Increasing the delivery of upper limb constraint-induced movement therapy programs for stroke and brain injury survivors: evaluation of the ACTIveARM project.

PURPOSE: To increase the number of constraint-induced movement therapy (CIMT) programs provided by rehabilitation services. METHODS: A before-and-after implementation study involving nine rehabilitation services. The implementation package to help change practice included file audit-feedback cycles, 2-day workshops, poster reminders, a community-of-practice and drop-in support. File audits were conducted at baseline, every three months for 1.5 years, and once after support ceased to evaluate maintenance of change. CIMT participant outcomes were collected to evaluate CIMT effectiveness and maintenance (Action Research Arm Test and Motor Activity Log). Staff focus groups explored factors influencing CIMT delivery. RESULTS: CIMT adoption improved from baseline where only 2% of eligible people were offered and/or received CIMT (n = 408 files) to more than 50% over 1.5 years post-implementation (n = 792 files, 52% to 73% offered CIMT, 27%-46% received CIMT). Changes were maintained at 6-month follow-up (n = 172 files, 56% offered CIMT, 40% received CIMT). CIMT participants (n = 74) demonstrated clinically significant improvements in arm function and occupational performance. Factors influencing adoption included interdisciplinary collaboration, patient support needs, intervention adaptations, a need for continued training, and clinician support. CONCLUSIONS: The implementation package helped therapists overcome an evidence-practice gap and deliver CIMT more routinely.

Constraint induced movement therapy (CIMT) is a highly effective intervention for arm recovery after acquired brain injury, recommended in multiple clinical practice guidelines yet delivery of CIMT in practice remains rare.A multifaceted implementation package including clinician training workshops, a community of practice, drop in support and regular audit and feedback cycles improved delivery of CIMT programs in practice by neurorehabilitation teams.Stroke survivors and people with brain injury who received a CIMT program in usual practice demonstrated clinically important improvements in arm function, dexterity and occupational performance.

DreamCoder: growing generalizable, interpretable knowledge with wake-sleep Bayesian program learning.

Expert problem-solving is driven by powerful languages for thinking about problems and their solutions. Acquiring expertise means learning these languages-systems of concepts, alongside the skills to use them. We present DreamCoder, a system that learns to solve problems by writing programs. It builds expertise by creating domain-specific programming languages for expressing domain concepts, together with neural networks to guide the search for programs within these languages. A 'wake-sleep' learning algorithm alternately extends the language with new symbolic abstractions and trains the neural network on imagined and replayed problems. DreamCoder solves both classic inductive programming tasks and creative tasks such as drawing pictures and building scenes. It rediscovers the basics of modern functional programming, vector algebra and classical physics, including Newton's and Coulomb's laws. Concepts are built compositionally from those learned earlier, yielding multilayered symbolic representations that are interpretable and transferrable to new tasks, while still growing scalably and flexibly with experience. This article is part of a discussion meeting issue 'Cognitive artificial intelligence'.

A self-contained fully-enclosed microfluidic cartridge for lab on a chip.

We describe a self-contained fully-enclosed cartridge for lab-on-a-chip applications where sample and reagents can be applied sequentially as is performed in a heterogeneous immunoassay, or nucleic acid extraction. Both the self-contained and fully-enclosed features of the cartridge are sought to ensure its safe use in the field by unskilled staff. Simplicity in cartridge design and operation is obtained via adopting a valveless concept whereby reagents are stored and used in the form of liquid plugs isolated by air spacers around a fluidic loop. Functional components integrated in the loop include a microfluidic chip specific to the target application, a novel peristaltic pump to displace the liquid plugs, and a pair of removable tubing segments where one is used to introduce biological sample and while the other is to collect eluant. The novel pump is fabricated through soft-lithography technique and works by pinching a planar channel under stainless-steel ball bearings that have been magnetically loaded. The utility of the cartridge is demonstrated for automated extraction and purification of nucleic acids (DNA) from a cell lysate on a battery-operated portable system. The cartridge shown here can be further extended to sample-in-answer-out diagnostic tests.