Increased physiotherapy capacity reduces duration of tracheostomy in situ, reduces hospital length of stay and improves functional outcomes for people with an acquired brain injury (ABI): a service review.

PURPOSE: To assess the impact of increased physiotherapy capacity in an acute regional Neurosurgery Centre on outcomes for people with an acquired brain injury (ABI) requiring a tracheostomy. MATERIALS AND METHODS: A service review of patients undergoing active tracheostomy weaning, admitted over two 15-week time periods; normal physiotherapy staffing with enhanced physiotherapy staffing. RESULTS: With a 50% increase in staffing, physiotherapy rehabilitation sessions increased from 2 to 4 times weekly. A mean improvement was found for patient outcomes; time with a tracheostomy in situ reduced by 11 days and the length of hospital stay reduced by 19 days. Functional status on discharge also improved, with 33% of patients able to mobilise on discharge with normal staffing levels and 77% of patients able to mobilise on discharge with enhanced staffing levels. CONCLUSION: A temporary increase in physiotherapy capacity gave the opportunity to evaluate the impact on physiotherapy rehabilitation frequency and patient outcomes. Results demonstrate the positive impact for this complex patient group on outcomes including rehabilitation frequency, length of stay, time to decannulation, and functional status on discharge. Early access to high-frequency specialist physiotherapy rehabilitation is a critical component of improving functional independence in people with an ABI requiring a tracheostomy.IMPLICATIONS FOR REHABILITATIONIncreasing the capacity of specialist neurological physiotherapy treatment within this healthcare setting for people who have acquired a brain injury and require tracheostomy intervention may have a significant impact for patients and the NHS.Service improvement projects that use rigorous research methodology produce outcomes and evaluations that are robust and reliable.Supporting health and care professionals to use research methods within service improvement projects exposes them to the value of embedding research within their clinical environments.

Effect of using a structured pacing protocol on post-exertional symptom exacerbation and health status in a longitudinal cohort with the post-COVID-19 syndrome.

Post-exertional symptom exacerbation (PESE) is a characteristic symptom of post-COVID syndrome (PCS). This prospective study investigated the effect of a 6-week structured World Health Organization (WHO) Borg CR-10 5-phase pacing protocol on PESE episodes and quality of life in a cohort of individuals with long-standing PCS (average duration of symptoms was 17 months). Participants received weekly telephone calls with a clinician to complete the Leeds PESE questionnaire (LPQ) and identify the appropriate phase of the pacing protocol. EQ-5D 5L was completed at the intervention's beginning and end to measure overall health. Thirty-one participants completed the 6-week protocol, with a statistically and clinically significant reduction in the average number of PESE episodes (from 3.4 episodes in Week 1 to 1.1 in Week 6), with an average decrease of 16% (95% CI: 9%-24%; p < 0.001) each week, and reduction across all three exertional triggers (physical, cognitive, and emotional). Physical activity levels showed moderate improvements during the intervention period. Mean EQ-5D 5L scores improved from 51.4 to 60.6 points (paired difference of 9.2 points, 95% CI: 3.2-15.2 points; p = 0.004). A structured pacing protocol significantly reduces PESE episodes and improves overall health in PCS.

A Mixed-Methods Evaluation of a Virtual Rehabilitation Program for Self-Management in Post-COVID-19 Syndrome (Long COVID).

Long COVID (LC) symptoms can be long standing, diverse and debilitating; comprehensive multidisciplinary rehabilitation programs are required to address this. A 10-week LC Virtual Rehabilitation Program (VRP) was developed to provide early education and self-management techniques to address the main symptoms of LC and was delivered to a group of persons with Long COVID (PwLC) online, facilitated by members of the multi-disciplinary rehabilitation team. This paper describes an evaluation of this VRP. Questionnaires completed by Healthcare Professionals (HCP) delivering the VRP were thematically analyzed to gain a priori themes and design semi-structured telephone interview questions for PwLC. Template analysis (TA) was used to analyze interview data. Routinely collected patient demographics and service data were also examined. Seventeen HCP survey responses were obtained and 38 PwLC telephone questionnaires were completed. The HCP interviews generated three a priori themes (1. Attendance and Availability, 2. Content, 3. Use of Digital Technology). TA was applied and three further themes emerged from the combined HCP and PwLC responses (4. Group Dynamics, 5. Individual Factors, 6. Internal Change). Key outcomes demonstrated that: the VRP was highly valued; digital delivery enabled self-management; barriers to attendance included work/life balance, use of technology, health inequalities; and LC was poorly understood by employers. Recommendations are provided for the design of VRPs for LC.

The modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) patient-reported outcome measure for Long Covid or Post-COVID-19 syndrome.

BACKGROUND: The C19-YRS is the literature's first condition-specific, validated scale for patient assessment and monitoring in Post-COVID-19 syndrome (PCS). The 22-item scale's subscales (scores) are symptom severity (0-100), functional disability (0-50), additional symptoms (0-60), and overall health (0-10). OBJECTIVES: This study aimed to test the scale's psychometric properties using Rasch analysis and modify the scale based on analysis findings, emerging information on essential PCS symptoms, and feedback from a working group of patients and professionals. METHODS: Data from 370 PCS patients were assessed using a Rasch Measurement Theory framework to test model fit, local dependency, response category functioning, differential item functioning, targeting, reliability, and unidimensionality. The working group undertook iterative changes to the scale based on the psychometric results and including essential symptoms. RESULTS: Symptom severity and functional disability subscales showed good targeting and reliability. Post hoc rescoring suggested that a 4-point response category structure would be more appropriate than an 11-point response for both subscales. Symptoms with binary responses were placed in the other symptoms subscale. The overall health single-item subscale remained unchanged. CONCLUSION: A 17-item C19-YRSm was developed with subscales (scores): symptom severity (0-30), functional disability (0-15), other symptoms (0-25), and overall health (0-10).

The COVID-19 Yorkshire Rehabilitation Scale (C19-YRS): Application and psychometric analysis in a post-COVID-19 syndrome cohort.

As our understanding of the nature and prevalence of post-coronavirus disease 2019 (COVID-19) syndrome (PCS) is increasing, a measure of the impact of COVID-19 could provide valuable insights into patients' perceptions in clinical trials and epidemiological studies as well as routine clinical practice. To evaluate the clinical usefulness and psychometric properties of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) in patients with PCS, a prospective, observational study of 187 consecutive patients attending a post-COVID-19 rehabilitation clinic was conducted. The C19-YRS was used to record patients' symptoms, functioning, and disability. A global health question was used to measure the overall impact of PCS on health. Classical psychometric methods (data quality, scaling assumptions, targeting, reliability, and validity) were used to assess the C19-YRS. For the total group, missing data were low, scaling and targeting assumptions were satisfied, and internal consistency was high (Cronbach's α = 0.891). Relationships between the overall perception of health and patients' reports of symptoms, functioning, and disability demonstrated good concordance. This is the first study to examine the psychometric properties of an outcome measure in patients with PCS. In this sample of patients, the C19-YRS was clinically useful and satisfied standard psychometric criteria, providing preliminary evidence of its suitability as a measure of PCS.

Culturally Relevant Pedagogy and Applied Behavior Analysis: Addressing Educational Disparities in PK-12 Schools.

The purpose of this article is to describe the theory of culturally relevant pedagogy (CRP) and its application to PK-12 education for behavior analysts working in schools. CRP is an educational framework that asserts that successful teachers of African American students help their students gain three repertoires: (1) sociopolitical awareness, (2) cultural competence, and (3) academic excellence. The CRP framework was designed to counter the effects that racial bias has on the academic and disciplinary experiences of some students of color. This article suggests that applied behavior analysis and CRP, when used together, may strengthen educators' efforts to reduce the effects of racism that some students of color experience. The authors first explain the tenets of CRP based on the work of Ladson-Billings (1995a, 1995b). Next, points of convergence between ABA and CRP are described. Finally, the authors offer recommendations for behavior analysts to consider when applying CRP in schools through the provision of examples of strategies and tactics derived from the behavioral literature that align with the CRP framework. The framework presented in this article has implications for behavior analysts interested in applying culturally relevant practices to their work as educators.

Guidelines for psychological practice for people with low-income and economic marginalization: Executive summary.

This is a summary of the guidelines for working with low-income and economically marginalized (LIEM) people developed by the American Psychological Association (APA) task force and approved by the APA Council of Representatives. The task force, consisting of psychologists from a range of psychological specialties and both practice and educational settings, created guidelines in four main categories: Education and Training, Health Disparities, Treatment Considerations, and Career Concerns and Unemployment. Each category includes specific guidelines and recommended interventions. Further, the task force identified two major assumptions that cut across all of the recommendations: (1) The intersection of economic status and other identities is critical to psychological and other aspects of health, and (2) biases and stigma exacerbate the negative experiences of living with LIEM, and must be acknowledged and confronted by psychologists and trainees. Many of the guidelines and corollary interventions reinforce the need for psychologists and trainees to engage in activities that increase their own self-awareness and knowledge of issues and concerns that are exacerbated by economic marginalization, as well as challenge their own implicit and explicit biases related to social class and poverty. The impact of economic marginalization on education, health, and career attainment are addressed, and adaptations to psychological interventions are recommended. The task force concludes with a call to engage psychologists in action that seeks and promotes economic justice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Multidisciplinary NHS COVID-19 Service to Manage Post-COVID-19 Syndrome in the Community.

The National Institute for Health and Care Excellence (NICE) describe "post COVID-19 syndrome" or "Long COVID" as a set of persistent physical, cognitive and/or psychological symptoms that continue for more than 12 weeks after illness and which are not explained by an alternative diagnosis. These symptoms are experienced not only by patients discharged from hospital but also those in the community who did not require inpatient care. To support the recovery of this group of people, a unique integrated rehabilitation pathway was developed following extensive service evaluations by Leeds Primary Care Services, Leeds Community Healthcare NHS Trust and Leeds Teaching Hospital NHS Trust. The pathway aligns itself to the NHS England "Five-point plan" to embed post-COVID-19 syndrome assessment clinics across England, supporting the comprehensive medical assessment and rehabilitation intervention for patients in the community. The pathway was first of its kind to be set up in the UK and comprises of a three-tier service model (level 1: specialist MDT service, level 2: community therapy teams and level 3: self-management). The MDT service brings together various disciplines with specialist skill sets to provide targeted individualized interventions using a specific core set of outcome measures including C19-YRS (Yorkshire Rehabilitation Scale). Community and primary care teams worldwide need such an integrated multidisciplinary comprehensive model of care to deal with the growing number of cases of post-COVID-19 syndrome effectively and in a timely manner.

A Proposal for Multidisciplinary Tele-Rehabilitation in the Assessment and Rehabilitation of COVID-19 Survivors.

A global pandemic of a new highly contagious disease called COVID-19 resulting from coronavirus (severe acute respiratory syndrome (SARS)-Cov-2) infection was declared in February 2020. Though primarily transmitted through the respiratory system, other organ systems in the body can be affected. Twenty percent of those affected require hospitalization with mechanical ventilation in severe cases. About half of the disease survivors have residual functional deficits that require multidisciplinary specialist rehabilitation. The workforce to deliver the required rehabilitation input is beyond the capacity of existing community services. Strict medical follow-up guidelines to monitor these patients mandate scheduled reviews within 12 weeks post discharge. Due to the restricted timeframe for these events to occur, existing care pathway are unlikely to be able to meet the demand. An innovative integrated post-discharge care pathway to facilitate follow up by acute medical teams (respiratory and intensive care) and a specialist multidisciplinary rehabilitation team is hereby proposed. Such a pathway will enable the monitoring and provision of comprehensive medical assessments and multidisciplinary rehabilitation. This paper proposes that a model of tele-rehabilitation is integrated within the pathway by using digital communication technology to offer quick remote assessment and efficient therapy delivery to these patients. Tele-rehabilitation offers a quick and effective option to respond to the specialist rehabilitation needs of COVID-19 survivors following hospital discharge.

A Descriptive Analysis of Applied Behavior Analysis Research With Economically Disadvantaged Children.

In the United States, approximately 43% of children under age 18 are considered economically disadvantaged. Research suggests that these children are at a greater risk for academic underperformance and dropping out of school than their peers who are not from economically disadvantaged backgrounds. As such, they may need effective educational interventions to improve their academic performance. The purpose of the current article is to describe the degree to which economically disadvantaged children are included in educational research in behavioral journals. Ninety-four studies were analyzed to determine the publication trends between 1968 and 2017. Studies were scored and categorized based on journal; publication year; several demographic characteristics for participants including age, income status, and disability diagnosis; and research designs, interventions, and target behaviors. Results suggest that economically disadvantaged children are increasingly included in behavior-analytic literature. However, there are opportunities for research with English language learners and children with disabilities. Implications for practice and research are discussed.

Association Between Proton Pump Inhibitor Exposure and Clostridium difficile Infection in Elderly, Hospitalized Patients.

This study did not find a statistically significant association between Clostridium difficile infections and use of proton pump inhibitors.

The reliability of the Leeds Movement Performance Index (LMPI): a new tool for neurological physiotherapy.

BACKGROUND: Measuring movement performance in people with neurological damage requires a tool that reflects physiotherapy assessment and clinical reasoning. The Leeds Movement Performance Index (LMPI) was previously developed by a group of neurological physiotherapists to fulfill these requirements. OBJECTIVE: To assess the reliability of the LMPI for use in neurological physiotherapy practice. METHODS: Twelve senior neurological physiotherapists were trained to use the LMPI and then asked to measure the movement performance of five patients whose movement had been previously video-recorded for this purpose. A retest session was completed after two weeks. Data were analysed to establish internal and external reliability. RESULTS: Internal reliability was assessed using Cronbach's alpha coefficient, applied to the entire scale (0.862) and to each item (range 0.795-0.892). External (inter-rater) reliability was assessed by a calculation of the intraclass correlation coefficient for scores awarded by multiple raters (0.959), with individual item reliability ranging from 0.874 to 0.968. External (test-retest) reliability was assessed by calculating the Spearman's rank correlation coefficient between scores obtained on two testing occasions (0.792) with values of individual items ranging from 0.397 to 0.674. A variance components analysis partitioned variance into components arising from between-patient variability (55.2%) between-therapist variability (7.8%) and between-testing variability (2.8%). CONCLUSIONS: RESULTS indicate that the LMPI is a reliable measurement tool when used by senior neurological physiotherapists.

Reducing palilalia by presenting tact corrections to young children with autism.

Palilalia, the delayed repetition of words or phrases, occurs frequently among individuals with autism and developmental disabilities. The current study used a combined multiple baseline and reversal design to investigate the effectiveness of presenting tacts as corrections for palilalia. During baseline, five preschoolers with autism emitted high rates of palilalia and low rates of mands and tacts during play and instructional activities. During treatment, when experimenters presented opportunities to echoically tact actions and objects following the emission of palilalia, its frequency decreased to low and stable levels and mands and tacts increased. Functional relationships between the tact corrections and emissions of palilalia, mands, and tacts were established during reversals to baseline and treatment conditions. Similar trends in responding were found for frequency of palilalia, mands, and tacts in non-treatment settings.

Generalized imitation and the mand: inducing first instances of speech in young children with autism.

It has been suggested that the use of a generalized motor imitation sequence before a vocal model may be an effective procedure for teaching nonvocal children with autism to speak. However, the tactic has rarely been empirically demonstrated. The purpose of this experiment was to test the effects of presenting a rapid generalized motor imitation sequence before an opportunity to imitate on the vocal speech of nonvocal children with autism. Participants emitted no vocal imitations during a mand training baseline. During the intervention, a rapid motor imitation sequence was presented before an opportunity to imitate a model's vocalizations. The teacher's presentation of the rapid motor imitation sequence was then faded by presenting an opportunity to vocally imitate without the sequence followed by an opportunity to independently mand. Results of the intervention phase indicated that all of the participants began to vocalize with the generalized motor imitation sequence and that mands were maintained during a follow-up phase and 3-month follow-up probes.