[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.

Stroke prevention--a population screening day in district XII of Budapest.

Along with advances in the treatment of acute stroke, new efforts have been made to enhance efficiency of the prevention of cerebrovascular diseases. Population screening is a way to contact high-risk patients, and there is an increasing international and national experience with the procedure. However, efforts are associated with high costs, so an efficient method, complying with local features, should be selected from the various methods. A stroke prevention day was organized in Szent János Hospital, localized in district XII, and data were analyzed. Taking advantage of the potentials of a large hospital, a comprehensive risk assessment - within the capacity of health care workers - was performed. Program and contact information of the screening day was published in the local newspaper of the district. Data of 48 residents of the district were analyzed. In addition to neurologists, a radiologist, a cardiologist and an ophtalmologist, as well as health care workers were involved in the project. A data sheet was filled in for all participants, including known risk factors, BMI, blood pressure and serum cholesterol levels. All participants had duplex sonography of the cervical vessels, cardiac evaluation and ophtalmic examination. Data were analyzed anonymously, and - if participants approved - postcode and educational level were also recorded. Among the 48 individuals screened, 35 were female and 13 were male. Average age was 62.86 (+/- 8.57) years, and participants were typically of higher educational level. 5 individuals had no known risk factors, most of them had 2-3 risk factors, and multiple risk factors were not uncommon. Individuals with six and seven risk factors were also found. 20 of 27 patients with known hypertension had target blood pressure levels. By duplex sonography, 36 individuals had mild, 4 had significant atherosclerosis. There was no significant carotid stenosis or occlusion. Based on ophtalmic evaluation, 26 patients had signs of vascular disease (mainly hypertensive fundus changes). Cardiac evaluation detected 14 patients with cardiovascular risk. The high standard of primary care in the district was reflected by the fact that all the 6 high-risk individuals were already in the care of general practitioners (GP-s). One of the main conclusions from the evaluation of the data is that the press, family and local communities play a major role in recruiting people for a screening day. In order to increase efficiency and cost-effectiveness of the program, GP-s should also be involved in the planning process, because efficiency may be increased by pre-selecting high-risk individuals.

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.

Lymphocyte calcium influx kinetics in multiple sclerosis treated without or with interferon ß.

Kv1.3 and IKCa1 potassium channels play an important role in the maintenance of calcium-influx during lymphocyte activation and present a possible target for selective immunomodulation. We investigated the calcium-influx characteristics of Th1, Th2, CD4, CD8 T-lymphocytes isolated from multiple sclerosis patients without or with interferon-beta therapy, and its modulation by Kv1.3 and IKCa1 channel inhibitors using flow cytometry. Specific immunomodulation of the CD8 subset can be reached through inhibition of Kv1.3 channels in multiple sclerosis patients without interferon-beta. However, this effect is not specific enough concerning all lymphocyte subsets influencing the autoimmune response, since it also affects anti-inflammatory Th2 cells.