Exercising daily living activities in robot-mediated therapy.

[Purpose] Investigation of the efficacy of robot-mediated therapy of the upper limb in patients with chronic stroke, in task-oriented training activities of daily living in real environment. [Subjects and Methods] 20 patients, each more than one year post-stroke (13-71 months) received 20 sessions of upper limb robot-mediated therapy. No other treatment was given. Each therapy session consisted of a passive motion and an active task therapy. During the active therapy, subjects exercised 5 activities of daily living. Assessments of the subjects were blind, and conducted one month prior to, at the start, at the end, and three months after the therapy course. The following outcome measures were recorded: Fugl-Meyer Scale-upper extremity subsection, Modified Ashworth Scale, Action Research Arm Test, Functional Independence Measure, Barthel Index. [Results] Significant improvements were observed between the start and the end of the therapy, except for Modified Ashworth Scale and Barthel Index. Results still held up at the follow-up visit three months later. [Conclusion] Practicing activities of daily living in real environment with robot-mediated physical therapy can improve the motor and functional ability of patients, even with relatively good initial functions, and even years post-stroke.

Correlation between Coronary Artery Disease with Other Arterial Systems: Similar, Albeit Separate, Underlying Pathophysiologic Mechanisms.

Atherosclerosis is a multifactorial systemic disease that affects the entire arterial tree, although some areas are more prone to lipid deposits than others. Moreover, the histopathological composition of the plaques differs, and the clinical manifestations are also different, depending on the location and structure of the atherosclerotic plaque. Some arterial systems are correlated with each other more than in that they simply share a common atherosclerotic risk. The aim of this perspective review is to discuss this heterogeneity of atherosclerotic impairment in different arterial districts and to investigate the current evidence that resulted from studies of the topographical interrelations of atherosclerosis.

[Physicians' and medical students' knowledge on rehabilitation]. / Rehabilitációs ismeretek kórházi orvosok és szigorlók körében.

UNLABELLED: There are few data on the rehabilitation knowledge of medical specialists and medical students. AIM: Assessment of the rehabilitation knowledge of medical specialists working in general hospitals and of final year medical students. METHODS: A paper form survey was performed using a questionnaire containing seven multiple choice questions and three definitions. Questionnaires were filled in independently on the spot. The three answering groups were physicians (specialized in orthopedic surgery, neurology or neurosurgery) working in a general hospital that had a rehabilitation ward, final year medical students from Semmelweis University, and trainees in rehabilitation medicine. The survey was voluntary and anonymous. RESULTS: Forty physicians, 42 students and 39 rehabilitation trainees filled in the questionnaire. Half of the students gave correct answers to questions about rehabilitation specialization, the existing university chairs, the percentage of people with disabilities in Hungary, and the way of sending patients for rehabilitation consultation. The number of beds designed for rehabilitation was unknown, but with regard to the existence of regulation by law the rights of people with disabilities were well-known by all groups. Very few were able to define the basic categories (rehabilitation, disability). Rehabilitation knowledge of physicians was not better than that of students, but rehabilitation trainees were better informed. CONCLUSIONS: According to findings of the authors, students and physicians do not have enough rehabilitation knowledge to perform medical activities adequately. Enlargement of the medical curriculum with basic rehabilitation knowledge is essential. A rehabilitation training course is necessary for physicians to be better equipped to carry out their daily hospital work.

The Role of Ultrasound in Accessing the Distal Radial Artery at the Anatomical Snuffbox for Cardiovascular Interventions.

In an effort to refine transcatheter vascular interventions, radial artery access has moved more distally at the anatomical snuffbox. Here, more challenges appear as the artery is smaller, more angulated, and more difficult to palpate. Including ultrasound guidance as a mandatory step during puncture may encourage more operators to switch to this approach. In the femoral approach, ultrasound guidance is strongly recommended because of bleeding complications, whereas in the proximal (conventional) radial approach, the role of ultrasound remains optional, and in current practice, almost all cases are performed by palpation of the pulse only. However, in distal radial access, the situation is different because the artery differs in caliber and position, and imaging can help the operator for a clean puncture, especially since repeated punctures are not only painful but also any hematoma formation leads to the complete compression of the artery and failure of access. The aim of this review is to investigate the rationale of vascular ultrasound during distal radial access and to establish some techniques and anatomical landmarks for the ultrasonographic exploration of the dorsal area of the hand.

COVID-19 and the ethical issues of justice and rationing in health care, with particular regard to the Italian experience / Az igazságosság és a besorolás etikai problémái az egészségügyben, különös tekintettel a COVID-19-járvány olaszországi tapasztalataira.

Összefoglaló. A 2020. év elején kirobbant COVID-19-világjárvány többek között ráirányította a figyelmet az életmento-életfenntartó kezelések igazságos elosztásának érzékeny kérdésére is. Európán belül elsoként Olaszországot sújtotta a katasztrófa, a válsághelyzetben pedig az érzéstelenítés, fájdalomcsillapítás, újraélesztés és intenzív ellátás területén tevékenykedo szakemberek olasz társasága, a SIAARTI 2020. március 6-án közzétett egy 15 pontos ajánlást. E szerint utilitarista megközelítéssel a rendelkezésre álló szukös eroforrásokat azon betegek kezelésére kellene fordítani, akik túlélési esélye nagyobb, valamint több életévre számíthatnak a jövoben, mert ez biztosíthatja a leheto legtöbb ember számára a leheto legnagyobb hasznot. A javaslat komoly szakmai vitát robbantott ki, amely egyértelmuvé tette, hogy az orvosi eszközök igazságos elosztására vonatkozó diskurzust feltétlenül folytatni kell, nemcsak Olaszországon belül, hanem a pandémiától sújtott többi államban is. Orv Hetil. 2020; 161(45): 1899-1907. Summary. Among other queries, the explosion of the COVID-19 pandemic at the beginning of 2020 has firmly put in focus the sensitive issue of how to allocate scarcely available life-saving treatments in a fair and just manner. The first European country to face an emergency caused by the pandemic was Italy. In a rapidly escalating crisis, on 6th March 2020, the Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) issued a series of 15 recommendations, suggesting that a utilitarian approach should be adopted in Italian health care and the extremely scarce resources should be reserved for patients with a greater probability of survival and life expectancy, in order to maximize the benefits for the largest possible number of people. The recommendations generated a heated debate among health care professionals, thereby evidencing that similar discussions must be initiated and pursued in all countries affected by the pandemic. Orv Hetil. 2020; 161(45): 1899-1907.

Evaluation of a companion robot based on field tests with single older adults in their homes.

The growing number of older adults places insurmountable load on family members and professional caregivers. Assistive technology with the aid of robots can present a possible solution. The goal of this article was to test a companion robot supporting older adults in their home environments. Eight senior volunteers were involved in the field test. They all lived alone and were self-supporting. The robot was capable of providing cognitive assistance to manage the user's daily routine. Each participant used the robot for 94.9 ± 19.6 days. The primary communication modality was voice communication in their natural language, while the touch screen display was also available for interaction with the robot. The assistance given in daily living was evaluated by subjective (the user's opinion) and objective (logged data) criteria. The most useful and the least reliable robot functions according to the users were the navigation and the verbal communication. Entertainment, locomotion, and weather forecast were the most frequently used functions, while the shopping list was the least popular. The companion robot used in the test was accepted enthusiastically by the senior subjects. Specific robot functions (mainly navigation in the apartment and the speech recognition) require improvement to better accommodate real circumstances.

Home care robot for socially supporting the elderly: focus group studies in three European countries to screen user attitudes and requirements.

The growing number of elderly individuals presents new challenges for society. Many elderly individuals have physical or cognitive impairments and require support from caregivers. An attempt to overcome the limitations caused by the lack of human caregivers is the inclusion of assistive technology such as socially active robots. The Domeo-project of the Ambient Assisted Living Joint Programme of the European Union aims to develop a new companion robotic system that would allow assistance to the elderly. The requirements and attitude of the potential users and caregivers have been assessed in Austria, France and Hungary. The robot functions were demonstrated to the participants. Three focus groups were formed: potential end users, older caregivers and younger caregivers. The discussions were recorded and processed according to six aspects: (i) acceptability and privacy, (ii) pertinence of services, (iii) possible obstacles, (iv) motivation level to use the proposed services, (v) organizational issues and (vi) recommendations. Minor differences were observed between the countries, but there were considerable differences regarding the age of the participants. The younger caregivers want to be assured of the safety of their client and to receive immediate notification in case of an emergency. As for the elderly, the most important aspect is to gain a companion and a physical helper. Many of the recommendations can be taken into consideration during robot development, but some of them are not realistic at present.

Robot-mediated upper limb physiotherapy: review and recommendations for future clinical trials.

Robot-mediated physiotherapy provides a new possibility for improving the outcome of rehabilitation of patients who are recovering from stroke. This study is a review of robot-supported upper limb physiotherapy focusing on the shoulder, elbow, and wrist. A literature search was carried out in PubMed, OVID, and EBSCO for clinical trials with robots providing shoulder, elbow, or wrist therapy. Results concerning motor control, spasticity, functional outcome, and the main features of the studies were evaluated. A total of 178 papers were found. On the basis of inclusion/exclusion criteria, 30 studies remained for evaluation. In these trials, a total of 493 patients received robot-aided therapy. The Fugl-Meyer assessment was the most commonly used motor scale, and in 24 of 27 trials, motor function improved significantly. The application of the Modified Ashworth Scale showed that spasticity decreased significantly in nine of 21 trials. Functional scales were only examined in one-third of the studies with significant changes being found in half of them. The intensity and duration of the interventions as well as the elapsed time poststroke were varied. There are several scales, which were used in only a few trials. Unifying the methodology in robotic trials is desirable. Clarification of the acute/subacute/chronic categories, standardizing the application of certain scales for outcome measure in each trial, use of functional scales, and a clearer description of the interventions are recommended.