Feasibility and Safety of Sequential Transcranial Direct Current Stimulation and Physical Therapy in Older Adults at Risk of Falling: A Randomized Pilot Study.

Objective: To establish the feasibility and safety of administering transcranial direct current stimulation (tDCS) immediately prior to physical therapy (PT) sessions in older adults at risk of falls. Design: A pilot randomized controlled study. Setting: Outpatient geriatric physical therapy clinic. Participants: Ten older adults living within supportive housing facilities (86.8±7.9 y/o, 8F) were enrolled in the study. Interventions: Participants received tDCS or sham stimulation targeting the left dorsal lateral prefrontal cortex for 20 minutes, immediately prior to up to 10 of their PT visits. Main Outcome Measures: Feasibility, safety, and functional outcomes were reported to inform the design of a larger and more definitive trial. Results: Six fallers (88.8±5.0 y/o, 5F) completed the study and received 82.3% of the possible stimulation sessions, suggesting adding a 20-minute session of stimulation immediately prior to PT training sessions, along with pre- and post-assessments is feasible. The blinding strategy was successful and all reported side effects were expected and transient. While feasible and safe, the trial was met with numerous challenges, including selection bias, time and energy commitment, and large variation in functional performance, that must be considered when designing and implementing larger more definitive trials. Conclusion: This study provides preliminary evidence about the feasibility, safety, and challenges to combine PT and tDCS in very frail older adults.

Effects of a safe patient handling and mobility program on patient self-care outcomes.

OBJECTIVE. The aim of this study was to determine the effect of a safe patient handling and mobility (SPHM) program on patient self-care outcomes. METHOD. We used a retrospective cohort design. Data were obtained from the electronic medical records of 1,292 patients receiving inpatient rehabilitation services. Self-care scores from the FIM™ for patients who participated in rehabilitation before implementation of an SPHM program were compared with the scores of patients who participated after implementation of the program. RESULTS. Patients who received inpatient rehabilitation services with an SPHM program were as likely to achieve at least modified independence in self-care as those who received inpatient rehabilitation services without an SPHM program. CONCLUSION. SPHM programs may not affect self-care performance in adults receiving inpatient rehabilitation services. However, more work must be done to define specific and effective methods for integrating patient handling technologies into occupational therapy practice.

Effect of a safe patient handling program on rehabilitation outcomes.

OBJECTIVE: To evaluate the effect of a safe patient handling (SPH) program on rehabilitation mobility outcomes. DESIGN: Retrospective cohort study. SETTING: A rehabilitation unit in a hospital system. PARTICIPANTS: Consecutive patients (N=1291) over a 1-year period without an SPH program in place (n=507) and consecutive patients over a 1-year period with an SPH program in place (n=784). INTERVENTIONS: The SPH program consisted of administrative policies and patient handling technologies. The policies limited manual patient handling. Equipment included ceiling- and floor-based dependent lifts, sit-to-stand assists, ambulation aides, friction-reducing devices, motorized hospital beds and shower chairs, and multihandled gait belts. MAIN OUTCOME MEASURES: The mobility subscale of the FIM. RESULTS: Patients rehabilitated in the group with SPH achieved similar outcomes to patients rehabilitated in the group without SPH. A significant difference between groups was noted for patients with initial mobility FIM scores of 15.1 and higher after controlling for initial mobility FIM score, age, length of stay, and diagnosis. Those patients performed better with SPH. CONCLUSIONS: SPH programs do not appear to inhibit recovery. Fears among therapists that the use of equipment may lead to dependence may be unfounded.

Safe-patient-handling equipment in therapy practice: implications for rehabilitation.

OBJECTIVE: To determine how safe-patient-handling (SPH) equipment is used in rehabilitation and how it affects therapists, patients, and therapy practice. METHOD: We used a qualitative, instrumental case study design. Thirty-five occupational and physical therapist practitioners from three facilities participated in the study. RESULTS: Therapists reported a broad range of applications for equipment (e.g., functional mobility and neuromusculoskeletal function). They reported that SPH equipment increased treatment options for therapists and increased participation options for patients, although equipment limitations exist. Three themes emerged from the analysis: choice, potential, and safety. CONCLUSION: SPH equipment has therapeutic applications in rehabilitation, especially for medically complex or bariatric patients. Therapists in this study engaged in a highly individualized, complex process of decision making when selecting and using SPH devices in rehabilitation. More research to refine and test therapeutic uses is necessary.