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1.
J Bodyw Mov Ther ; 28: 341-347, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34776162

RESUMO

BACKGROUND: Despite proven health benefits of regular participation in physical activities (PA), adults with stroke fail to achieve recommended levels of PA. Sports being an enjoyable activity is more likely to encourage participation. Therefore, the objectives of the present study are i) to develop and test the feasibility of adaptive sports for promoting PA and Quality of Life (QoL) in community-dwelling adults with stroke, and ii) to explore the participants perception and experiences of playing adaptive sports. METHODS: Two focus groups were conducted among the eight experts and a person with stroke to develop adaptive sports. To test the feasibility of these adaptive sports, in a multi methods study eighteen community dwelling adults with stroke were recruited. Participants played adaptive sports twice a week for two months in a community center. Participants pre and post intervention PA levels and QoL were measured. Participants were also interviewed at the end of the program to explore their experiences of participation in adaptive sports. RESULTS: At the end of the program retention rate of the participants was 83.33% and there was a significant improvement in PA levels, while the improvement in QoL was not statistically significant. Participants expressed positive experience with the program. There were no adverse events during or after the participation. Health benefits, fitness, and fun were reported as facilitators, while lack of access to the sporting facility and lack of caregiver support were reported as barriers to participation. CONCLUSION: Adaptive sports appear to be safe, feasible, and well accepted by the adults with stroke.

2.
Disabil Rehabil ; : 1-14, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666575

RESUMO

PURPOSE: The objective of this scoping review was to get an overview of barriers emerging across the globe from the pandemic that are likely to increase the level of pre-existing disability status of neurologically challenged populations. METHODS: Database searches (PubMed/MEDLINE, CINAHL, ProQuest, Ovid, Scopus, and Web of Science) updated to December 2020 were conducted. Articles that identified challenges or barriers to neuro-rehabilitation, impact on disability status and health care services were included. Full-text articles limited to the English language with no restrictions on study design were included. Data was synthesized based on recurrent themes that were identified. RESULTS: Thirty-seven studies were included in this review. Neurological populations considered: stroke, multiple sclerosis, amyotrophic lateral sclerosis, parkinson's disease, autism, developmental disabilities, and those who required neurosurgical care. Barriers were grouped into categories as increased disease risk and complications, delayed or restricted access to neuro-rehabilitation, limited hospital access, telerehabilitation limitations, and shutdown of special centers of aid. CONCLUSIONS: COVID-19 pandemic has given rise to barriers that affect almost every aspect of healthcare and rehabilitation in neurologically challenged populations prompting an increase in their disability level. This can assist policymakers in designing mitigation strategies to minimize the detrimental effects on this vulnerable population.Implications for rehabilitationPandemic has led to the worsening of existing motor and non-motor symptoms, which need to be monitored, assessed and managed medically, and through rehabilitation in neurologically challenged populations.Notable decline of cognition and physical activity in neurologically challenged populations needs to be assessed and efforts to reverse these outcomes should be attempted.Rehabilitation services, hospital care and centers of aid need to be made more accessible for neurologically challenged populations with COVID-19 precautionary measures.Telemedicine and telerehabilitation need to be upgraded to enhance further face to face like interactions and for tracking of progressive disease.

3.
NeuroRehabilitation ; 48(4): 505-512, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33967067

RESUMO

BACKGROUND: Independent mobility is the most important determinant of quality of life after stroke and it is vital that training aimed at restoration of gait is based on contemporary evidence. Despite several practice guidelines for gait rehabilitation after stroke existing globally, their feasibility of application in low-resource settings is often questionable. OBJECTIVE: To investigate the current practices in gait training among Indian physiotherapists involved in the rehabilitation of stroke survivors. METHODS: A questionnaire on the various aspects of gait training was developed and the content was validated by experts. The survey was made available online and distributed among Indian physiotherapists working in the field of stroke rehabilitation, using snowball sampling. Frequency distribution was used to summarize responses to each component of the questionnaire. RESULTS: Responses were obtained from 250 practicing physiotherapists. The majority of the respondents (55%) reported that they initiate gait training within seven days after stroke. Gait training sessions ranged from 15-30 minutes (55%), once every day (44%), and the majority (89%) reported use of subjective outcome measures to evaluate gait. Although most respondents agreed on the use of assistive aids, 24% indicated that their use may deter gait, rather than improve it. Nearly 86% of the respondents reported that they do not follow standard guidelines pertaining to gait rehabilitation for stroke survivors. CONCLUSION: The findings of the study point toward a lack of evidence-based practice among Indian physiotherapists while training gait after stroke. This implied the urgent need for development and implementation of country specific guidelines for stroke rehabilitation.


Assuntos
Atitude do Pessoal de Saúde , Custos e Análise de Custo , Prática Clínica Baseada em Evidências/métodos , Terapia por Exercício/métodos , Marcha , Reabilitação do Acidente Vascular Cerebral/métodos , Prática Clínica Baseada em Evidências/economia , Terapia por Exercício/economia , Humanos , Índia , Fisioterapeutas/psicologia , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral/economia , Inquéritos e Questionários
4.
Gait Posture ; 83: 132-140, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33137637

RESUMO

BACKGROUND: Gait is considered to be the most important determinant of functional independence in activities of daily living. The challenges faced by stroke survivors in India differ from the western population due to economic, cultural, and geographical factors and this, in turn, may influence the choice of intervention. Hence, there is a need to understand the current gait training trends for stroke survivors in low resource settings like India. RESEARCH QUESTION: To systematically review the literature on interventional strategies for improving gait among stroke survivors in India. METHODS: Six databases were searched to identify RCTs delivering gait training to stroke survivors having some gait deficits in terms of speed or any other kinematic parameters. Studies of the English language from India were included. Two independent reviewers screened, extracted data, and assessed the study quality. A descriptive synthesis was undertaken and the data was summarized. RESULTS: Of 2112 potentially relevant articles, 12 studies with a total of 412 participants were included after title, abstract and full-text screening. Studies tested the efficacy of interventions such as mirror therapy, motor imagery, transcutaneous electrical nerve stimulation, strengthening, and task-based training. The outcome measures were kinematic gait-analysis, gait velocity, Functional Ambulation Categories, Timed Up and Go, Fugl-Meyer Assessment. From the results of this review, active task-based gait training and strengthening along with motor priming seems to be the most tested interventions. Future studies may need to design interventions targeting both impairment and function to bring about maximum improvement in gait after stroke. SIGNIFICANCE: Reviews addressing gait practices in developing countries for people with stroke are scarce. The present review would assist physiotherapists in developing countries to utilize evidence-based criteria for the selection of gait training approaches post-stroke. Due to the environmental and contextual demands, the effect of interventions for recovery among stroke survivors should be improvised in low resource settings. This review can be a source of recommendation in giving effective strategies for clinical practice.


Assuntos
Atividades Cotidianas/psicologia , Marcha/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Humanos
6.
Complement Ther Clin Pract ; 39: 101110, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32379645

RESUMO

BACKGROUND: The evidence on aquatic therapy (AT) for improving balance and gait deficits post-stroke is unclear. Therefore, this study aimed to determine the effect of AT on balance and gait in stroke survivors. METHODS: We searched CINAHL, PubMed, Web of Science, Aqua4balance, Ewac, Cochrane, and EMBASE databases from inception to 1st November 2019. RESULTS: Eleven studies with 455 participants were included for the review. Meta-analysis showed that AT was effective for improving balance (MD 3.23, 95% CI 1.06, 5.39; p = 0.004; I2 = 61%) and gait speed (MD 0.77, 95% CI 0.25, 1.29; p = 0.004; I2 = 0%) when delivered alone. AT was effective in improving cadence (MD 4.41, 95% CI 0.82, 8.00; p = 0.02; I2 = 68%) when delivered as an adjunct to land-based therapy. CONCLUSION: AT may be used to improve balance and gait after stroke; however, the evidence to support its use is still low.


Assuntos
Terapia por Exercício/métodos , Marcha/fisiologia , Hidroterapia/métodos , Equilíbrio Postural/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Humanos
7.
Braz J Phys Ther ; 24(1): 61-68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30501938

RESUMO

OBJECTIVE: To explore the personal and environmental contextual factors that influence use of affected arm for function among stroke survivors. METHODS: We conducted a qualitative phenomenological study using an interpretivist paradigm among 23 stroke survivors in their late sub-acute and chronic stages and their relatives living in the rural regions of India using maximum variation sampling. Semi-structured interviews were conducted to identify personal and environmental contextual factors relevant to arm use. Their current level of arm use, motor and functional ability were evaluated using Motor Activity Log, AbilHand and Lawton Instrumental Activities of Daily Living scales and the scores were categorized in order to describe and compare the participant's characteristics before analyzing each interview. Differences among the contextual factors of participants with high and low levels of functional arm use and exercise using paretic limb were analyzed using qualitative content analysis. RESULTS: Study participants followed active exercises or passive interventions to improve their arm. Their immediate social environment influenced these decisions. Lack of awareness on how to self-engage or scale down their physical environment to match their abilities demoted active functional task performance. Ability to perceive small gains in arm function helped them sustain their efforts. CONCLUSION: Context influences arm use. Addressing contextual determinants influencing arm use such as facilitating understanding about the need for active functional task engagement; identifying and addressing factors moderating motivation to sustain functional task practice and enriching objects to match their movement abilities can increase arm use and promote upper limb recovery.


Assuntos
Paresia/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Atividades Cotidianas , Exercício Físico , Humanos , Vida Independente , Índia , Motivação , Movimento , Sobreviventes , Análise e Desempenho de Tarefas , Extremidade Superior/fisiologia
8.
BMJ Open ; 9(9): e023963, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31530586

RESUMO

INTRODUCTION: After a stroke, 55% of survivors do not regain the ability to completely use their arm in daily life functioning. Currently, evidence-based guidelines recommend functional training for improving the affected hand after stroke. However, promoting an optimal quantity and quality of functional training is influenced by personal and environmental contextual factors. Studies that comprehensively target multiple factors regulating arm use are limited. This study compares the effects of functional training to multifactorial context-enhancing functional training program for improving functional arm use and recovery after stroke. METHODS AND ANALYSIS: This is a protocol for an observer-blinded, two parallel groups, randomised controlled trial. A total of 126 community-dwelling subacute and chronic stroke survivors will be included in the study. A tailor-made multifactorial context-enhancing intervention-incorporating education, environmental enrichment and behaviour change techniques to reinforce functional training will be provided to the experimental group. The functional training group will be provided with functional exercises. The intervention will be delivered for 2 months. The primary outcomes of functional arm use and recovery will be measured using Motor Activity Log, Goal Attainment Scale and Rating of Everyday Arm-use in the Community and Home scale. The secondary outcomes of arm motor impairment and function will be measured using Fugl-Meyer upper limb score, Action Research Arm Test, ABILHAND questionnaire and Stroke Impact Scale. These will be measured at three points in time: before, after 2 months and after 1-month follow-up. The outcome measures will be analysed using one-way analysis of variance and regression analysis will be performed to identify factors limiting optimal task practice. ETHICS AND DISSEMINATION: The study has been approved by the Institutional Ethics Committee of Kasturba Hospital, Manipal, India. Participants will sign a written informed consent prior to participation. The results will be published on completion of the trial and communicated to community-dwelling stroke survivors. TRIAL REGISTRATION NUMBER: CTRI/2017/10/010108.


Assuntos
Terapia por Exercício/normas , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/normas , Acidente Vascular Cerebral/terapia , Extremidade Superior/fisiopatologia , Atividades Cotidianas , Método Duplo-Cego , Feminino , Humanos , Masculino , Estudos Observacionais como Assunto , Paresia/etiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Sobreviventes
9.
J Int Soc Prev Community Dent ; 9(1): 94-98, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30923701

RESUMO

Denture esthetics as defined by Glossary of prosthodontics terms the effect produced by a dental prosthesis that affects the beauty and attractiveness of the person. [1] Removable partial dentures (RPDs) are the widely accepted and treatment of choice for most cases as it is both effective and affordable. Partially edentulous treatment planning includes both esthetics and masticatory function. A prosthesis that is highly esthetic will improve patient's motivation and acceptance. It is a very wrong notion to expect that patients will tolerate unesthetic partial dentures because good masticatory capability has been achieved. Esthetics plays a vital role in the success of partial dentures, and the length and mobility of the patient's lips play a significant role in achieving it. [2] Patients with short lips or highly mobile lips pose problems as esthetics are compromised because most clasp arms, denture borders, and other components will show when the patient smiles or speaks. [3] RPDs can easily look artificial; hence, special emphasis should aim toward restoring function, phonetics, esthetics with a long-term benefits which requires meticulous attention during fabrication. This case reports is an esthetic clasp designed for a cast partial denture for a young girl for esthetic and function.

11.
Br J Neurosurg ; 26(1): 104-6, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21767126

RESUMO

We describe an endoscopic transsphenoidal excision of a GH-PRL-secreting pituitary adenoma and remodeling of frontotemporal fibrous dysplasia in a patient with McCune-Albright syndrome. Sphenoid dysplasia rendered transsphenoidal surgery challenging, but a study of the radiological anatomy and good surgical planning made this feasible. Medical therapy and radiation was required for persistent acromegaly after surgery.


Assuntos
Endoscopia/métodos , Displasia Fibrosa Poliostótica/complicações , Neoplasias Hipofisárias/cirurgia , Prolactinoma/cirurgia , Adulto , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
12.
J Neurosurg Pediatr ; 7(2): 213-7, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21284470

RESUMO

The authors report on a 6-year-old boy who presented with a tense subgaleal hematoma and proptosis 2 weeks after a minor head injury that were successfully managed by continuous closed-system drainage and blood transfusion. At evaluation he was found to have a transient mild factor XIII deficiency.


Assuntos
Traumatismos Craniocerebrais/complicações , Deficiência do Fator XIII/complicações , Hematoma/etiologia , Doenças Orbitárias/etiologia , Crânio , Criança , Humanos , Masculino
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