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1.
Brain Inj ; 35(5): 609-619, 2021 04 16.
Artículo en Inglés | MEDLINE | ID: mdl-33678101

RESUMEN

Purpose: This pilot feasibility study aimed to gain preliminary insight into the acceptability and usefulness of the FAB-PBS program for providing behavior support to families following acquired brain injury (ABI) in community settings. The FAB-PBS program is based on a Positive Behavior Support (PBS) framework and principles of Family-Centered Care and Family-Directed Intervention. It consists of an education phase followed by individualized sessions during which the family is supported to develop and implement a PBS plan.Methods: A mixed-methods design was utilized, with feedback obtained from family members via short questionnaires and semi-structured interviews post education phase and individualized sessions, and at three-month follow up.Results: Two family members completed the full FAB-PBS program and reported high satisfaction with the program and increased confidence in providing behavior support. Findings also suggested an increase in desired behaviors and a decrease in challenging behaviors presented by family members with ABI.Conclusions: The FAB-PBS program may be an acceptable and feasible approach to increasing the capability of family caregivers in providing behavior support following ABI. Further pilot testing is required to inform the development of a larger feasibility study.


Asunto(s)
Cuidadores , Familia , Estudios de Factibilidad , Humanos , Proyectos Piloto , Encuestas y Cuestionarios
2.
Cochrane Database Syst Rev ; 10: CD011550, 2019 10 13.
Artículo en Inglés | MEDLINE | ID: mdl-31606891

RESUMEN

BACKGROUND: Duchenne muscular dystrophy (DMD) is the most common X-linked neuromuscular disorder. When boys with DMD reach the second decade of life, they lose their ability to walk and become wheelchair dependent. Standing devices and orthoses are considered to be an essential component in the therapy management of DMD. Clinical opinion and research from other neurological conditions highlight the proposed benefits of standing device use, however, its effect within this population is currently unknown. A review of the evidence for the use of standing devices and orthoses is necessary to inform all stakeholders, including people with DMD, clinicians, decision makers and funders, and to guide future research. OBJECTIVES: To assess the effects of standing devices and orthoses on musculoskeletal impairments (such as pain, contracture, scoliosis development and bone density) in boys and men with DMD, and secondarily to determine their effect on quality of life, participation in activities, and patient experience (satisfaction). We also considered any adverse events associated with their use. SEARCH METHODS: We searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, AMED, PsycINFO, CINAHL Plus, PEDro, and ProQuest Dissertations & Theses Global up to 5 September 2019. We checked references in identified trials, handsearched journal abstracts, and searched trials registries. SELECTION CRITERIA: We planned to include randomised controlled trials (RCTs) and quasi-RCTs of any model of standing device for use in DMD. The control interventions would have been any other comparison group, including no standing device, a different model of standing device, usual care, or an alternative form of assistive weight bearing. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. MAIN RESULTS: Although we identified 13 potentially relevant studies, none met the inclusion criteria for this review. AUTHORS' CONCLUSIONS: Since there were no RCTs or quasi-RCTs available to evaluate the effectiveness of standing devices in people with DMD, studies are needed to investigate the effectiveness of standing devices in this population.

3.
Cochrane Database Syst Rev ; 10: CD008728, 2019 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-31573069

RESUMEN

BACKGROUND: Falls are one of the most common complications after stroke, with a reported incidence ranging between 7% in the first week and 73% in the first year post stroke. This is an updated version of the original Cochrane Review published in 2013. OBJECTIVES: To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. Our primary objective was to determine the effect of interventions on the rate of falls (number of falls per person-year) and the number of fallers. Our secondary objectives were to determine the effects of interventions aimed at preventing falls on 1) the number of fall-related fractures; 2) the number of fall-related hospital admissions; 3) near-fall events; 4) economic evaluation; 5) quality of life; and 6) adverse effects of the interventions. SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group (September 2018) and the Cochrane Bone, Joint and Muscle Trauma Group (October 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 9) in the Cochrane Library; MEDLINE (1950 to September 2018); Embase (1980 to September 2018); CINAHL (1982 to September 2018); PsycINFO (1806 to August 2018); AMED (1985 to December 2017); and PEDro (September 2018). We also searched trials registers and checked reference lists. SELECTION CRITERIA: Randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. DATA COLLECTION AND ANALYSIS: Two review authors (SD and WS) independently selected studies for inclusion, assessed trial quality and risk of bias, and extracted data. We resolved disagreements through discussion, and contacted study authors for additional information where required. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person-year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate and applied GRADE to assess the quality of the evidence. MAIN RESULTS: We included 14 studies (of which six have been published since the first version of this review in 2013), with a total of 1358 participants. We found studies that investigated exercises, predischarge home visits for hospitalised patients, the provision of single lens distance vision glasses instead of multifocal glasses, a servo-assistive rollator and non-invasive brain stimulation for preventing falls.Exercise compared to control for preventing falls in people after strokeThe pooled result of eight studies showed that exercise may reduce the rate of falls but we are uncertain about this result (rate ratio 0.72, 95% CI 0.54 to 0.94, 765 participants, low-quality evidence). Sensitivity analysis for single exercise interventions, omitting studies using multiple/multifactorial interventions, also found that exercise may reduce the rate of falls (rate ratio 0.66, 95% CI 0.50 to 0.87, 626 participants). Sensitivity analysis for the effect in the chronic phase post stroke resulted in little or no difference in rate of falls (rate ratio 0.58, 95% CI 0.31 to 1.12, 205 participants). A sensitivity analysis including only studies with low risk of bias found little or no difference in rate of falls (rate ratio 0.88, 95% CI 0.65 to 1.20, 462 participants). Methodological limitations mean that we have very low confidence in the results of these sensitivity analyses.For the outcome of number of fallers, we are very uncertain of the effect of exercises compared to the control condition, based on the pooled result of 10 studies (risk ratio 1.03, 95% CI 0.90 to 1.19, 969 participants, very low quality evidence). The same sensitivity analyses as described above gives us very low certainty that there are little or no differences in number of fallers (single interventions: risk ratio 1.09, 95% CI 0.93 to 1.28, 796 participants; chronic phase post stroke: risk ratio 0.94, 95% CI 0.73 to 1.22, 375 participants; low risk of bias studies: risk ratio 0.96, 95% CI 0.77 to 1.21, 462 participants).Other interventions for preventing falls in people after strokeWe are very uncertain whether interventions other than exercise reduce the rate of falls or number of fallers. We identified very low certainty evidence when investigating the effect of predischarge home visits (rate ratio 0.85, 95% CI 0.43 to 1.69; risk ratio 1.48, 95% CI 0.71 to 3.09; 85 participants), provision of single lens distance glasses to regular wearers of multifocal glasses (rate ratio 1.08, 95% CI 0.52 to 2.25; risk ratio 0.74, 95% CI 0.47 to 1.18; 46 participants) and a servo-assistive rollator (rate ratio 0.44, 95% CI 0.16 to 1.21; risk ratio 0.44, 95% CI 0.16 to 1.22; 42 participants).Finally, transcranial direct current stimulation (tDCS) was used in one study to examine the effect on falls post stroke. We have low certainty that active tDCS may reduce the number of fallers compared to sham tDCS (risk ratio 0.30, 95% CI 0.14 to 0.63; 60 participants). AUTHORS' CONCLUSIONS: At present there exists very little evidence about interventions other than exercises to reduce falling post stroke. Low to very low quality evidence exists that this population benefits from exercises to prevent falls, but not to reduce number of fallers.Fall research does not in general or consistently follow methodological gold standards, especially with regard to fall definition and time post stroke. More well-reported, adequately-powered research should further establish the value of exercises in reducing falling, in particular per phase, post stroke.

4.
BMC Med Educ ; 18(1): 219, 2018 Sep 24.
Artículo en Inglés | MEDLINE | ID: mdl-30249238

RESUMEN

BACKGROUND: E-learning allows delivery of education in many diverse settings and researchers have demonstrated it can be as effective as learning conducted in traditional face-to-face settings. However, there are particular practices and skills needed in the area of providing patient self-management support (SMS), that may not be achievable online. The aim of this study was to compare three approaches in the training of university students regarding the preparation of a Chronic Condition Self-Management Care Plan: 1) traditional face-to-face delivery of SMS training, 2) an e-learning approach and 3) a blended approach (combining e-learning and face-to-face teaching). METHODS: Graduate entry physiotherapy students and medical students at Flinders University were recruited. Depending on the cohort, students were either exposed to traditional face-to-face training, e-learning or a blended model. Outcomes were compared between the three groups. We measured adherence to care plan processes in the preparation of an assessment piece using the Flinders Program Chronic Care Self Management tools. A total of 183 care plans were included (102 traditional, 52 blended, 29 e-learning,). All students submitted the Flinders Program Chronic Care Plan for university assessment and these were later assessed for quality by researchers. The submission was also assigned a consumer engagement score and a global competence score as these are integral to successful delivery of SMS and represent the patient perspective. RESULTS: The blended group performed significantly better than the traditional group in quality use of the Flinders Program tools: Problem and Goals (P < 0.0001). They also performed significantly better in the total care plan score (P < 0.0001) and engagement score (P < 0.0001). There was no significant difference between the groups for the Partners in Health tool. CONCLUSIONS: In this pilot study, the blended learning model was a more effective method for teaching self-management skills than the traditional group, as assessed in the development of a chronic condition self-management care plan. We anticipate that future research with identical groups of students would yield similar results but in the meantime, academics can have confidence that blended learning is at least as effective as traditional learning methods.


Asunto(s)
Educación a Distancia , Educación de Postgrado/métodos , Especialidad de Fisioterapia/educación , Enfermedad Crónica/terapia , Estudios de Cohortes , Humanos , Escuelas para Profesionales de Salud , Automanejo , Australia del Sur , Estudiantes de Medicina
6.
Brain Inj ; 29(6): 661-75, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25826712

RESUMEN

OBJECTIVES: To examine family involvement in the management of behavioural problems following ABI in the community. RESEARCH DESIGN: Systematic literature review. METHODS: Six electronic databases relevant to the field of brain injury were searched between 1980-2013. Citation indexes were used and references from articles hand searched for further literature. Studies that met the broad inclusion criteria were screened for relevance and articles selected for full-text review independently considered by two reviewers. Those found to be relevant were analysed using PEDro and McMasters critical appraisal tools. RESULTS: Three hundred and three studies were identified after duplicates were removed and 56 were assessed for relevance, yielding 10 studies for review. Although the majority of studies were weak in design, five revealed significant findings supportive of family involvement in the management of behavioural problems following ABI, especially where interventions consisted of both educational components and individualized behavioural plans. Findings revealed no significant changes in family burden following behavioural interventions. CONCLUSIONS: There is limited research and lack of high evidence studies evaluating family involvement in behaviour management following ABI; therefore, no conclusions can be drawn regarding its efficacy. More research is needed, with larger sample sizes and more rigorous design, including proper comparison groups.


Asunto(s)
Lesiones Encefálicas/psicología , Lesiones Encefálicas/rehabilitación , Terapia Conductista , Lesiones Encefálicas/terapia , Familia , Humanos , Características de la Residencia , Resultado del Tratamiento
7.
Arch Phys Med Rehabil ; 95(2): 276-82, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24025659

RESUMEN

OBJECTIVE: To investigate current knowledge and application in practice of constraint-induced movement therapy (CIMT) by therapists within the United Kingdom. DESIGN: An online 19-item survey. SETTING: Neurological rehabilitation. PARTICIPANTS: Occupational therapists and physiotherapists (N=489) currently working or within 3 months of working with the adult acquired brain injury population were recruited from 2 specialist interest groups. INTERVENTIONS: Database administrators of 2 specialist interest groups circulated an e-mail to all therapists on the database to invite them to complete the online survey. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Most therapists (62.9%, n=306) had not used CIMT. Those who had used it were only using 2 or 3 components of the core 7-component CIMT protocol. Therapists identified 2 main barriers to the implementation of CIMT: lack of resources (staffing; 20.7%, n=63) and lack of training (20%, n=61). CONCLUSIONS: Adoption into practice remains limited. Despite a significant evidence base in support of CIMT, most therapists are not using CIMT in practice. This article indicates how concerns and barriers related to CIMT may be minimized to translate this robust intervention from research into clinical practice.


Asunto(s)
Lesiones Encefálicas/rehabilitación , Terapia por Ejercicio/métodos , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Resultado del Tratamiento , Reino Unido
8.
Health Sci Rep ; 7(6): e2117, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38831776

RESUMEN

Background and Purpose: Currently there are approximately one billion people worldwide affected by a neurological condition. These conditions may result in a variety of impairments that require assessment and management from a physiotherapist. However, there is a lack of consensus in the literature as to what domains physiotherapists working in clinical settings include in their assessment of this population, with only five domains identified in a recent systematic review. This study aimed to explore current physiotherapy assessments in people with neurological conditions, including barriers, enablers, and influencing factors. Methods: A National online survey of Australian physiotherapists who assessed adults with neurological conditions in their clinical practice. Results: A total of 212 respondents from all states in Australia completed the survey. The mean (SD) age was 35.7 (9.6) years, and the majority were female (85.4%). Respondents worked across various settings assessing stroke most frequently (58.0%). Study results demonstrated variability in assessment practice, with a number of assessment domains being assessed more commonly including balance, muscle strength, gait, falls and safety, function, goal setting, range of movement, pain, co-ordination, activity tolerance, postural alignment and symmetry, and the upper limb. Experienced physiotherapists and those in rural and remote settings included fewer domains in their assessments. On the other hand, physiotherapists in the community setting included certain domains more frequently than those in other settings. Barriers and enablers were related to therapist caseload, knowledge, and intrinsic patient factors. Discussion: There is variability in domains assessed by Australian physiotherapists, with an emerging consensus for a number of assessment domains. Study results suggest that clinical experience, geographical location, and clinical setting may play a role in the assessment patterns observed. Implications on Physiotherapy Practice: There is little evidence to support what physiotherapists assess in practice, in different settings, in different states within Australia. This study indicates that experience, geographical location, and clinical setting affect the number and types of domains included in the assessment. Further research is needed to develop a consensus on best practices.

9.
Cochrane Database Syst Rev ; (5): CD008728, 2013 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-23728680

RESUMEN

BACKGROUND: Falls are one of the most common medical complications after stroke with a reported incidence of 7% in the first week after stroke onset. Studies investigating falls in the later phase after stroke report an incidence of up to 73% in the first year post-stroke. OBJECTIVES: To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group (November 2012) and the Cochrane Bone, Joint and Muscle Trauma Group (May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012, Issue 5, MEDLINE (1950 to May 2012), EMBASE (1980 to May 2012), CINAHL (1982 to May 2012), PsycINFO (1806 to May 2012), AMED (1985 to May 2012) and PEDro (May 2012). We also searched trials registers, checked reference lists and contacted authors. SELECTION CRITERIA: Randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. DATA COLLECTION AND ANALYSIS: Review authors independently selected studies for inclusion, assessed trial quality, and extracted data. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate. MAIN RESULTS: We included 10 studies with a total of 1004 participants. One study evaluated the effect of exercises in the acute and subacute phase after stroke but found no significant difference in rate of falls (rate ratio 0.92, 95% CI 0.45 to 1.90, 95 participants). The pooled result of four studies investigating the effect of exercises on preventing falls in the chronic phase also found no significant difference for rate of falls (rate ratio 0.75, 95% CI 0.41 to 1.38, 412 participants).For number of fallers, one study examined the effect of exercises in the acute and subacute phase after stroke but found no significant difference between the intervention and control group (risk ratio 1.19, 95% CI 0.83 to 1.71, 95 participants). The pooled result of six studies examining the effect of exercises in the chronic phase also found no significant difference in number of fallers between the intervention and control groups (risk ratio 1.02, 95% CI 0.83 to 1.24, 616 participants).The rate of falls and the number of fallers was significantly reduced in two studies evaluating the effect of medication on preventing falls; one study (85 participants) compared vitamin D versus placebo in institutionalised women after stroke with low vitamin D levels, and the other study (79 participants) evaluated alendronate versus alphacalcidol in hospitalised people after stroke.One study provided single lens distance glasses to regular wearers of multifocal glasses. In a subgroup of 46 participants post-stroke there was no significant difference in the rate of falls (rate ratio 1.08, 95% CI 0.52 to 2.25) or the number of fallers between both groups (risk ratio 0.74, 95% CI 0.47 to 1.18). AUTHORS' CONCLUSIONS: There is currently insufficient evidence that exercises or prescription of single lens glasses to multifocal users prevent falls or decrease the number of people falling after being discharged from rehabilitation following their stroke. Two studies testing vitamin D versus placebo and alendronate versus alphacalcidol found a significant reduction in falls and the number of people falling. However, these findings should be replicated before the results are implemented in clinical practice.


Asunto(s)
Accidentes por Caídas/prevención & control , Accidente Cerebrovascular/complicaciones , Accidentes por Caídas/estadística & datos numéricos , Alendronato/administración & dosificación , Conservadores de la Densidad Ósea/administración & dosificación , Ejercicio Físico , Anteojos , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Vitamina D/administración & dosificación , Vitaminas/administración & dosificación
10.
Clin Rehabil ; 27(10): 867-78, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23543340

RESUMEN

OBJECTIVE: To examine the evidence base underlying self-management programmes specific to stroke survivors. DATA SOURCES: Eleven electronic databases were searched using combinations of keywords related to stroke and self-management. REVIEW METHODS: Studies involving adults with a clinical diagnosis of stroke, which explored self-management interventions, were included. Study selection was verified by two reviewers who independently conducted methodological quality appraisal and data extraction using a tool developed by The American Academy for Cerebral Palsy and Developmental Medicine. RESULTS: Fifteen studies were included in this review. Significant treatment effects in favour of the self-management intervention were found in six out of nine randomized controlled trials, and three out of six non-randomized trials in our review. Four randomized controlled trials involving more than 100 participants per trial reported statistically significant results in favour of the self-management group in relation to measures of disability, confidence in recovery, the stroke specific quality of life (sub-scales of family roles and fine motor tasks), and the physical component scale of the short form SF-36 Score. The wide range of outcome measures used prevented comparison across studies. CONCLUSIONS: This review provides some preliminary support for the potential importance of self-management interventions after stroke. The most appropriate content and best approach for delivery of these interventions remains to be determined. Further high-quality randomized controlled trials are needed to test the feasibility, acceptability, and efficacy of stroke self-management programmes.


Asunto(s)
Actividades Cotidianas , Familia , Calidad de Vida , Autocuidado/métodos , Rehabilitación de Accidente Cerebrovascular , Adulto , Anciano , Bases de Datos Bibliográficas , Humanos , Persona de Mediana Edad
11.
Clin Rehabil ; 27(1): 63-74, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22752539

RESUMEN

OBJECTIVE: To develop and test the feasibility of an energy conservation programme to manage fatigue in multiple sclerosis. DESIGN: A pilot randomized controlled trial. SETTING: Community setting. SUBJECTS: People with multiple sclerosis reporting fatigue. INTERVENTIONS: An energy conservation programme was compared to a peer support group. Both interventions were delivered in group format with 2-hour sessions once a week for five weeks. Patients' views about the interventions were sought in discussion groups one week post intervention. MAIN MEASURES: The primary feasibility outcomes were recruitment and adherence. Other outcome measures were the Fatigue Impact Scale, Fatigue Severity Scale, MS-Impact Scale-29, MS Self-efficacy Scale, Beck's Depression Scale-Fast Screen and Epworth Sleepiness Scale. Outcomes were administered at baseline, post intervention, 6-week and 3-month follow-up. RESULTS: Almost 30% of the people approached to take part in the study did not commit to participation because of transport/time issues. Twenty-three patients took part in the study. Three patients dropped out, one reporting adverse effects. A power calculation indicated that a sample of 56 (28 per group) would be required for a main randomized controlled trial. Patients valued peer support and those in the energy conservation group described the programme as useful, but reported difficulties completing some practice activities. CONCLUSION: An energy conservation programme in the community is feasible and welcomed by people with multiple sclerosis. However, future research needs to consider longer follow-ups and practical issues to improve recruitment rate by accommodating to patients' needs.


Asunto(s)
Fatiga/etiología , Fatiga/terapia , Esclerosis Múltiple/complicaciones , Metabolismo Energético , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto
12.
J Eval Clin Pract ; 29(8): 1402-1424, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37538002

RESUMEN

RATIONALE: There is a lack of consensus in the literature related to what is assessed clinically by physical therapists in people with neurological disorders. AIMS: This mixed-methods systematic review aimed to identify domains that physiotherapists routinely assess in people with neurological conditions in clinical settings and explored factors influencing assessment domains including country, clinical setting, therapist experience and neurological condition. METHOD: Five databases were searched from 1946 to 31st January 2023. Studies with any design reporting on domains assessed by a physiotherapist, in people with neurological conditions in any clinical setting, were included. Independent reviewers assessed eligibility and risk of bias using relevant McMaster critical appraisal tools. Data were extracted and synthesised following the Joanna Briggs Institute approach for mixed systematic reviews. RESULTS: A total of 23 (16 quantitative, 7 qualitative) studies involving 3134 participants were included. The studies were rated as high (n = 14) or medium (n = 9) quality. The domains of function (n = 14); postural alignment and symmetry (n = 11); gait (n = 11); balance (n = 9), and muscle strength (n = 8) were most frequently included in assessments. Five key themes were identified from the qualitative studies: the clinical reasoning process, clinical use of standardised measures, utilisation of the senses, clinician experience and information gathering. There was minimal data on how country, clinical setting, therapist experience and neurological condition influence inclusion of assessed domains. CONCLUSION: Five domains were most frequently included in assessment: function; postural alignment and symmetry; gait; muscle strength; and balance. This limited number of domains is in stark contrast to the full neurological physiotherapy assessment recommended by expert textbooks. Further research is needed to understand the reasons why this might be so.


Asunto(s)
Enfermedades del Sistema Nervioso , Humanos , Técnicos Medios en Salud , Modalidades de Fisioterapia , Investigación Cualitativa
13.
Disabil Rehabil ; 42(9): 1305-1315, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-30653928

RESUMEN

Purpose: (1) to provide insight into the family's experience and support needs following acquired brain injury (ABI) specific to behavioural changes; (2) to provide an overview of empirically-based behaviour support approaches for individuals with ABI; and (3), to examine family involvement in implementing behavioural interventions.Methods: Review of the literature.Results: Family members experience significant distress resulting from neurobehavioural changes in relatives with ABI, and report unmet informational and practical support needs regarding this issue. The importance of utilising family expertise within the rehabilitation process is widely acknowledged, with the increasing involvement of family members being promoted. There is growing evidence supporting the use of positive behaviour support approaches for individuals with ABI in community settings, and evidence supporting the involvement of family within behavioural interventions.Conclusions: This review suggests the need to develop alternative support models that shift the focus towards building competence in everyday support people rather than dependency on the service system. A bottom-up approach is recommended, with the aim of addressing unmet support needs and increasing the competence of family members in supporting behaviour change in individuals with ABI. Recommendations are provided in informing an optimal community-based neurobehavioural support model. Implications for RehabilitationPositive behaviour support is recommended in supporting behavioural changes following brain injury, with family expertise utilised in this process.Evidence suggests that family members can be effectively trained in developing and implementing behaviour support strategies.Family involvement in behavioural interventions may address unmet support needs and increasing the competence of family members in supporting behavioural changes following brain injury.


Asunto(s)
Terapia Conductista , Lesiones Encefálicas/rehabilitación , Cuidadores , Familia , Humanos
14.
Stroke ; 40(4): e89-97, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19182079

RESUMEN

BACKGROUND AND PURPOSE: In the Western world, the Bobath Concept or neurodevelopmental treatment is the most popular treatment approach used in stroke rehabilitation, yet the superiority of the Bobath Concept as the optimal type of treatment has not been established. This systematic review of randomized, controlled trials aimed to evaluate the available evidence for the effectiveness of the Bobath Concept in stroke rehabilitation. Method- A systematic literature search was conducted in the bibliographic databases MEDLINE and CENTRAL (March 2008) and by screening the references of selected publications (including reviews). Studies in which the effects of the Bobath Concept were investigated were classified into the following domains: sensorimotor control of upper and lower limb; sitting and standing, balance control, and dexterity; mobility; activities of daily living; health-related quality of life; and cost-effectiveness. Due to methodological heterogeneity within the selected studies, statistical pooling was not considered. Two independent researchers rated all retrieved literature according to the Physiotherapy Evidence Database (PEDro) scale from which a best evidence synthesis was derived to determine the strength of the evidence for both effectiveness of the Bobath Concept and for its superiority over other approaches. RESULTS: The search strategy initially identified 2263 studies. After selection based on predetermined criteria, finally, 16 studies involving 813 patients with stroke were included for further analysis. There was no evidence of superiority of Bobath on sensorimotor control of upper and lower limb, dexterity, mobility, activities of daily living, health-related quality of life, and cost-effectiveness. Only limited evidence was found for balance control in favor of Bobath. Because of the limited evidence available, no best evidence synthesis was applied for the health-related quality-of-life domain and cost-effectiveness. CONCLUSIONS: This systematic review confirms that overall the Bobath Concept is not superior to other approaches. Based on best evidence synthesis, no evidence is available for the superiority of any approach. This review has highlighted many methodological shortcomings in the studies reviewed; further high-quality trials need to be published. Evidence-based guidelines rather than therapist preference should serve as a framework from which therapists should derive the most effective treatment.


Asunto(s)
Medicina Basada en la Evidencia , Modalidades de Fisioterapia , Rehabilitación de Accidente Cerebrovascular , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función
15.
Clin Rehabil ; 23(11): 1051-5, 2009 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19786419

RESUMEN

OBJECTIVE: To investigate the content of acute stroke physiotherapy to treat postural control and mobility problems. DESIGN: Stroke physiotherapists recorded the interventions used to treat postural control and mobility during treatment sessions. They recorded five sessions for at least five patients each. Descriptive statistics assessed the frequency with which the interventions were used. SETTING: Hospital-based acute stroke care. SUBJECTS: Thirty-six acute stroke physiotherapists recorded 2374 interventions in 364 treatment sessions for 76 patients. MAIN MEASURES: The Stroke Physiotherapy Intervention Recording Tool. RESULTS: Facilitation techniques were the most frequently used interventions (n = 1258, 53%) with exercise (n = 115, 5%), teaching others how to help the patient (n = 99, 4%) and provision of equipment (n = 63, 3%) the least frequently used. CONCLUSIONS: Acute stroke physiotherapists primarily use therapist-led 'hands-on' interventions to treat postural control and mobility problems. Interventions to promote activity or practice outside the treatment session are infrequently used.


Asunto(s)
Ambulación Precoz/métodos , Modalidades de Fisioterapia , Rehabilitación de Accidente Cerebrovascular , Anciano , Anciano de 80 o más Años , Recolección de Datos , Adhesión a Directriz , Humanos , Pacientes Internos , Persona de Mediana Edad , Limitación de la Movilidad , Equilibrio Postural , Accidente Cerebrovascular/complicaciones , Reino Unido
16.
Disabil Rehabil ; 41(7): 854-860, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-29171308

RESUMEN

PURPOSE: This article proposes a theoretical framework to help professionals include family as active members in brain injury rehabilitation. A trend towards greater family involvement has lead to the development of family-collaboration models. However, current models appear to focus on information sharing rather than increasing the capability of family members. This article introduces a family-directed approach to brain injury model, which provides a theoretical framework for supporting family as facilitators of change. METHODS: Family-collaboration models and literature regarding family experiences following brain injury and support needs are reviewed to identify the driving forces behind family engagement in rehabilitation, including effective professional-family relationships, and important factors in the delivery of education underpinned by evidence-based practices. RESULTS: The family-directed approach to brain injury model is based on principles of hope, family expertise, education/skill building, and family-directed intervention. CONCLUSIONS: The family-directed approach to brain injury model provides a theoretical framework for educating and training family members as facilitators in the management process: promoting competence rather than dependency on service systems. Guiding recommendations encourage professionals to reflect on the importance of their therapeutic relationships and their capacity to positively impact rehabilitation outcomes beyond the technical aspects of health care and treatment. Implications for Rehabilitation Training family members as facilitators in the rehabilitation process is suggested to reduce dependency on the service system, address families' unmet support needs, and to optimize rehabilitation outcomes for individuals with brain injury. The family-directed approach to brain injury model is proposed to guide the increased involvement of family as active members in the rehabilitation team and to define potential active ingredients in this process.


Asunto(s)
Lesiones Encefálicas , Cuidadores , Información de Salud al Consumidor/métodos , Familia/psicología , Rehabilitación , Lesiones Encefálicas/psicología , Lesiones Encefálicas/rehabilitación , Cuidadores/educación , Cuidadores/psicología , Participación de la Comunidad/métodos , Salud de la Familia , Humanos , Modelos Organizacionales , Relaciones Profesional-Familia , Rehabilitación/organización & administración , Rehabilitación/psicología , Resultado del Tratamiento
17.
Exp Gerontol ; 111: 1-9, 2018 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-29969664

RESUMEN

Hip fractures are a global concern, resulting in poor outcomes and high health care costs. They mostly affect people >80 years. Hip fractures are influenced by various (modifiable) risk factors. Emerging evidence suggests hand grip strength (HGS) to be one of several useful tools to identify hip fracture risk. This is the first systematic review that aims to assess the evidence underlying the relationship between hip fracture incidence and HGS. Eleven studies were selected for this review (six case-control and five cohort studies), comprising 21,197 participants. Where reported, HGS was significantly decreased in individuals with a hip fracture near the time of injury as compared to controls (p < 0.001); HGS was associated with increased hip fracture risk in all included studies. Meta-analysis was not possible. All studies included in this systematic review confirmed a relationship between decreased HGS and hip fracture incidence. We were not able to quantify the strength of this relationship, due to the heterogeneity of the included studies. HGS merits further investigation as a useful tool for identifying individuals that might be at elevated risk for sustaining a hip fracture.


Asunto(s)
Fuerza de la Mano , Fracturas de Cadera/epidemiología , Anciano , Anciano de 80 o más Años , Anciano Frágil , Humanos , Incidencia , Factores de Riesgo
18.
Gait Posture ; 55: 55-61, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-28412603

RESUMEN

BACKGROUND: Impaired balance is common in neurological disorders. Cervical dystonia is a neurological movement disorder affecting the neck. The effect of this aberrant head posture on physical function is unknown. OBJECTIVES: To compare balance, mobility, gait and stepping reactions between ten people with cervical dystonia and ten control adults. METHODS: Spatiotemporal gait parameters and walking speed were assessed using a computerised walkway. Step length and time, time in double support and gait variability were calculated, then normalised to gait speed. Centre of pressure path length was assessed with eyes open and eyes closed to calculate a Romberg Quotient. Simple and choice reaction times were measured using customised apparatus while mobility was assessed by the timed up and go. Cervical spine range of motion was measured using a head mounted goniometer. Self-reported scales included Falls Self Efficacy Scale and Dystonia Discomfort Scale. RESULTS: There was a difference between groups for most outcome measures. The timed up-and-go and walking speed was slower (both P<0.005) and the Romberg Quotient lower (P=0.046) in cervical dystonia. People with cervical dystonia had lower falls self-efficacy (P=0.0002). Reduced cervical range of motion was correlated with balance, stepping reaction time and mobility (all P<0.05). Timed up and go was positively associated with stepping reaction time (P<0.01). Dystonia discomfort did not impact function. CONCLUSIONS: People with cervical dystonia displayed deficits in balance, gait and stepping reactions, and expressed higher fear of falling. Studies to further elucidate functional limitations and their impact on activity and participation in daily life are required.


Asunto(s)
Accidentes por Caídas/prevención & control , Marcha/fisiología , Modalidades de Fisioterapia , Equilibrio Postural/fisiología , Tortícolis/rehabilitación , Velocidad al Caminar/fisiología , Adulto , Anciano , Femenino , Humanos , Masculino , Autoeficacia , Tortícolis/fisiopatología , Caminata
19.
Disabil Rehabil ; 28(13-14): 873-81, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-16777775

RESUMEN

PURPOSE: The purpose of this study was to characterize the gait cycle of patients with hemiplegia before and after a period of outpatient physiotherapy based on the Bobath concept. METHODS: Nine patients, at least 6 weeks post stroke and recently discharged from a stroke unit, were measured before and after a period of outpatient physiotherapy (mean duration = 17.4 weeks). Therapy was documented using a treatment checklist for each patient. The primary outcome measures were a number of gait variables related to the therapists' treatment hypothesis, recorded during the gait cycle using the CODA motion analysis system. Other secondary outcome measures were the Motor Assessment Scale, Modified Ashworth Scale, subtests of the Sodring Motor Evaluation Scale, the Step test, a 10-m walk test, the Barthel Index and the London Handicap Score. RESULTS: Recovery of more normal gait patterns in the gait cycle (using motion analysis) did not occur. Significant changes in temporal parameters (loading response, single support time) for both legs, in one kinematic (dorsiflexion during stance) and one kinetic variable on the unaffected side (hip flexor moment), and most of the clinical measures of impairment, activity and participation (with the exception of the Modified Ashworth Scale and the 10-m walk) were noted. CONCLUSIONS: Study findings did not support the hypothesis that the Bobath approach restored more normal movement patterns to the gait cycle. Further research is required to investigate the treatment techniques that are effective at improving walking ability in people after stroke.


Asunto(s)
Marcha , Hemiplejía/rehabilitación , Modalidades de Fisioterapia , Rehabilitación/métodos , Rehabilitación de Accidente Cerebrovascular , Caminata , Anciano , Estudios de Cohortes , Femenino , Hemiplejía/etiología , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Recuperación de la Función , Accidente Cerebrovascular/complicaciones , Resultado del Tratamiento
20.
Clin Neurophysiol ; 127(1): 769-778, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25900020

RESUMEN

OBJECTIVE: To characterise short afferent inhibition (SAI) and the cortical silent period (CSP) in the primary motor cortex representations of the infraspinatus muscle in healthy adults and people experiencing chronic shoulder pain, to determine the impact of a suprascapular nerve block (SSNB). METHODS: Neurophysiological measures were obtained in 18 controls and 8 patients with chronic shoulder pain, pre and post SSNB and 1 week later. Pain intensity was assessed by a visual analogue scale. RESULTS: SAI was apparent in controls (all P<0.03) and a CSP was observed which reduced in the presence of SAI (all P<0.0001). Compared to controls, shoulder pain patients demonstrated higher active motor threshold (P=0.046), less SAI (P=0.044), a longer CSP (P=0.048) and less modulation of the CSP by SAI (P=0.045). Higher motor thresholds were related to higher pain scores (P=0.009). The SSNB immediately restored SAI (P=0.013), with a positive relationship between increased SAI and reduced pain (P=0.031). The SSNB further reduced modulation of CSP by SAI at 1 week post injection (P=0.006). CONCLUSIONS: SAI and the CSP were present and demonstrated robust interaction in controls, which was aberrant in patients. The SSNB transiently restored SAI but had no effect on the CSP; however CSP modulation by SAI was further attenuated 1 week post injection. SIGNIFICANCE: The current findings improve understanding of the neurophysiology of the shoulder motor cortex and its modulation by chronic pain. The effect of SSNB in shoulder pain patients should be interpreted with caution until proven in a larger population. Interventions that target intracortical inhibition might increase efficacy in people with chronic shoulder pain.


Asunto(s)
Dolor Crónico/terapia , Corteza Motora/fisiología , Bloqueo Nervioso/métodos , Inhibición Neural/fisiología , Dolor de Hombro/terapia , Estimulación Magnética Transcraneal/métodos , Adulto , Vías Aferentes/fisiología , Anciano , Dolor Crónico/diagnóstico , Dolor Crónico/fisiopatología , Estudios de Cohortes , Electromiografía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Escápula/inervación , Escápula/fisiología , Dolor de Hombro/diagnóstico , Dolor de Hombro/fisiopatología , Resultado del Tratamiento , Adulto Joven
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