Combining Transcranial Direct Current Stimulation With Hand Robotic Rehabilitation in Chronic Stroke Patients: A Double-Blind Randomized Clinical Trial.

OBJECTIVE: This study aimed to assess the impact of combining transcranial direct current stimulation with end-effector robot-assisted treatment on upper limb function, spasticity, and hand dexterity in chronic stroke patients. DESIGN: This was a prospective, double-blind randomized trial with 20 equally allocated stroke patients. The experimental group received dual transcranial direct current stimulation (anode over affected M1, cathode over contralateral M1) alongside robot-assisted treatment, while the control group received sham transcranial direct current stimulation with the same electrode placement + robot-assisted treatment. Each patient underwent 20 combined transcranial direct current stimulation and robot-assisted treatment sessions. The primary outcome measure was the Fugl-Meyer Upper Limb motor score, with secondary outcomes including AMADEO kinematic measures, Action Research Arm Test, and Functional Independence Measure. Assessments were conducted at baseline, after rehabilitation, and 3 mos later. RESULTS: Combining bilateral transcranial direct current stimulation with robot-assisted treatment did not yield additional improvements in Fugl-Meyer Upper Limb motor score, Functional Independence Measure, or Action Research Arm Test scores among stroke patients. However, the real transcranial direct current stimulation group showed enhanced finger flexion in the affected hand based on AMADEO kinematic measures. CONCLUSIONS: The addition of transcranial direct current stimulation to robot-assisted treatment did not result in significant overall functional improvements in chronic stroke patients. However, a benefit was observed in finger flexion of the affected hand.

Effect of Doll Therapy in Behavioral and Psychological Symptoms of Dementia: A Systematic Review.

(1) Background: Behavioral and psychological symptoms of dementia (BPSD) are a threat for people with dementia and their caregivers. Doll therapy is a non-pharmacological person-centered therapy to promote attachment, company, and usefulness with the aim of minimizing challenging behaviors. However, the results are not clear. (2) Objective: To know the effectiveness of doll therapy in reducing behavioral and psychological symptoms of people with dementia at a moderate-severe phase. (3) Methodology: The systematic review was informed according to the criteria established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were conducted in eight databases: Cochrane, PubMed, Web of Science, Cinahl, Embase, Lilacs, PeDro, and Scopus before October 2021. Studies were selected when they accomplished the simple majority of Consolidated Standards of Reporting Trials (CONSORT). The risk of bias was appraised with the Cochrane Collaboration Risk of Bias Tool. The review protocol was recorded in Inplasy:1539. (4) Results: The initial search strategy showed 226 relevant studies, 7 of which met the eligibility criteria. In the included studies, a total number of 295 participants (79% female) with a mean age of 85 years were enrolled. There was found to be a reduction in challenging and aggressive behaviors, the participants were less rough and irritable, and their communication skills and emotional state were also improved. (5) Conclusion: Our findings suggest that doll therapy improves the emotional state of people with dementia, diminishes disruptive behaviors, and promotes communication. However, randomized studies with a larger sample size and higher methodological rigor are needed, as well as follow-up protocols in order to reaffirm these results.

Parents' and Teachers' Perceptions of Physical Activity in Schools: A Meta-Ethnography.

The aim of this meta-ethnographic study was to analyze parents' and teachers' perceptions of barriers and facilitators to physical activity in children. Facilitators were the benefits of physical activity, modeling, participation, children's preferences, and factors supporting active transport. Barriers were quantifying the physical activity, parents' lack of time, the cost of activities, bad weather, traffic, long distances, and the lack of facilities and safety. The level of physical activity does not depend exclusively on individual factors related to the child; rather, barriers and facilitators are influenced by the social and school context and the physical and built environment. It is important that school nurses understand these contextual factors, so that they can take these into consideration when designing their intervention programs.

Parents' Perceptions on Barriers and Facilitators of Physical Activity among Schoolchildren: A Qualitative Study.

Given that physical activity (PA) plays an important role in early childhood, understanding the factors that affect the practice of PA at an early age could help develop effective strategies for overcoming barriers and increasing activity levels in this age group. A qualitative study was conducted based on grounded theory aimed at exploring the perceptions of mothers and fathers from Cuenca and Ciudad Real (Castilla La Mancha, Spain) regarding barriers and facilitators of physical activity of their children during the adiposity rebound period. Data were collected using focus groups involving 46 parents of children in the 3rd grade of pre-school and 1st grade of elementary school. During the analysis, the socio-ecological model and grounded theory were used. The barriers encountered were the preferences of children for sedentary activities (individual factors), academic tasks as a main priority of parents, the influence of older siblings and the unfavorable school environment (microsystem), the lack of family conciliation (mesosystem), and barriers related to the built environment or lack of facilities for physical activity (exosystem). Facilitators were the preferences for active games (individual factors), parental models including the co-participation of parents in activities, the influence of friends, living in large homes, the support provided by teachers and the school (microsystem), living in rural areas, having sufficient facilities, favorable weather conditions (exosystem), and the existence of free or subsidized activities (macro system). Programs aimed at promoting PA in early childhood should include strategies that address contextual factors and not only focus on individual factors related to the child.