Interventions to support children after a parental acquired brain injury: a scoping review.

OBJECTIVE: This scoping review aimed to identify manualised programs and practice suggestions to support children's health literacy, behaviors and emotions after a parental acquired brain injury. METHODS: A systematic search of five scientific databases (PsychINFO, MEDLINE, ProQuest, Scopus, Cochrane) and gray literature occurred. Inclusion criteria included: studies and gray literature published 1989 to 2023, in English, child populations with relationship to parental acquired brain injury, identifying manualised programs or practice suggestions via content analysis approach. ETHICAL CONSIDERATIONS: No data were collected from human participants. All included studies, where relevant, demonstrated consent and/or ethical processes. RESULTS: Sixteen relevant studies and three gray literature resources (n = 19) were identified, including two studies that detailed manualised programs, and fifteen studies and two resource packs that included practice suggestions. Five common domains within practice suggestions were identified: systemic commitment (n = 17); family-centered approaches (n = 16); child-centered practices (n = 15); structured programs (n = 9); and peer support (n = 8). CONCLUSIONS: More rigorous evaluation is required to test the potential benefits of manualised programs and practice suggestions. A systemic commitment at clinical and organizational levels to provide child and family-centered practices, structured programs, and access to peer support, early and throughout adult-health care settings, may help to meet the support needs of children.

Team-based rehabilitation after mild traumatic brain injury - description of the clinical pathway.

PURPOSE: Describe clinical practice, inter-disciplinary clinical pathway and core principles of care within a mild traumatic brain injury (mTBI) rehabilitation team. METHODS: An observational study examined inter-disciplinary practice, nested within an observational trial investigating team-based mTBI rehabilitation. Data were collected to describe clinical service over 12 months. Activity data quantified clinical sessions per participant, mode of service delivery and content of sessions using custom-designed codes. The clinical team gathered narrative data to confirm the inter-disciplinary clinical pathway and individual discipline practice. RESULTS: 168 participants entered the rehabilitation program during the 12 months. A single Allied Health Screening Assessment identified patient priorities. Occupational Therapy (OT) and Physiotherapy (PT) provided the majority of clinical sessions; the team also comprised Social Work, Rehabilitation Medicine, Speech Pathology and Clinical Psychology. Telehealth was the most common service delivery mode (54%). Median session numbers per participant ranged 1-4 for all disciplines; mean/maximum occasions of service were highest for PT (6.9/44) and OT (6.8/39). CONCLUSION: A small proportion of participants received much higher number of sessions, consistent with intractable issues after mTBI. High attendance rates indicate the predominantly telehealth-delivered model was feasible. The clinical approach included early prioritizing of discipline input and follow-up after discharge.

The Buffalo Concussion Treadmill and Bike Tests in People With Mild-to-Moderate Traumatic Brain Injury: An Exploratory Clinical Audit.

OBJECTIVE: To assess the performance on the Buffalo Concussion Treadmill and Bike Tests in nonathletic people following a mild-to-moderate traumatic brain injury. SETTING: An outpatient rehabilitation clinic. PARTICIPANTS: Forty-nine patients with mild-to-moderate traumatic brain injury who underwent the Buffalo Concussion Treadmill or Bike Test as usual clinical care. DESIGN: A retrospective clinical audit. MAIN MEASURES: Demographics and brain injury-specific clinical data, Depression Anxiety Stress Scale; Rivermead Post-Concussion Symptom Questionnaire, and performance outcomes on the Buffalo Concussion Treadmill or Bike Test. RESULTS: Forty-nine patients (mean age: 33.7 ± 13.0 years), on average 56.2 ± 36.4 days post-injury, completed the Buffalo Concussion Treadmill or Bike Test. Fourteen patients stopped the test due to symptom exacerbation with a mean test duration of 8.1 ± 4.5 minutes, reaching an age-predicted maximum heart rate of 72.9% ± 12.4% and reporting a rating of perceived exertion of 13.4 ± 2.2. Those who terminated the test for other reasons had a significantly longer test duration (14.0 ± 4.7 minutes, P = .01), with a higher age-predicted maximum heart rate (83.3% ± 12.8%, P = .01) and rating of perceived exertion (17.0 ± 2.5, P = .01). Within the group who stopped for other reasons, 10 were due to symptoms deemed unrelated to the injury at the time of the test and 2 were stopped by the therapist for safety reasons. A significant but weak correlation between heart rate and rating of perceived exertion existed only for those who terminated the test for other reasons ( r = 0.38, P = .02). Overall, a shorter test duration was associated with higher scores of both self-reported depression ( r = -0.41, P < .01) and late postconcussion symptoms ( r = -0.40, P < .01). CONCLUSION: The Buffalo Concussion Treadmill or Bike Test can be used in the nonathletic mild-to-moderate traumatic brain injury population to differentiate between those who experience symptom exacerbation during exercise and those who do not based on symptom exacerbation, test duration, and poor perception of exertion. Further research is required to determine whether other reasons for test termination are related to the injury.

Economic evaluation of digitally enabled aged and neurological rehabilitation care in the Activity and MObility UsiNg Technology (AMOUNT) trial.

OBJECTIVE: To investigate the trial-based cost-effectiveness of the addition of a tailored digitally enabled exercise intervention to usual care shown to be clinically effective in improving mobility in the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial compared to usual care alone. DESIGN: Economic evaluation alongside a pragmatic randomized controlled trial. PARTICIPANTS: 300 people receiving inpatient aged and neurological rehabilitation were randomized to the intervention (n = 149) or usual care control group (n = 151). MAIN MEASURES: Incremental cost effectiveness ratios were calculated for the additional costs per additional person demonstrating a meaningful improvement in mobility (3-point in Short Physical Performance Battery) and quality-adjusted life years gained at 6 months (primary analysis). The joint probability distribution of costs and outcomes was examined using bootstrapping. RESULTS: The mean cost saving for the intervention group at 6 months was AU$2286 (95% Bootstrapped cost CI: -$11,190 to $6410) per participant; 68% and 67% of bootstraps showed the intervention to be dominant (i.e. more effective and cost saving) for mobility and quality-adjusted life years, respectively. The probability of the intervention being cost-effective considering a willingness to pay threshold of AU$50,000 per additional person with a meaningful improvement in mobility or quality-adjusted life year gained was 93% and 77%, respectively. CONCLUSIONS: The AMOUNT intervention had a high probability of being cost-effective if decision makers are willing to pay AU$50,000 per meaningful improvement in mobility or per quality-adjusted life year gained, and a moderate probability of being cost-saving and effective considering both outcomes at 6 months post randomization.

A study of the accuracy of the Fitbit Zip in measuring steps both indoors and outdoors in a mixed rehabilitation population.

OBJECTIVE: To assess (1) step count accuracy of the Fitbit Zip, compared to manual step count, in people receiving outpatient rehabilitation, in indoor and outdoor conditions, and (2) impact of slow walking speed on Fitbit accuracy. DESIGN: Observational study. SETTING: A metropolitan rehabilitation hospital. SUBJECTS: Adults (n = 88) attending a subacute rehabilitation outpatient clinic with walking speeds of between 0.4 and 1.0 m/s. INTERVENTIONS: Two 2-minute walk tests, one indoors and one outdoors, completed in random order. MAIN MEASURES: Step count recorded manually by observation and by a Fitbit Zip, attached to the shoe on the dominant or non-affected side. Subgroup analysis included assessment accuracy for those considered limited community walkers (slower than 0.8 m/s) and those considered community walkers (faster than 0.8 m/s). RESULTS: The Fitbit significantly (P < 0.05) undercounted steps compared to manual step count, indoors and outdoors, with percentage agreement slightly higher outdoors (mean 92.4%) than indoors (90.1%). Overall, there was excellent consistent agreement between the Fitbit and manual step count for both indoor (ICC 0.83) and outdoor (ICC 0.88) walks. The accuracy of the Fitbit was significantly (P < 0.05) reduced in those who walked slower than 0.8 m/s outdoors (ICC 0.80) compared to those who walk faster than 0.8 m/s (ICC 0.90). CONCLUSIONS: The Fitbit Zip shows high step count accuracy with manual step count in a mixed subacute rehabilitation population. However, accuracy is affected by walking speed, with decreased accuracy in limited community walkers.

Towards a Clinical Decision-Making Algorithm Guiding Locomotor Therapy Modality in Subacute Stroke: An Exploratory Study.

OBJECTIVES: To propose a clinical decision-making algorithm guiding modality choice and transition from the Lokomat® robotic to body-weight supported treadmill training in subacute stroke, due to current evidence being limited, making clinical decisions difficult. MATERIALS AND METHODS: For 10 adult patients with subacute stroke completing Lokomat® therapy, physiotherapist clinical judgement regarding body-weight supported treadmill training readiness and the following objective measurements were collected; Functional Ambulation Category; sit to stand/standing ability; Lokomat® settings; maximal active hip and knee flexion in standing; and gait biomechanics during body-weight supported treadmill training. Based on observed patterns a proposed clinical decision-making algorithm was developed. RESULTS: Clinical judgement deemed four of 10 participants ready to transition to body-weight supported treadmill training. Unlike participants judged not ready, these participants had: a) a Functional Ambulation Category of 1; b) independence with sit to stand and standing with even weight bearing; c) Lokomat®: Body-Weight Support <30%, Guidance Force <30-35%, speed >2.0kph; d) >45° standing active hip and knee flexion; e) no significant issues with physiological stepping in treadmill training or only requiring assistance from one therapist to achieve this. CONCLUSION: Participants judged ready for transition from the Lokomat® to body-weight supported treadmill training presented with increased independent functional ability, more challenging Lokomat® settings, greater active volitional lower-limb control, and less issues with physiological stepping in treadmill training, than those participants judged not ready. Results were translated into a proposed clinical decision-making algorithm guiding transition from the Lokomat® to body-weight supported treadmill training, to be further tested in clinical trials.

Goal setting for people with mild cognitive impairment or dementia in rehabilitation: A scoping review.

INTRODUCTION: Goal setting is an integral part of the rehabilitation process and assists occupational therapists to target therapy towards achieving meaningful outcomes. People with mild cognitive impairment or dementia may experience barriers participating in goal setting due to preconceptions that the person cannot participate owing to changes in both cognitive and communicative abilities. The aim of this review was to identify goal setting approaches, common goals identified, and enablers and barriers to goal setting for people with mild cognitive impairment or dementia participating in specific rehabilitation programmes. METHODS: Four electronic databases were searched in April 2020 for English language articles that described goal setting processes during a rehabilitation programme for people with mild cognitive impairment or dementia. Studies of all designs were included. Two authors screened citations and full text articles. Data were extracted, synthesised, and presented narratively. RESULTS: Twenty-seven studies met the eligibility criteria. Both structured and nonstructured goal setting methods were used with common tools including the Canadian Occupational Performance Measure, the Bangor Goal Setting Interview and Goal Attainment Scaling. The nature of goals tended to depend on the scope of the rehabilitation programme in which the person was involved. Goal setting was more difficult for people with more advanced symptoms of dementia and when staff lacked skills and experience working with people with dementia. Use of a structured approach to goal setting, establishment of therapeutic rapport, individualisation of goals, and family involvement were reported to be beneficial. CONCLUSION: Collaborative goal setting is a foundation of rehabilitation for people with dementia and should not be avoided due to preconceptions that the person cannot participate. Results suggests that occupational therapists can use a number of strategies to maximise participation and engagement and play a pivotal role in upskilling staff to enable effective goal setting for people with mild cognitive impairment or dementia.

Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial.

BACKGROUND: Digitally enabled rehabilitation may lead to better outcomes but has not been tested in large pragmatic trials. We aimed to evaluate a tailored prescription of affordable digital devices in addition to usual care for people with mobility limitations admitted to aged care and neurological rehabilitation. METHODS AND FINDINGS: We conducted a pragmatic, outcome-assessor-blinded, parallel-group randomised trial in 3 Australian hospitals in Sydney and Adelaide recruiting adults 18 to 101 years old with mobility limitations undertaking aged care and neurological inpatient rehabilitation. Both the intervention and control groups received usual multidisciplinary inpatient and post-hospital rehabilitation care as determined by the treating rehabilitation clinicians. In addition to usual care, the intervention group used devices to target mobility and physical activity problems, individually prescribed by a physiotherapist according to an intervention protocol, including virtual reality video games, activity monitors, and handheld computer devices for 6 months in hospital and at home. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery [SPPB]; continuous version; range 0 to 3; higher score indicates better mobility) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months. The dataset was analysed using intention-to-treat principles. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000936628). Between 22 September 2014 and 10 November 2016, 300 patients (mean age 74 years, SD 14; 50% female; 54% neurological condition causing activity limitation) were randomly assigned to intervention (n = 149) or control (n = 151) using a secure online database (REDCap) to achieve allocation concealment. Six-month assessments were completed by 258 participants (129 intervention, 129 control). Intervention participants received on average 12 (SD 11) supervised inpatient sessions using 4 (SD 1) different devices and 15 (SD 5) physiotherapy contacts supporting device use after hospital discharge. Changes in mobility scores were higher in the intervention group compared to the control group from baseline (SPPB [continuous, 0-3] mean [SD]: intervention group, 1.5 [0.7]; control group, 1.5 [0.8]) to 6 months (SPPB [continuous, 0-3] mean [SD]: intervention group, 2.3 [0.6]; control group, 2.1 [0.8]; mean between-group difference 0.2 points, 95% CI 0.1 to 0.3; p = 0.006). However, there was no evidence of a difference between groups for upright time at 6 months (mean [SD] proportion of the day spent upright at 6 months: intervention group, 18.2 [9.8]; control group, 18.4 [10.2]; mean between-group difference -0.2, 95% CI -2.7 to 2.3; p = 0.87). Scores were higher in the intervention group compared to the control group across most secondary mobility outcomes, but there was no evidence of a difference between groups for most other secondary outcomes including self-reported balance confidence and quality of life. No adverse events were reported in the intervention group. Thirteen participants died while in the trial (intervention group: 9; control group: 4) due to unrelated causes, and there was no evidence of a difference between groups in fall rates (unadjusted incidence rate ratio 1.19, 95% CI 0.78 to 1.83; p = 0.43). Study limitations include 15%-19% loss to follow-up at 6 months on the co-primary outcomes, as anticipated; the number of secondary outcome measures in our trial, which may increase the risk of a type I error; and potential low statistical power to demonstrate significant between-group differences on important secondary patient-reported outcomes. CONCLUSIONS: In this study, we observed improved mobility in people with a wide range of health conditions making use of digitally enabled rehabilitation, whereas time spent upright was not impacted. TRIAL REGISTRATION: The trial was prospectively registered with the Australian New Zealand Clinical Trials Register; ACTRN12614000936628.

Augmented Performance Feedback during Robotic Gait Therapy Results in Moderate Intensity Cardiovascular Exercise in Subacute Stroke.

BACKGROUND: Low cardiovascular fitness is common poststroke. Conventional subacute stroke rehabilitation does not meet Australian National Stroke Guidelines for cardiovascular exercise, particularly in mobility-dependent patients. Walking robotics can potentially achieve recommended cardiovascular exercise with these patients. AIM: The primary aim was to determine whether sustained moderate intensity cardiovascular exercise can be achieved using 3 Lokomat Augmented Performance Feedback activities in mobility-dependent adults with subacute stroke. Secondary aims were to assess if cardiovascular workload was influenced by the activity completed, participants motivation or enjoyment, or changes in Lokomat settings. METHODS: Ten patients with subacute stroke (mean (SD) age: 63.4 (13) years) participated in 6x20-minute Lokomat study sessions. Each study session involved a warm-up and 3x5-minute APF activities presented in a random order. Metabolic data were collected using the COSMED-K5. Participants rated their perceived exertion on the BORG CR10 scale and Lokomat settings of body-weight support, guidance force, and speed were recorded. RESULTS: Moderate intensity cardiovascular exercise was achieved and maintained over the 15 minutes of exercise, objectively demonstrated by a mean (SD) Metabolic Equivalent Task of 3.1 (1.3), and mean (SD) oxygen consumption of 8.0 (3.8) ml/kg/min, estimated as 52% VO2max. This was subjectively confirmed by exertion scores between 3 and 5. The cardiovascular workload was not affected by which activity was completed, participant motivation or enjoyment, or significant progression of Lokomat settings between study sessions. CONCLUSIONS: Mobility-dependent patients with subacute stroke can achieve sustained moderate intensity cardiovascular exercise on the Lokomat when using APF activities.

Early Supported Discharge by Caregiver-Mediated Exercises and e-Health Support After Stroke: A Proof-of-Concept Trial.

BACKGROUND AND PURPOSE: This proof-of-concept trial investigated the effects of an 8-week program of caregiver-mediated exercises commenced in hospital combined with tele-rehabilitation services on patient self-reported mobility and caregiver burden. METHODS: Sixty-three hospitalized stroke patients (mean age 68.7, 64% female) were randomly allocated to an 8-week caregiver-mediated exercises program with e-health support or usual care. Primary outcome was the Stroke Impact Scale mobility domain. Secondary outcomes included length of stay, other Stroke Impact Scale domains, readmissions, motor impairment, strength, walking ability, balance, mobility, (extended) activities of daily living, psychosocial functioning, self-efficacy, quality of life, and fatigue. Additionally, caregiver's self-reported fatigue, symptoms of anxiety, self-efficacy, and strain were assessed. Assessments were completed at baseline and at 8 and 12 weeks. RESULTS: Intention-to-treat analysis showed no between-group difference in Stroke Impact Scale mobility (P=0.6); however, carers reported less fatigue (4.6, confidence interval [CI] 95% 0.3-8.8; P=0.04) and higher self-efficacy (-3.3, CI 95% -5.7 to -0.9; P=0.01) at week 12. Per-protocol analysis, examining those who were discharged home with tele-rehabilitation demonstrated a trend toward improved mobility (-9.8, CI 95% -20.1 to 0.4; P=0.06), significantly improved extended activities of daily living scores at week 8 (-3.6, CI 95% -6.3 to -0.8; P=0.01) and week 12 (3.0, CI 95% -5.8 to -0.3; P=0.03), a 9-day shorter length of stay (P=0.046), and fewer readmissions over 12 months (P<0.05). CONCLUSIONS: Caregiver-mediated exercises supported by tele-rehabilitation show promise to augment intensity of practice, resulting in improved patient-extended activities of daily living, reduced length of stay with fewer readmissions post stroke, and reduced levels of caregiver fatigue with increased feelings of self-efficacy. The current findings justify a larger definite phase III randomized controlled trial. CLINICAL TRIAL REGISTRATION: URL: http://www.anzctr.org.au. Unique identifier: ACTRN12613000779774.

Over ground walking and body weight supported walking improve mobility equally in cerebral palsy: a randomised controlled trial.

OBJECTIVE: To assess partial body weight supported treadmill training versus over ground training for walking ability in children with mild to moderate cerebral palsy. DESIGN: Randomised controlled trial. SETTING: A Special Needs school in Singapore. SUBJECTS: Thirty children with cerebral palsy, aged 6-18, with a Gross Motor Function Classification System score of II-III. INTERVENTIONS: Two times 30 minute sessions of walking training per week for 8 weeks, progressed as tolerated, either over ground (control) or using partial body weight supported treadmill training (intervention). MAIN MEASURES: The 10 metre walk test, and the 6 minute walk test. Secondary measures were sub-sections D and E on the Gross Motor Function Measure. Outcomes were assessed at baseline, and after 4 and 8 weeks of training. RESULTS: There was no effect of group allocation on any outcome measure, while time was a significant factor for all outcomes. Walking speed improved significantly more in the intervention group by week 4 (0.109 (0.067)m/s vs 0.048 (0.071)m/s, P=0.024) however by week 8 the change from baseline was similar (intervention 0.0160 (0.069)m/s vs control 0.173 (0.109)m/s, P=0.697). All gains made by week 4 were significantly improved on by week 8 for the 10 metre walk test, 6 minute walk test, and the gross motor function measure. CONCLUSIONS: Partial body weight supported treadmill training is no more effective than over ground walking at improving aspects of walking and function in children with mild to moderate cerebral palsy. Gains seen in 4 weeks can be furthered by 8 weeks.

Anabolic steroids for rehabilitation after hip fracture in older people.

BACKGROUND: Hip fracture occurs predominantly in older people, many of whom are frail and undernourished. After hip fracture surgery and rehabilitation, most patients experience a decline in mobility and function. Anabolic steroids, the synthetic derivatives of the male hormone testosterone, have been used in combination with exercise to improve muscle mass and strength in athletes. They may have similar effects in older people who are recovering from hip fracture. OBJECTIVES: To examine the effects (primarily in terms of functional outcome and adverse events) of anabolic steroids after surgical treatment of hip fracture in older people. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (10 September 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2013 Issue 8), MEDLINE (1946 to August Week 4 2013), EMBASE (1974 to 2013 Week 36), trial registers, conference proceedings, and reference lists of relevant articles. The search was run in September 2013. SELECTION CRITERIA: Randomised controlled trials of anabolic steroids given after hip fracture surgery, in inpatient or outpatient settings, to improve physical functioning in older patients with hip fracture. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials (based on predefined inclusion criteria), extracted data and assessed each study's risk of bias. A third review author moderated disagreements. Only very limited pooling of data was possible. The primary outcomes were function (for example, independence in mobility and activities of daily living) and adverse events, including mortality. MAIN RESULTS: We screened 1290 records and found only three trials involving 154 female participants, all of whom were aged above 65 years and had had hip fracture surgery. All studies had methodological shortcomings that placed them at high or unclear risk of bias. Because of this high risk of bias, imprecise results and likelihood of publication bias, we judged the quality of the evidence for all primary outcomes to be very low.These trials tested two comparisons. One trial had three groups and contributed data to both comparisons. None of the trials reported on patient acceptability of the intervention.Two very different trials compared anabolic steroid versus control (no anabolic steroid or placebo). One trial compared anabolic steroid injections (given weekly until discharge from hospital or four weeks, whichever came first) versus placebo injections in 29 "frail elderly females". This found very low quality evidence of little difference between the two groups in the numbers discharged to a higher level of care or dead (one person in the control group died) (8/15 versus 10/14; risk ratio (RR) 0.75, 95% confidence interval (CI) 0.42 to 1.33; P = 0.32), time to independent mobilisation or individual adverse events. The second trial compared anabolic steroid injections (every three weeks for six months) and daily protein supplementation versus daily protein supplementation alone in 40 "lean elderly women" who were followed up for one year after surgery. This trial provided very low quality evidence that anabolic steroid may result in less dependency, assessed in terms of being either dependent in at least two functions or dead (one person in the control group died) at six and 12 months, but the result was also compatible with no difference or an increase in dependency (dependent in at least two levels of function or dead at 12 months: 1/17 versus 5/19; RR 0.22, 95% CI 0.03 to 1.73; P = 0.15). The trial found no evidence of between-group differences in individual adverse events.Two trials compared anabolic steroids combined with another nutritional intervention ('steroid plus') versus control (no 'steroid plus'). One trial compared anabolic steroid injections every three weeks for 12 months in combination with daily supplement of vitamin D and calcium versus calcium only in 63 women who were living independently at home. The other trial compared anabolic steroid injections every three weeks for six months and daily protein supplementation versus control in 40 "lean elderly women". Both trials found some evidence of better function in the steroid plus group. One trial reported greater independence, higher Harris hip scores and gait speeds in the steroid plus group at 12 months. The second trial found fewer participants in the anabolic steroid group were either dependent in at least two functions, including bathing, or dead at six and 12 months (one person in the control group died) (1/17 versus 7/18; RR 0.15, 95% CI 0.02 to 1.10; P = 0.06). Pooled mortality data (2/51 versus 3/51) from the two trials showed no evidence of a difference between the two groups at one year. Similarly, there was no evidence of between-group differences in individual adverse events. Three participants in the steroid group of one trial reported side effects of hoarseness and increased facial hair. The other trial reported better quality of life in the steroid plus group. AUTHORS' CONCLUSIONS: The available evidence is insufficient to draw conclusions on the effects, primarily in terms of functional outcome and adverse events, of anabolic steroids, either separately or in combination with nutritional supplements, after surgical treatment of hip fracture in older people. Given that the available data points to the potential for more promising outcomes with a combined anabolic steroid and nutritional supplement intervention, we suggest that future research should focus on evaluating this combination.

Primary contact physiotherapy for patients with suggested vestibulopathy for an Australian ENT clinic: a retrospective cohort study.

OBJECTIVE: To examine the newly established role of a primary contact physiotherapist in an ENT clinic, in an Australian cohort and context, over two phases of development. METHODS: A retrospective cohort study was conducted with data collected from a medical record audit. Over the study duration, the primary contact physiotherapist completed initial appointments with patients; follow-up appointments were subsequently conducted by medical staff. RESULTS: There was a 46 per cent reduction in patients with suggested vestibulopathy requiring an ENT medical review. This reduction could hypothetically increase to 71 per cent with follow-up primary contact physiotherapist appointments. Improvements in the service delivery model and a primary contact physiotherapist arranging diagnostic assessments could improve waitlist times and facilitate better utilisation of medical staff time. CONCLUSION: The primary contact physiotherapist can help in the management of patients with suspected vestibulopathy on an ENT waitlist. This is achieved through: a reduction of patients requiring ENT review, improvements to waitlist time and improved utilisation of medical specialists' time.

Physiotherapy assessment of people with neurological conditions in Australia: A national survey.

Background and Purpose: Currently there are approximately one billion people worldwide affected by a neurological condition. These conditions may result in a variety of impairments that require assessment and management from a physiotherapist. However, there is a lack of consensus in the literature as to what domains physiotherapists working in clinical settings include in their assessment of this population, with only five domains identified in a recent systematic review. This study aimed to explore current physiotherapy assessments in people with neurological conditions, including barriers, enablers, and influencing factors. Methods: A National online survey of Australian physiotherapists who assessed adults with neurological conditions in their clinical practice. Results: A total of 212 respondents from all states in Australia completed the survey. The mean (SD) age was 35.7 (9.6) years, and the majority were female (85.4%). Respondents worked across various settings assessing stroke most frequently (58.0%). Study results demonstrated variability in assessment practice, with a number of assessment domains being assessed more commonly including balance, muscle strength, gait, falls and safety, function, goal setting, range of movement, pain, co-ordination, activity tolerance, postural alignment and symmetry, and the upper limb. Experienced physiotherapists and those in rural and remote settings included fewer domains in their assessments. On the other hand, physiotherapists in the community setting included certain domains more frequently than those in other settings. Barriers and enablers were related to therapist caseload, knowledge, and intrinsic patient factors. Discussion: There is variability in domains assessed by Australian physiotherapists, with an emerging consensus for a number of assessment domains. Study results suggest that clinical experience, geographical location, and clinical setting may play a role in the assessment patterns observed. Implications on Physiotherapy Practice: There is little evidence to support what physiotherapists assess in practice, in different settings, in different states within Australia. This study indicates that experience, geographical location, and clinical setting affect the number and types of domains included in the assessment. Further research is needed to develop a consensus on best practices.

Implementing circuit class training can increase therapy time and functional independence in people with stroke receiving inpatient rehabilitation: findings from a retrospective observational clinical audit.

BACKGROUND: Increased therapy time and task-specific practice can improve functional recovery post stroke. This observational study aimed to determine whether the clinical implementation of circuit training increases therapy time and improves function in stroke rehabilitation. METHODS: In a retrospective clinical audit, medical records of 110 people (mean age 78.7, standard deviation 13.0, 49.1% male, 57.3% severe stroke) admitted to a stroke inpatient rehabilitation ward were evaluated to determine the differences between pre (Individual Therapy (IT), n = 55) and post (Circuit Class Therapy (CCT), n = 55) service change implementation. The primary outcome was the amount of time spent in physiotherapy daily (minutes). Secondary outcomes included the Functional Independence Measure (FIM) score and length of stay (LOS). RESULTS: The CCT Group spent significantly more time in physiotherapy daily during their rehabilitation LOS compared to the IT Group (mean difference 8.45 (95% CI 5.99 to 10.90) mins, p < 0.001). No significant between-group differences were observed for FIM scores or LOS (p ≥ 0.066). CONCLUSION: This study suggests that the clinical implementation of CCT can significantly increase therapy time by close to 9 minutes per session, with functional gains that are equivalent to usual care. This was achieved with a patient-to-staff ratio of 3:1, compared to the 1:1 ratio in IT, concurring with existing evidence in support of CCT as an alternative service delivery model for inpatient stroke rehabilitation.

Moderate intensity aerobic exercise may enhance neuroplasticity of the contralesional hemisphere after stroke: a randomised controlled study.

Upregulation of neuroplasticity might help maximize stroke recovery. One intervention that appears worthy of investigation is aerobic exercise. This study aimed to determine whether a single bout of moderate intensity aerobic exercise can enhance neuroplasticity in people with stroke. Participants were randomly assigned (1:1) to a 20-min moderate intensity exercise intervention or remained sedentary (control). Transcranial magnetic stimulation measured corticospinal excitability of the contralesional hemisphere by recording motor evoked potentials (MEPs). Intermittent Theta Burst Stimulation (iTBS) was used to repetitively activate synapses in the contralesional primary motor cortex, initiating the early stages of neuroplasticity and increasing excitability. It was surmised that if exercise increased neuroplasticity, there would be a greater facilitation of MEPs following iTBS. Thirty-three people with stroke participated in this study (aged 63.87 ± 10.30 years, 20 male, 6.13 ± 4.33 years since stroke). There was an interaction between Time*Group on MEP amplitudes (P = 0.009). Participants allocated to aerobic exercise had a stronger increase in MEP amplitude following iTBS. A non-significant trend indicated time since stroke might moderate this interaction (P = 0.055). Exploratory analysis suggested participants who were 2-7.5 years post stroke had a strong MEP facilitation following iTBS (P < 0.001). There was no effect of age, sex, resting motor threshold, self-reported physical activity levels, lesion volume or weighted lesion load (all P > 0.208). Moderate intensity cycling may enhance neuroplasticity in people with stroke. This therapy adjuvant could provide opportunities to maximize stroke recovery.

"We got there in the end . somehow, we got there": a qualitative study of healthcare professionals providing care in the community to people with chronic aphasia, and how technology could assist.

PURPOSE: Little is known about the experience of healthcare professionals (HCPs) in the community providing healthcare to people with aphasia. In this study we aimed to explore the experiences of community HCPs in healthcare conversations with people with aphasia, and whether a high-tech, purpose-built aphasia app could assist. METHODS: A generic qualitative study was conducted. HCPs from seven different clinical backgrounds were interviewed and data was thematically analysed. RESULTS: The experiences of healthcare providers providing healthcare to people with aphasia were identified in six major themes. These were: (1) Healthcare communication topics; (2) HCP knowledge; (3) Communication exchanges during the interactions (4) Communication impacts on care; (5) Interactions and relationships grew easier over time; and (6) How technology could help interactions. CONCLUSIONS: HCPs with more aphasia knowledge reported having more positive experiences. Unsuccessful interactions were believed to lead to negative emotional responses in people with aphasia and HCPs, and that miscommunications could lead to compromised care. HCPs reported that interactions and relationships with people with aphasia grew easier over time. HCPs need system level support to acquire the knowledge and skills needed to engage people with aphasia in effective healthcare conversations. Technology has potential to improve interactions.

The overall experience of Health care professionals (HCPs) providing healthcare to people with aphasia was reported to be challenging, taking extra emotional and intellectual effort and time.When communication was unsuccessful this often led to emotional distress for both the HCP and person with aphasia and compromised care for the person with aphasia.HCPs with more knowledge and skill, who had conversation partner training, were more likely to have successful communication interactions.More system-level supports such as conversation partner training, and technology support were perceived to be beneficial.

Incidence of nontraumatic spinal cord injury: a Spanish cohort study (1972-2008).

OBJECTIVES: To assess the incidence of nontraumatic spinal cord injury (SCI) in a determined catchment area in Spain, and to evaluate clinical presentations and trends over time. DESIGN: Population-based case series study between January 1972 and December 2008 [corrected]. SETTING: A hospital with a specialized SCI unit in a delimited health area in Spain. PARTICIPANTS: Hospital inpatients and outpatients with nontraumatic SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Age- and sex-specific incidence rates. RESULTS: An adjusted incidence rate of 11.4 per million population was found for this region (12.3 for males, 10.4 for females). A total of 541 cases (53% male) were reported over the 37-year study period. Incidence rates increased with age, with a peak in the 60- to 69-year age group. Tumors were the major cause of SCI. Most of the lesions were at the thoracic level, and C and D were the most frequently observed American Spinal Injury Association grades. CONCLUSIONS: Nontraumatic SCI shows a relatively even sex distribution and tends to affect older adults. Injuries are mainly attributable to age-related conditions and result mostly in incomplete lesions, which present with paraplegia. This study revealed that although incidence rates for nontraumatic SCI are similar to those previously reported for traumatic SCI in the same area and during the same period, demographic and clinical characteristics are different. These findings have important implications regarding the delivery of rehabilitation and support services to this group of patients, and suggest the need for health policies that involve improved care and prevention resources.

Life altering effects on children when a family member has an acquired brain injury; a qualitative exploration of child and family perceptions.

OBJECTIVE: To investigate the impact of familial acquired brain injury on children and adult family members, including their views of the support provided, gaps and recommendations for future interventions. RESEARCH DESIGN: Qualitative exploratory study using a phenomenological approach. METHOD: Twenty-six participants were recruited from 12 families across the South Australian Brain Injury Rehabilitation Service (SABIRS) and external community brain injury agencies in Adelaide, South Australia. Sixteen children aged 5-18 participated through ten semi-structured interviews. Ten adults attended six interviews. Following transcription and member checking, thematic analyses occurred with pooled data from all interviews undergoing open, axial and selective coding. MAIN RESULTS: Analyses revealed four main themes: (1) help parents help their children, (2) improve family functioning by giving children meaningful roles, (3) staff: don't leave children "in the dark," and (4) support for children is not one size fits all. CONCLUSIONS: Children and adults reported significant gaps in support offered by acute and brain injury services after familial acquired brain injury. Children and adults need to receive intervention in addition to the patient. To fill identified gaps, participants recommended more input by clinical staff including the use of technology; specifically, the development of age-appropriate applications, educational videos and interactive games.IMPLICATIONS FOR REHABILITATIONProviding intervention directly to children and non-injured adults by clinical staff as early as the Intensive Care Unit and sub-acute rehabilitation after parental acquired brain injury is recommended to support their adjustment and improve family functioning.The development of age-appropriate and engaging tools via the use of technology is proposed to fill consumers identified gaps in brain injury support and education which could widen access and provide a flexible approach for support to be available anywhere, any time.

Physical exercise for people with mild traumatic brain injury: A systematic review of randomized controlled trials.

BACKGROUND: Recent research recommends physical exercise rather than rest following a mild traumatic brain injury (mTBI). OBJECTIVE: To determine the effect of physical exercise on persistent symptoms in people with mTBI. METHODS: A search of randomized controlled trials was conducted in CINAHL, Cochrane Library, EMBASE, MEDLINE, SportDiscus and Web of Science, from 2010 to January 2021. Studies were included if they described the effects of a physical exercise intervention in people with mTBI on persistent symptoms. Study quality, intervention reporting, and confidence in review findings were assessed with the CASP, TIDieR and GRADE respectively. RESULTS: 11 eligible studies were identified for inclusion. Study interventions broadly comprised of two categories of physical exercise, i.e., aerobic (n = 8) and vestibular (n = 3). A meta-analysis (n = 3) revealed the aerobic exercise group improvement was significantly larger compared to the usual care group -0.39 (95% CI: -0.73 to -0.05, p = 0.03). Only three studies using vestibular exercise reported on persistent symptoms and yielded mixed results. CONCLUSIONS: This study demonstrated that the use of aerobic exercise is supported by mixed quality evidence and moderate certainty of evidence, yet there is limited evidence for the use of vestibular exercise for improving persistent symptoms in people with mTBI.