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2.
PLoS Med ; 17(2): e1003029, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32069288

RESUMO

BACKGROUND: Digitally enabled rehabilitation may lead to better outcomes but has not been tested in large pragmatic trials. We aimed to evaluate a tailored prescription of affordable digital devices in addition to usual care for people with mobility limitations admitted to aged care and neurological rehabilitation. METHODS AND FINDINGS: We conducted a pragmatic, outcome-assessor-blinded, parallel-group randomised trial in 3 Australian hospitals in Sydney and Adelaide recruiting adults 18 to 101 years old with mobility limitations undertaking aged care and neurological inpatient rehabilitation. Both the intervention and control groups received usual multidisciplinary inpatient and post-hospital rehabilitation care as determined by the treating rehabilitation clinicians. In addition to usual care, the intervention group used devices to target mobility and physical activity problems, individually prescribed by a physiotherapist according to an intervention protocol, including virtual reality video games, activity monitors, and handheld computer devices for 6 months in hospital and at home. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery [SPPB]; continuous version; range 0 to 3; higher score indicates better mobility) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months. The dataset was analysed using intention-to-treat principles. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000936628). Between 22 September 2014 and 10 November 2016, 300 patients (mean age 74 years, SD 14; 50% female; 54% neurological condition causing activity limitation) were randomly assigned to intervention (n = 149) or control (n = 151) using a secure online database (REDCap) to achieve allocation concealment. Six-month assessments were completed by 258 participants (129 intervention, 129 control). Intervention participants received on average 12 (SD 11) supervised inpatient sessions using 4 (SD 1) different devices and 15 (SD 5) physiotherapy contacts supporting device use after hospital discharge. Changes in mobility scores were higher in the intervention group compared to the control group from baseline (SPPB [continuous, 0-3] mean [SD]: intervention group, 1.5 [0.7]; control group, 1.5 [0.8]) to 6 months (SPPB [continuous, 0-3] mean [SD]: intervention group, 2.3 [0.6]; control group, 2.1 [0.8]; mean between-group difference 0.2 points, 95% CI 0.1 to 0.3; p = 0.006). However, there was no evidence of a difference between groups for upright time at 6 months (mean [SD] proportion of the day spent upright at 6 months: intervention group, 18.2 [9.8]; control group, 18.4 [10.2]; mean between-group difference -0.2, 95% CI -2.7 to 2.3; p = 0.87). Scores were higher in the intervention group compared to the control group across most secondary mobility outcomes, but there was no evidence of a difference between groups for most other secondary outcomes including self-reported balance confidence and quality of life. No adverse events were reported in the intervention group. Thirteen participants died while in the trial (intervention group: 9; control group: 4) due to unrelated causes, and there was no evidence of a difference between groups in fall rates (unadjusted incidence rate ratio 1.19, 95% CI 0.78 to 1.83; p = 0.43). Study limitations include 15%-19% loss to follow-up at 6 months on the co-primary outcomes, as anticipated; the number of secondary outcome measures in our trial, which may increase the risk of a type I error; and potential low statistical power to demonstrate significant between-group differences on important secondary patient-reported outcomes. CONCLUSIONS: In this study, we observed improved mobility in people with a wide range of health conditions making use of digitally enabled rehabilitation, whereas time spent upright was not impacted. TRIAL REGISTRATION: The trial was prospectively registered with the Australian New Zealand Clinical Trials Register; ACTRN12614000936628.


Assuntos
Computadores de Mão , Exercício Físico , Monitores de Aptidão Física , Limitação da Mobilidade , Reabilitação Neurológica/métodos , Modalidades de Fisioterapia , Smartphone , Jogos de Vídeo , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Realidade Virtual
3.
Neuron ; 105(4): 604-620, 2020 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-32078796

RESUMO

Stroke is one of the leading causes of long-term disability. Advanced technological solutions ("neurotechnologies") exploiting robotic systems and electrodes that stimulate the nervous system can increase the efficacy of stroke rehabilitation. Recent studies on these approaches have shown promising results. However, a paradigm shift in the development of new approaches must be made to significantly improve the clinical outcomes of neurotechnologies compared with those of traditional therapies. An "evolutionary" change can occur only by understanding in great detail the basic mechanisms of natural stroke recovery and technology-assisted neurorehabilitation. In this review, we first describe the results achieved by existing neurotechnologies and highlight their current limitations. In parallel, we summarize the data available on the mechanisms of recovery from electrophysiological, behavioral, and anatomical studies in humans and rodent models. Finally, we propose new approaches for the effective use of neurotechnologies in stroke survivors, as well as in people with other neurological disorders.


Assuntos
Estimulação Encefálica Profunda/métodos , Destreza Motora/fisiologia , Plasticidade Neuronal/fisiologia , Recuperação de Função Fisiológica/fisiologia , Córtex Sensório-Motor/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Encefálica Profunda/instrumentação , Humanos , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/fisiopatologia , Doenças do Sistema Nervoso/reabilitação , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Córtex Sensório-Motor/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/instrumentação
4.
Rev. neurol. (Ed. impr.) ; 70(3): 93-102, 1 feb., 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-187254

RESUMO

Introducción: El ictus afecta gravemente a la funcionalidad y la calidad de vida de la persona. Por ello, uno de los objetivos principales es la recuperación funcional del miembro superior. La terapia robótica supone una nueva orientación hacia la cual dirigir la rehabilitación del paciente con ictus. Por ello, se realizó una revisión bibliográfica sobre la efectividad del dispositivo Armeo(R) en la rehabilitación del miembro superior en pacientes con ictus. Desarrollo: Se recopilaron artículos que investigaran la rehabilitación del miembro superior a través de Armeo en pacientes con ictus hasta abril de 2019. Se consultaron las siguientes bases de datos: PubMed, Web of Science, Medline Complete, Scopus, CINAHL y BRAIN. Se analizaron seis artículos, entre los cuales había ensayos controlados aleatorizados y ensayos clínicos. Los principales resultados de los estudios indican una tendencia positiva de la terapia robótica con Armeo combinada con terapia convencional. Conclusión: La baja calidad metodológica y las limitaciones encontradas en los estudios determinan la necesidad de estudios futuros que investiguen la efectividad del dispositivo. A pesar de ello, el efecto positivo observado motiva a nuevas investigaciones


Introduction: The stroke affects the functionality and quality of life of the person. Therefore, one of the main objectives is the functional recovery of the upper limb. Robotic therapy is a new tool of rehabilitation in stroke patients. The aim of this paper is to accomplish a bibliographic review about the effectiveness of the Armeo(R) device in the rehabilitation of the upper limb in patients with stroke. Development: This review includes studies dated until April 2019, which investigate the rehabilitation of the upper limb through Armeo in patients with stroke. The following databases were consulted: PubMed, Web of Science, Medline Complete, Scopus, CINAHL and BRAIN. Six articles were selected and analyzed, including randomized controlled trials and clinical trials. The main results of the studies indicate a positive trend of the robotic therapy with Armeo combined with conventional therapy. Conclusion: The low quality and the limitations found on the studies determine the need for future studies that investigate the effectiveness of the device. Despite this, the positive effect observed motivates new research


Assuntos
Humanos , Reabilitação Neurológica , Extremidade Superior/fisiopatologia , Robótica/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Resultado do Tratamento , Cognição , Terapia por Exercício/métodos , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia
5.
Fisioterapia (Madr., Ed. impr.) ; 42(1): 5-16, ene.-feb. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-187810

RESUMO

Objetivo: Establecer el efecto de un programa de intervención basado en el reaprendizaje motor sobre el control postural en adultos con hemiparesia. Material y método: Se realizó un ensayo clínico no aleatorizado, prospectivo, con grupo control y enmascaramiento simple. Se realizó un muestreo intencional de adultos de ambos sexos con hemiparesia de entre 18 y 60 años. Se analizaron 34 personas en el grupo control (intervención convencional) y 35 en el experimental (reaprendizaje motor orientado a la tarea). Ambos grupos recibieron programas de fisioterapia 3 veces a la semana durante 6 semanas. Se aplicaron las siguientes pruebas: escala de Tinetti, test de organización sensorial, Timed Get Up and Go, test del alcance funcional y evaluación de la calidad de patrones de movimiento básicos y selectivos. Se realizaron análisis de diferencias intramuestrales e intermuestrales. Resultados: Se encontró una diferencia promedio de 3cm en la prueba del alcance funcional (p=0,035) y de 2,43 puntos en la calidad de patrones de movimiento de miembros inferiores (p=0,011) a favor del grupo experimental. En las demás pruebas no hubo diferencias significativas (p>0,05). Conclusiones: El programa evaluado es más efectivo para mejorar el control postural antigravitatorio y la calidad de patrones selectivos de miembros inferiores, comparado con un programa fisioterapéutico convencional. Sin embargo, en el análisis intramuestral se evidenció que aquel produce cambios significativos en la estabilidad durante la marcha, el control postural antigravitatorio, el equilibrio, la organización sensorial y en la calidad de los patrones de movimiento de mano, miembro inferior, movilidad en sedente-arrodillado, bípedo, marcha, desplazamientos en bípedo y global


Objective: To establish the impact of an intervention programme based on motor relearning on postural control in adults with hemiparesis. Material and method: A prospective non-randomised single-masked clinical trial with control group was conducted. The sample was collected intentionally, and consisted of adults of both sexes with hemiparesis between 18 to 60 years old. Thirty-four individuals from the control group (conventional intervention) and 35 individuals from the experimental group (task-oriented motor re-learning) were analysed. Both groups were involved in physiotherapy programmes 3 times a week for 6 weeks. Tinetti Balance Scale, Sensory Organization Test, Timed Get Up and Go test, Functional Movement Assessment and quality of basic and selective movement patterns assessment were applied. Analysis of intra-sample and inter-sample differences was performed. Results: An average difference of 3cm was found in Functional Movement Assessment (P=.035) and 2.43 points in the quality of lower limb movement patterns (P=.011), in favour of the experimental group. The other tests did not show significant differences (P>.05). Conclusions: This programme is more effective at improving postural anti-gravitational control and the quality of selective lower limb patterns compared to a conventional physiotherapeutic programme. However, in the intra-sample analysis, it was evidenced that it produces significant changes in stability during gait, anti-gravitational postural control, balance, sensory organisation and in the quality of hand movement patterns, lower limb, seated mobility-kneeling, biped, walking, biped and global movements


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Paresia/terapia , Equilíbrio Postural , Modalidades de Fisioterapia/instrumentação , Lesões Encefálicas/reabilitação , Reabilitação Neurológica/métodos , Paresia/reabilitação , Estudos Prospectivos , Postura/fisiologia , Análise da Marcha/métodos
6.
Tumori ; 106(1): 12-24, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31452454

RESUMO

OBJECTIVE: This study reviews the scientific literature to identify and describe which assessment tools (ATs) are used in pediatric oncology and neuro-oncology rehabilitation and which development neuropsychomotor (DNPM) ATs were built for children with central nervous system (CNS) tumors. METHODS: A systematic review was performed searching PubMed, CINAHL, PEDro, Science Direct, and Catalog of National Institute of Tumors databases and specialized journals. The search covered 7 years (2010-2017) and used relevant keywords in different combinations. A further search was carried out on DNPM rehabilitation manuals and academic thesis. RESULTS: The review retrieved 35 eligible articles containing 63 ATs. The most common ATs were the Behavioral Rating Inventory of Executive Function (BRIEF) and the Wechsler Intelligence Scale for Children (WISC). Most of the ATs covered a single area of child development among behavioral/psychological, cognitive, and motor areas. A total of 159 ATs were found in manuals and thesis, and only 17 of them were already identified in the journal search. None of the ATs identified in both searches had been specifically developed for children with CNS tumor. CONCLUSION: The results highlight the need to develop and validate a global multidimensional AT for children with CNS tumor, overcoming the fragmentation of the assessment procedures and promoting standardized rehabilitation protocols.


Assuntos
Neoplasias do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/reabilitação , Reabilitação Neurológica , Testes Neuropsicológicos , Transtornos Psicomotores/etiologia , Transtornos Psicomotores/reabilitação , Neoplasias do Sistema Nervoso Central/diagnóstico , Neoplasias do Sistema Nervoso Central/terapia , Criança , Humanos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Transtornos Psicomotores/diagnóstico , Transtornos Psicomotores/terapia , Resultado do Tratamento
7.
Dev Neurorehabil ; 23(1): 50-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30668211

RESUMO

Aim: To determine the feasibility and acceptability of parent-delivered elastic taping to the thumb and wrist in infants with cerebral palsy (CP).Design: Randomized cross-over feasibility trial.Participants: 20 infants (11 male; mean age 22 months) with CP.Intervention: Groups A and B received taping for 4 and 2 weeks, respectively.Outcomes: Primary: Recruitment and retention rates; adherence to protocol; Parent Satisfaction Questionnaire. Secondary: House Thumb score; Zancolli classification; Assisting Hand Assessment (AHA)/mini AHA. Exploratory: Duration of hand regard, thumb in palm, and open hand contact with toys during AHA/mini AHA.Results: Recruitment was feasible (95.2% uptake). Completion rates were 80% and 60% in Groups A and B. Questionnaire feedback was generally positive. Some parents reported increased awareness of the taped hand. Objective improvements were rare though one participant showed consistent improvement in thumb position.Conclusion: Taping proved feasible and acceptable; individual case benefit suggests further research is required.Trial registration: ISRCTN41918400.


Assuntos
Paralisia Cerebral/reabilitação , Reabilitação Neurológica/métodos , Polegar/patologia , Atividades Cotidianas , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Pais
8.
Dev Neurorehabil ; 23(1): 18-30, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31042403

RESUMO

Purpose: To conduct a qualitative investigation of engagement in pediatric rehabilitation therapy.Methods: Interviews were conducted with 10 youth, 10 caregivers, and 10 service providers. Transcripts were analyzed thematically using an inductive approach.Results: Themes illustrated three perspectives: engagement as a connection with components of the therapy process, engagement as working together, and engagement as an affective and motivational process. Engagement created valued connections with therapy components and forward momentum for therapy.Conclusions: The themes supported a view of engagement as complex, transactional, and multidimensional. Participants focused on different, yet not discrepant, aspects of engagement. Youth focused on having fun and personal connection with service providers. Caregivers provided a more complex perspective encompassing both their own and their child's engagement, with an emphasis on relationship, understanding what is taking place, and feeling valued in the process. Service providers highlighted goal attainment and the value of engagement in bringing about outcomes.


Assuntos
Cuidadores/psicologia , Reabilitação Neurológica/normas , Enfermeiras Pediátricas/psicologia , Satisfação do Paciente , Adolescente , Criança , Família/psicologia , Feminino , Humanos , Masculino , Motivação , Enfermeiras Pediátricas/normas , Participação do Paciente , Inquéritos e Questionários
9.
Dev Neurorehabil ; 23(1): 9-17, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31055992

RESUMO

Aim: Aggressive incidents (AI) are a serious concern in health care and can have negative effects on the physical and emotional well-being staff. This study aimed to determine frequency, characteristics and risk factors for aggressive behavior.Methods: AI were recorded during six months by the staff in a pediatric rehabilitation clinic using the evaluation form for AI (EVA). Patients were divided into the study group (patients who were involved in AI) and controls.Results: 14/105 (13%) of patients were involved in 79 AI. 0.44 AI per day occurred. Most often AI occurred on Mondays and 98% included physical, 22% verbal aggression. Most frequent target (43%) were nurses, followed by therapists (31.6%).Significant risk factors for AI were: previous aggressive behavior (p = .038), lower cognitive and higher mobility sub-scores in the WeeFIM. Conclusion: Findings emphasize the magnitude of AI in pediatric rehabilitation and thus the importance of implement preventive strategies.Abbreviations: ADL: Activity of daily living; AI: Aggressive Incidents; CFCS: Communication Function Classification System; EVA: Recording aggressive incidents (Erfassung von Aggressionsereignissen); GMFCS: Gross Motor Function Classification System; MACS: Manual Ability Classification System; SOAS-R: Staff Observation of Aggression Scale-Revised; WeeFIM: Functional Independence Measure for Children; WPV: Workplace violence.


Assuntos
Agressão/psicologia , Reabilitação Neurológica/estatística & dados numéricos , Centros de Reabilitação/estatística & dados numéricos , Violência no Trabalho/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Fatores de Risco , Inquéritos e Questionários , Violência no Trabalho/psicologia
10.
Dev Neurorehabil ; 23(1): 59-63, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31342814

RESUMO

Children with autism spectrum disorder (ASD) are at increased risk for being overweight/obese and face a variety of challenges with achieving the recommended levels of physical activity. Physical activity level has additionally been linked to motor skills, sleep, cognitive function and academic performance, and mental health in children with ASD. We pilot tested the feasibility and preliminary efficacy of walking routes as a novel approach to increasing physical activity among children with ASD. Physical activity was measured by accelerometry in 21 children ages 6-10 years. Participants received feedback on their physical activity and were counseled on using their surrounding neighborhoods to increase their physical activity. Non-completion (n = 9) reasons included equipment discomfort, family challenges, and diagnosis misattribution. While small changes in physical activity level and sedentary time were observed, neither was statistically significant. Further controlled studies on walking route interventions should continue to explore the potential benefits among this high-risk population.


Assuntos
Transtorno do Espectro Autista/reabilitação , Condicionamento Físico Humano/métodos , Caminhada , Transtorno do Espectro Autista/fisiopatologia , Criança , Feminino , Humanos , Masculino , Reabilitação Neurológica/métodos , Sobrepeso/prevenção & controle , Condicionamento Físico Humano/psicologia , Condicionamento Físico Humano/normas
11.
Dev Neurorehabil ; 23(1): 64-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31411516

RESUMO

Objective: To explore the effects of a web platform, aiming to support parents of children 5-12 years old with suspected or diagnosed developmental coordination disorder (DCD), on parental knowledge and skills.Method: A randomized pilot trial was undertaken (Clinical trial NCT03141333). Parents of the intervention group (n = 15) had access to a web platform (including resources, forum and virtual interactions) for three months. The control group (n = 13) only had access to resources. The primary outcome was measured pre- and post-intervention with the Parent Knowledge and Skills Questionnaire. Pre- post-questionnaires evaluated secondary outcomes (parents' sense of competence, children's strenghts and difficulties, and occupational performance).Results and discussion: All outcome measures improved over time for the intervention group. However, those improvements were not clinically or statistically significant (p 0.08-0.41).Conclusion: Web platforms supporting parents of children with DCD need further evaluation. Especially, usability of web platforms and new outcome measures should be explored.


Assuntos
Transtornos das Habilidades Motoras/reabilitação , Reabilitação Neurológica/métodos , Pais/psicologia , Apoio Social , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Inquéritos e Questionários
12.
NeuroRehabilitation ; 45(4): 453-461, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31868687

RESUMO

BACKGROUND: Anoxic brain injury (ABI) is a neurological condition associated to a severe deterioration of brain functioning, whose symptomatology and clinical outcomes may be heterogeneous: cognitive deficits, language disorders like dysarthria and swallowing impairments. Nevertheless, there is still a lack of information on the rehabilitation outcomes. OBJECTIVE: To confirm the occurrence of communication and swallowing deficits in 37 ABI patients and to examine whether intensive rehabilitation may contribute to any improvements and its relation to ABI severity and functional autonomy. METHODS: 37 patients, hospitalized at IRCCS San Camillo Hospital from 2011 to 2018 were analyzed retrospectively. All patients completed a functional evaluation and a language and swallowing assessment, within one week from hospital admission (T0). The assessment was repeated after an intensive rehabilitation treatment (T1). RESULTS: Results show that dysphagia is a frequent and severe outcome in anoxic patients, whereas communication disorders (aphasia and dysarthria) are less severe. Moreover, ABI patients seem to be positively sensitive to an intensive rehabilitation program. CONCLUSIONS: An early multidisciplinary management of communicative-linguistic and swallowing functions is crucial in order to prevent adverse events and to plan a tailored rehabilitation pathway.


Assuntos
Transtornos da Comunicação/epidemiologia , Transtornos de Deglutição/epidemiologia , Hipóxia/complicações , Adulto , Transtornos da Comunicação/reabilitação , Transtornos de Deglutição/reabilitação , Feminino , Humanos , Hipóxia/epidemiologia , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/métodos , Resultado do Tratamento
13.
NeuroRehabilitation ; 45(4): 513-517, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31868688

RESUMO

OBJECTIVE: To determine the prevalence of vitamin D deficiency among individuals with traumatic brain injury (TBI) undergoing acute inpatient rehabilitation. SETTING: Inpatient rehabilitation. PARTICIPANTS: Participants were admitted from November 1st, 2010 through June 30th, 2015 with diagnosis of mild-severe TBI and had serum 25 OH vitamin D levels checked upon admission. 369 out of 845 met inclusion. DESIGN: Retrospective cohort. MAIN MEASURES: 25 OH vitamin D, vitamin D treatment. RESULTS: The majority of patients were male (67%), Caucasian (89%) with private insurance (61%) and a mean age of 43.5±21.0 years. 25 OH vitamin D levels were categorized: deficient (<20 ng/mL), insufficient (20-29.9 ng/mL), and sufficient (≥30 ng/mL). There were 95 (26%) patients that were deficient, 131 (36%) that were insufficient, and 143 (39%) that were sufficient. Race/ethnicity was found to be significant (p = 0.0145) with the largest percentage of Hispanics found in the insufficient and deficient categories, and the largest percentage of Blacks in the deficient category. Most patients with deficient or insufficient vitamin D levels were prescribed vitamin D replacement during their rehab stay (p < 0.0001). CONCLUSION: The majority of patients undergoing acute inpatient rehabilitation were found to have insufficient or deficient vitamin D levels, therefore it should be routinely screened and treated as indicated.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Deficiência de Vitamina D/epidemiologia , Adulto , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/estatística & dados numéricos , Prevalência
14.
NeuroRehabilitation ; 45(4): 519-524, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31868690

RESUMO

BACKGROUND: Contemporary goals of rehabilitation after traumatic brain injury (TBI) aim to improve cognitive and motor function by applying concepts of neuroplasticity. This can be challenging to carry out in TBI patients with motor, balance, and cognitive impairments. OBJECTIVE: To determine whether use of dynamic body-weight support (DBWS) would allow safe administration of intensive motor therapy during inpatient rehabilitation and whether its use would yield greater improvement in functional recovery than standard-of-care (SOC) therapy in adults with TBI. METHODS: Data in this retrospective cohort study was collected from patients with TBI who receive inpatient rehabilitation incorporating DBWS (n = 6) and who received inpatient rehabilitation without DBWS (SOC, n = 6). The primary outcome measure was the change in Functional Independence Measures (FIM) scores from admission to discharge. RESULTS: There was significant improvement in total FIM scores at discharge compared to admission for both the DBWS (p = 0.001) and SOC (p = 0.005) groups. Overall, the DBWS group had greater improvement in total FIM score and FIM subscales compared to the SOC group. CONCLUSIONS: Our results suggest DBWS has the potential to allow a greater intensity of therapy during inpatient rehabilitation and yield better outcomes compared to SOC in patients with TBI.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Vida Independente/normas , Reabilitação Neurológica/métodos , Aparelhos Ortopédicos , Adulto , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Movimento , Reabilitação Neurológica/instrumentação , Alta do Paciente/estatística & dados numéricos , Recuperação de Função Fisiológica
15.
NeuroRehabilitation ; 45(4): 525-536, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31868691

RESUMO

BACKGROUND: There is little high-level evidence for the effect of the nonverbal facilitation of swallowing on swallowing ability in the subacute stage of rehabilitation following severe acquired brain injury (ABI). OBJECTIVE: To pilot test a randomised controlled trial to determine the effect of an intensification of the nonverbal facilitation of swallowing on dysphagia. METHODS: Ten patients with severe ABI and dysphagia were randomised into two groups at a highly specialised neurorehabilitation clinic.The intervention group received an intensification of the nonverbal facilitation of swallowing and the control group received basic care of the face and mouth in addition to treatment as usual for two sessions of 20 minutes per day for three weeks.Outcomes were Functional Oral Intake Scale (FOIS), Penetration Aspiration Scale (PAS), and electrophysiological swallowing specific parameters (EMBI). RESULTS: The intensified intervention was feasible. PAS and FOIS scores improved in both groups, with no differences between groups. The swallowing specific parameters reflected clinically observed changes in swallowing. CONCLUSIONS: PAS and FOIS are feasible instruments to measure dysphagia. It is possible and valid to measure swallowing frequency and kinematics using electromyography and bioimpedance. The definitive study should have widened inclusion criteria and optimise intervention timing to maintain patient arousal.


Assuntos
Lesões Encefálicas/reabilitação , Transtornos de Deglutição/reabilitação , Deglutição , Reabilitação Neurológica/métodos , Adulto , Lesões Encefálicas/complicações , Transtornos de Deglutição/etiologia , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
16.
Fortschr Neurol Psychiatr ; 87(12): 711-713, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31847033

RESUMO

Evaluations of cases of a neurological early rehabilitation clinic carried out by the medical services of health insurances (2018) are described and analyzed. More than a quarter of the 1098 cases were evaluated. Examinations focused on hours of ventilation, unnecessary hospitalization, intensity of nursing and features of the definition of early neurological rehabilitation. Strategies to minimize are errors described.


Assuntos
Seguro Saúde , Reabilitação Neurológica , Alemanha , Hospitalização , Humanos , Reabilitação Neurológica/economia
17.
Dement. neuropsychol ; 13(4): 422-426, Oct.-Dec. 2019.
Artigo em Inglês | LILACS | ID: biblio-1056009

RESUMO

ABSTRACT Despite recent advances in cognitive rehabilitation of patients with cognitive disorders, there are many major obstacles to the optimized global use of this therapeutic resource. Objective: The authors outline the concept of 'therapeutic synergism', i.e. the concurrent use of pharmacological and cognitive rehabilitation therapies to maximize functional benefits, addressing the optimization of therapeutic approaches for cognitive disorders. Methods: Three psychopharmacological and rehabilitation interrelationship paradigms are presented in three different clinical settings. Results: Paradigm 1: Behavioral and cognitive symptoms that hinder a cognitive rehabilitation program, but can be improved with psychopharmacology. Paradigm 2: Cognitive symptoms that hinder cognitive rehabilitation, but can be improved with anticholinesterases. Paradigm 3: Behavioral symptoms that hamper the use of cognitive rehabilitation, but can be improved by psychotropic drugs. Conclusion: Judicious use of psychotropic drugs in cognitive disorders can benefit, directly or indirectly, cognitive functions, thereby favoring other treatment modalities for cognitive impairment, such as neuropsychological rehabilitation.


RESUMO Apesar dos recentes avanços na reabilitação cognitiva de pacientes com distúrbios cognitivos, existem muitos e graves obstáculos ao uso otimizado globalmente desse recurso terapêutico. Objetivo: Os autores destacam o conceito de 'sinergismo terapêutico', ou seja, o uso simultâneo de terapias de reabilitação farmacológica e cognitiva, maximizando os benefícios funcionais, a fim de abordar a otimização da abordagem terapêutica dos distúrbios cognitivos. Métodos: Três paradigmas de inter-relacionamento psicofarmacológico e de reabilitação são apresentados em três contextos clínicos diferentes. Resultados: Paradigma 1: sintomas comportamentais e cognitivos que dificultam um programa de reabilitação cognitiva, mas podem ser melhorados com a psicofarmacologia. Paradigma 2: sintomas cognitivos que dificultam a reabilitação cognitiva, mas podem ser melhorados com anticolinesterásicos. Paradigma 3: sintomas comportamentais que dificultam o uso da reabilitação cognitiva melhorada por drogas psicotrópicas. Conclusão: O uso criterioso das drogas psicotrópicas nos distúrbios cognitivos pode beneficiar, direta ou indiretamente, as funções cognitivas, favorecendo, portanto, outras modalidades de tratamento para o comprometimento cognitivo, como a reabilitação neuropsicológica.


Assuntos
Humanos , Psicofarmacologia , Terapêutica , Sinergismo Farmacológico , Reabilitação Neurológica
18.
Rev. neurol. (Ed. impr.) ; 69(12): 497-506, 16 dic., 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-187119

RESUMO

Introducción: La terapia con realidad virtual (TRV) constituye una herramienta poderosa que motiva a los pacientes con ictus a participar activamente en su neurorrehabilitación, y proporciona retroalimentación aumentada del rendimiento, con objeto de obtener mejores resultados terapéuticos gracias a la potenciación de los mecanismos de neuroplasticidad. Objetivo: Exponer los datos más relevantes sobre las aplicaciones de la TRV en la neurorrehabilitación postictus. Desarrollo: Búsqueda de artículos en PubMed, últimos libros y principales guías de práctica clínica y sociedades científicas publicados con respecto a dichas aplicaciones. Conclusiones: Los diferentes ensayos clínicos aleatorizados (ECA) realizados demuestran que la TRV facilita, de forma segura y estadísticamente significativa, la recuperación motora y funcional del miembro superior, la marcha, el equilibrio, la calidad de vida relacionada con la salud y las actividades de la vida diaria, junto con la terapia convencional, sin ser globalmente superior a la terapia convencional. Aún no se conocen los mecanismos específicos subyacentes. Los ECA futuros deberán definir el perfil de paciente respondedor según la TRV empleada, permitiendo generar enfoques de neurorrehabilitación que conjuguen una TRV personalizada inmersiva y la experiencia clínica de los terapeutas para maximizar los resultados. Son precisos ECA bien diseñados, incluyendo muestras amplias de pacientes adecuadamente seleccionados, para redactar un documento de consenso que permita recomendar, con un mayor nivel de evidencia y de forma generalizada, la implementación de la TRV como terapia complementaria en la neurorrehabilitación postictus, determinar si los efectos beneficiosos se mantienen a largo plazo y clarificar qué esquema de tratamiento es el más apropiado


Introduction: Virtual reality therapy (VRT) constitutes a powerful and motivating tool for stroke patients to actively participate in the process of neurorehabilitation, providing augmented performance feedback, with the aim of achieving better therapeutic results owing to the enhancing of neuroplasticity mechanisms. Aim: To report the most relevant data about the applications of VRT in the post-stroke neurorehabilitation. DEVELOPMENT. We conducted a PubMed search for articles, latest books, leading clinical practice guidelines, and scientific societies, regarding such applications. Conclusions: Different performed randomized clinical trials (RCT) show that VRT safely facilitates in a statistically significant way motor and functional recovery of upper limb, gait, balance, quality of life related to health, and activities of daily living, together with conventional therapy, but have no clearly demonstrated overall superiority to conventional therapy. In this regard, underlying specific mechanisms remain elusive at this stage. Future RCT should define the good responder stroke patient profile based on the VRT used in conjunction with conventional therapy, allowing the generation of neurorehabilitation approaches that combine a customized immersive VRT with the clinical experience of the therapists, to maximize the results. It is necessary to carry out well-designed RCT, including larger samples of appropriately selected stroke subjects, to draft a consensus document that allows recommending, with a greater level of evidence and on a widespread basis, the implementation of VRT as add-on therapy in post-stroke neurorehabilitation. As well as to determine if the beneficial effects are maintained in the long term and to clarify the most suitable treatment Schedule


Assuntos
Humanos , Adulto , Realidade Virtual , Reabilitação Neurológica/métodos , Reabilitação do Acidente Vascular Cerebral , Qualidade de Vida , Caminhada , Atividade Motora
19.
J Med Life ; 12(3): 236-238, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31666824

RESUMO

Dysphagia is recorded in approximately a third of ischemic stroke patients and is associated with malnutrition, aspiration, and pneumonia. We report a case study that assessed dysphagia (GUSS, Gugging Swallowing Screen), paralysis (MRC, Medical Research Council), and disability (mRS, modified Rankin Scale) in the AVANT program (Austrian Vietnamese Advancement Neurorehabilitation Treatment) - a collaboration program between Vietnam and Austria to standardize and systemize neurorehabilitation after stroke practice in Vietnam.


Assuntos
Aminoácidos/uso terapêutico , Transtornos de Deglutição/tratamento farmacológico , Transtornos de Deglutição/etiologia , Reabilitação Neurológica , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Deglutição , Transtornos de Deglutição/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem
20.
Handb Clin Neurol ; 163: 435-456, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31590745

RESUMO

Acute trauma to the brain can lead to chronic changes in an individual's neurologic functioning, with some of the most debilitating and far-reaching consequences leading to compromised goal-directed functioning. Underlying sources of dysfunction can be dynamic, complex, and challenging to effectively address. This chapter delineates key principles that can be valuable for improving goal-directed functioning. The chapter is grounded in neuroscience and theoretical underpinnings while emphasizing practical approaches to maximizing functional improvements in an individual's personal life. Rehabilitation efforts can be maximized by taking into account multiple levels and facets of goal-directed functioning in cohesive, individualized treatments. Core functions subserved by prefrontal cortical networks may be targeted and strengthened through specific approaches to training. Optimization of functioning may require unraveling and addressing some of the many factors that can modulate brain processes. We dedicate special emphasis to considering the regulation of cognitive-emotional functioning during goal pursuit, especially pertinent to treatment of combined physical and experiential trauma that is a hallmark of military service injuries. These foundations point to frontiers for innovation in strengthening goal-directed functioning after brain injury.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Cognição/fisiologia , Objetivos , Reabilitação Neurológica/métodos , Lesões Encefálicas Traumáticas/fisiopatologia , Humanos , Recuperação de Função Fisiológica/fisiologia
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