Description of an interdisciplinary, holistic cognitive rehabilitation program for adults with mild to moderate cognitive impairment after acquired brain injury.

PURPOSE: Cognitive rehabilitation research has progressed slowly, in part due to incomplete reporting of intervention content and delivery and the difficulties this produces for discerning program effectiveness. This knowledge gap can be reduced by providing detailed intervention descriptions. We document the content/ingredients and therapeutic targets of a cognitive rehabilitation program for adults with mild-to-moderate cognitive impairment. METHODS: The documentation process used a method of participatory/collaborative research. Discussions with the clinical team identified session content/ingredients and therapeutic targets, which were then described using Body Functions, and Activities & Participation domains from the International Classification of Function, Disability and Health (ICF). Domains most frequently targeted by each clinician were identified as Primary Targets. RESULTS: Each clinician produced a detailed description of session content, implementation, and ICF-coded therapeutic targets. This revealed that the whole program targets 29 ICF domains, seven of which were identified as Primary Targets: Higher-level Cognitive; Attention; Memory; Emotional; Global Psychosocial, Temperament and Personality, and Conversation. CONCLUSIONS: Documentation of treatment targets enabled identification of appropriate outcome measures which are now being used to investigate program efficacy. This step-by-step explanation of the documentation process could serve as a guide for other teams wanting to document their rehabilitation interventions and/or establish similar programs.IMPLICATIONS FOR REHABILITATIONIncomplete reporting of intervention content and delivery contributes to difficulties in discerning the effectiveness of complex rehabilitation programs.Current recommendations for rehabilitation intervention reporting suggest that these difficulties can be partially overcome by providing detailed descriptions of intervention content/ingredients and treatment targets.Human and physical resources differ widely from one clinical setting to another and the existence of clear program descriptions can guide clinicians who wish to create similar programs.Detailed descriptions of rehabilitation interventions are necessary to accurately measure patient outcomes and generate testable hypotheses about proposed mechanisms of action.Program descriptions are needed for the development of treatment theories and the advancement of evidence-based practice in rehabilitation.

Characteristics of Canadians Living With Long-Term Health Conditions or Disabilities Who Had Unmet Rehabilitation Needs During the First Wave of the COVID-19 Pandemic: A Cross-sectional Study.

OBJECTIVE: This study aimed to describe the characteristics associated with unmet rehabilitation needs in a sample of Canadians with long-term health conditions or disabilities during the first wave of the COVID-19 pandemic. DESIGN: We used data from the Impacts of COVID-19 on Canadians Living With Long-Term Conditions and Disabilities, a national cross-sectional survey with 13,487 respondents. Unmet needs were defined as needing rehabilitation (ie, physiotherapy/massage/chiropractic, speech therapy, occupational therapy, counseling services, or support groups) but not receiving due to the pandemic. We used multivariable modified Poisson regression to examine the association between demographic, socioeconomic, and health-related characteristics and unmet rehabilitation needs. RESULTS: More than half of the sample were 50 years and older (52.3%), female (53.8%), and 49.3% reported unmet rehabilitation needs. Those more likely to report unmet needs were females, those with lower socioeconomic status (receiving disability benefits or social assistance, job loss, increased work hours, decreased household income or earnings), and those with lower perceived general health or mental health status. CONCLUSIONS: Among Canadians with disabilities or chronic health conditions, marginalized groups are more likely to report unmet rehabilitation needs. Understanding the systemic and upstream determinants is necessary to develop strategies to minimize unmet rehabilitation needs and facilitate the delivery of equitable rehabilitation services.

Moving on. A farewell from the last Editor-in-Chief who says: 'Rehabilitation is a way of thinking, not a way of doing'.

What is rehabilitation? From 1994 to 2021, while I was privileged to be Editor of Clinical Rehabilitation, I explored this in editorials. I also encouraged and selected submissions that considered, in one way or another, the central features of rehabilitation. Why? Because when I started in rehabilitation, the general attitude among doctors and other healthcare professionals was that rehabilitation was pleasant but with no evidence of effectiveness. Further, they did not think a doctor had a role to play and did not think there was anything special for rehabilitation experts to know or have skills in. In this editorial, I discuss how, as editor, I used my position to support and encourage the publication of articles that produced evidence, considered the conceptual and scientific basis of rehabilitation, and ultimately answered the above question. I illustrate this with a few specific papers published in Clinical Rehabilitation. After 30 years, I have concluded that the essential feature characterising rehabilitation is its way of thinking about the patient's problems and how to solve them. Rehabilitation is holistic, person-centred, and concerned about social integration rather than disease or disability. Moreover, there is a mass of evidence showing it benefits patients.

Horticultural Therapy for Improving the Work Performance and Interpersonal Relationships of Persons with Intellectual Disabilities.

For the occupational adaptation and social integration of the intellectually disabled, it is helpful to improve their work performance and interpersonal skills. The purpose of the study was to evaluate the effectiveness of horticultural therapy (HT) programs to improve work performance and interpersonal relationships of persons with intellectual disabilities. Based on observations and analyses of how people with intellectual disabilities work, we have developed a 12-session HT program that includes upper limb movements and physical activities to improve hand function. We recruited, with the consent of their legal guardians, 14 (6 males, 8 females) participants who had intellectual disabilities and were working at a sheltered workshop in K-gu, Seoul, South Korea. The program consisted of twelve sixty-minute sessions that were conducted twice a week at a rooftop garden. For pre- and post-evaluation of the program, the survey of functional adaptive behavior (SFAB), interpersonal negotiation strategies, a horticultural job evaluation (self), hand function tests (pegboard, pinch gauge, fingertips), and blood sample tests for physiological indicators of exercise were conducted. Interpersonal negotiation strategies, functional adaptive behaviors, and physical abilities for job behaviors, including agility and grasping of the hand, improved significantly from before to after the program (p < 0.05). A positive result of VEGF (vascular endothermic growth factor) in blood sample tests implies the need for further research on cognitive changes caused by horticultural activities. This study has limitations due to the small number of participants, but the results suggest that low- to medium-intensity horticultural treatment programs using the upper body and hands could be effective for vocational rehabilitation of the intellectually disabled.

[Work-Related Medical Rehabilitation (WMR) Care in Psychosomatic Medicine in Comparison with Other Indications]. / Medizinisch-berufliche Orientierung (MBOR) in der Psychosomatischen Rehabilitation im Vergleich zu somatischen Indikationen.

BACKGROUND: So far, there is little data on the quality of work-related medical rehabilitation (WMR)-care in the routine, including from a user perspective. The best data are still available for orthopedic rehabilitation. For psychosomatic rehabilitation, a special need for WMR is known due to the long periods of inability to work and the frequent early retirements. It is unclear how precisely and to what extent WMR services are provided in routine care. METHODS: In 2019, a representative sample (N=34.887) of employed insured persons up to 65 years old, stratified by indication, was surveyed by the German Pension Insurance fund six months after their rehabilitation with the self-assessment tool MBOR-R. In addition, standard data of the rehabilitation provider (RSD) were collected, from which WMR-related therapeutic offer data (KTL) could be taken. Rehabilitants were asked about their return to work as part of the catamnesis. RESULTS: The participation rate in the survey is 29%, complete survey and RSD data are available after exclusion of addiction rehabilitation and post-operative-procedures from a total of 6.128 rehabilitants, of which N=1.460 after psychosomatic rehabilitation. The comparison of indications shows that 37% of the rehabilitation patients need WMR, which is by far the highest rate. WMR care in psychosomatic rehabilitation is still the best developed and most targeted, but still far from the standards required by the pension insurance. More than 50% of the rehabilitants, even after WMR, rate their employment-related treatment offer as too low. These subjective rehabilitation assessments in the MBOR-R questionnaire prove to be a relevant factor for the prognosis of the return to work quotes, in contrast to the documented KTL services, in addition to the need indicators of WMR and the implementation of WMR. DISCUSSION: The results suggest that in the field of psychosomatic rehabilitation, too, increased efforts should be made in the future to offer and expand basic WMR services for all rehabilitants and core and special services for rehabilitants with poor work ability and an increased risk of permanent work disability (BBPL) in routine care. The scope and design of MBOR measures should also be quality-optimized from the user's perspective in order to achieve the greatest possible effects.Limitations of the results result from the restriction to rehabilitants of the German Federal Pension Insurance, to limited participation rates, Limitations of the interpretability of the therapy documentations and due to the study design with a one-point measurement and remembered pre-values.

Measuring Equine-Assisted Therapy: Validation and Confirmatory Factor Analysis of an ICF-Based Standardized Assessment-Tool.

The International Classification of Functioning, Disability, and Health (ICF) of the World Health Organization (WHO) was established as an international framework for monitoring rehabilitation outcomes and the impacts of health interventions since, as the term "functioning" implies, it emphasizes a person's "lived health" in addition to their biological health status. Equine-assisted therapy (EAT) represents a holistic intervention approach that aims to improve both biomedical functioning and the patient's lived health in relation to performing activities and participating in social situations. In this study, the psychometric properties of an ICF-based digital assessment tool for the measurement of the rehabilitation impacts of EAT were analyzed via simultaneous confirmatory factor analyses (CFA) and reliability and sensitivity tests. In total, 265 patients from equine-assisted therapy centers in Germany were included for CFA. Change sensitivity was assessed via multi-level analyses based on 876 repeated assessments by 30 therapists. Results show satisfactory model-fit statistics; McDonald's omega (ML) showed excellent scores for the total scale (ω = 0.96) and three subscales (ω = 0.95; ω = 0.95, ω = 0.93). The tool proved itself to be change sensitive and reliable (change sensitivity p ≤ 0.001), retest r = 0.745 **, p ≤ 0.001). Overall, the developed assessment tool satisfactorily fulfills psychometric requirements and can be applied in therapeutic practice.

International and national perspective of disability and policy disconnect in Pakistan: A narrative review.

In the developed societies, supportive environmental, physical and social conditions enable participation of persons with disabilities in the mainstream through actions, like provision of ramps and reserved parking. In contrast, in the developing countries like Pakistan, with focus on visual disability, years lost to disabilities compromise and restrict the productive life span of the disabled. The current narrative review was planned to highlight the perspective of disability in the context of Pakistan to bring to limelight the issues requiring immediate focus of the health authorities and the government through a holistic and sustainable approach. Of the 177 publications found on literature search, 33(%) English-language, full-text studies were reviewed. To address disability issues, long-term sustainable actions, like health reforms, including ensuring availability of rehabilitation professionals in hospitals, legislative reforms to initiate relevant legislations, capacity-building of persons with disabilities, including their mainstreaming, are deemed essential.

Development of an ICF-based assessment tool for equine-assisted therapy: model structure and reliability.

BACKGROUND: Scientific investigation and documentation of equine-assisted therapy has increased over the past several years. Yet there are no standardized and validated tools for evidence-based measurement of processes and outcomes to assess equine-assisted interventions. AIM: The objective of this cross-sectional survey study was to develop a standardized assessment tool for the effective measurement of equine-assisted therapy based on the common language of the International Classification of Functioning, Disability and Health (ICF) framework of the World Health Organization (WHO). DESIGN: Cross-sectional study. SETTING: Six equine-assisted therapy rehabilitation centers in Germany. POPULATION: Persons with indications for equine-assisted therapy. METHODS: In a qualitative conceptual portion of the study, four semi-structured focus group interviews were conducted and analyzed with a total of 17 experts and therapists according to the aims, content, and sphere of influence of equine-assisted therapy via structured content analysis. Based on these findings and a linkage to the classification system of ICF, a standardized assessment tool (a general module and three specialized submodules) for equine-assisted therapy was developed. It was field-tested with 116 participants at six locations in a multicenter practical field approach and statistically analyzed via explorative factor analyses and reliability tests. RESULTS: Explorative factor analysis provided support for a three-factor structure for the general module, including psychosocial, motor, and mental functioning scales. For both submodules, i.e., the individual and group settings, a two-factor structure was indicated. Reliability was in the good to excellent range for all modules. CONCLUSIONS: A global 80-item assessment tool, divided into a general and three submodules, provides a first step toward a standardized ICF-based assessment of the effects of equine-assisted therapy. A common language in measuring therapy outcomes could increase synchronization and integration of equine-assisted therapy interventions into the international healthcare system. By applying the ICF in multidisciplinary services in rehabilitation management, improved coordination and networking of all necessary services can be provided. CLINICAL REHABILITATION IMPACT: The developed assessment tool contributes to evidence-based outcome-measurement and therapy monitoring of equine-assisted interventions. Prospectively, it could enable cost-effectiveness analyses and comparability with other health system interventions.

The effects of kinesiology treatment on morphological characteristics of top table tennis players with disabilities / Efectos del tratamiento de kinesiología en las características morfológicas de los mejores jugadores de tenis de mesa con discapacidades

SUMMARY: Sports results of table tennis players with disabilities depend on the functionality level, but also on morphological characteristics. There is an increased risk of obesity in these athletes with disability due to a reduced level of locomotor functionality. The hitherto practice showed that leading table tennis players with disabilities in Serbia did not have an additional kinesiology treatment implemented as part of their training process, which would encourage both strengthening and flexibility of muscle groups relevant for the efficacy of table tennis game, and reduction of body mass and voluminosity. The goal of this paper is to apply an additional kinesiology treatment and determine its effect of on the morphological characteristics of leading table tennis players with disabilities. Eight representatives, table tennis players with disabilities, both male and female, aged between 23 and 52, were included in the additional kinesiology treatment that lasted for nine months. The measures of longitudinal skeleton dimensionality, body mass and volume, subcutaneous adipose tissue and body mass index were analyzed. In order to establish the effects of kinesiology treatment Student's t-test was used, while the results were processed by means of a statistical package SPSS, version 14.0. The values were estimated at p < 0.05 significance level. Male respondents demonstrated statistically significant changes in biceps skinfold (p = 0.05). In the case of female respondents no statistically significant difference was observed in anthropometric space. The additional kinesiology treatment indicates a trend towards reduced voluminosity and body mass of both male and female respondents, but not at a statistically significant level, which is probably the result of an insufficient number of respondents. Continued additional kinesiology treatment should be included in the training process of male and female table tennis players with disabilities, which has not been the case up until now.

RESUMEN: Los resultados deportivos de los jugadores de tenis de mesa con discapacidad dependen del nivel de funcionalidad, pero también de las características morfológicas. Existe un mayor riesgo de obesidad en estos atletas con discapacidad debido a un nivel reducido de funcionalidad locomotora. La práctica hasta ahora mostró que los principales jugadores de tenis de mesa con discapacidades en Serbia no cuentan con un tratamiento de kinesiología adicional, implementado como parte de su proceso de entrenamiento, que fomentaría tanto el fortalecimiento como la flexibilidad de los grupos musculares relevantes para el juego de tenis de mesa, y la reducción de masa corporal y voluminosidad. El objetivo de este trabajo fue aplicar un tratamiento kinesiológico adicional y determinar su efecto sobre las características morfológicas de los principales jugadores de tenis de mesa con discapacidad. Ocho representantes, jugadores de tenis de mesa con discapacidad, tanto hombres como mujeres, con edades entre 23 y 52 años, fueron incluidos en el tratamiento adicional de kinesiología que tuvo una duración de nueve meses. Se analizaron las medidas de dimensionalidad esquelética longitudinal, masa y volumen cor- poral, tejido adiposo subcutáneo e índice de masa corporal. Para establecer los efectos del tratamiento kinesiológico se utilizó la prueba t de Student, mientras que los resultados se procesaron mediante el paquete estadístico SPSS, versión 14.0. Los valores se estimaron a un nivel de significación p < 0,05. Los hombres encuestados demostraron cambios estadísticamente significativos en el pliegue cutáneo del bíceps (p = 0,05). En el caso de las mujeres encuestadas no se observó diferencia estadísticamente significativa en el espacio antropométrico. El tratamiento de kinesiología adicional indica una tendencia hacia la reducción de la voluminosidad y la masa corporal de los encuestados masculinos y femeninos, pero no a un nivel estadísticamente significativo, lo que probablemente sea el resultado de un menor número de encuestados. El tratamiento kinesiológico continuo debe incluirse en el proceso de formación de los jugadores de tenis de mesa con discapacidad, lo que no ha sido el caso hasta el momento.

Psychometric properties of the Chinese version of the Trunk Impairment Scale in people with a stroke.

BACKGROUND: The Trunk Impairment Scale (TIS) has been translated into Chinese, but the psychometric properties of the Chinese version of the TIS (TIS-C) have not yet been established. We aimed to examine the reliability and validity of the TIS-C for assessing sitting balance among Chinese people with a stroke. METHODS: A descriptive, cross-sectional design was used. We recruited a convenience sample of 170 subacute stroke patients aged 18 years or over from the neurology departments of four traditional Chinese medicine hospitals in China. Patients completed the TIS-C, the Berg Balance Scale and the Modified Barthel Index. The psychometric properties of the TIS-C were examined to establish test-retest reliability, internal consistency, equivalence, and content, criterion, and construct validity. RESULTS: Intraclass correlation coefficients for inter-rater and intra-rater reliability ranged from 0.75 to 0.89 and from 0.90 to 0.97, respectively. The TIS-C Cronbach α was 0.86. The strong correlation between the total score of the TIS-C and the Berg Balance Scale (rs = 0.81, p < 0.001) or Modified Barthel Index (rs = 0.84, p < 0.001) suggested good concurrent and convergent validity, respectively. Known-group validity was supported by the significant difference (p < 0.001) in TIS-C scores between participants with mild and moderate stroke. CONCLUSIONS: The TIS-C is a valid and reliable tool for assessing static and dynamic sitting balance as well as coordination of trunk movement among stroke survivors with mild and moderate stroke.

HIV-related disability and rehabilitation: perception of health care workers.

Background: Health care workers play an integral role in the rehabilitation and care of people living with HIV who face multiple impairments and often disabilities. The aim of the article was to understand the perceptions and attitudes of health care workers towards caring for people living with HIV, and experiencing disability. Methods: Fifteen health care workers offering care to people living with HIV were interviewed using a semi-structured guide. These health care workers included doctors, a social worker, a pharmacist, a dietician, an occupational therapist, a physiotherapist, and nurses and HIV couPnsellors who were employed at a public health care facility in KwaZulu-Natal. Data from the interviews were transcribed and analysed using conventional content analysis. Results: Four themes emerged from semi-structured interviews with the health care workers: a holistic disability framework, a multidisciplinary team dynamic, organisational barriers and recommendations by health care workers. Conclusion: Health care workers perceived a shift from a biomedical perspective of disability to a bio-psychosocial interpretation that is influenced by contextual and environmental barriers imposed by communities on people living with HIV. Barriers included stigmatisation that leads to attitudinal barriers and social exclusion of people living with HIV and experiencing disabilities within communities. Lack of resources, including of equipment, and a shortage of health care staff also posed barriers to the care offered to people living with HIV and experiencing disabilities. Participants agreed that improved communication in the multidisciplinary health care team, as well as continuing education and training, would enable health care workers to offer improved, integrated care to people living with HIV who experience disabilities.

The Basics of Nutrition: A Primary Rehabilitation Intervention.

Nutrition, the process by which a body nourishes itself through the transformation of food into energy and body tissues, is the most important factor in health maintenance, response to injury or illness, short-term and long-term rehabilitation, and longevity. Most rehabilitation providers and the individuals they treat have limited training and knowledge on even the basics of nutrition. An appropriate diet for individuals who are either in a health maintenance or an active program of rehabilitation includes 1500 to 2500 calories per day delivered via a balanced range of foodstuffs, preferably in a whole-food, plant-based manner.

Inappropriate/d bodies: Reorganizing the terms of life and death.

The aim of this article is to offer insight into the different meanings of death that pierce the lives of people with disabilities and to discuss how those meanings are formed through a close connection with their bodies. To do that, I take an anthropological approach to trace the life paths of two individuals from a southern Latin American metropolis, exploring their embodied experiences of disability. Based on their accounts, I look at how their bodies are affected by specific conditions of stigma, dispossession, and social death, but also how, as "inappropriate/d" bodies, they rise above the logic of difference and move from a state of "absence" to a state of "presence" in the social world.

Dance Programs for School-Age Individuals With Disabilities: A Systematic Review.

The purpose of this systematic review was to examine published research literature pertaining to dance programs for school-age individuals with disabilities by describing study characteristics and major findings. Electronic database searches were conducted to identify relevant articles published between January 2008 and August 2018. Sixteen articles met all inclusion criteria, and extracted data from the articles included major findings, study design characteristics (e.g., sample size), and dance program characteristics (e.g., location of program). The methodological quality of each study was assessed using the Crowe Critical Appraisal Tool. Major findings expand on previous reviews on dance by including school-age individuals with disabilities. The critical appraisal of the articles demonstrates a gap in study design rigor between studies. Future research should aim to specify sampling strategies, use theories to frame the impact of dance programs, and provide a thorough description of ethical processes and dance classes.

[How to improve social and professional reinsertion of patients with neurodiabilities ? Practical indications for the general practitioner]. / Comment faciliter la réinsertion socioprofessionnelle du patient neurolésé ? Outils pour le praticien.

One part of the population of neurolesioned patients is the transition of young patients with neurodisabilities to adult life. To guarantee favourable social and professional reinsertion is a major challenge, requiring inter-professional care. For this reason, in 2006 the CHUV, Lausanne created a transition-consultation framework with neuro-paediatricians and adult neurologists specialised in neuro-rehabilitation linked to a Swiss pilot social and professional reinsertion project collaborating with the invalidity insurance. As a model of the follow up of neurolesioned patients, this article reports the results of the reinsertion project that aims to bring awareness to the general practitioner of an inter-disciplinary care method adaptable to individuals. The holistic service saves time and improves the rate of successful reinsertion of young adults into social and professional life.

Les jeunes en transition de l'enfance à l'âge adulte présentant une maladie neurodéveloppementale sont une population spécialement vulnérable. Le suivi de leurs problèmes de santé et leur insertion socioprofessionnelle représentent un véritable défi. Au CHUV, à Lausanne, une consultation de transition entre les neurorééducateurs pédiatriques et adultes a été créée en 2006 ainsi qu'un projet pilote suisse de réinsertion socioprofessionnelle en collaboration avec l'Office de l'assurance invalidité pour le canton de Vaud. Le résultat de ce projet pilote, qui peut être utilisé comme modèle pour tous les patients neurolésés, est rapporté ici avec comme objectif d'informer le médecin traitant et de lui permettre d'utiliser les outils de cette prestation holistique afin d'optimiser la durée et la qualité de la réinsertion.

Effectiveness of expiratory muscle strength training on expiratory strength, pulmonary function and cough in the adult population: a systematic review.

BACKGROUND: Respiratory muscle strength declines in certain disease states, leading to impaired cough, reduced airway clearance and an increased risk of aspiration pneumonia. Respiratory muscle training may therefore reduce this risk. OBJECTIVES: To assess current evidence of expiratory muscle strength training (EMST) on maximum expiratory pressure, cough flow and spirometry. DATA SOURCES: Databases including CINAHL, Medline, Science Direct and PEDRo were searched. ELIGIBILITY CRITERIA: Randomised controlled trials investigating expiratory muscle strength training on maximum expiratory pressure, pulmonary function or cough in any adult population, published before December 2017. STUDY APPRAISAL: Data were extracted to a trial description form and study quality evaluated by two reviewers. Meta-analysis was performed with calculation of mean differences and 95% confidence intervals. RESULTS: Nine studies met inclusion criteria and ranged in size from 12 to 42 participants. Trials investigated EMST in healthy adults (2), multiple sclerosis (3), COPD (2), acute stroke (1) and spinal cord injury (1). Overall, EMST improved maximum expiratory pressure (15.95cmH2O; 95% CI: 7.77 to 24.12; P<0.01) with no significant impact on cough flow (4.63L/minute; 95%CI -27.48 to 36.74; P=0.78), forced vital capacity (-0.16L; 95%CI -0.35 to 0.02; P=0.09) or forced expiratory volume in 1second (-0.09L; 95%CI -0.10 to -0.08; P<0.001) vs control or sham training. CONCLUSIONS: Meta-analysis indicated a small significant increase in maximum expiratory pressure following EMST. Improvements in maximum expiratory pressure did not lead to improvements in cough or pulmonary function. LIMITATIONS: Variations in protocol design and population limited the overall effect size. Systematic Review Registration PROSPERO CRD42018104190.

Integrated Thermal Rehabilitation: A New Therapeutic Approach for Disabilities.

A mutual link between somatic and visceral neural pathways is known in medicine. This study addresses therapeutic effectiveness of an integrated rehabilitative approach of thermal aquatic environment, combined with neuromuscular manual stimulation, on activation of afferent sensory visceral and somatic efferent neuronal motor pathways in different pathologies of neuromuscular motor and respiratory systems. The study included 63 patients subjected to a protocol consisting of hydroponic treatment, hydrokinesitherapy associated with ozonized vascular pathway, and mud therapy associated with cardiorespiratory treatment performed in aquatic environment and aided by neuromuscular manual therapy. The therapeutic protocol consisted of rehabilitation sessions 5 days a week for 2 months. The outcome measures were spirometry tests and the following evaluation instruments: Tinetti Gait and Balance assessment scale, Functional Independence Measurement, visual analogue scale, and the EQ-5D-5 L instrument. The tests were applied before and after the protocol completion. The findings demonstrate a general increase in patients' everyday living autonomy and quality of life, with a particular improvement in respiratory function tests. We conclude that the integrated thermal approach holds promise in therapeutic rehabilitation of disabilities.

Augmented reality-based dance intervention for individuals with Parkinson's disease: A pilot study.

BACKGROUND: The effects of dance on improving the symptoms of individuals with Parkinson's disease (PD) is well documented. Augmented reality devices, such as Google Glass, may be used to implement dance interventions to improve mobility and balance. OBJECTIVE: To evaluate the feasibility, safety, and acceptability of a mobile dance intervention and obtain preliminary efficacy estimates for assessment of the research protocol. METHODS: Seven participants with PD were asked to use Google Glass preloaded with Moving Through Dance modules for three weeks. Changes in motor functions (balance, mobility) and non-motor functions (mood, quality of life) were evaluated before and after completion of the intervention. RESULTS: Recruitment rate was 50%, retention rate was 100%, and adherence to usage was 95%. The intervention was safe and accepted by participants. Use of Moving Through Glass improved mobility with a cognitive load (F(1, 5) = 10.76; p < 0.05). However, there were no significant changes to the participants' balance scores, quality of life or mood. CONCLUSIONS: The outcomes of this pilot study suggest that Moving Through Glass, as a mobile dance intervention, may be a safe way to increase physical activity through dance in individuals with PD. Its efficacy should be investigated in a properly powered randomized controlled trial.

Chair-based exercise programs in institutionalized older women: Salivary steroid hormones, disabilities and frailty changes.

PURPOSE: Many people experience aging-related losses in different physical domains, which leads to a condition often called physical frailty (PF). The aim of this study was to analyse the effects of two different, 28-weeks, class chair-exercise protocols on salivary steroid hormones (SH), PF, and functional disabilities (FD) in frail older women. METHODS: A sample of older frail individuals (n = 60, 817.84 years) participated in the study and were divided into three groups: chair elastic-band muscle strength exercises (CSE), n = 20), chair-multimodal exercise (CME, n = 21) and a control non-exercise group (CGne, n = 19). Both exercise programs consisted of 45 min of supervised chair-based exercise group classes, carried out 3 times/week. CME participants performed a progressive training using walking, mobility and body weight resistance exercises. The CSE participants exercised using an elastic-band system of progressive exercises. Both CSE and CME followed a circuit training protocol. The controls did not change their usual lifestyle. The indicators of PF, FD and SH concentrations were analyzed before and after the intervention. RESULTS: Both exercise programs diminished the PF status showing significant time and time versus treatment interactions (p < .01). An increase in the CME group, between baseline and 14-weeks, and in the CSE group, after 28 weeks, for Testosterone concentrations was observed (p < .01). Dehydroepiandrosterone (DHEA) increased after 28-weeks in the CME group and decreased in the CGne after the same period (p < .05). Both exercise programs decreased the negative scores of several FD domains, specially fear of falling that showed significant effects with time (p < .01), and time vs intervention (p < .05). CONCLUSION: Both chair-exercise based programs were effective in stimulating positive changes in physical health and in steroid hormone responses, especially in DHEA. The control group did show a negative trend towards an increased PF status and decreased levels of SH. It is crucial for public health to identify the main factors associated with Functional Disability and Physical Frailty that underlie the development of new methods for complementary therapies, such as the use of low doses of hormonal supplementation combined with long-term exercise interventions.

Thriving through relationships: assistance dogs' and companion dogs' perceived ability to contribute to thriving in individuals with and without a disability.

Purpose: Companion dogs can provide psychosocial benefits for their owners. Assistance dogs reportedly provide similar benefits, while also performing specific tasks. These psychosocial benefits may increase their handler's quality of life and ability to thrive - defined as having the ability to grow and flourish, especially in the face of adversity. Currently, no studies compare assistance dogs' effectiveness to companion dogs' in assisting their handler/owner to thrive, an important comparison given that companion dogs are typically less expensive to acquire, and more readily available.Methods: The Thriving Through Relationships (TTR) theory was used to inform the development of a human-dog relationship survey, which was distributed through assistance dog organizations and to the general public.Results: Participants were divided into three groups: persons with a disability who had an assistance dog (n = 165), persons with a disability who had a companion dog (n = 249) and persons with no disability who had a companion dog (n = 198). Perceived overall support was statistically different between the three groups, F (2, 394) = 14.45, p < .001. Assistance dog handlers reported receiving significantly higher levels of support than companion dog owners with disabilities (p < .01) or without disabilities (p < .001). In fact, assistance dogs were reported to provide more support (p < .017) than companion dogs on nine out of ten separate indicators of thriving.Conclusion: Overall, dogs are perceived to provide support that improves their handler/owner's ability to thrive. Most importantly, however, assistance dogs may provide greater support than companion dogs for persons with a disability and, therefore, may be worth the additional time and financial cost.Implications for RehabilitationAssistance dogs could assist rehabilitation by improving coping skills, especially during times of adversity, as demonstrated through the ten indicators of thriving.Assistance dogs and companion dogs are not inter-changeable when it comes to providing support for individuals with a disability.