP difficulties (OR = 0.55, Cl: 0.47, 0.65 (p ≤ 0.001)). Additionally, a slight association between SP difficulties and parental education level (OR = 0.80) was found. No association was found regarding geographic area, i.e., where in Denmark the children attended school (OR = 1.00). Conclusion. The study results suggest that approximately 20% of the children in Danish public schools might have SP difficulties and over 20% might be at risk of having SP difficulties. The results suggest that Danish schools should focus on both identifying children with SP difficulties and implement interventions such as sensory integration through occupational therapy to help children with SP difficulties, in order to improve their ability to participate and learn from school activities.

Investigating Therapies for Freezing of Gait Targeting the Cognitive, Limbic, and Sensorimotor Domains.

BACKGROUND: Freezing of gait (FOG) is arguably the most disabling motor symptom experienced with Parkinson's disease (PD), but treatments are extremely limited due to our poor understanding of the underlying mechanisms. Three cortical domains are postulated in recent research (ie, the cognitive, limbic, and sensorimotor domains), thus, treatments targeting these mechanisms of FOG may potentially be effective. Cognitive training, cognitive behavioral therapy (CBT, a well-known anxiety intervention), and proprioceptive training may address the cognitive, limbic, and sensorimotor domains, respectively. OBJECTIVE: To investigate whether these 3 treatments could improve functional outcomes of FOG. METHODS: In a single-blind, randomized crossover design, 15 individuals with PD and FOG were randomized into different, counterbalanced orders of receiving the interventions. Each consisted of eight 1-hour sessions, twice weekly for 4 weeks. FOG severity was assessed as the primary outcome using a novel gait paradigm that was aimed at evoking FOG when the cognitive, limbic, or sensorimotor domains were independently challenged. RESULTS: FOG severity significantly improved after the cognitive intervention, with strong trends toward improvement specifically in the baseline and cognitive-challenge assessment conditions. CBT, as the anxiety intervention, resulted in significantly worse FOG severity. In contrast, proprioceptive training significantly improved FOG severity, with consistent trends across all conditions. CONCLUSIONS: The cognitive and proprioceptive treatments appeared to improve different aspects of FOG. Thus, either of these interventions could potentially be a viable treatment for FOG. However, although the results were statistically significant, they could be sensitive to the relatively small number of participants in the study. Considering the significant results together with nonsignificant trends in both FOG and gait measures, and given equal time for each intervention, proprioceptive training produced the most consistent indications of benefits in this study. (clinicaltrials.gov NCT03065127).

Prediction of Balance After Inpatient Rehabilitation in Stroke Subjects with Severe Balance Alterations at the Admission.

BACKGROUND: Patients with severe motor alterations would be those on who the prediction of the expected motor response after inpatient rehabilitation programs is most required. OBJECTIVES: To analyze if the balance progress measured by the Berg Balance Scale and the time of hospitalization could be independent predictors of the Berg Balance at the end of a post stroke rehabilitation program in patients with severe balance alteration at the admission. Secondly, to compare a Berg Balance prediction model at the time of discharge based on the Berg Balance at the time of admission (model 1) to a Berg Balance prediction model at the time of discharge based on Berg Balance progress and the time of hospitalization (model 2). METHODS: Subjects suffering a first subacute supratentorial stroke admitted for inpatient rehabilitation between 2010 through 2018 were included to develop two linear regression models of predicted Berg Balance at discharge (n=149). RESULTS: According to model 1 (p < 0.0001, R2= 0.166), the Berg Balance at the admission would be a predictor of the Berg Balance at discharge from hospitalization. According to model 2 (p < 0.0001, R2= 0.993) the Berg Balance progress (ß= 1.026; p < 0.0001) and the hospitalization time (ß=-0.006; p < 0.0001) would be independent predictors of the Berg Balance at discharge. CONCLUSIONS: The motor response to the rehabilitation programs in subacute patients with severe motor alterations could be explained on the basis of balance condition at the admission, but this explanation may be improved considering the progress on the balance the patients achieve during inpatient rehabilitation irrespective the time of hospitalization.

Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019.

BACKGROUND: Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritised in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury. METHODS: To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability (YLDs) of 25 diseases, impairments, or bespoke aggregations of sequelae that were selected as amenable to rehabilitation. All analyses were done at the country level and then aggregated to seven regions: World Bank high-income countries and the six WHO regions (ie, Africa, the Americas, Southeast Asia, Europe, Eastern Mediterranean, and Western Pacific). FINDINGS: Globally, in 2019, 2·41 billion (95% uncertainty interval 2·34-2·50) individuals had conditions that would benefit from rehabilitation, contributing to 310 million [235-392] YLDs. This number had increased by 63% from 1990 to 2019. Regionally, the Western Pacific had the highest need of rehabilitation services (610 million people [588-636] and 83 million YLDs [62-106]). The disease area that contributed most to prevalence was musculoskeletal disorders (1·71 billion people [1·68-1·80]), with low back pain being the most prevalent condition in 134 of the 204 countries analysed. INTERPRETATION: To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need. FUNDING: Bill & Melinda Gates Foundation.

Parosmia is Associated with Relevant Olfactory Recovery After Olfactory Training.

OBJECTIVE/HYPOTHESIS: This study aims to determine the association between parosmia and clinically relevant recovery of olfactory function in patients with post-infectious olfactory dysfunction (PIOD) receiving olfactory training. STUDY DESIGN: Retrospective cohort study. METHODS: This was a retrospective cohort study of patients with PIOD that received olfactory training. Adult patients with the major complaint of quantitative smell loss were recruited and treated at several ENT clinics in German between 2008 and 2018. The outcome was based on the association between smell-loss related factors (including parosmia and phantosmia) and clinically relevant changes in overall and subdimension olfactory function of threshold, discrimination, and identification using binary logistic regression analysis. RESULTS: A total of 153 participants with PIOD were included. Clinically relevant improvements in overall olfactory function were more likely in those that had lower baseline olfactory function. Relevant improvements in discrimination function were more likely in those that had lower baseline olfactory function and those that had parosmia at the initial visit. Similarly, relevant improvements in odor identification were more likely in those that had a lower baseline olfactory function and in those who had parosmia at the first visit. Clinically significant improvements in odor threshold were more likely in those who were older in age. CONCLUSIONS: This study demonstrated that the presence of parosmia is associated with clinically relevant recovery in olfactory discrimination and identification function in patients with PIOD receiving olfactory training. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:618-623, 2021.

Evaluation of balance in children with sensorineural hearing loss according to age.

PURPOSE: Hearing is an important sensory skill for psychomotor development. As the cochlea and vestibule share the membranous labyrinth of the inner ear, children with sensorineural hearing loss (SNHL) may have vestibular dysfunction. This study aimed to evaluate static, dynamic, functional balance, and mobility as a whole in children with SNHL. MATERIAL AND METHODS: Eighty children, 40 with bilateral severe-to-profound SNHL (20 children between the ages of 6-10 were included in the Group 1, and 20 children between the ages of 11-15 were included in the Group 2) and 40 with normal-hearing (the Group 3 included 20 children between the ages of 6-10 and the Group 4 of 20 children between the ages of 11-15) were included in the study. The Single-Leg Stance (SLS) Test, Functional Reach Test (FRT), Time Up and Go (TUG) Test, and Pediatric Balance Scale (PBS) were used to evaluate the balance skills of children. RESULTS: The present study found out that children with SNHL in both age groups performed worse than those with normal-hearing in FRT, SLS, and PBS. In the TUG test, children with SNHL in the younger age group had lower performance compared to their peers with normal-hearing while the TUG performance of children with SNHL in the older age group was similar to their normal-hearing peers. CONCLUSION: It was concluded that the static, dynamic and functional balance skills of children with SNHL were impaired compared to their normal-hearing peers. Including balance assessment in the routine test battery in children with SNHL may be decisive for early diagnosis and rehabilitation of balance disorders. It may be beneficial to add static, dynamic and functional balance tests to the test battery in addition to mobility assessment, especially in children with SNHL in the older age groups.

Intervención de terapia ocupacional en niños con dificultades de procesamiento sensorial: un estudio de caso múltiple en una escuela en Paris / Occupational therapy intervention for children with challenges in sensory processing: a multiple case study from a school in Paris

PROPÓSITO: El principal objetivo de este estudio fue describir el proceso y evaluar la eficacia de terapia ocupacional con abordaje de integración sensorial para 3 niños con dificultades de procesamiento sensorial, con el fin de ayudar a desarrollar modelos de practica apropiados en planificación e implementación de la intervención de terapia ocupacional. MÉTODO: Se utilizó un diseño de estudio de casos múltiples. Todos los participantes eran estudiantes de la misma escuela y fueron remitidos a terapia ocupacional debido a dificultades en escritura, torpeza motora y participación en clase. Los participantes recibieron sesiones individuales de 45 minutos de duración. La duración media de la intervención fue de 27 sesiones realizadas una vez por semana en el transcurso del año lectivo. Los niños fueron evaluados antes y después de la intervención con entrevistas a padres y maestros, observaciones clínicas y pruebas estandarizadas. RESULTADOS: Luego de la intervención se observaron mejores resultados en habilidades de desempeño de las evaluaciones estandarizadas Bruininks-Oseretsky Test of Motor Proficiency, Segunda Edición (BOT™-2) y Prueba de Desarrollo de la Percepción Visual - Tercera Edición (DTVP-3). Además, se observó mejora en la calidad de la escritura y la participación en los juegos de motricidad gruesa en todos los niños. CONCLUSIÓN: Los resultados de este estudio se adhieren a la literatura en el sentido de que la terapia ocupacional bajo un marco de integración sensorial parece ser un método efectivo para mejorar las habilidades de desempeño y la participación funcional de los niños con desafíos de procesamiento sensorial.

PURPOSE: The main purpose of this study was to describe the process and evaluate the effectiveness of occupational therapy under a sensory integration framework for 3 children with sensory processing challenges, in order to help develop models of good practice in planning and implementation of occupational therapy intervention. METHOD: A Multiple Case Study design was utilized. All participants were students at the same school and were referred to occupational therapy because of concerns with handwriting, clumsiness and class participation. Participants received individual, 45 minutes long intervention sessions. The mean length of intervention was 27 sessions delivered 1 time per week over the course of the academic year. Children were evaluated before and after intervention with parent/teacher interviews, clinical observations and standardized tests. RESULTS: After the intervention all participants obtained higher scores for performance skills in the standardized tests Bruininks-Oseretsky Test of Motor Proficiency, Second Edición (BOT™-2) and Developmental Test of Visual Perception ­ Third Edition (DTVP-3). Furthermore, improved handwriting quality and participation on gross motor games was reported for all participants. CONCLUSION: The results of this study adhere to the literature in that occupational therapy under a sensory integration framework seems to be an effective method for enhancing performance skills and functional participation of children with sensory processing challenges.

Patrones de procesamiento sensorial e intervención temprana en niños menores de 3 años: una revisión de la literatura / Sensory processing patterns and early intervention in children under 3 years of age: a review of the literature

La presente revisión se centra en proporcionar una visión general de la literatura que identifica estudios enfocados en definir los patrones de procesamiento sensorial en niños menores de 3 años y los enfoques de intervención identificados en esta población. Durante la última década ha existido un crecimiento constante de la literatura relacionada con el procesamiento sensorial en los niños pequeños, sin embargo, la información disponible entre las diferentes publicaciones es aún limitada y segmentada. En esta revisión se recopilaron 15 artículos sobre los patrones de procesamiento sensorial en los niños pequeños y 10 artículos relacionados con los enfoques de intervención para un total de 25 artículos publicados entre 2007 y 2017. Del análisis de la información obtenida acerca de los patrones de procesamiento sensorial, surgieron los siguientes temas: el diagnóstico y los factores de riesgo, el tipo de disfunción del procesamiento sensorial y el impacto funcional. Entre los temas que surgieron al analizar los enfoques de intervención, se destaca la importancia de la familia como un tema general que abarca subtemas de intervención, tales como: estrategias sensoriales, capacitación de los padres e intervenciones grupales. Si bien es necesario continuar desarrollando investigaciones que amplíen nuestro conocimiento en relación con estos temas en general, la evidencia apoya la efectividad de la intervención temprana.

La presente revisión se centra en proporcionar una visión general de la literatura que identifica estudios enfocados en definir los patrones de procesamiento sensorial en niños menores de 3 años y los enfoques de intervención identificados en esta población. Durante la última década ha existido un crecimiento constante de la literatura relacionada con el procesamiento sensorial en los niños pequeños, sin embargo, la información disponible entre las diferentes publicaciones es aún limitada y segmentada. En esta revisión se recopilaron 15 artículos sobre los patrones de procesamiento sensorial en los niños pequeños y 10 artículos relacionados con los enfoques de intervención para un total de 25 artículos publicados entre 2007 y 2017. Del análisis de la información obtenida acerca de los patrones de procesamiento sensorial, surgieron los siguientes temas: el diagnóstico y los factores de riesgo, el tipo de disfunción del procesamiento sensorial y el impacto funcional. Entre los temas que surgieron al analizar los enfoques de intervención, se destaca la importancia de la familia como un tema general que abarca subtemas de intervención, tales como: estrategias sensoriales, capacitación de los padres e intervenciones grupales. Si bien es necesario continuar desarrollando investigaciones que amplíen nuestro conocimiento en relación con estos temas en general, la evidencia apoya la efectividad de la intervención temprana.

Investigating the Effects of Vestibular Rehabilitation on Balance Function in Cochlear Implant Recipients.

BACKGROUND: Cochlear Implantation (CI) is an effective surgical approach to rehabilitate the severe to profound hearing-impaired patients. However, the insertion of CI electrodes into the cochlea may adversely affect vestibular receptors, resulting in vertigo or dizziness. The present study aimed to investigate the impacts of Vestibular Rehabilitation Therapy (VRT) exercises on dizziness symptoms of patients who underwent CI. METHODS: A total of 21 consecutive patients (age range: 28 to 61 years) with profound sensorineural hearing loss undergoing CI operation participated. The VRT therapy plan consisted of a habituation and adaptation exercises in combination with gait and balance exercises. The handicapping influences of dizziness was measured using a Dizziness Handicap Inventory (DHI) scale to measure the level of respondent's performance on physical, emotional, and functional dimensions. Visual Analogue Scale (VAS) was also conducted to assess the severity of dizziness symptoms. The DHI and VAS scales were conducted before VRT and at "oneweek", "two-week", and "four-week" following the last rehabilitation session. RESULTS: A repeated-measure analysis of variance demonstrated a significant decrement and a consequent improvement in DHI scores after vestibular exercises in all emotional, physical and functional domains (p < 0.001). We also found that the influence of implanted ear (p=0.076) and gender (p=0.094) variables on DHI scores were not statistically significant. The mean VAS score was 5.87 ± 2.27 at baseline stage and it reduced significantly during the course of the therapy (second week, 2.02 ±1.75, p < 0.001; and forth week, 1.51 ± 1.29, p < 0.001). CONCLUSION: The findings of this study showed that vestibular rehabilitation therapy has a positive impact on the symptoms of the patients who underwent CI surgery. These exercises lead to an improvement in balance and postural stability, and a reduction in the self-report measure of handicaps. These findings provide the basis for better pre-operative counseling and postoperative vestibular rehabilitation to CI recipients.

Rehabilitation of older people with Parkinson's disease: an innovative protocol for RCT study to evaluate the potential of robotic-based technologies.

BACKGROUND: Parkinson's disease is one of the most frequent causes of disability among the older adults. It is a chronic-progressive neuro-degenerative disease, characterized by several motor disorders. Balance disorders are a symptom that involves the body axis and do not respond to dopaminergic therapy used in Parkinson's disease. Therefore, physiotherapy becomes an important intervention for the management of motor disorders. Originally, these rehabilitative approaches were based on empirical experiences, but several scientific evidences suggests that neuronal plasticity is exercise-dependent. In this context, robotic rehabilitation plays an important role because it allows to perform task-oriented exercises and to increase the number of repetitions and their intensity. This protocol study aims to evaluate the effectiveness of robotic-based intervention of the older adults with Parkinson's disease, designed to improve the gait and to reduce the risk of falling. METHODS: This study is a single-blinded randomized controlled trial. The primary outcomes are: risk of falling, gait performance and fear of falling measured through Performance-Oriented Mobility Assessment (POMA), instrumental gait analysis and Short Falls Efficacy Scale - International (FES-I), respectively. One hundred ninety-five patients with PD will be recruited and randomly divided into three groups, to receive a traditional rehabilitation program or a robotic rehabilitation using Tymo system or Walker View in addition to the traditional therapy. Assessments will be performed at baseline, at the end of treatment and 6 months, 1 year and 2 years from the end of the treatment. A 10-treatment session will be conducted, divided into 2 training sessions per week, for 5 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system. DISCUSSION: The final goals of the present study are to propose a new approach in the PD rehabilitation, focused on the use of robotic device, and to check the results not only at the end of the treatment but also in the long term. TRIAL REGISTRATION: NCT04087031, registration date September 12, 2019.

Sensory retraining improves light touch threshold of the paretic hand in chronic stroke survivors: a single-subject A-B design.

Background: Light touch, one of the primary and basic sensations, is often neglected in sensory retraining programmes for stroke survivors.Objective: This study aimed to investigate the effects of sensory retraining on the light touch threshold of the hand, dexterity and upper limb motor function of chronic stroke survivors.Methods: Five chronic stroke survivors with sensory impairment participated in this single-subject A-B design study. In baseline (A) phase, they only received standard rehabilitation. In the treatment (B) phase, they received a 6-week sensory retraining intervention in addition to standard rehabilitation. In both phases, they were evaluated every 3 days. Light touch threshold, manual dexterity and upper limb motor function were assessed using Semmes-Weinstein Monofilaments, Box-Block Test and Fugl-Meyer Assessment, respectively. Visual analysis, nonparametric Mann-Whitney U test and, c-statistic were used for assessing the changes between phases.Results: All participants indicated changes in trend or slope of the total score of light touch or both between the two phases. The results of the c-statistic also showed the statistical difference in the total score of light touch between baseline and treatment in all participants (p < 0.001). Also, the results of the c-statistic and Mann-Whitney U test supported the difference of manual dexterity and motor function of the upper limb between baseline and treatment in all participants (p < 0.001).Conclusion: Current findings showed that sensory retraining may be an effective adjunctive intervention for improving the light touch threshold of the hand, dexterity and upper limb motor function in chronic stroke survivors.

Effects of hybrid-functional electrical stimulation (FES) rowing whole-body exercise on neurologic improvement in subacute spinal cord injury: secondary outcomes analysis of a randomized controlled trial.

STUDY DESIGN: Secondary outcome measures analysis of a randomized, controlled study. OBJECTIVE: To assess the effects of hybrid-functional electrical stimulation (FES) rowing on motor and sensory recovery in individuals with spinal cord injury (SCI) 6-18 months post injury. SETTING: Outpatient rehabilitation network. METHODS: 25 participants 6-12 months after SCI were randomly assigned to hybrid-FES rowing (n = 10) or standard of care (n = 15) groups. The hybrid-FES rowing group completed 6 months of rowing scheduled 3 times per week for 26 weeks at an exercise intensity of 70-85% of maximal heart rate. The standard of care group either participated in an arm ergometer exercise program (n = 6) or a waitlist without an explicit exercise program (n = 9). Changes in motor score and combined sensory score of the International Standards for Neurological Classification of SCI (ISNCSCI) were analyzed. RESULTS: Both groups demonstrated increases in motor and combined sensory scores, but no significant differences were noted between intervention groups (motor difference mean ↑1.3 (95% CI, -1.9 to 4.4), combined sensory difference mean ↓10 (-30 to 18)). There was an average of 63% adherence to the hybrid-FES rowing protocol, with no significant correlation in changes in motor or combined sensory score in the hybrid-FES rowing group with total distance or time rowed. CONCLUSIONS: No significant effects to neurologic improvement were found with hybrid-FES rowing when compared with standard of care interventions in individuals with SCI 6-18 months post injury.

[Effects of a physical exercise programme on the risk of falls, balance, and walking speed in older people with intellectual disabilities]. / Efecto de un programa de ejercicio físico sobre el riesgo de caídas, equilibrio y velocidad de la marcha en personas mayores con discapacidad intelectual.

INTRODUCTION: People with intellectual disabilities (ID) have balance disturbances and risk of falls, which are aggravated with ageing. This study aimed to provide information on the effects of an exercise programme on fall risk, balance, and walking speed in a group of older people with ID. MATERIALS AND METHODS: Eight people with mild to moderate ID (mean age: 56.37±7.08 years) participated in a 12-week programme based on a weekly session that included exercises aimed at strengthening stabilising muscles, stimulating proprioception, and enhancing reflexes in unstable situations. The effects of the programme on the risk of falling and on balance and walking speed were assessed using the Tinetti scale and the Timed Up and Go test, respectively. RESULTS: The programme was feasible and no adverse effects were registered. At the end of the programme, the risk of falls remained unchanged, while balance and gait speed improved significantly. CONCLUSIONS: A three-month weekly programme based on muscle strengthening and proprioceptive re-education exercises was feasible and had a positive impact on balance and walking speed in a group of older people with ID. These results lay the foundation for future randomised clinical trials aiming to confirm the effects of such programmes on the risk of falls in this population.