Psychological Health in Late Effects of Poliomyelitis: Ten-Year Follow-Up.

BACKGROUND: Individuals with late effects of poliomyelitis (LEoP) cope with various physical and psychological symptoms throughout their entire life which become more severe as they are ageing. OBJECTIVES: To perform a 10-year follow-up of the functional status and levels of psychological health of individuals with LEoP and to examine the associations of hope levels, work status, health perceptions, and life satisfaction with functional and psychological changes. DESIGN: A within-subject 10-year follow-up study. PARTICIPANTS: Eighty-two individuals with LEoP who participated in a previous study 10 years ago. METHODS: Outcome measures included the functional status of individuals with LEoP assessed by the activities of daily living (ADL) questionnaire, emotional distress based on the Global Health Questionnaire (GHQ), hope based on the Hope Scale, life satisfaction as measured by the Satisfaction with Life Scale (SWLS), and subjective health perception. The McNemar test, paired t-test, Spearman's correlation coefficient, and linear regression were used for statistical analysis. RESULTS: The mean age was 66.9 ± 8.5 years with a male-female ratio of 0.52. A significant functional deterioration was noticed during the follow-up years. Yet, the functional deterioration was not associated with changes in psychological health. Psychological health was associated with elevated levels of hope and life satisfaction. Individuals with LEoP who continued to work demonstrated higher psychological health, higher levels of hope, and greater life satisfaction. CONCLUSIONS: Individuals with LEoP demonstrated significant psychological health, manifested in their ability to block emotional distress and maintain life satisfaction despite the deterioration in their functional status. Hope and psychological health were associated with increased life satisfaction. Work appeared to be a significant source of psychological health in this population.

Cushioned Footwear Effect on Pain and Gait Characteristics of Individuals with Knee Osteoarthritis: A Double-Blinded 3 Month Intervention Study.

One of the recommendations for individuals with knee osteoarthritis (OA) is the use of specific footwear, such as sturdy or cushioned shoes. However, the long-term use effects of using cushioned shoes on the pain and spatiotemporal gait parameters in individuals with knee OA are yet to be reported. We therefore aimed to compare the efficacy of cushioned sport footwear versus sham shoes on motor functions, pain and gait characteristics of individuals with knee OA who used the shoes for 3 months. In a double-blinded study, we provided 26 individuals with knee OA with cushioned sport shoes and 12 individuals with knee OA with similar sport shoes without cushioning for 3 months. The gait analysis, the timed up and go (TUG) test and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were conducted and the pain levels were measured at the baseline, 1 month, and 3 months after the baseline. We found that the cushioned shoes reduce the amount of pain (based on WOMAC) in the affected knee and increase functionality in the research group, but not in the control group. Gait velocity and cadence were increased in both groups. Gait spatiotemporal parameters and their symmetry were unaffected during the intervention. We conclude that the use of cushioned shoes should be recommended to individuals with knee OA for alleviating pain.

Upper extremity self-efficacy correlates with daily hand-use of individuals with high functional capacity post-stroke.

PURPOSE: To understand the role of affected upper extremity (UE) self-efficacy for explaining daily-hand-use in individuals post-stroke. Specifically, to describe UE self-efficacy and to assess the associations between UE self-efficacy to UE motor and functional capacity and daily hand-use. MATERIALS AND METHODS: This cross-sectional study included individuals post-stroke receiving rehabilitation with high UE functional capacity [Action Research Arm Test (ARAT) > 50]. The Rating of Everyday Arm-Use in the Community and Home (REACH) assessed perceived UE daily use and the Confidence in Arm and Hand Movement scale (CAHM) assessed UE self-efficacy. Functional capacity was assessed by the ARAT and the Fugl-Meyer-motor-assessment assessed motor impairment. Correlations between measures were assessed. RESULTS: Twenty-two individuals, aged 19-80, with high UE functional capacity [median (IQR) ARAT-56.5 (54-57)] and varying UE self-efficacy [median (IQR) CAHM-76.7 (58-84.4)], were included. UE self-efficacy was significantly correlated with the ARAT (rs = 0.53, p < 0.01) and REACH (rs = 0.51, p < 0.01) but ARAT was not significantly correlated with REACH. CONCLUSIONS: UE self-efficacy is correlated with perceived daily hand-use in individuals with high functional capacity. Further research and a deeper understanding of the clinical implications of UE self-efficacy are warranted. UE self-efficacy should perhaps be assessed during rehabilitation. IMPLICATIONS FOR REHABILITATIONIndividuals with stroke with high affected upper extremity functional capacity do not necessarily use this hand for daily living.Upper extremity self-efficacy is correlated with perceived daily hand-use in individuals with high functional capacity; participants with higher upper extremity self-efficacy also reported more daily hand-use.Upper extremity self-efficacy seems to be upper extremity task or situation-specific.Upper extremity self-efficacy should be assessed during rehabilitation and the clinical implications of (low) upper extremity self-efficacy should be further researched.

Correlations between Disease Severity and Rehabilitation Outcomes in Patients Recovering from Covid-19 Infection.

OBJECTIVE: Based on long-term follow-up of patients with COVID-19, to evaluate whether the severity of acute COVID-19 infection affects rehabilitation outcomes. DESIGN: Observational cohort study. SUBJECTS: A total of 61 post-acute COVID-19 patients underwent inpatient and outpatient customized rehabilitation treatment. METHODS: The severity of acute COVID-19 infection was measured with the World Health Organization Clinical Progression Scale (WHO-CPS). Motor, cognitive, and functional variables were measured using standard and specified scales 6 months or more after acute illness. RESULTS: Of the 61 subjects, 65.6% had severe disease according to WHO-CPS. Significant improvement was found in activities of daily living functions (Functional Independence Measure (FIM) at admission 103.7 ± 18.9 vs FIM at discharge 118.7 ± 6.8) (p < 0.00). Of participants, 88% were able to wean off oxygen completely. A significant correlation was found between higher WHO-CPS, prolonged acute hospitalization, and days of ventilation were correlated with lower total and motor FIM at admission, but not with cognitive FIM or Montreal Cognitive Assessment (MoCA). No correlation was found between WHO-CPS, prolonged acute hospitalization and day of ventilation and funnctional level at discharge. CONCLUSION: The severity of acute COVID-19 infection affects the functional status of survivors at admission to rehabilitation, but, contrary to expectations, not the functional outcomes at discharge. These findings show that even patients with severe acute COVID-19 infection may improve their daily functioning significantly during rehabilitation program.

Positive Effect of Manipulated Virtual Kinematic Intervention in Individuals with Traumatic Stiff Shoulder: A Pilot Study.

Virtual reality enables the manipulation of a patient's perception, providing additional motivation to real-time biofeedback exercises. We aimed to test the effect of manipulated virtual kinematic intervention on measures of active and passive range of motion (ROM), pain, and disability level in individuals with traumatic stiff shoulder. In a double-blinded study, patients with stiff shoulder following proximal humerus fracture and non-operative treatment were randomly divided into a non-manipulated feedback group (NM-group; n = 6) and a manipulated feedback group (M-group; n = 7). The shoulder ROM, pain, and disabilities of the arm, shoulder and hand (DASH) scores were tested at baseline and after 6 sessions, during which the subjects performed shoulder flexion and abduction in front of a graphic visualization of the shoulder angle. The biofeedback provided to the NM-group was the actual shoulder angle while the feedback provided to the M-group was manipulated so that 10° were constantly subtracted from the actual angle detected by the motion capture system. The M-group showed greater improvement in the active flexion ROM (p = 0.046) and DASH scores (p = 0.022). While both groups improved following the real-time virtual feedback intervention, the manipulated intervention provided to the M-group was more beneficial in individuals with traumatic stiff shoulder and should be further tested in other populations with orthopedic injuries.

A Performance-Based Teleintervention for Adults in the Chronic Stage after Acquired Brain Injury: An Exploratory Pilot Randomized Controlled Crossover Study.

This pilot study aimed to investigate the initial effect of a remotely delivered performance-based client-centered intervention on activity performance and participation among adults in the chronic phase after acquired brain injury (ABI). Sixteen participants living at home with little to no assistance in basic daily activities were allocated into intervention or waitlist control groups. Assessments were conducted at the baseline, after the 3-month intervention/wait period, and at a 3-month follow-up. The primary outcomes were activity performance using the Canadian Occupational Performance Measure (COPM) and the Performance Quality Rating Scale (PQRS) and participation using the Mayo-Portland Adaptability Inventory-4 (MPAI-4). The intervention included weekly videoconferencing sessions using the Cognitive Orientation to Daily Occupational Performance approach (tele-CO-OP). The participants identified five functional goals, of which three were directly addressed. Wilcoxon signed-ranks test results showed no significant improvements in the control group at the end of the 3-month wait period. Pooled data from both groups showed significant improvements in COPM scores for trained and untrained goals following the intervention. Significant improvements were also found in the PQRS and MPAI-4 scores. Improvements were partially maintained at follow-up. Our preliminary results suggest that tele-CO-OP may positively impact the lives of adults after ABI who are coping with long-term disability.

Correlations between Electro-Diagnostic Findings, the Severity of Initial Infection, and the Rehabilitation Outcomes among COVID-19 Patients.

Patients with Coronavirus-2019 (COVID-19) manifest many neuromuscular complications. We evaluated the correlations between electromyography and nerve conduction measurements among COVID-19 patients and the severity of the initial infection, as well as the rehabilitation outcomes, and searched for the factors which best predict the rehabilitation outcomes. A total of 19 COVID-19 patients (16 men; mean ± SD age 59.1 ± 10.4), with WHO clinical progression scale of 6.8 ± 2.3, received rehabilitation for 3.9 ± 2.5 months. The Functional Independence Measure (FIM), the 10 m walk test, the 6 minute walk test, and grip force were collected before and after the rehabilitation period. Motor Nerve Conduction (MNC), Sensory Nerve Conduction (SNC) and electromyographic abnormalities were measured. All of the MNC measures of the median nerve correlated with the WHO clinical progression scale and duration of acute hospitalization. The MNC and SNC measures correlated with the rehabilitation duration and with FIM at discharge. The MNC distal latency of the median and the peroneal nerves and the MNC velocity of the median and tibial nerves predicted 91.6% of the variance of the motor FIM at discharge. We conclude that nerve conduction measurements, especially in COVID-19 patients with severe illness, are important in order to predict prognosis and rehabilitation outcomes.

Assessing the fear of COVID-19 scale among health care workers in Israel: a psychometric validation study.

We explored the psychometric properties of the Hebrew version of the Fear of COVID-19 (FCV-19S) scale among health care workers in a large medical center in Israel. Participants (N = 705) completed the FCV-19S scale, as well as resilience, subjective well-being, and meaning in life using validated scales. Results showed a two-factor structural model accounting for 79.33% of the total variance. Both factors were negatively associated with resilience and satisfaction with life. Results suggest the FCV-19S has good psychometric properties among health care workers and may be used to assess the effects of the pandemic in this population.

Evaluating Lower Limb Kinematics Using Microsoft's Kinect: A Simple, Novel Method.

Purpose: Our aim was to evaluate the Microsoft Kinect sensor (MKS) as a markerless system for motion capture and analysis of lower limb motion, compare it with a state-of-the-art marker-based system (MBS), and investigate its accuracy in simultaneously capturing several lower limb joint movements on several planes while participants walked freely. Method: Participants were asked to walk while gait data were simultaneously recorded by both the MKS and the MBS. Software for analysing the Kinect data stream was developed using Microsoft Visual Studio and Kinect for Windows software development kits. Visual three-dimensional (3D) C-Motion software was used to calculate 3D joint angles of the MBS. Deviation of the joint angles calculated by the two systems was calculated using root-mean-square error (RMSE) on the basis of a designated formula. Results: The calculated RMSE average was <5° between the two systems, a level of difference that has practically no clinical significance. Conclusions: Quantitative measurements of the joint angles of the knee and hip can be acquired using one MKS with some accuracy. The system can be advantageous for clinical use, at the pre- and post-treatment stages of rehabilitation, at significantly lower costs. Further evaluation of the MKS should be performed with larger study populations.

Objectif : évaluer le capteur Kinect de Microsoft (CKM), un système sans marqueur de capture des mouvements et d'analyse des mouvements des membres inférieurs, par rapport à un système de marqueur (SDM) de pointe et en étudier la précision pour capter simultanément plusieurs mouvements des membres inférieurs sur divers plans, pendant une période de marche libre des sujets. Méthodologie : les participants ont été invités à marcher pendant que les données sur la démarche étaient enregistrées dans les systèmes de CKM et de SDM. Le logiciel pour analyser les données du CKM a été mis au point au moyen de l'outil Microsoft Visual Studio de la trousse de développement logiciel de Kinect pour Windows. Le logiciel Visual3D (C-Motion) a été utilisé pour calculer les angles tridimensionnels de l'articulation du SDM. L'écart-type des angles de l'articulation calculés par les deux systèmes a été obtenu au moyen de l'erreur quadratique moyenne (EQM) d'après une formule préétablie. Résultats : la moyenne de l'EQM était inférieure à cinq degrés entre les deux systèmes, soit une différence qui n'a pratiquement aucune signification clinique. Conclusion : on peut obtenir les mesures quantitatives des angles de l'articulation du genou et de la hanche avec une certaine précision au moyen d'un CKM. Ce système peut être avantageux pour un usage clinique avant et après la réadaptation, à un coût peu élevé. L'évaluation du capteur Kinect devrait être poursuivie dans le cadre d'une étude auprès de populations plus vastes.

Falls in Post-Polio Patients: Prevalence and Risk Factors.

Individuals with post-polio syndrome (PPS) suffer from falls and secondary damage. AIM: To (i) analyze the correlation between spatio-temporal gait data and fall measures (fear and frequency of falls) and to (ii) test whether the gait parameters are predictors of fall measures in PPS patients. METHODS: Spatio-temporal gait data of 50 individuals with PPS (25 males; age 65.9 ± 8.0) were acquired during gait and while performing the Timed Up-and-Go test. Subjects filled the Activities-specific Balance Confidence Scale (ABC Scale) and reported number of falls during the past year. RESULTS: ABC scores and number of falls correlated with the Timed Up-and-Go, and gait cadence and velocity. The number of falls also correlated with the swing duration symmetry index and the step length variability. Four gait variability parameters explained 33.2% of the variance of the report of falls (p = 0.006). The gait velocity was the best predictor of the ABC score and explained 24.8% of its variance (p = 0.001). CONCLUSION: Gait variability, easily measured by wearables or pressure-sensing mats, is an important predictor of falls in PPS population. Therefore, gait variability might be an efficient tool before devising a patient-specific fall prevention program for the PPS patient.

Risk factors for functional deterioration in a cohort with late effects of poliomyelitis: A ten-year follow-up study.

BACKGROUND: More than 7000 patients developed poliomyelitis during the main epidemic in the fifties in Israel. In recent years, there is a further deterioration in their condition due to accelerated aging process and post-polio syndrome. OBJECTIVE: To evaluate the risk factors for the progression of functional status in a cohort of patients with late effect of poliomyelitis over a period of ten years. METHODS: A cross-sectional cohort study including 82 individuals with late effect of poliomyelitis evaluated over ten years. Mean age was 67±8.5 years, 52.4%were men and 79.3%were Jewish. Functional status was evaluated by activities of daily living (ADL) questionnaire. Risk factors, including general comorbidities, history of poliomyelitis infection, use of assistive devices, employment, and physical activity statuses were evaluated using specific questionnaires. RESULTS: Independence in ADL functions deteriorated significantly over ten years. Older age, ethnicity, use of a wheelchair, and use of orthotic devices in childhood were risk factors for deterioration in ADL function. No correlation was found between the presence of other comorbidities or poliomyelitis parameters and worsening of ADL functions. CONCLUSIONS: Late effect of poliomyelitis was associated with deterioration in ADL functions probably due to the combined effect of the initial severity of the paralytic poliomyelitis symptoms and accelerated aging.

[DISEASE SEVERITY AND PSYCHOLOGICAL HEALTH AMONG POLIOMYELITIS PATIENTS IN JERUSALEM - 10 YEARS FOLLOW-UP STUDY].

INTRODUCTION: More than 7000 patients contracted poliomyelitis (polio) during the major epidemic in the fifties in Israel. In recent years, there is further deterioration in their condition due to the accelerated aging process and post-polio syndrome. OBJECTIVES: To evaluate the correlation between disease severity, functional and psychological parameters among polio patients in Jerusalem over a period of 10 years. METHODS: A total of 145 polio patients were included in the study; 82 of them were evaluated 10 years ago. The severity of polio sequelae was evaluated using the Index of Post-Polio Sequelae (IPPS) and the psychological status was evaluated using the General Health Questionnaire (GHQ), Hope and Satisfaction with Life scales. RESULTS: The mean age of our sample was 66.4 ± 8.0 years as compared to 57.8 ± 12.8 years in the previous study; 75.9% were Jewish and 28.3% were employed as compared to 75% and 37.3% in the previous study. The severity of polio symptoms according to the IPPS increased and more patients needed assistance in ADL as compared to the previous study, whereas the GHQ score was unchanged. The condition of non-Jewish polio patients was worse as compared to their Jewish counterparts. CONCLUSIONS: The severity of long standing polio symptoms increased with age in correlation with the reduced level of independence in ADL functions. Polio patients have emotional resilience albeit their physical deterioration and work is a significant source of emotional strength. DISCUSSION: Long standing poliomyelitis has a significant effect on patients' health even after many years. The disease contributes to accelerated aging and therefore there is a need for special rehabilitation programs including vocational training in order to prevent further functional deterioration in this population.

Muscle activity while ambulating on stairs and slopes: A comparison between individuals scheduled and not scheduled for knee arthroplasty and healthy controls.

OBJECTIVE: To examine muscle activity patterns of the lower limbs while ascending and descending stairs and slope in adults with knee Osteoarthritis (knee-OA), who were scheduled or not scheduled for Total Knee Replacement (TKR) and healthy controls. METHODS: This cross-sectional study included three groups: knee-OA subjects scheduled for TKR (TKR group; N = 15) and not scheduled for TKR (NTKR group; N = 15) and age-matched controls (N = 11). Outcome measures included: joint range of motion (ROM), Timed Up and Go (TUG), joint pain levels, and functional disability (Oxford) score. Also, durations of muscle activity (rectus femoris, semitendinosus, medial gastrocnemius, bilaterally, and soleus, and tibialis anterior of the OA limb) were recorded while the subjects ascended and descended stairs and a level surface. RESULTS: Both knee-OA groups had significantly higher Oxford scores and bilateral knee pain levels compared to the control group. The TKR group had higher TUG score compared to the NTKR group. The activation duration of the Tibialis Anterior of the OA limb while ascending and descending stairs and slope were higher in the TKR group compared to the NTKR group. No differences in muscle activity durations were found when comparing the OA limb to contralateral limb. CONCLUSION: The muscle activity strategies differentiated between individuals scheduled and not scheduled for TKR. The longer duration of muscle activity of Tibialis Anterior muscle in the TKR group compared to the NTKR group suggest that customized prehabilitation program is required for these groups.

Functional electrical stimulation compared with ankle-foot orthosis in subacute post stroke patients with foot drop: A pilot study.

Background: The conventional treatment for foot drop includes an ankle-foot orthosis (AFO) or functional electrical stimulation (FES). Goal: To compare gait parameters in patients following a subacute post stroke with foot drop treated with AFO or FES. Method: Twenty one subacute patients with stroke with foot drop were fitted with FES (N = 10) or AFO (N = 11). Evaluations were performed at baseline, following 4 weeks and 12 weeks. Spatiotemporal gait parameters and symmetry, dynamic electromyography, 10-m walk test, 6-min walk test, timed up and go, functional ambulation classification, and perception of improvement in walking were measured. The gait analysis measures were collected without the assistive devices while the functional measures were collected with them. Results: Both groups showed improvement in all of the outcome measures, with no between-groups differences. The swing duration's and step length's symmetry indicated better gait symmetry in the FES group after 12 weeks (p = 0.037, effect size = -0.538 and p = 0.028 effect size = -0.568, respectively). The FES group perceived significant improvement in gait after 4 weeks, while subjects in the AFO group reported to perceive improvement only after 12 weeks. Conclusions: Our findings suggest that FES is at least as effective as traditional AFO and may be more so.

Kinematics following gait perturbation in adults with knee osteoarthritis: Scheduled versus not scheduled for knee arthroplasty.

OBJECTIVE: To compare recovery kinematics following trip-simulated perturbation during gait between three groups: adults without knee Osteoarthritis (OA) and adults with OA, scheduled and not scheduled for Total Knee Replacement (TKR). METHODS: People with OA scheduled for TKR (TKR group; N = 19) and not scheduled (NTKR group; N = 17) were age-matched with People without OA (N = 19). Outcome measures included: joint range of motion (ROM), Timed Up and Go (TUG), joint pain levels, Oxford score, Instrumental Activities of Daily Living Questionnaire, and the Activities-specific Balance Confidence Scale. Also, spatiotemporal gait parameters and joint kinematics were recorded during perturbed and unperturbed gait. The perturbed gait data were normalized by unperturbed gait data. RESULTS: There were no differences between the two OA groups in the four questionnaire scores and joint ROM. The TUG score of the TKR group was higher than that of the NTKR group. There were no statistically significant between-group differences in the normalized spatiotemporal parameters. The OA groups showed statistically significant lower anterior pelvic tilt ranges and higher maximal hip adduction of the contralateral limb compared to the Non-OA group. When the contralateral limb was perturbed, the TKR group showed significantly lower pelvic rotation range compared to the NTKR and Non-OA groups. When the OA limb was perturbed, the maximal hip flexion of the injured limb was significantly lower and the maximal knee flexion higher in the OA groups compared with the Non-OA group. CONCLUSION: The recovery strategy from trip-simulated perturbation of individuals with OA differs from that of individuals without OA. This may emphasize the importance of devising a treatment plan that focuses on improving balance and reactions to gait perturbation.

Hospice Care: Hope and Meaning in Life Mediate Subjective Well-Being of Staff.

OBJECTIVES: Subjective well-being has been associated with decreased work burnout and elevated work engagement. We investigated the impact of hope and meaning in life on subjective well-being among workers in a hospice care setting. Comparison was made to health-care workers in a rehabilitation unit. METHODS: Thirty-five hospice care workers were surveyed and their responses compared with those of 36 rehabilitation workers. Survey instruments measuring hope, meaning in life, work engagement, and satisfaction with life were utilized. RESULTS: Individuals working in a hospice care center have significantly higher levels of work engagement than their counterparts in rehabilitation. For both groups, hope was significantly related to subjective well-being. For hospice care but not rehabilitation workers, meaning in life was also related to subjective well-being. Multivariate analysis showed that hope and meaning in life were independent factors predicting subjective well-being in hospice care workers. SIGNIFICANCE OF RESULTS: Hospice care workers are highly engaged in their work despite the challenging nature of their work. What characterizes these workers is a level of subjective well-being that is related to both meaning in life and hope. Maintaining a high level of subjective well-being may be an important factor in preventing burnout among those working in hospice care settings.

Activity Performance, Participation, and Quality of Life Among Adults in the Chronic Stage After Acquired Brain Injury-The Feasibility of an Occupation-Based Telerehabilitation Intervention.

Objective: Acquired brain injury (ABI) is a leading cause of long-term disability. This calls for effective and accessible interventions to support participation in the community over time. One promising avenue to answer this need is telerehabilitation. Prior to conducting a larger trial, the main objective of this pilot study is to explore the feasibility, acceptability, and preliminary efficacy of a metacognitive occupation-based intervention in a telerehabilitation format with adults and older adults in the chronic phase after ABI. Methods: Five community dwelling participants (ages 65-72), 6-10 months post-ABI, with scores 2-4 on the modified Rankin scale and without dementia, completed the teleintervention. The intervention included ~10 weekly videoconferencing sessions administered by an occupational therapist using the Cognitive Orientation to Daily Occupational Performance approach. Each participant defined five functional goals and three were trained and two were not trained during the intervention. Evaluations were conducted at pre, post, and 3-month follow-up. The primary outcome measures included activity performance (The Canadian Occupational Performance Measure; COPM), participation (the Mayo-Portland Adaptability Inventory-4 Participation Index; MPAI-4-P), and quality of life (QoL) (stroke impact scale; SIS). Other measures included a feedback interview, satisfaction questionnaire, field notes, and a treatment fidelity checklist. Results: The teleintervention was found to be feasible and the participants expressed a high degree of satisfaction with the intervention and the technology use. A Wilcoxon Signed-Ranks test indicated statistically significant improvements post intervention in COPM performance (z = -2.023, p = 0.043) and satisfaction (z = -2.023, p = 0.043) ratings. Additionally, clinically significant improvements (≥2 points) in both performance and satisfaction with performance were found for each participant in at least three of their five defined functional goals. Trends toward significant improvement were found in MPAI-4-P ratings post intervention (z = -1.826, p = 0.068). Furthermore, clinically significant improvements (≥15 points) post intervention were found for each participant in some subscales of the SIS. Results were partially maintained at 3-month follow-up. Conclusions: This pilot study demonstrated the feasibility of a metacognitive occupation-based telerehabilitation intervention and its potential benefits in activity performance, participation, and QoL for older adults coping with long-term disability following ABI. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03048708.

Effectiveness of a tele-rehabilitation intervention to improve performance and reduce morbidity for people post hip fracture - study protocol for a randomized controlled trial.

BACKGROUND: Most surviving hip-fracture patients experience reduced mobility and lose some of their functional ability, which increases the risk of complications and rehospitalization. Post-discharge transitional programs to reduce readmissions and disabilities have shown some success. Telerehabilitation refers to the use of technologies to provide rehabilitation services to people in their homes. Considering the need for long-term follow-up care for people with hip fracture, in-home telerehabilitation could increase independence, decrease hospital stays and reduce the burden for caregivers. The objective of this study is to investigate the effectiveness of an intervention program based on telerehabilitation on activities of daily living (ADL), quality of life (QOL), depression and burden on caregivers compared to face-to-face home visits and usual care of community-dwelling older adults after hip fracture. METHODS/DESIGN: This will be a three-armed randomized control trial (RCT) including pre/post intervention and follow-up. The trial will include 90 older people with hip fractures who will be randomly assigned to a telerehabilitation group (N = 30), face-to-face visits (N = 30) and a control group. The aim of the intervention is to improve the transition from rehabilitation units to community dwelling. It will include 10 videoconferencing/ face-to-face sessions from an occupational therapist in the presence of the primary caregiver. Each session will be utilized to guide the participants to achieve their self-identified goals, focusing on problem-solving for daily life situations and on the ability to implement the discussed strategies for a variety of activities. Outcome measures include Functional Independence Measure (FIM) for evaluation of ADL, SF-12 for evaluation of Health-related QOL, The Geriatric Depression Scale (GDS) and The Zarit Caregiver Burden Scale. Data will be analyzed using Repeated measures MANOVA. DISCUSSION: The current study will enable the cost-effectiveness examination of a suggested rehabilitation service based on available technology. The proposed intervention will increase accessibility of in-home rehabilitation services, improve function and health, and reduce economic burden. TRIAL REGISTRATION: NCT03376750 (12/15/2017).

Differences in muscle activity and fatigue of the upper limb between Task-Specific training and robot assisted training among individuals post stroke.

OBJECTIVE: To compare the activity and fatigue of upper extremity muscles, pain levels, subject satisfaction levels, perceived exertion, and number of repetitions in Task-Specific Training (TST) compared with Robot-Assisted Training (RAT) in individuals post-stroke. METHODS: Twenty sub-acute post stroke subjects (16 men; median (interquartile range) age 64.0 (71.5-57.0) years) received two 30-min treatment sessions, one TST and one RAT. Before each session, the Visual Analogue Scale (VAS) was administered. Activity levels and fatigue of six muscles were monitored using surface electromyography and the number of repetitions was counted. After each session, the subjective assessment questionnaire of treatment, the Borg scale and VAS were administered. RESULTS: During TST, the Anterior Deltoid, Upper Trapezius and Biceps were more active, while during the RAT, the Triceps was more active. The Triceps activity increased during TST towards the end of the session. The pain levels increased after TST and the number of repetitions was higher compared to RAT. There were no significant differences in muscle fatigue, perceived physical exertion and subject satisfaction levels between both treatment sessions. CONCLUSION: This is the first study to explore the biomechanics of both treatment methods and might therefore shed light on the mechanisms behind their positive outcomes. Due to the differences in the biomechanics of the treatments, a combination of both treatments may be beneficial to the activation of different muscle groups, thereby contributing to the rehabilitation program post stroke.

Evaluation of the effectiveness of a novel gait trainer in increasing the functionality of individuals with motor impairment: A case series.

Regaining the ability to independently ambulate following a physical disability can increase functional ability and participation of patients in daily life. Gait trainers are assistive devices that enable body support and provide safety during gait. However, most conventional gait trainers are pre-configured to a constant position, therefore not suitable for practicing sit-to-stand function, and require assistance from a caregiver in order to mount the device from a sitting position. We therefore evaluated the effectiveness of a dynamically-adjusting gait trainer, designed to provide independence and safety during gait and various activities, in both lab setting and at home in four subjects (one female, three males, ages 32-79 years) with limited ambulation. Spatiotemporal parameters and gait symmetry were recorded, as well as activity levels, actual use of device, and satisfaction. Although gait parameters and physical activity levels were not notably improved, and in one case were worsened, three subjects reported positive experience with the gait trainer. The new gait trainer may have advantages in supporting users with limited mobility during walking and various functions and decrease the risk for falls. A longer practice time and individual fitting process are recommended for better accommodation to the new possibilities.