Evaluation of a skin barrier cream for managing IAD in elderly patients using high-frequency ultrasound.

Incontinence-associated dermatitis (IAD) is a defined pathological entity and presents a significant burden for patients and health-care systems. The main objective of this evaluation was to test the efficacy and safety of a skin barrier cream in the management of uncomplicated IAD in elderly patients. Ten incontinent patients with mobility problems that presented with signs of IAD were included in the evaluation. The evaluation took place during a 2-week period. The product's efficacy was objectively evaluated in each patient with high-frequency ultrasound scans taken from the irritated skin compared with an ultrasound scan taken from normal adjacent (control) skin. Data analysis showed a statistical significance in favour of the capacity of the product to help reduce inflammatory signs. Photographic follow-up allowed correlation of ultrasound findings and clinical signs. The product was effective in treating the skin irritation and preventing further skin breakdown. There were no adverse events during the evaluation.

An Intensive Exercise Program Using a Technology-Enriched Rehabilitation Gym for the Recovery of Function in People With Chronic Stroke: Usability Study.

BACKGROUND: Rehabilitation improves poststroke recovery with greater effect for many when applied intensively within enriched environments. The failure of health care providers to achieve minimum recommendations for rehabilitation motivated the development of a technology-enriched rehabilitation gym (TERG) that enables individuals under supervision to perform high-intensity self-managed exercises safely in an enriched environment. OBJECTIVE: This study aimed to assess the feasibility of the TERG approach and gather preliminary evidence of its effect for future research. METHODS: This feasibility study recruited people well enough to exercise but living with motor impairment following a stroke at least 12 months previously. Following assessment, an 8-week exercise program using a TERG (eg, virtual reality treadmills, power-assisted equipment, balance trainers, and upper limb training systems) was structured in partnership with participants. The feasibility was assessed through recruitment, retention, and adherence rates along with participant interviews. Effect sizes were calculated from the mean change in standard outcome measures. RESULTS: In total, 70 individuals registered interest, the first 50 were invited for assessment, 39 attended, and 31 were eligible and consented. Following a pilot study (n=5), 26 individuals (mean age 60.4, SD 13.3 years; mean 39.0, SD 29.2 months post stroke; n=17 males; n=10 with aphasia) were recruited to a feasibility study, which 25 individuals completed. Participants attended an average of 18.7 (SD 6.2) sessions with an 82% attendance rate. Reasons for nonattendance related to personal life, illness, weather, care, and transport. In total, 19 adverse events were reported: muscle or joint pain, fatigue, dizziness, and viral illness, all resolved within a week. Participants found the TERG program to be a positive experience with the equipment highly usable albeit with some need for individual tailoring to accommodate body shape and impairment. The inclusion of performance feedback and gamification was well received. Mean improvements in outcome measures were recorded across all domains with low to medium effect sizes. CONCLUSIONS: This study assessed the feasibility of a holistic technology-based solution to the gap between stroke rehabilitation recommendations and provision. The results clearly demonstrate a rehabilitation program delivered through a TERG is feasible in terms of recruitment, retention, adherence, and user acceptability and may lead to considerable improvement in function, even in a chronic stroke population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-doi.org/10.3389/fresc.2021.820929.

A Co-creation Centre for Accessible Rehabilitation Technology.

Background: The prevalence of disabling conditions is increasing globally. Rehabilitation improves function and quality of life across many conditions, particularly when applied intensively. The limited workforce, however, cannot deliver evidence-based intensive rehabilitation. By providing individuals with the tools for self- rehabilitation, technology helps bridge the gap between evidence and practise. Few people, however, can access rehabilitation technology. Barriers such as cost, training, education, portability and poor design stand in the way of equitable access. Our group of engineers and researchers have established a centre dedicated to developing accessible technology through close, frequent engagement with users and industry. Methods: The centre employs a co-creation model, coupling engineering and science with user experience and industrial partnerships to develop accessible technology and associated processes. Due to the complexity and size of the challenge the initial focus is stroke. Recruited through a medical charity, participants, with a wide range of disabilities, use prototype and commercial technology during an 8-week rehabilitation programme with supervision from health professionals. The centre includes de-weighting systems, neurostimulation, virtual reality, treadmills, bespoke rehab games, communication apps, powered exercise equipment and gamified resistance equipment. Standard outcome measures (International Classification of Functioning, Disability and Health) are recorded before, during, immediately after, and 3 months after the intervention and used in combination with an interview to design the initial rehabilitation programme, which is reviewed fortnightly. Qualitative methods (surveys and interviews) are used to capture personal experiences of the programme and individual technology and an advisory group of stroke survivors help interpret outcomes to feed into the technology design process. Ethical approval has been granted for a pilot cohort study with stroke survivors, which is currently underway (01/09/2021-31/12/2021) investigating acceptability and feasibility, due to report findings in 2022. Discussion: Through partnerships, research collaborations and a co-creation model a new centre dedicated to the development of accessible rehabilitation technology has been launched and currently undergoing acceptability and feasibility testing with stroke survivors. The centre, through its close engagement with users and industry, has the potential to transform the way rehabilitation technology is developed and help revolutionise the way rehabilitation is delivered.

Neuromechanical Differences Between Successful and Failed Sit-to-Stand Movements and Response to Rehabilitation Early After Stroke.

BACKGROUND: Recovery of the sit-to-stand (StS) movement early after stroke could be improved by targeting physical therapy at the underlying movement deficits in those people likely to respond. AIM: To compare the movement characteristics of successful and failed StS movements in people early after stroke and identify which characteristics change in people recovering their ability to perform this movement independently following rehabilitation. METHODS: Muscle activity and kinematic (including center of mass, CoM) data were recorded from 91 participants (mean 35 days after stroke) performing the StS movement before (baseline), immediately after (outcome), and 3 months after (follow-up) rehabilitation. Three subgroups (never-able [n = 19], always-able [n = 51], and able-after-baseline [n = 21]) were compared at baseline with the able-after-baseline subgroup compared before and after rehabilitation. RESULTS: The subgroups differed at baseline for quadriceps onset time ( P = .009) and forward body position when quadriceps peaked ( P = .038). Following rehabilitation, the able-after-baseline subgroup increased their forward position ( P < .001), decreased the time difference between bilateral quadriceps peaks ( P < .001) and between quadriceps and hamstrings peaks on the nonhemiplegic side ( P = .007). An improved performance in the always-able subgroup was associated with a number of baseline factors, including forward positioning ( P = .002) and time difference between peak activity of bilateral quadriceps ( P = .001). CONCLUSIONS: This neuromechanical study of StS before and after rehabilitation in a sample of people early after stroke identified the importance of temporal coupling between forward trunk movement and quadriceps and hamstrings' activity. These findings advance the science of stroke rehabilitation by providing evidence-based therapy targets to promote recovery of the StS movement.

Community cycling exercise for stroke survivors is feasible and acceptable.

Background: Physical activity is recommended after stroke but levels for stroke survivors are typically low. The use of indoor recumbent cycling, delivered through local government leisure facilities, may increase access to exercise among stroke survivors. Objective: This study aimed to evaluate the acceptability and feasibility of an indoor cycling program delivered through existing local government services. Methods: Participants were recruited through stroke liaison nurses and public advertising. After a home visit to assess eligibility and conduct psychological and general health assessments, participants attended their local leisure center for an initial fitness test and short battery of physical tests. Then, an 8 week training program was designed with weekly goals. Following the program the assessments were retaken along with an evaluation questionnaire. In-depth, semi-structured, interviews were conducted with 15 participants and five fitness coaches. Results: One hundred fifteen individuals volunteered to participate during a 10-month recruitment period, 77 met the inclusion criteria and consented, 66/77 (86%) completed the program including all nine non-ambulatory participants. The program and procedures (recruitment and outcome measures) were feasible and acceptable to participants (81% reported following the program). Participants were generally very positive about the experience. Significant improvements in sit-to-stand capacity (Mpre = 25.2 s, Mpost = 19.0 s, p = .002), activities of daily living (NEADL, Mpre = 12.2, Mpost = 13.2, p = .002), psychosocial functioning (SAQOL, Mpre = 3.82, Mpost = 4.15, p = .001), energy (SAQOL, Mpre = 3.75, Mpost = 4.02, p = .018) and depression (GHQ, Mpre = .97, Mpost = .55, p = .009) were observed. Conclusion: A cycling-based exercise program delivered through local leisure center staff and facilities was shown to be feasible and acceptable for people living with stroke.

Quantifying sit-to-stand and stand-to-sit transitions in free-living environments using the activPAL thigh-worn activity monitor.

PURPOSE: Standing up, sitting down and walking require considerable effort and coordination, which are crucial indicators to rehabilitation (e.g. stroke), and in older populations may indicate the onset of frailty and physical and cognitive decline. Currently, there are few reports robustly quantifying sit-to-stand and stand-to-sit transitions in free-living environments. The aim of this study was to identify and quantify these transitions using the peak velocity of sit-to-stand and stand-to-sit transitions to determine if these velocities were different in a healthy cohort and a mobility-impaired population. METHODS: Free-living sit-to-stand and stand-to-sit acceleration data were recorded from 21 healthy volunteers and 34 stroke survivors using activPAL3™ monitors over a one-week period. Thigh inclination velocity was calculated from these accelerometer data. Maximum velocities were compared between populations. RESULTS: A total of 10,299 and 11,392 sit-to-stand and stand-to-sit transitions were recorded in healthy volunteers and stroke survivors, respectively. Healthy volunteers had significantly higher overall mean peak velocities for both transitions compared with stroke survivors [70.7°/s ± 52.2 versus 44.2°/s ± 28.0 for sit-to-stand, P < 0.001 and 74.7°/s ± 51.8 versus 46.0°/s ± 31.9 for stand-to-sit; P < 0.001]. Mean peak velocity of transition was associated with increased variation in peak velocity across both groups. CONCLUSION: There were significant differences in the mean peak velocity of sit-to-stand and stand-to-sit transitions between the groups. Variation in an individual's mean peak velocity may be associated with the ability to perform these transitions. This method could be used to evaluate the effectiveness of interventions following injury such as stroke, as well as monitor decline in functional ability.

Large-scale mapping of mutations affecting zebrafish development.

BACKGROUND: Large-scale mutagenesis screens in the zebrafish employing the mutagen ENU have isolated several hundred mutant loci that represent putative developmental control genes. In order to realize the potential of such screens, systematic genetic mapping of the mutations is necessary. Here we report on a large-scale effort to map the mutations generated in mutagenesis screening at the Max Planck Institute for Developmental Biology by genome scanning with microsatellite markers. RESULTS: We have selected a set of microsatellite markers and developed methods and scoring criteria suitable for efficient, high-throughput genome scanning. We have used these methods to successfully obtain a rough map position for 319 mutant loci from the Tübingen I mutagenesis screen and subsequent screening of the mutant collection. For 277 of these the corresponding gene is not yet identified. Mapping was successful for 80 % of the tested loci. By comparing 21 mutation and gene positions of cloned mutations we have validated the correctness of our linkage group assignments and estimated the standard error of our map positions to be approximately 6 cM. CONCLUSION: By obtaining rough map positions for over 300 zebrafish loci with developmental phenotypes, we have generated a dataset that will be useful not only for cloning of the affected genes, but also to suggest allelism of mutations with similar phenotypes that will be identified in future screens. Furthermore this work validates the usefulness of our methodology for rapid, systematic and inexpensive microsatellite mapping of zebrafish mutations.

Timing phases of the sit-to-walk movement: validity of a clinical test.

The sit-to-walk (STW) movement is a functional task that challenges balance and co-ordination. There is a paucity of literature investigating the phases of this movement and its significance in a clinical rehabilitation context. Measuring phases of this movement may provide clinically applicable data for screening subjects for mobility problems and evaluating interventions. Fifty-six subjects from three groups; young (<65 years old), elderly (>65 years old) and elderly at risk of falling (EARF), performed the STW movement freely from a chair. Switches placed on the backrest, chair seat and two on the floor identified the times of movement events: onset, seat-off, swing-off and stance-off. These events defined three phases: flexion, extension and stance. Timing of events and phase duration data derived from this switch system were correlated with those taken from a three-dimensional motion analysis system. All switch events closely matched the motion analysis events with ICC (model 2.1) scores ranging from 0.93 to 1.00. Duration of all STW phases were statistically longer in the EARF group compared to both unimpaired groups (p<0.05). Data from the four switch configuration demonstrated excellent concurrent validity when associated with data from a three-dimensional motion analysis system in identifying the phases of STW. Measurement of the phases of the STW task has potential in screening those at risk of falling and informing care strategies to prevent falls.

A technique to record the sedentary to walk movement during free living mobility: A comparison of healthy and stroke populations.

BACKGROUND: Hesitation between moving from a sedentary posture (lying/sitting) to walking is a characteristic of mobility impaired individuals, as identified from laboratory studies. Knowing the extent to which this hesitation occurs during everyday life would benefit rehabilitation research. This study aimed to quantify this transition hesitation through a novel approach to analysing data from a physical activity monitor based on a tri-axial accelerometer and compare results from two populations; stroke patients and age-matched unimpaired controls. METHODS: Stroke patients living at home with early supported discharge (n=34, 68.9YO±11.8) and age-matched controls (n=30, 66.8YO±10.5) wore a physical activity monitor for 48h. The outputs from the monitor were then used to determine the transitions from sedentary to walking. The time delay between a sedentary posture ending and the start of walking classified four transition types: 1) fluent (<=2s), 2) hesitant (>2s<=10s), 3) separated (>10s) and 4) a change from sedentary with no registered walking to a return to sedentary. RESULTS: Control participants initiated walking after a sedentary posture on 92% of occasions. Most commonly (43%) this was a fluent transition. In contrast stroke patients walked after changing from a sedentary posture on 68% of occasions with only 9% of transitions classed as fluent, (p<0.05). DISCUSSION/ CONCLUSION: A new data analysis technique reports the frequency of walking following a change in sedentary position in stroke patients and healthy controls and characterises this transition according to the time delay before walking. This technique creates opportunities to explore everyday mobility in greater depth.

Sit to stand activity during stroke rehabilitation.

Objectives The sit to stand (STS) movement is key to independence and commonly affected by stroke. Repetitive practice is likely to improve STS ability during rehabilitation, however current practice levels are unknown. The objective of this study was simply to count the number of STS movements performed during the rehabilitation period of stroke patients using a physical activity monitor (PAM) and test whether being observed altered outcome. Methods Participants were medically stable patients referred for rehabilitation following stroke. Participants were randomly allocated to either wear or not wear the PAM for 14 days. STS ability and general mobility were recorded before and after. Results Sixty-one patients was recruited; aged 68.4 ± 13.15 years, weight 77.12 ± 22.73 Kg, Height 1.67 ± 0.1 m, within 9 ± 9 days of their stroke and an NIHSS score of 6.4 ± 3.3. The monitored group (n = 38) performed 25.00 ± 17.24 daily STS movements. Those requiring assistance achieved 14.29 ± 16.10 per day while those independent in the movement achieved 34.10 ± 12.44. There was an overall improvement in mobility (p = 0.002) but not STS performance (p = 0.053) neither outcome was affected by group allocation (p = 0.158). Cognition and mobility at baseline explained around 50% of daily STS variability. Discussion Low levels of STS activity were recorded during the rehabilitation period of stroke patient. The mean daily STS activity was lower than reports for frail older people receiving rehabilitation, and substantially below levels recorded by community living older adults. STS repetitions may represent general physical activity and these low levels support previous reports of sedentary behavior during rehabilitation.

Has packing sinus wounds become a ritualistic practice?

Wound healing is both a science and an art, and modern advances in wound management are ensuring that advanced clinicians use both clinical knowledge and experience when deciding on wound dressings and therapies. When there is a lack of evidence, then selection of dressings or therapies becomes extremely difficult and inappropriate treatment can occur. This is generally the situation with sinus wounds. There is very little evidence available to help decide on suitable dressings for these intractable wounds. The use of high frequency ultrasound (HFU) can help to guide practice on whether or not to pack sinus wounds. This article will explore the potential of ultrasound use by describing a case study of a patient with a sinus wound where HFU was used to examine the sinus and inform the practitioners on the appropriate choice of wound dressing.

Defining phases for the sit-to-walk movement.

OBJECTIVE: To define phases of the sit-to-walk movement and test their consistency in a normal population. DESIGN: An observational study of thirteen healthy volunteers. BACKGROUND: Moving from sitting to walking is a daily activity that may present difficulty for some populations in terms of control and stability. METHODS: The movement was partitioned into phases according to changes in ground reaction forces and peak velocity of the total body centre of mass. Consistency of each phase duration was assessed. RESULTS: Four phases of sit-to-walk were defined; flexion momentum, extension, unloading and stance. ICC scores for phase duration ranged from 0.54 (extension) to 0.81 (stance). CONCLUSIONS: This is the first study to define distinct phases of the sit-to-walk movement. There was moderate to good consistency for phase duration. RELEVANCE: By defining and testing phases of the sit-to-walk movement this study enhances understanding of this everyday movement and provide a model for future research.

Daily and hourly frequency of the sit to stand movement in older adults: a comparison of day hospital, rehabilitation ward and community living groups.

BACKGROUND AND AIMS: The sit to stand (STS) movement is commonly performed in daily life, and can be used as an indicator of activity. This study aimed to quantify the usual frequency and distribution of the STS movement performed by older adults in both home and rehabilitation settings. METHODS: Three groups of older adults were recruited; healthy older adults living in the community, older adults living in the community attending rehabilitation services at a day hospital, and frail older patients in a rehabilitation ward. Participants wore an activity monitor, which reported posture continuously for a week. The number of STS movements was the primary outcome measure, and mean values of daily STS frequency were reported. The pattern of activity was investigated using median values of STS hourly rate. RESULTS: Healthy older adults living in the community performed significantly more STS movements per day (n=20; 71±25) than either older adults attending a day hospital (n=20; 57±23) or frail older patients in a rehabilitation ward (n=30; 36±16). For all participants, the hourly rate of STS movements ranged from zero to 48, although the median hourly rate was two (healthy older adults) and one (both rehabilitation groups). CONCLUSION: Measurement of the number of STS movements performed over the course of a week in three groups of older adults, demonstrated significant differences in daily number of STS movements and in the hourly pattern between the groups. Activity patterns can provide additional information on clinically relevant aspects of physical activity and function to daily averages.