Effects of repetitive transcranial magnetic stimulation combined with sensory cueing on unilateral neglect in subacute patients with right hemispheric stroke: a randomized controlled study.

OBJECTIVE: To compare the effects of rTMS combined with sensory cueing, rTMS alone, and conventional rehabilitation on unilateral neglect, hemiplegic arm functions and performance of activities of daily living. DESIGN: A single-blinded randomized controlled trial. SETTING: A convalescent hospital. SUBJECTS: Sixty inpatients with left unilateral neglect after stroke. INTERVENTIONS: Patients were randomly assigned to three groups: rTMS combined with sensory cueing, rTMS, and conventional rehabilitation alone. rTMS at 1 Hz was applied over P5 of the contralesional hemisphere while vibration cueing was emitted using a wristwatch device on the hemiplegic arm, five days per week for two weeks. The first two groups received the same dosage of conventional rehabilitation on top of their experimental interventions. Blinded assessments were administered at baseline, 2 weeks postintervention, and 6 weeks follow-up. MAIN MEASURES: Neglect and arm motor performance. RESULTS: Both rTMS combined with sensory cueing (99.6±33.0) and rTMS alone (88.2±28.7) significantly reduced unilateral neglect than conventional rehabilitation (72.7±33.1) when measured using the conventional subtests of the Behavioural Inattention Test, but the combination was better than rTMS alone. Hemiplegic arm functions and activities of daily living improved in all patients across the three groups but no significant differences were found between the groups. CONCLUSION: The combination of inhibitory P5-rTMS with sensory cueing was better than either rTMS or conventional rehabilitation alone in producing a stronger and long-lasting improvement in unilateral neglect, but the improvement was not associated with improved arm function or independence in activities of daily living.

Stigma and the use of umbrellas, hiking poles and walking sticks to aid walking in Hong Kong.

Background: The use of walking aids is widely acknowledged as one of the most relied-on forms of assistive technology. Using stick-shaped devices, such as a cane, is often the entrance for many people to the world of assistive technologies, often accompanied by the negative stigma associated with ageing and disability. Objectives: This study investigated the perception of disability and needs of the Hong Kong population using walking aids, aiming to inform device design and service provision. Methods: We observed 391 individuals using cane-like devices in their natural environment and conducted semi-structured interviews with 28 participants to understand stigma, barriers to acquisition, training, and design requirements. Results: Half of the interviewees (50%, n = 14) did not feel disabled when using a walking stick, while 39% felt slightly disabled. 56% of the observed sample used non-medical-looking aids like hiking poles or umbrellas. Most interviewees (79%) purchased off-the-shelf devices, but less than half received seller support in choosing appropriate aids. Conclusion: The feelings associated with using walking sticks and similar devices are mostly positive. There is a preference in Hong Kong for using devices without a medical appearance to aid walking, such as umbrellas and hiking poles. There is a need to raise awareness of the risks of using umbrellas to aid walking and empower the user to make informed decisions when purchasing walking aid devices. In addition, there is a need to support the supply chain of walking aids, including umbrellas and hiking poles, to provide more information on device use, misuse, training, and maintenance.

'Smart reminder': A feasibility pilot study on the effects of a wearable device treatment on the hemiplegic upper limb in persons with stroke.

INTRODUCTION: Emerging literature suggests that wearable devices offer a promising option for self-directed home-based upper limb training for persons with stroke. However, little research is available to explore integrating smartphone applications with wearable devices to provide upper limb telerehabilitation to stroke survivors at home. This study examined the feasibility and potential therapeutic effects of a wearable device integrated with a smartphone-based telerehabilitation system to provide upper limb rehabilitation to stroke survivors at home. METHODS: Twelve stroke survivors from community support groups participated in a treatment consisting of 4-week telerehabilitation using a wearable device and 4-week conventional therapy successively in a single-blind, randomised crossover study. A 3-week washout period was administered between the two 4-week treatments. The primary outcome measures were the Fugl Meyer Assessment, the Action Research Arm Test, and the active range of motion (ROM) of the upper limb. Secondary outcome measures included the Motor Activity Log and exercise adherence. RESULTS: Results showed that the active ROM of participants' hemiplegic shoulder improved more significantly after 4 weeks of telerehabilitation with the wearable device than with conventional therapy. No significant differences were found in other outcome measures. CONCLUSIONS: A 4-week telerehabilitation programme using a wearable device improves the hemiplegic upper limb in community-dwelling stroke survivors and may be feasible as an effective intervention for self-directed upper limb rehabilitation at home.

The Effects of Light Therapy on Sleep, Agitation and Depression in People With Dementia: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To evaluate the effects of light therapy on the alleviation of sleep disturbances, agitation and depression in people with dementia. METHODS: A search was performed in PubMed, Medline, SCOPUS, Web of Science, EMBASE, CINAHL, Cochrane Library, for studies published between 2000 and 2021. RESULTS: A total of 4315 articles were screened. Sixteen articles were eligible for this review and 11 randomized controlled studies were included in the meta-analysis. Light therapy had a significant effect on reducing the number of awakenings in sleep (n = 4; 95% CI = -.56, -.05; I2 = 0%; SMD = -.31) but was not significant in reducing the wake after sleep onset (n = 3; 95% CI = -.14, .59; I2 = 0%; SMD = .23), agitation (n = 4; 95% CI = -1.02, .45; I2 = 87%; SMD = -.28) and depression (n = 6; 95% CI = -.80, .40, I2 = 85%; SMD = -.20). CONCLUSION: Light therapy appeared to be more effective in terms of alleviating sleep disturbances, rather than reducing agitation and depression, but its long-term effects remain unclear.

Effects of home-based occupational therapy telerehabilitation via smartphone for outpatients after hip fracture surgery: A feasibility randomised controlled study.

INTRODUCTION: This study aimed to investigate the effects of a home-based occupational therapy telerehabilitation (TR) via smartphone in enhancing functional and motor performance and fall efficacy for outpatients receiving day hospital rehabilitation after hip fracture surgery in Hong Kong. METHODS: This was a feasibility randomised controlled trial with two groups - an experimental group and a comparison group - and a sample of 31 older adults attending a geriatric day hospital who had undergone hip fracture surgery within 12 weeks of diagnosis. Patients were assessed at baseline, immediately after a three-week intervention and at three-week post-intervention follow-up for motor performance, activities of daily living (ADL) functioning and fall efficacy. The experimental group received a home programme using the Caspar Health e-system and a mobile app for smartphones, while the comparison group received paper-and-pencil instructions for the home programme on a weekly basis for three weeks. RESULTS: Compared to the comparison group, significant improvements in fall efficacy and instrumental ADL performance at post intervention and follow-up were found in the experimental group. However, in the comparison group, inadequate social support was a factor contributing to better muscle strength testing in both the affected and non-affected legs. There were no significant differences between the two groups in regard to the other variables. DISCUSSION: This study supports the potential use of TR via smartphone as an alternative home programme for use in occupational therapy practice with older adults after hip fracture surgery.

Effects of telerehabilitation in occupational therapy practice: A systematic review.

OBJECTIVE/BACKGROUND: This study aimed to review the current evidence on the application of telerehabilitation in occupational therapy practice and its clinical outcomes over the last 10 years. METHODS: A systematic review was performed on studies published in English in the decade 2008 to 2017, retrieved from seven electronic databases (MEDLINE, Cochrane Library, CINAHL, Web of Science, SAGE, Science Direct and EMBASE). Only articles evaluating the use of telerehabilitation to provide occupational therapy services from a distance were included, with no restrictions on pathology, impairment, age, or the nature of occupational therapy intervention. RESULTS: Fifteen articles (three randomised controlled trials, eight quasi-experimental studies, one trial with single-group post-intervention and three case studies) were reviewed. Despite various study designs and outcome measures, most studies indicated positive therapeutic effects of using telerehabilitation in occupational therapy practice. There is insufficient evidence, however, to confirm that telerehabilitation is more effective than the face-to-face model. Little evidence was shown on the long-term effect and cost efficacy. Only two studies used smartphones in their applications. CONCLUSION: Telerehabilitation offers an alternative service delivery model for occupational therapy, not only bridging distance but also offering user-friendly treatment for patients at home. Further research, particularly on the use of the most cutting-edge mobile technology, is needed to determine effectiveness in occupational therapy practice treating various diseases, conditions and impairments and the characteristics of patients, interventions and therapists that lead to the best fit with this alternative and emerging form of service delivery.