RESUMO
BACKGROUND: Stroke sequelae can have an impact on daily life activities such as driving. French legislation stipulates that post-stroke patients should undergo a multi-professional fitness-to-drive assessment before being allowed to drive again. This retrospective study aims to explore the determinants of multi-professional fitness-to-drive recommendations. METHODS: Sixty-six post-stroke patients assessed for fitness to drive in the Kerpape Center, France in 2019 were included. Favorable or unfavorable driving recommendations were attributed to patients following a joint decision by a multi-professional team. Individual characteristics obtained from medical records were compared. RESULTS: Findings showed that 64% of stroke patients received a favorable fitness-to-drive recommendation. Across all demographic, clinical, and driving characteristics, the time interval between stroke and assessment was significantly longer for patients designated as unfit to drive than for those designated as fit to drive (P = .004). Furthermore, the proportion of instrumental sequelae was higher in patients designated as unfit to drive than in those designated as fit to drive (P = .022). Stepwise logistic regression showed that the presence of instrumental sequelae, mainly aphasia, was the best predictor of fitness-to-drive recommendations. CONCLUSIONS: The post-stroke time interval and the presence of instrumental sequelae explained the difference between patients recommended as fit-to-drive and unfit-to-drive. Furthermore, aphasia was found be the best predictor of a fitness-to-drive recommendation. It is possible that aphasia impacts the understanding of instructions during on-road testing. These findings emphasize the need for a standardized multi-professional fitness-to-drive assessment, since the determinants of fitness-to-drive recommendation differ between studies.
Assuntos
Condução de Veículo , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Estudos Retrospectivos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Fatores de Tempo , Idoso de 80 Anos ou mais , França , Estado Funcional , Equipe de Assistência ao Paciente , Avaliação da Deficiência , Fatores de RiscoRESUMO
Assistive devices are designed to enhance individuals with disabilities' functional abilities. The rise of 3D printing technology enabled the production of individualized assistive devices (IADs). A REHAB-LAB is intended for IAD provision involving technical referents and occupational therapists. This study aimed to develop the REHAB-LAB logic model; to explore its fidelity and desirability; and to explore the characteristics of arising initiatives of IAD production. The REHAB-LAB logic model development involved stakeholders throughout the research process. A pragmatic multimethod approach followed two phases 1) logic model development and 2) exploration of its fidelity and desirability. The REHAB-LAB logic model presented the resources (equipment, space, human) required to implement IAD provision in a rehabilitation center, and the expected deliverables (activities and outputs). The REHAB-LAB logic model highlights the interdisciplinarity of IAD provision including occupational therapists, doctors, engineers, managers, and technical referents and places the users at the center of the IAD production. Results confirmed the fidelity and desirability of the REHAB-LAB logic model. The REHAB-LAB logic model can be used as a reference for future healthcare organizations wishing to implement an IAD provision. This research highlighted the interest of IAD provision based on the REHAB-LAB model involving users and transdisciplinary practices.
Assuntos
Pessoas com Deficiência , Tecnologia Assistiva , Humanos , Pessoas com Deficiência/reabilitação , Atividades CotidianasRESUMO
OBJECTIVES: To explore: (i) relationships between power wheelchair performance, confidence, mobility and the severity of user's cognitive impairment; (ii) relationships between cognitive functioning and power wheelchair performance, confidence and mobility; and (iii) how cognitive scores influence power wheelchair performance, confidence and mobility. DESIGN: Cross-sectional exploratory study. SUBJECTS: Independent power wheelchair users; ≥18 years. OUTCOME MEASURES: Cognitive assessments (Montreal Cognitive Assessment, Motor-Free Visual Perception Test, and Dysexecutive Questionnaire) and power wheelchair driving assessments (Power mobility Indoor Driving Assessment, Wheelchair-Skills-Test-Questionnaire, and Life-Space Assessment). Analyses were completed using multivariate analysis of variance and principal component analysis. RESULTS: There were a total of 30 participants (with a mean (SD) age of 58 (15) years, who had a mean (SD) of 3 (6.2) years of experience of power wheelchair use, (SD) and a mean score of 22 (5 on) the Montreal Cognitive Assessment. There were statistically significant differences in all power wheelchair driving assessments, depending on the severity of cognitive impairment (moderate, p = 0.009; mild, p = <0.001; none, p = 0.009). The first principal component suggested that cognitive functioning, visual perception, and performance explained 69% of the variability in the first principle componenent. The second and third principal components suggested that confidence and the built and social environments also played significant roles in power wheelchair use. CONCLUSION: There are correlations between cognitive functioning and power wheelchair use in experienced users, with the severity of cognitive impairment influencing power wheelchair driving outcomes.
Assuntos
Pessoas com Deficiência , Cadeiras de Rodas , Cognição , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
STUDY DESIGN: Prospective, open label, observational. OBJECTIVES: To present results of the first clinical study on a newly developed robotic exoskeleton (Atalante®, Wandercraft, Paris, France) that enables individuals with spinal cord injury (SCI) to perform ambulatory functions without technical aids. SETTING: Two sites specialized in SCI rehabilitation, France. METHODS: Inclusion criteria were presence of chronic complete SCI (AIS A) ranging from T5 to T12. The study protocol included 12 one-hour training sessions during 3 weeks. Patients walked on floor with robotic assistance and wore a harness connected to a mobile suspension system (without weight-bearing) to prevent from falling. Main outcome was the ability to walk 10 meters unassisted, secondary outcomes were assessment of other ambulatory functions, bladder and bowel functions, pain and spasticity. RESULTS: Twelve patients were enrolled, and 11 completed the protocol, mean age 33,9 years. Six patients had T6 levels of lesion or above. Seven patients passed the 10mWT at the 12th session unassisted (mean walking speed 0.13 m/s) while four required some human help. All patients succeeded at the other ambulatory tests (stand-up, sit-down, balance, turn). There were no significant change for bladder (Qualiveen) or bowel (NBD) functions, neuropathic pain (NPSI, NPRS), yet five patients reported a subjective improvement of their bowel function. Impact on spasticity was variable depending on the muscle examined (Ashworth). Ischial skin erosion was seen in one patient that needed local dressing. CONCLUSION: The Atalante system is safe and enables to perform ambulatory functions in patients with complete SCI.
Assuntos
Exoesqueleto Energizado , Robótica , Traumatismos da Medula Espinal , Humanos , Estudos Prospectivos , CaminhadaRESUMO
Balance disorders after stroke have a particularly detrimental influence on recovery of autonomy and walking. The present study is aimed at assessing the effect of proprioceptive stimulation by neck muscle vibration (NMV) on the balance of patients with right hemispheric lesion (RHL) and left hemispheric lesion (LHL). Thirty-one (31) patients (15 RHL and 16 LHL), mean age 61.5 years (±10.6), mean delay 3.1 (±1.6) months after one hemispheric stroke were included in this prospective study. The mean position in mediolateral and anteroposterior plane of the CoP (center of pressure) and the surface were evaluated using a force platform at rest and immediately after 10 min of vibration on the contralesional dorsal neck muscle. NMV decreases the lateral deviation balance induced by the stroke. Twenty patients (64.5 %) experienced a visual illusion of light spot moving toward the side opposite stimulus. These patients showed more improvement by vibration than those without visual illusion. There was an interaction between sensitivity and side of stroke on the effect of NMV. Proprioceptive stimulation by NMV reduces postural asymmetry after stroke. This short-term effect of the vibration is more effective in patients susceptible to visual illusion. This result was consistent with a central effect of NMV on the structures involved in the elaboration of perception of body in space.
Assuntos
Ilusões/fisiologia , Músculos do Pescoço/fisiologia , Equilíbrio Postural/fisiologia , Propriocepção/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Vibração/uso terapêutico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos do Pescoço/fisiopatologia , Estudos Prospectivos , Reabilitação do Acidente Vascular CerebralRESUMO
The evolution of a patient suffering from a serious head injury can require the placement of a tracheotomy. This helps with respirator weaning and usually enables the patient to be moved from the neurosurgical intensive care ward to the neurosurgery ward. Patients fitted with a tracheotomy will therefore be cared for by post-intensive care neurological rehabilitation departments.