HEART rate variability biofeedback for long COVID symptoms (HEARTLOC): protocol for a feasibility study.

INTRODUCTION: Long COVID (LC), also known as post-COVID-19 syndrome, refers to symptoms persisting 12 weeks after COVID-19 infection. It affects up to one in seven people contracting the illness and causes a wide range of symptoms, including fatigue, breathlessness, palpitations, dizziness, pain and brain fog. Many of these symptoms can be linked to dysautonomia or dysregulation of the autonomic nervous system after SARS-CoV2 infection. This study aims to test the feasibility and estimate the efficacy, of the heart rate variability biofeedback (HRV-B) technique via a standardised slow diaphragmatic breathing programme in individuals with LC. METHODS AND ANALYSIS: 30 adult LC patients with symptoms of palpitations or dizziness and an abnormal NASA Lean Test will be selected from a specialist Long COVID rehabilitation service. They will undergo a 4-week HRV-B intervention using a Polar chest strap device linked to the Elite HRV phone application while undertaking the breathing exercise technique for two 10 min periods everyday for at least 5 days a week. Quantitative data will be gathered during the study period using: HRV data from the chest strap and wrist-worn Fitbit, the modified COVID-19 Yorkshire Rehabilitation Scale, Composite Autonomic Symptom Score, WHO Disability Assessment Schedule and EQ-5D-5L health-related quality of life measures. Qualitative feedback on user experience and feasibility of using the technology in a home setting will also be gathered. Standard statistical tests for correlation and significant difference will be used to analyse the quantitate data. ETHICS AND DISSEMINATION: The study has received ethical approval from Health Research Authority (HRA) Leicester South Research Ethics Committee (21/EM/0271). Dissemination plans include academic and lay publications. TRIAL REGISTRATION NUMBER: NCT05228665.

Problems encountered by parents of infants with clubfoot treated by the Ponseti method in Madagascar: A study to inform better practice.

OBJECTIVE: Ponseti treatment for clubfoot is effective and inexpensive, improving children's social participation. Two rehabilitation centres in Madagascar piloted Ponseti treatment; however, at one centre 46% of infants failed to complete treatment. The aim of this study was to determine the causes of defaulting in order to facilitate subsequent improvements nationwide when treatment is rolled out to all centres. METHODS: Questionnaire-based interviews. PATIENTS: Twenty mothers of infants younger than 1 year were interviewed after 3 months of treatment in relation to difficulties they experienced with continuing treatment. RESULTS: Fifteen families of these had financial problems: 7 incurred debt, 2 sold possessions, 4 parents stopped work an 2 did not give any further details. All mothers experienced distress; 9 hid their child's foot, and 8 were accused of wrong-doing during pregnancy. Three families travelled more than 500 km to the treatment centre and journeys were costly and difficult. Ponseti splints were acceptable, but aftercare of the splints proved problematic. CONCLUSION: Repeated travel to the clinic resulted in financial and social burden on the families, which reduced their ability to engage in treatment. The findings of this study are similar to work from other countries, but publications on rehabilitation from Madagascar are few. Improved support for parents, information, splinting with better materials and provision of treatment more locally are needed. Financial support for parents is key to enhancing children's life chances.

A proof of concept study investigating the feasibility of combining iPAM robot assisted rehabilitation with functional electrical stimulation to deliver whole arm exercise in stroke survivors.

Rehabilitation robots can provide exercise for stroke survivors with weakness at the shoulder and elbow, but most do not facilitate hand movements. The aim was to combine robotics and functional electrical stimulation to facilitate exercise in stroke survivors with upper limb impairment. iPAM Mk II was used to assist active reaching in combination with an Odstock Pace stimulator to assist hand opening. The ABILHAND, Action Research Arm Test (ARAT) and the Stroke Impact Scale (SIS) were recorded at baseline and completion. Nine participants (eight males and one female; mean age = 58 years) were recruited; mean time since stroke was 16 months (range = 6-64). The ABILHAND at baseline was -2.73, improving to -1.45 at follow-up (p = 0.038). The ARAT changed from 4.1 to 2.6 (p = 0.180), and the SIS from 49 to 60 (p = 0.019). This study demonstrates that it is possible to combine two technologies in stroke rehabilitation.

Functional electrical stimulation for the upper limb in tetraplegic spinal cord injury: a systematic review.

Technological advances have helped to improve functional ability in spinal cord injury survivors. The aim of this study is to systematically review the evidence for functional electrical stimulation (FES) on functional tasks involving the upper limb in people with spinal cord injuries. The authors systematically searched from September 2009 to September 2014 in relevant databases using a combination of keywords covering spinal cord injury and FES. Studies were selected using pre-determined criteria. The search yielded 144 studies. Only five studies met the inclusion criteria. All five reported improvements immediately and at follow-up in functional ability as a result of FES or FES combined with conventional therapy. There is some preliminary evidence that FES may reduce disability due to upper limb-related activity limitations in tetraplegic spinal cord injury. Further work needs to examine the role of FES in more detail and in combination with other treatments.