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1.
Sensors (Basel) ; 20(6)2020 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-32197493

RESUMEN

Background: The Trunk Impairment Scale (TIS) is recommended for clinical research use to assess trunk impairment post-stroke. However, it is observer-dependent and neglects the quality of trunk movements. This study proposes an instrumented TIS (iTIS) using the Valedo system, comprising portable inertial sensors, as an objective measure of trunk impairment post-stroke. Objective: This study investigates the concurrent and discriminant ability of the iTIS in chronic stroke participants. Method: Forty participants (20 with chronic stroke, 20 healthy, age-matched) were assessed using the TIS and iTIS simultaneously. A Spearman rank correlation coefficient was used to examine concurrent validity. A ROC curve was used to determine whether the iTIS could distinguish between stroke participants with and without trunk impairment. Results: A moderate relationship was found between the observed iTIS parameters and the clinical scores, supporting the concurrent validity of the iTIS. The small sample size meant definitive conclusions could not be drawn about the parameter differences between stroke groups (participants scoring zero and one on the clinical TIS) and the parameter cut-off points. Conclusion: The iTIS can detect small changes in trunk ROM that cannot be observed clinically. The iTIS has important implications for objective assessments of trunk impairment in clinical practice.

2.
BMC Public Health ; 19(1): 1512, 2019 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-31718605

RESUMEN

BACKGROUND: Due to the high prevalence and adverse consequences, overweight and obesity in children continues to be a major public health concern worldwide. Socioeconomic background and health-related behaviours (such as diet, physical activity and sedentary behaviors) are important factors associated with weight status in children. Using a series of height and weight assessments from the Australian Capital Territory Physical Activity and Nutrition Survey (ACTPANS), trends in prevalence of overweight and obesity by socioeconomic status were examined in ACT Year 6 school children between 2006 and 2018. METHODS: The ACTPANS has been conducted every 3 years since 2006. A total of 6729 children were surveyed. Complete data on height and weight were available for 6384 (94.9%) participants. Trends in the prevalence of overweight and obesity and associations between weight status and risk factors (such as socioeconomic status, physical activity, screen time and consumption of sugar-sweetened soft drinks (SSD)) were examined using logistic regression. RESULTS: The prevalence of overweight and obesity remained stable in girls (from 22.5% in 2006 to 21.6% in 2018) but declined in boys (from 27.8 to 17.9%). During the same period, levels of physical activity increased slightly, while screen time and the consumption of fast food and SSD decreased. Socioeconomic gradient, based on the school-level Index of Community Socio-Educational Advantage (ICSEA), was highly associated with prevalence of overweight and obesity. Since 2006, the estimated prevalence of overweight and obesity has remained high in the lowest SES groups, but a concurrent downward trend was observed in the highest SES group, leading to increasing disparity between SES groups. Children in the lowest ICSEA quintile were more likely to be overweight or obese compared to those in the moderate and highest ICSEA quintiles. Children in lower ICSEA quintiles also reported lower levels of physical activity, higher levels of screen time, and higher levels of fast food and SSD consumption compared to those in higher ICSEA quintiles. CONCLUSIONS: While recent trends in overweight and obesity in ACT children are encouraging, the prevalence remains unacceptably high, especially in those from low socioeconomic backgrounds. Additional prevention efforts are required to address the socioeconomic disparity.


Asunto(s)
Conducta del Adolescente , Conducta Infantil , Conductas Relacionadas con la Salud , Obesidad Pediátrica/epidemiología , Clase Social , Adolescente , Territorio de la Capital Australiana/epidemiología , Peso Corporal , Niño , Dieta , Ejercicio , Femenino , Disparidades en el Estado de Salud , Humanos , Modelos Logísticos , Masculino , Sobrepeso/epidemiología , Sobrepeso/etiología , Obesidad Pediátrica/etiología , Prevalencia , Factores de Riesgo , Instituciones Académicas , Tiempo de Pantalla , Conducta Sedentaria , Encuestas y Cuestionarios
3.
Nurs Manag (Harrow) ; 26(3): 27-35, 2019 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-31468839

RESUMEN

Digital healthcare provision in England has been driven mainly by a 'top-down' approach and a focus on digital infrastructure rather than front-line delivery. This has laid the foundation, but digital care delivery still has a long way to go. This article describes an action learning programme to create digitally ready nurses. The programme, which underpins action six of NHS England's ten-point plan for general practice nursing, shows that a 'ground-up' approach to upskill and empower front-line clinicians is central to embedding technology-enabled care services (TECS). Following completion of the action learning sets (ALSs), 24 general practice nursing digital champions across Staffordshire have used TECS to deliver a range of benefits for their practice teams. This has informed the introduction and extension of the programme, with national funding for a further 12 regional pilot ALSs across England in 2018-19. Importantly, the active learning individualised approach provides a digitally ready workforce with the ability and support to adopt TECS in areas of clinical need. This ability is central to the next stage in the digital transformation of healthcare.


Asunto(s)
Medicina General/organización & administración , Personal de Enfermería/educación , Telemedicina/organización & administración , Inglaterra , Humanos , Investigación en Educación de Enfermería , Investigación en Evaluación de Enfermería , Personal de Enfermería/psicología , Aprendizaje Basado en Problemas , Medicina Estatal
4.
Nurs Manag (Harrow) ; 2019 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-31468906

RESUMEN

Digital healthcare provision in England has been driven mainly by a 'top-down' approach and a focus on digital infrastructure rather than front-line delivery. This has laid the foundation, but digital care delivery still has a long way to go. This article describes an action learning programme to create digitally ready nurses. The programme, which underpins action six of NHS England's ten-point plan for general practice nursing, shows that a 'ground-up' approach to upskill and empower front-line clinicians is central to embedding technology-enabled care services (TECS). Following completion of the action learning sets (ALSs), 24 general practice nursing digital champions across Staffordshire have used TECS to deliver a range of benefits for their practice teams. This has informed the introduction and extension of the programme, with national funding for a further 12 regional pilot ALSs across England in 2018-19. Importantly, the active learning individualised approach provides a digitally ready workforce with the ability and support to adopt TECS in areas of clinical need. This ability is central to the next stage in the digital transformation of healthcare.

5.
Front Neurol ; 10: 567, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31293493

RESUMEN

Background: Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life, and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation. Aim: To conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations are made for upper limb assessment. Methods: We systematically reviewed published guidance on measures and protocols for assessment of upper limb function in neurological rehabilitation via electronic databases from January 2007-December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to "rehabilitation" and "assessment" or "measurement". Reasons for exclusion were documented. Results: From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion, and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed Journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardized measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation. Conclusions: We present a comprehensive, critical, and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers, and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.

6.
Arthritis Care Res (Hoboken) ; 71(11): 1473-1481, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30320976

RESUMEN

OBJECTIVE: This original systematic review aimed to summarize evidence within observational studies on the factors associated with hand functional disability in adults with rheumatoid arthritis (RA). METHODS: A rigorous extensive systematic literature search was conducted in 6 medical databases for peer-reviewed English language observational studies that explore the factors associated with hand function for people with RA. Factors were critically classified under the domains of the International Classification of Functioning, Disability and Health (ICF) framework and health-related factors. The methodologic quality was determined using the appraisal tool for cross-sectional studies. Factors related to hand function that were investigated in ≥2 studies were explored using a best-evidence synthesis. RESULTS: Twenty articles from 1,271 citations met the inclusion criteria. All presented cross-sectional data (5 high-quality and 15 low-quality articles), resulting in limited evidence in the best-evidence synthesis. For the factors classified under the ICF domains, the best-evidence synthesis indicated that a diverse range of positive and negative factors were associated with hand function. However, key factors were hand strength, disease activity, and pain intensity. It is evident that few sociodemographic factors have been explored for the association with hand function. CONCLUSION: Although the level of evidence was limited, modifiable factors such as grip strength, disease activity, and pain were identified as the most influential factors on hand function in people with RA. The findings of the present review indicate that important sociodemographic factors that impact hand function in individuals with RA have not yet been considered or reported in clinical research.

7.
Top Stroke Rehabil ; 26(2): 94-100, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30422096

RESUMEN

BACKGROUND: Training of the upper limb (UL) is limited in stroke rehabilitation, and about 50% of stroke survivors do not regain useful function in their upper limb. OBJECTIVES: This study explored what factors affect rehabilitation and use of upper limb after stroke from a stroke survivor and healthcare professional perspective to better understand low engagement in UL rehabilitation in the chronic stages of stroke. METHOD: Eight chronic stroke survivors and 21 healthcare professionals took part in semi-structured interviews or in one of three focus groups, respectively. RESULTS: Thematic analysis revealed three main themes: Availability of resources, Healthcare professional-patient relationship, and Psychosocial factors. Availability of resources and Healthcare professional-patient relationship indicated that due to resource pressures and a lack of communication and education, positive upper limb rehabilitation behaviors (e.g. engaging and integrating the upper limb in daily activity) were not always established in the early stages post-stroke. Psychosocial factors illustrated the cognitive and psychological barriers to sustained engagement with upper limb rehabilitation. CONCLUSION: The findings indicate that stroke survivors and healthcare professionals have very similar understandings of barriers to UL activity, and positive upper limb rehabilitation behaviors are not always established early in recovery post-stroke. Increased resources and healthcare professional-patient relationships seem key factors to establishing positive perceptions of UL rehabilitation. Addressing psychosocial issues and resource limitations may help sustain engagement with UL rehabilitation.


Asunto(s)
Personal de Salud , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/fisiopatología , Sobrevivientes , Extremidad Superior/fisiopatología , Actividades Cotidianas , Adulto , Anciano , Actitud del Personal de Salud , Conducta , Comunicación , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Relaciones Profesional-Paciente , Sistemas de Apoyo Psicosocial
8.
NeuroRehabilitation ; 43(4): 395-412, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30400112

RESUMEN

BACKGROUND: Post-stroke trunk control is reported to be associated with trunk performance and recovery of the upper limb, but the evidence for the influence of trunk exercise on both of these is unclear. OBJECTIVE: To evaluate the effect of trunk exercises on trunk performance post-stroke, and to determine if these exercises result in improved upper limb function. METHODS: A comprehensive search of the literature published between January 1990 and February 2017 was conducted using the following electronic databases; AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PsychInfo and SPORTDiscus. Only randomized, controlled trials, published in English, evaluating the effect of trunk exercises on trunk performance and/or upper limb function post-stroke, were included. RESULTS: A total of 17 studies involving 599 participants were analysed. Meta-analysis showed that trunk exercises had a large significant effect on trunk performance post-stroke. This effect varied from very large for acute stroke to medium for subacute and chronic stroke. None of the included studies had measured the effect of trunk exercise on upper limb impairment or functional activity. CONCLUSIONS: Trunk exercises improve trunk performance for people with acute, subacute and chronic strokes. As yet there is no evidence to support the effect of trunk exercise on upper limb function.


Asunto(s)
Terapia por Ejercicio/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Terapia por Ejercicio/efectos adversos , Humanos , Rehabilitación de Accidente Cerebrovascular/efectos adversos , Torso/fisiopatología , Extremidad Superior/fisiopatología
9.
Sensors (Basel) ; 18(8)2018 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-30044382

RESUMEN

This paper presents research into a user-friendly electronic sleeve (e-sleeve) with integrated electrodes in an array for wearable healthcare. The electrode array was directly printed onto an everyday clothing fabric using screen printing. The fabric properties and designed structures of the e-sleeve were assessed and refined through interaction with end users. Different electrode array layouts were fabricated to optimize the user experience in terms of comfort, effectivity and ease of use. The e-sleeve uses dry electrodes to facilitate ease of use and the electrode array can survive bending a sufficient number of times to ensure an acceptable usage lifetime. Different cleaning methods (washing and wiping) have been identified to enable reuse of the e-sleeve after contamination during use. The application of the e-sleeve has been demonstrated via muscle stimulation on the upper limb to achieve functional tasks (e.g., hand opening, pointing) for eight stroke survivors.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/fisiopatología , Textiles , Dispositivos Electrónicos Vestibles , Adulto , Anciano , Brazo , Electrodos , Humanos , Persona de Mediana Edad , Impresión , Adulto Joven
10.
Disabil Rehabil ; 40(20): 2424-2432, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-28597701

RESUMEN

PURPOSE: To enhance understanding of the relationship between upper limb and eye movements during reaching tasks in people with stroke. METHODS: Eye movements were recorded from 10 control participants and 8 chronic stroke participants during a visual orienting task (Experiment 1) and a series of reaching tasks (Experiment 2). Stroke participants completed the reaching tasks using (i) their less impaired upper limb, (ii) their more impaired upper limb without support, and (iii) their more impaired upper limb, with support (SaeboMAS gravitational support and/or electrical stimulation). Participants were tested individually and completed both experiments in the same session. RESULTS: Oculomotor control and the coordination between the upper limb and the oculomotor system were found to be intact in stroke participants when no limb movements were required, or when the less impaired upper limb was used. However, when the more impaired upper limb was used, success and accuracy in reaching decreased and patterns of eye movements changed, with an observed increase in eye movements to the limb itself. With upper limb support, patterns of hand-eye coordination were found to more closely resemble those of the control group. CONCLUSION: Deficits in upper limb motor systems result in changes in patterns of eye movement behavior during reaching tasks. These changes in eye movement behavior can be modulated by providing upper limb support. Implications for Rehabilitation Deficits in upper limb motor systems can result in changes in patterns of eye movement behavior during reaching tasks. Upper limb support can reduce deficits in hand-eye coordination. Stroke rehabilitation outcomes should consider motor and oculomotor performance.


Asunto(s)
Movimientos Oculares , Músculos Oculomotores/fisiopatología , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular , Extremidad Superior/fisiopatología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Análisis y Desempeño de Tareas , Resultado del Tratamiento
11.
J Rehabil Assist Technol Eng ; 5: 2055668318765406, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-31191932

RESUMEN

Purpose: Reliability of motor-evoked potential threshold and amplitude measurement of upper limb muscles is important when detecting changes in cortical excitability. The objective of this study was to investigate intra-rater, test-retest reliability and minimal detectable change of resting motor threshold and amplitude of a proximal and distal upper limb muscles, anterior deltoid and distal extensor digitorum communis in healthy adults. Method: To measure motor-evoked potential responses, transcranial magnetic stimulation was interfaced with electromyography and neuronavigation equipment. Two measurements were conducted on day 1 and a third measurement three days later. Reliability was analysed using intraclass correlation coefficients. Results: Twenty participants completed the study. Excellent intra-rater (intraclass correlation coefficient = 0.91 (extensor digitorum), 0.94 (anterior deltoid)) and good to excellent test-retest reliability (intraclass correlation coefficient = 0.69 (anterior deltoid), 0.84 (extensor digitorum)) was found for resting motor threshold. Minimal detectable change for resting motor threshold was found at 10.95% (extensor digitorum) and 16.35% (anterior deltoid) between first and third measurements. Motor-evoked potential amplitude of extensor digitorum communis had fair to good intra-rater (intraclass correlation coefficient = 0.50) and test-retest reliability (intraclass correlation coefficient = 0.65). Conclusions: Our results suggest that resting motor threshold is a reliable neurophysiological measure even for proximal shoulder muscles. Future research should further explore the reliability of motor-evoked potential amplitude before integration into neurological rehabilitation.

12.
J Neurol Phys Ther ; 41 Suppl 3: S32-S38, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28628594

RESUMEN

BACKGROUND AND PURPOSE: Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on health care resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is found in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible because of social and environmental factors. This article addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy. SUMMARY OF KEY POINTS: We provide an overview of TH and present evidence that a web-supported program, used in conjunction with constraint-induced therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, "LifeCIT," is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial and mechanomyographic sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained. RECOMMENDATIONS FOR CLINICAL PRACTICE: We propose that wearable sensor technologies and TH programs have the potential to provide most-effective, intensive, home-based stroke rehabilitation.


Asunto(s)
Motivación , Cooperación del Paciente , Modalidades de Fisioterapia , Rehabilitación de Accidente Cerebrovascular/métodos , Telemedicina , Dispositivos Electrónicos Vestibles , Humanos , Internet , Movimiento , Accidente Cerebrovascular/fisiopatología , Resultado del Tratamiento
13.
J Neuroeng Rehabil ; 13(1): 86, 2016 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-27663356

RESUMEN

BACKGROUND: The need for cost-effective neurorehabilitation is driving investment into technologies for patient assessment and treatment. Translation of these technologies into clinical practice is limited by a paucity of evidence for cost-effectiveness. Methodological issues, including lack of agreement on assessment methods, limit the value of meta-analyses of trials. In this paper we report the consensus reached on assessment protocols and outcome measures for evaluation of the upper extremity in neurorehabilitation using technology. The outcomes of this research will be part of the development of European guidelines. METHODS: A rigorous, systematic and comprehensive modified Delphi study incorporated questions and statements generation, design and piloting of consensus questionnaire and five consensus experts groups consisting of clinicians, clinical researchers, non-clinical researchers, and engineers, all with working experience of neurological assessments or technologies. For data analysis, two major groups were created: i) clinicians (e.g., practicing therapists and medical doctors) and ii) researchers (clinical and non-clinical researchers (e.g. movement scientists, technology developers and engineers). RESULTS: Fifteen questions or statements were identified during an initial ideas generation round, following which the questionnaire was designed and piloted. Subsequently, questions and statements went through five consensus rounds over 20 months in four European countries. Two hundred eight participants: 60 clinicians (29 %), 35 clinical researchers (17 %), 77 non-clinical researchers (37 %) and 35 engineers (17 %) contributed. At each round questions and statements were added and others removed. Consensus (≥69 %) was obtained for 22 statements on i) the perceived importance of recommendations; ii) the purpose of measurement; iii) use of a minimum set of measures; iv) minimum number, timing and duration of assessments; v) use of technology-generated assessments and the restriction of clinical assessments to validated outcome measures except in certain circumstances for research. CONCLUSIONS: Consensus was reached by a large international multidisciplinary expert panel on measures and protocols for assessment of the upper limb in research and clinical practice. Our results will inform the development of best practice for upper extremity assessment using technologies, and the formulation of evidence-based guidelines for the evaluation of upper extremity neurorehabilitation.

14.
IEEE Trans Neural Syst Rehabil Eng ; 24(2): 235-48, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25823038

RESUMEN

Few interventions address multiple sclerosis (MS) arm dysfunction but robotics and functional electrical stimulation (FES) appear promising. This paper investigates the feasibility of combining FES with passive robotic support during virtual reality (VR) training tasks to improve upper limb function in people with multiple sclerosis (pwMS). The system assists patients in following a specified trajectory path, employing an advanced model-based paradigm termed iterative learning control (ILC) to adjust the FES to improve accuracy and maximise voluntary effort. Reaching tasks were repeated six times with ILC learning the optimum control action from previous attempts. A convenience sample of five pwMS was recruited from local MS societies, and the intervention comprised 18 one-hour training sessions over 10 weeks. The accuracy of tracking performance without FES and the amount of FES delivered during training were analyzed using regression analysis. Clinical functioning of the arm was documented before and after treatment with standard tests. Statistically significant results following training included: improved accuracy of tracking performance both when assisted and unassisted by FES; reduction in maximum amount of FES needed to assist tracking; and less impairment in the proximal arm that was trained. The system was well tolerated by all participants with no increase in muscle fatigue reported. This study confirms the feasibility of FES combined with passive robot assistance as a potentially effective intervention to improve arm movement and control in pwMS and provides the basis for a follow-up study.


Asunto(s)
Brazo/fisiología , Estimulación Eléctrica/métodos , Aprendizaje/fisiología , Movimiento/fisiología , Esclerosis Múltiple/rehabilitación , Robótica/métodos , Adulto , Algoritmos , Terapia por Estimulación Eléctrica , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Reproducibilidad de los Resultados , Resultado del Tratamiento
15.
Phys Ther ; 95(8): 1163-71, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25721122

RESUMEN

BACKGROUND: Trunk control is thought to contribute to upper extremity (UE) function. However, this common assumption in neurorehabilitation has not been validated in clinical trials. OBJECTIVE: The study objectives were to investigate the effect of providing external trunk support on trunk control and UE function and to examine the relationship between trunk control and UE function in people with chronic stroke and people who were healthy. DESIGN: A cross-sectional study was conducted. METHODS: Twenty-five people with chronic stroke and 34 people who were healthy and matched for age and sex were recruited. Trunk control was assessed with the Trunk Impairment Scale (TIS), and UE impairment and UE function were assessed with the UE subsection of the Fugl-Meyer Assessment (FMA-UE) and the Streamlined Wolf Motor Function Test (SWMFT), respectively. The TIS and SWMFT were evaluated, with and without external trunk support; the FMA-UE was evaluated without trunk support. RESULTS: With trunk support, people with stroke showed improvement from 18 to 20 points on the TIS, a reduction in SWMFT performance times from 37.20 seconds to 35.37 seconds for the affected UE, and improvement from 3.3 points to 3.4 points on the SWMFT Functional Ability Scale for the function of the affected UE. With trunk support, the SWMFT performance time for people who were healthy was reduced from 1.61 seconds to 1.48 seconds for the dominant UE and from 1.71 seconds to 1.59 seconds for the nondominant UE. A significant moderate correlation was found between the TIS and the FMA-UE (r=.53) for people with stroke. LIMITATIONS: The limitations included a nonmasked assessor and a standardized height of the external trunk support. CONCLUSIONS: External trunk support improved trunk control in people with chronic stroke and had a statistically significant effect on UE function in both people with chronic stroke and people who were healthy. The findings suggest an association between trunk control and the UE when external trunk support was provided and support the hypothesis that lower trunk and lumbar stabilization provided by external support enables an improvement in the ability to use the UE for functional activities.


Asunto(s)
Aparatos Ortopédicos , Accidente Cerebrovascular/fisiopatología , Tórax/fisiopatología , Extremidad Superior/fisiopatología , Anciano , Estudios de Casos y Controles , Enfermedad Crónica , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Resultado del Tratamiento
16.
Biomed Tech (Berl) ; 60(3): 179-91, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25355246

RESUMEN

Functional electrical stimulation (FES) has been shown to be an effective approach to upper-limb stroke rehabilitation, where it is used to assist arm and shoulder motion. Model-based FES controllers have recently confirmed significant potential to improve accuracy of functional reaching tasks, but they typically require a reference trajectory to track. Few upper-limb FES control schemes embed a computational model of the task; however, this is critical to ensure the controller reinforces the intended movement with high accuracy. This paper derives computational motor control models of functional tasks that can be directly embedded in real-time FES control schemes, removing the need for a predefined reference trajectory. Dynamic models of the electrically stimulated arm are first derived, and constrained optimisation problems are formulated to encapsulate common activities of daily living. These are solved using iterative algorithms, and results are compared with kinematic data from 12 subjects and found to fit closely (mean fitting between 63.2% and 84.0%). The optimisation is performed iteratively using kinematic variables and hence can be transformed into an iterative learning control algorithm by replacing simulation signals with experimental data. The approach is therefore capable of controlling FES in real time to assist tasks in a manner corresponding to unimpaired natural movement. By ensuring that assistance is aligned with voluntary intention, the controller hence maximises the potential effectiveness of future stroke rehabilitation trials.


Asunto(s)
Brazo/fisiología , Simulación por Computador/normas , Terapia por Estimulación Eléctrica/métodos , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/fisiopatología , Extremidad Superior/fisiopatología , Adulto , Algoritmos , Humanos , Masculino , Recuperación de la Función
17.
J Tissue Viability ; 23(3): 81-93, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25193657

RESUMEN

Most traumatic lower limb amputees ambulate using a prosthetic limb. Comfort, appearance of the missing limb and function are confirmed as being important during rehabilitation post-amputation. Emerging evidence suggests that impaired tissue viability of the stump affects rehabilitation and thus clinical ability to provide optimum care. The primary objective of this systematic review was to identify key factors relating to tissue viability of the residual limb in lower extremity traumatic amputees. A secondary objective was to identify factors that affect rehabilitation post-amputation. In total, 218 studies were assessed; 37 met pre-determined criteria. Studies were classified according to the WHO ICF framework and the NHMRC level of evidence. Five key themes emerged; Prosthetic Fit; The Residuum; Quality of Life; Amputee Care and Prosthetic Use. The evidence indicates that high frequencies of skin problems affecting tissue viability within this population are inherently linked to intolerance of the prosthesis. Stump integrity, amputee care regimen and pain were also identified as impacting on quality of life, affecting rehabilitation and the ability to become independently mobile. Levels of evidence within all studies were low and indicative of the majority being non-randomised cohort studies or case-control studies. As there are a limited number of interventional studies, further development of robust outcome measures, clinical trials and prospective studies are of utmost importance to unravel the links between tissue viability and the other key factors. This will inform clinical management strategies and help develop targeted therapies and care pathways.


Asunto(s)
Amputación Traumática/rehabilitación , Traumatismos de la Pierna/rehabilitación , Supervivencia Tisular , Miembros Artificiales , Humanos , Ajuste de Prótesis , Calidad de Vida , Resultado del Tratamiento
18.
J Natl Cancer Inst Monogr ; 2014(48): 66-75, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25174027

RESUMEN

BACKGROUND: Accounting for 10%-15% of all non-Hodgkin lymphomas in Western populations, peripheral T-cell lymphomas (PTCL) are the most common T-cell lymphoma but little is known about their etiology. Our aim was to identify etiologic risk factors for PTCL overall, and for specific PTCL subtypes, by analyzing data from 15 epidemiologic studies participating in the InterLymph Consortium. METHODS: A pooled analysis of individual-level data for 584 histologically confirmed PTCL cases and 15912 controls from 15 case-control studies conducted in Europe, North America, and Australia was undertaken. Data collected from questionnaires were harmonized to permit evaluation of a broad range of potential risk factors. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression. RESULTS: Risk factors associated with increased overall PTCL risk with a P value less than .05 included: a family history of hematologic malignancies (OR = 1.92, 95% CI = 1.30 to 2.84); celiac disease (OR = 17.8, 95% CI = 8.61 to 36.79); eczema (OR = 1.41, 95% CI = 1.07 to 1.85); psoriasis (OR = 1.97, 95% CI = 1.17 to 3.32); smoking 40 or more years (OR = 1.92, 95% CI = 1.41 to 2.62); and employment as a textile worker (ever) (OR = 1.58, 95% CI = 1.05 to 2.38) and electrical fitter (ever) (OR = 2.89, 95% CI = 1.41 to 5.95). Exposures associated with reduced overall PTCL risk included a personal history of allergies (OR = 0.69, 95% CI = 0.54 to 0.87), alcohol consumption (ever) (OR = 0.64, 95% CI = 0.49 to 0.82), and having ever lived or worked on a farm (OR = 0.72, 95% CI = 0.55% to 0.95%). We also observed the well-established risk elevation for enteropathy-type PTCL among those with celiac disease in our data. Conclusions Our pooled analyses identified a number of new potential risk factors for PTCL and require further validation in independent series.


Asunto(s)
Estilo de Vida , Linfoma de Células T Periférico/epidemiología , Linfoma de Células T Periférico/etiología , Exposición Profesional , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Australia/etnología , Estudios de Casos y Controles , Comorbilidad , Europa (Continente)/epidemiología , Europa (Continente)/etnología , Femenino , Humanos , Linfoma de Células T Periférico/diagnóstico , Masculino , Persona de Mediana Edad , América del Norte/epidemiología , América del Norte/etnología , Oportunidad Relativa , Factores de Riesgo , Adulto Joven
19.
J Natl Cancer Inst Monogr ; 2014(48): 115-24, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25174032

RESUMEN

BACKGROUND: Little is known about the etiology of hairy cell leukemia (HCL), a rare B-cell lymphoproliferative disorder with marked male predominance. Our aim was to identify key risk factors for HCL. METHODS: A pooled analysis of individual-level data for 154 histologically confirmed HCL cases and 8834 controls from five case-control studies, conducted in Europe and Australia, was undertaken. Age-, race and/or ethnicity-, sex-, and study-adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression. RESULTS: The usual patterns for age and sex in HCL were observed, with a median age of 55 years and sex ratio of 3.7 males to females. Cigarette smoking was inversely associated with HCL (OR = 0.51, 95% CI = 0.37 to 0.71) with dose-response relationships observed for duration, frequency, and lifetime cigarette smoking (P(trend) < .001). In contrast, occupation as a farmer was positively associated with HCL (OR = 2.34, 95% CI = 1.36 to 4.01), with a dose-response relationship observed for duration (OR = 1.82, 95% CI = 0.85 to 3.88 for ≤ 10 years vs never; and OR = 2.98, 95% CI = 1.50 to 5.93 for >10 years vs never; P(trend) = .025). Adult height was also positively associated with HCL (OR = 2.69, 95% CI = 1.39 to 5.29 for upper vs lower quartile of height). The observed associations remained consistent in multivariate analysis. CONCLUSIONS: Our observations of an increased risk of HCL from farming exposures and decreased risk from smoking exposures, independent of one another, support a multifactorial origin and an etiological specificity of HCL compared with other non-Hodgkin lymphoma subtypes. The positive association with height is a novel finding that needs replication.


Asunto(s)
Leucemia de Células Pilosas/epidemiología , Leucemia de Células Pilosas/etiología , Estilo de Vida , Exposición Profesional , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Australia/etnología , Estudios de Casos y Controles , Comorbilidad , Europa (Continente)/epidemiología , Europa (Continente)/etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , América del Norte/epidemiología , América del Norte/etnología , Oportunidad Relativa , Factores de Riesgo , Factores Sexuales , Adulto Joven
20.
J Neuroeng Rehabil ; 11: 105, 2014 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-24981060

RESUMEN

BACKGROUND: Functional electrical stimulation (FES) during repetitive practice of everyday tasks can facilitate recovery of upper limb function following stroke. Reduction in impairment is strongly associated with how closely FES assists performance, with advanced iterative learning control (ILC) technology providing precise upper-limb assistance. The aim of this study is to investigate the feasibility of extending ILC technology to control FES of three muscle groups in the upper limb to facilitate functional motor recovery post-stroke. METHODS: Five stroke participants with established hemiplegia undertook eighteen intervention sessions, each of one hour duration. During each session FES was applied to the anterior deltoid, triceps, and wrist/finger extensors to assist performance of functional tasks with real-objects, including closing a drawer and pressing a light switch. Advanced model-based ILC controllers used kinematic data from previous attempts at each task to update the FES applied to each muscle on the subsequent trial. This produced stimulation profiles that facilitated accurate completion of each task while encouraging voluntary effort by the participant. Kinematic data were collected using a Microsoft Kinect, and mechanical arm support was provided by a SaeboMAS. Participants completed Fugl-Meyer and Action Research Arm Test clinical assessments pre- and post-intervention, as well as FES-unassisted tasks during each intervention session. RESULTS: Fugl-Meyer and Action Research Arm Test scores both significantly improved from pre- to post-intervention by 4.4 points. Improvements were also found in FES-unassisted performance, and the amount of arm support required to successfully perform the tasks was reduced. CONCLUSIONS: This feasibility study indicates that technology comprising low-cost hardware fused with advanced FES controllers accurately assists upper limb movement and may reduce upper limb impairments following stroke.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Recuperación de la Función , Rehabilitación de Accidente Cerebrovascular , Extremidad Superior/fisiopatología , Adulto , Fenómenos Biomecánicos , Codo/fisiopatología , Estudios de Factibilidad , Femenino , Hemiplejía/etiología , Hemiplejía/fisiopatología , Hemiplejía/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Hombro/fisiopatología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Muñeca/fisiopatología
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