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in category rehabilitation medicine and physical therapy

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1: Post-acute COVID-19 syndrome negatively impacts health and wellbeing despite less severe acute infection
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Posted 06 Nov 2020

Post-acute COVID-19 syndrome negatively impacts health and wellbeing despite less severe acute infection
3,630 downloads medRxiv rehabilitation medicine and physical therapy

Laura Tabacof, Jenna Tosto-Mancuso, Jamie Wood, Mar Cortes, Amy R Kontorovich, Dayna McCarthy, Dahlia Rizk, Nicki Mohammadi, Erica Breyman, Leila Nasr, Christopher P Kellner, David Putrino

IntroductionOne of the noted features of COVID-19 is the spectrum of expressivity in symptoms among those with the disease, ranging from no or mild symptoms that may last a small number of days, to severe and/or longer lasting symptoms. It is emerging that many patients have long lasting symptoms, several months after initial infection with COVID-19. The aim of this research was to characterize post-acute COVID-19 syndrome (PACS). MethodsThis was a retrospective cross-sectional observational study. Participants were patients recovering from COVID-19 infection, enrolled in Mount Sinai Hospitals COVID-19 Precision Recovery Program (PRP). Inclusion criteria were confirmed or probable (based on World Health Organization criteria) initial diagnosis of COVID-19; post-acute COVID-19 syndrome (defined as experiencing symptoms > 6 weeks since acute symptom onset) and being currently enrolled in the PRP during the months of July and August 2020. Study survey data were collected using REDCap. Demographic data, COVID-19 clinical data and patient-reported outcomes for breathlessness (Medical Research Council Breathlessness Scale), fatigue and quality of life (EuroQoL 5D-5L) were collected. Results84 individuals with PACS were included. Symptoms persisted at mean (range) 151 (54 to 255) days. The most prevalent persistent symptoms were fatigue (92%), loss of concentration/memory (74%), weakness (68%), headache (65%) and dizziness (64%). Most participants reported increased levels of disability associated with breathlessness, increased fatigue and reduced quality of life. ConclusionsPersistent symptoms following COVID-19 infection are prevalent, debilitating and appear to affect individuals regardless of acute infection severity or prior health status. More detailed research is required in order to identify specific symptom clusters associated with PACS, and to devise effective interventional strategies.

2: Effectiveness of McKenzie Manipulative Therapy on Pain, Functional Activity and Disability for Lumbar Disc Herniation
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Posted 17 Jul 2020

Effectiveness of McKenzie Manipulative Therapy on Pain, Functional Activity and Disability for Lumbar Disc Herniation
2,103 downloads medRxiv rehabilitation medicine and physical therapy

Mohammad Anwar Hossain, Iqbal K Jahid, Md. Forhad Hossain, Zakir Uddin, Md. Feroz Kabir, K M Amran Hossain, Md.Nazmul Hassan, Lori Maria Walton

Introduction: Lumbar disc herniation (LDH) is one of the common determinations for low back pain and there are priorities of a cost-effective therapeutic approach. The objective of the study was to explore the effectiveness of McKenzie Manipulative Therapy (MMT) for patients with LDH. Methodology: Assessor blinded RCT carried out for 36 months at CRP. Seventy-two subjects ages 28- 47 years, clinically and radiologically diagnosed with LDH were randomly recruited from hospital records and sixty-eight found eligible. The control group received stretching exercise and graded oscillatory mobilization, and the experimental group received McKenzie manipulative therapy for 12 sessions in 4 weeks, both groups received a standard set of care in addition. The pain was the primary outcome and secondary outcome was participation in functional activities and disability. Results: Pain and Disability found significant (p<.05) improvement in both groups, with the McKenzie approach significantly superior to the control group. Bothersome in activities (SBI) found significant compared to baseline for both groups (p <.01). McKenzie was significantly superior in outcomes for fear avoidance (FABQ) total and SBI feeling of abnormal sensation in leg compared to the control group (p < .05). Conclusion: The McKenzie manipulative therapy approach reported effective for pain, disability, and participating in activities for single or multiple level LDH patients in a short time from day 1 to week 4 and the treatment effect extends after 6 months.

3: The British Thoracic Society survey of rehabilitation to support recovery of the Post Covid -19 population.
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Posted 12 May 2020

The British Thoracic Society survey of rehabilitation to support recovery of the Post Covid -19 population.
1,950 downloads medRxiv rehabilitation medicine and physical therapy

Sally J Singh, Amy C Barradell, Neil J Greening, Charlotte E Bolton, R Gisli Jenkins, Louise Preston, John R Hurst

Objectives Those discharged from hospital after treatment for Covid-19 are likely to have significant and ongoing symptoms, functional impairment and psychological disturbances. There is an immediate need to develop a safe and efficient discharge process and recovery programme. Pulmonary rehabilitation is well placed to deliver a rehabilitation programme for this group but will most likely need to be adapted for the post Covid-19 population. The purpose of this survey was to rapidly identify the components of a post-Covid-19 rehabilitation assessment and elements of a successful rehabilitation programme that would be required to deliver a comprehensive service for those post Covid-19 to inform service delivery. Design A survey comprising a series of closed questions and a free text comments box allowing for a qualitative analysis. Setting Online survey. Participants British Thoracic Society members and multi-professional clinicians, across specialities were invited to take part. Results 1031 participants responded from a broad range of specialities over 6 days. There was overwhelming support for early post discharge from hospital phase of the recovery programme to advise patients about the management of fatigue (95% agreed/ strongly agreed), breathlessness (94%), and mood disturbances (including symptoms of anxiety and depression) 92%. At the 6-8-week time point an assessment was considered important, focusing on the assessment of a broad range of possible symptoms and the need to potentially return to work. Recommendations for the intervention described a holistic programme focusing on symptom management, return of function and return to employment. The free text comments added depth to the survey and the need not to reinvent the wheel rather adapt well established (pulmonary rehabilitation) services to accommodate the needs of the post Covid-19 population. Conclusion The responses indicate the huge interest and the urgent need establish a programme to support and mitigate the long term impact of Covid-19.

4: Does one exercise a day make the knee stronger and keep surgery away? A randomized dose-response trial of home-based knee-extensor exercise in patients eligible for knee replacement (the QUADX-1 trial).
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Posted 07 Apr 2021

Does one exercise a day make the knee stronger and keep surgery away? A randomized dose-response trial of home-based knee-extensor exercise in patients eligible for knee replacement (the QUADX-1 trial).
1,755 downloads medRxiv rehabilitation medicine and physical therapy

Rasmus Skov Husted, Anders Troelsen, Henrik Husted, Birk Groenfeldt, Kristian Thorborg, Thomas Kallemose, Michael Skovdal Rathleff, Thomas Bandholm

ObjectivesTo firstly investigate the efficacy of three different dosages of home-based, knee-extensor strength exercise on isometric knee-extensor strength in patients eligible for knee replacement due to severe knee osteoarthritis, and secondly, the influence of exercise on symptoms, physical function and decision on surgery. DesignRandomized dose-response trial. SettingPrimary and secondary care. ParticipantsOne-hundred and forty patients eligible for knee replacement were included. Eligibility for surgery was assessed by an orthopedic surgeon specialized in knee arthroplasty. InterventionsPatients were randomized to three groups; 2, 4 or 6 home-based knee-extensor exercise-sessions per week (group 2, 4 and 6 respectively) for 12 weeks (N=47/group). Exercise instruction was given by a trained physiotherapist. Main outcome measuresThe primary outcome was isometric knee-extensor strength. Secondary outcomes were Oxford Knee Score, Knee Osteoarthritis Outcome Score, average knee pain last week (0-10 numeric rating scale), 6-minute walk test, stair climbing test, exercise adherence and "need for surgery". The primary endpoint was after 12 weeks of exercise (before surgery) and the secondary after surgery. Outcome assessors and patients were blinded to allocation. ResultsAfter 12 weeks of exercise, data were available for 117 patients (N=39/group). Isometric knee-extensor strength increased in all groups but intention-to-treat analysis showed no difference between the three groups in change from baseline to after 12 weeks of exercise in isometric knee-extensor muscle strength: Group 2 vs. 4 (0.009 Nm/kg [95% CI-0.15 to 0.17], P=0.913), group 2 vs. 6 (-0.03 Nm/kg [95% CI-0.18 to 0.13], P=0.725) and group 4 vs. 6 (-0.04 Nm/kg [95% CI-0.20 to 0.13], P=0.668). For the secondary outcomes a significant difference before surgery was found between group 2 and group 6 for Oxford Knee Score (4.2 [95% CI 0.6 to 7.8], P=0.02) and average knee pain last week (NRS 0-10) (-1.1 [95%-2.2 to-0.1], P=0.03) in favour of group 2. No other differences were observed before and after surgery. After the 12-week exercise intervention, 38 (32.5%) patients wanted surgery and 79 (67.5%) postponed surgery. This was independent of exercise dosage. ConclusionKnee-extensor strength increased with both 2, 4 and 6 exercise sessions per week but none of the prescribed exercise dosages were superior to the others for the primary outcome isometric knee-extensor strength after 12 weeks. Two home-based knee-extensor exercise sessions a week seems superior to six for patient-reported outcomes, and across exercise dosages, only one in three patients decided to have surgery after the coordinated home-based exercise intervention. Trial registrationClinicalTrials.gov identifier: NCT02931058, pre-registered October 10th, 2016. Protocol PubMed (PMID: 29347947). What is already known on this topicClinical guidelines recommend exercise therapy targeting the knee-extensor muscles in patients eligible for knee replacement before surgery is considered. Exercise therapy may reduce knee osteoarthritis symptoms and impact the decision on surgery, but the dose-response relationship is not described. Exercise therapy is typically delivered as supervised programs requiring physical attendance at fixed times and often require self-payment, which may be a barrier for some patients. What this study addsKnee-extensor strength increased with 2, 4 and 6 exercise sessions per week, but none of the prescribed exercise dosages were superior to the others after 12 weeks - indicating no dose-response relationship. Two in three patients eligible for knee replacement decided to postpone knee replacement surgery after 12 weeks of home-based exercise with one simple exercise. This study successfully employed a model of coordinated care where the patients decision on surgical treatment was re-evaluated based on symptom changes following simple home-based exercise therapy. These findings suggest using a model of coordinated non-surgical and surgical care to improve the decision on surgery for patients eligible for knee replacement.

5: Motivational Strategies for Stroke Rehabilitation: A Descriptive Cross-sectional Study
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Posted 12 Nov 2019

Motivational Strategies for Stroke Rehabilitation: A Descriptive Cross-sectional Study
1,697 downloads medRxiv rehabilitation medicine and physical therapy

Kazuaki Oyake, Makoto Suzuki, Yokei Otaka, Satoshi Tanaka

Background and PurposeThe addition of motivational strategies to a rehabilitation program is thought to enhance patient adherence and improve outcomes. However, little is known about how rehabilitation professionals motivate stroke patients during rehabilitation. The primary objective of this study was to provide a comprehensive and quantitative list of motivational strategies for stroke rehabilitation. In addition, we aimed to examine (1) whether professionals with more clinical experience used a higher number of motivational strategies, (2) the purpose for using each strategy, and (3) the information considered when choosing strategies. MethodsThis descriptive, cross-sectional study was conducted using a web survey with a random sample of 407 rehabilitation professionals including physicians, nurses, physical therapists, occupational therapists, and speech-language-hearing therapists. ResultsWe received data for 362 participants. Fifteen strategies were found to be used by more than 75% of the respondents reported using to motivate their patients. Almost all of the respondents reported that they actively listen to and praise their patients to increase patient adherence to rehabilitation programs. Respondents with more clinical experience tended to use a higher number of motivational strategies (rho = 0.208, p < 0.001). For 11 of the 15 strategies selected by more than 75% of respondents, the highest percentage of respondents reported that they used the strategies to make rehabilitation worthwhile for their patients. The majority of respondents reported that they decide which motivational strategy to use by considering comprehensive information regarding the patient health condition, environmental factors, and personal factors. ConclusionsThe comprehensive list of motivational strategies obtained may be useful for increasing patient adherence to rehabilitation, especially for professionals with less clinical experience. Furthermore, our findings regarding the purpose for using each strategy and the information used to choose strategies might help rehabilitation professionals to utilize the motivational strategy list.

6: Intracortical Microstimulation Elicits Human Fingertip Sensations
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Posted 30 May 2020

Intracortical Microstimulation Elicits Human Fingertip Sensations
1,481 downloads medRxiv rehabilitation medicine and physical therapy
7: Effect of Respiratory Muscle Training on Dysphagia in Stroke Patients - A Retrospective Pilot Study
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Posted 11 Feb 2020

Effect of Respiratory Muscle Training on Dysphagia in Stroke Patients - A Retrospective Pilot Study
1,437 downloads medRxiv rehabilitation medicine and physical therapy

Robert J Arnold, Nina Bausek

BackgroundDysphagia is prevalent with cerebrovascular accidents and contributes to the burden of disease and mortality. Strengthening of the dysfunctional swallow muscles through respiratory muscle training (RMT) has proven effective in improving swallow effectiveness and safety. However, approaches to strengthen only the expiratory muscle groups (EMST) dominate the clinical study literature, with variable outcomes. This study investigated the effect of a simultaneous inspiratory and expiratory muscle strengthening strategy to improve swallowing function in stroke patients. MethodsTwenty post-stroke patients were randomly assigned to either intervention group (IG) or control group (CG). The intervention group was treated with three 5-minute sessions of resistive respiratory muscle training every day for 28 days, while the control group received no RMT. Respiratory and swallow outcomes were assessed pre- and post-intervention and included Mann Assessment of Swallowing Ability (MASA), Fiberoptic Endoscopic Evaluation of Swallowing (FEES) with Penetration/Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS), patient visual analogue scale (VAS), and peak expiratory flow (PEF). ResultsAfter 28 days, the intervention group demonstrated greater improvements (pVal < 0.05) in PEF (IG: 168.03% vs CG: 17.47%), VAS (IG: 103.85% vs CG: 27.54%), MASA (IG: 37.28% vs CG: 6.92%), PAS (IG: 69.84% vs CG: 12.12%), and FOIS (IG: 93.75% vs CG: 21.21%). ConclusionCombined resistive inspiratory and expiratory muscle training is a feasible and effective method to improve signs and symptoms of dysphagia in stroke patients.

8: Brain-Computer Interface Robotics for Hand Rehabilitation After Stroke: A Systematic Review
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Posted 15 Dec 2019

Brain-Computer Interface Robotics for Hand Rehabilitation After Stroke: A Systematic Review
1,286 downloads medRxiv rehabilitation medicine and physical therapy

Paul Dominick E Baniqued, Emily C Stanyer, Muhammad Awais, Ali Alazmani, Andrew E Jackson, Mark A. Mon-Williams, Faisal Mushtaq, Raymond J Holt

BackgroundElectroencephalography-based brain-computer interfaces (BCI) that allow the control of robotic devices to support stroke patients during upper limb rehabilitation are increasingly popular. Hand rehabilitation is focused on improving dexterity and fine motor control and is a core approach for helping stroke survivors regain activities of daily living. This systematic review examines recent developments in BCI-robotic systems for hand rehabilitation and identifies evidence-based clinical studies on stroke patients. MethodsA search for January 2010-October 2019 articles using Ovid MEDLINE, Embase, PEDro, PsycINFO, IEEE Xplore and Cochrane Library databases was performed. The selection criteria included BCI-hand robotic systems for rehabilitation in various development stages involving tests on healthy human subjects or stroke survivors. Data fields include those related to study design, participant characteristics, technical specifications of the system, and clinical outcome measures. Results30 studies were identified as eligible for qualitative review and among these, 11 studies involved testing a BCI-hand robot on chronic and subacute stroke patients. Statistically significant improvements in motor assessment scores relative to controls were observed for two BCI-hand robot interventions. The degree of robot control for the majority of studies was limited to triggering the device to perform grasping or pinching movements using motor imagery. Most employed a combination of kinaesthetic and visual response via the robotic device and display screen, respectively, to match feedback to motor imagery. ConclusionMost studies on BCI-robotic systems for hand rehabilitation report systems at prototype or pre-clinical stages of development. Some studies report statistically significant improvements in functional recovery after stroke, but there is a need to develop a standard protocol for assessing technical and clinical outcomes so that the necessary evidence base on efficiency and efficacy can be developed.

9: Virtual reality telerehabilitation for spatial neglect post-stroke: perspectives from stroke survivors, carers and clinicians
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Posted 10 Jan 2020

Virtual reality telerehabilitation for spatial neglect post-stroke: perspectives from stroke survivors, carers and clinicians
1,216 downloads medRxiv rehabilitation medicine and physical therapy

Helen Morse, Laura Biggart, Valerie Pomeroy, Stephanie Rossit

Spatial neglect is a common and severe cognitive consequence of stroke, yet there is currently no effective rehabilitation tool. Virtual Reality (VR) telerehabilitation tools have the potential to provide multisensory and enjoyable neuropsychological therapies and remotely monitor adherence without the presence of a therapist at all times. In order to inform the development of these tools researchers and industry need to better understand end-user perspectives about these technologies to ensure these are acceptable and user-friendly to ultimately optimize adherence and efficacy. Therefore, this study explored end-user perspectives on the use of self-administered VR telerehabilitation for spatial neglect. We used a mixed-method design including focus groups, self-administered questionnaires and individual interviews with stroke survivors (N = 7), their carers (N = 3) and stroke clinicians (N = 6). End-user perspectives identified clarity of instructions, equipment (cost, available resources) and for some, level of experience with technology as barriers of use. Perceived facilitators of use were performance feedback, engagement and enjoyment, and psychological benefits associated by self-administered VR telerehabilitation. Overall, end-users were positive and interested in using VR telerehabilitation for spatial neglect. These perspectives enabled us to produce practical recommendations to inform future development, enhance engagement and uptake of self-administered VR telerehabilitation.

10: Effectiveness of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: study protocol for a randomized controlled trial
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Posted 06 May 2020

Effectiveness of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: study protocol for a randomized controlled trial
1,182 downloads medRxiv rehabilitation medicine and physical therapy

Shaikh Nabi Bukhsh Nazir, Syed Shahzad Ali, Saeed Akhtar

Knee Osteoarthritis (KOA) patients have a huge negative impact on gait parameters and altered biomechanics in many components, including impairments of dynamic lower limb alignment and lumbopelvic movement control. The understanding of these components seems to be very crucial and there is need to add these unfocused components in treatment regimens in the research setting to see its effects; before using as a routine treatment regime in Clinical practice for patients with KOA. This study protocol focuses on whether Mulligan joint mobilization with movement provides evident effects on decreasing pain and restoring the joint biomechanics. Trunk stabilization exercises improve the stability of the trunk which distributes the weight of the body evenly on both feet biomechanically. The treatment effects of both treatments are inconclusive. Accordingly, the study aims to determine the efficacy of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening for KOA. It is a study protocol of a three-arm randomized control trial. Initial screening of the subjects will be carried out by a referring consultant. Subjects who fulfill the study criteria will be randomly allocated into three groups After an explanation of study objective and obtaining informed consent. Group 1 will receive mulligan mobilization with kinesiotaping and knee strengthening. Group 2 will receive trunk stabilization exercise, knee strengthening, and Kinesiotaping. Group 3 will receive knee strengthening along with kinesiotaping. All participants will be evaluated using visual analogue scale, Knee injury and Osteoarthritis Outcome Score, stair climb test and 6-minute walk test at 1st, 3rd and 6th week. The results of this study will answer a clearly focused question investigated in KOA patients. Finding of this study will serve as a guide to inform clinical decision making for healthcare professionals, researcher, and patients. Keywords: Osteoarthritis, knee joint, manual therapy, kinesiotape, exercise therapies, isometric contraction.

11: Computerized physical and cognitive training improves functional architecture of the brain in adults with Down Syndrome: a longitudinal network science EEG study
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Posted 30 May 2020

Computerized physical and cognitive training improves functional architecture of the brain in adults with Down Syndrome: a longitudinal network science EEG study
1,099 downloads medRxiv rehabilitation medicine and physical therapy

Alexandra Anagnostopoulou, Charis Styliadis, Panagiotis Kartsidis, Evangelia Romanopoulou, Vasiliki Zilidou, Chrysi Karali, Maria Karagianni, Manousos Klados, Evangelos Paraskevopoulos, Panagiotis D. Bamidis

Understanding the neuroplastic capacity of people with Down Syndrome (PwDS) can potentially reveal the causal relationship between aberrant brain organization and phenotypic characteristics. We used resting-state EEG recordings to identify how a neuroplasticity-triggering training protocol relates to changes in the functional connectivity of the brains intrinsic cortical networks. Brain activity of 12 PwDS before and after a ten-week protocol of combined physical and cognitive training was statistically compared to quantify changes in directed functional connectivity in conjunction with psychosomatometric assessments. PwDS showed increased connectivity within the left hemisphere and from left to right hemisphere, as well as increased physical and cognitive performance. Our findings reveal a strong adaptive neuroplastic reorganization as a result of the training that leads to a less-random network with a more pronounced hierarchical organization. Our results go beyond previous findings by indicating a transition to a healthier, more efficient, and flexible network architecture, with improved integration and segregation abilities in the brain of PwDS. Resting-state electrophysiological brain activity is used here for the first time to display meaningful relationships to underlying DS processes and outcomes of importance in a translational inquiry. This trial is registered with ClinicalTrials.gov Identifier NCT04390321. Author SummaryThe effects of cognitive and physical training on the neuroplasticity attributes of people with and without cognitive impairment have been well documented via neurophysiological evaluations and network science indices. However, there is still insufficient evidence for people with Down Syndrome (PwDS). We investigated the effects of a combinational training protocol on the brain network organization of 12 adult PwDS using EEG and network indices coupled with tests assessing their cognitive and physical capacity. We report evidence of adaptational neuroplastic effects, pointing to a transitional state towards a healthier organization with an increased ability to integrate and segregate information. Our findings underline the ability of the DS brain to respond to the cognitive demands of external stimuli, reflecting the possibility of developing independent-living skills.

12: Lower limb muscle activity underlying temporal gait asymmetry post-stroke
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Posted 29 Oct 2019

Lower limb muscle activity underlying temporal gait asymmetry post-stroke
1,014 downloads medRxiv rehabilitation medicine and physical therapy

Gabriela M. Rozanski, Andrew H. Huntley, Lucas D. Crosby, Alison Schinkel-Ivy, Avril Mansfield, Kara K. Patterson

ObjectiveAsymmetric walking after stroke is common, detrimental, and difficult to treat, but current knowledge of underlying physiological mechanisms is limited. This study investigated electromyographic (EMG) features of temporal gait asymmetry (TGA). MethodsParticipants post-stroke with or without TGA and control adults (n=27, 8, and 9, respectively) performed self-paced overground gait trials. EMG, force plate, and motion capture data were collected. Lower limb muscle activity was compared across groups and sides (more/less affected). Correlation between burst timing variables and asymmetry ratios was examined. ResultsSignificant group by side interaction effects were found: fewer TGA group dorsiflexor bursts during swing (p=.0009), more affected plantarflexor stance activity ended early (p=.0006) and less affected dorsiflexor on/off time was delayed (p<.01) in persons with asymmetry compared to symmetric and normative controls. Less affected side EMG timing correlated most with swing time ratio (r=0.68-0.90, p<.001). ConclusionsTemporal patterns of muscular activation, particularly about the ankle around the stance-to-swing transition period, are associated with TGA. The results may reflect specific impairments or compensations that affect locomotor coordination. SignificanceNeuromuscular underpinnings of spatiotemporal asymmetry have not been previously characterized. These novel findings may inform targeted therapeutic strategies to improve gait quality after stroke.

13: Demonstration of a portable intracortical brain-computer interface
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Posted 23 Sep 2019

Demonstration of a portable intracortical brain-computer interface
996 downloads medRxiv rehabilitation medicine and physical therapy

Jeffrey M Weiss, Robert Gaunt, Robert Franklin, Michael L Boninger, Jennifer Collinger

While recent advances in intracortical brain-computer interfaces (iBCI) have demonstrated the ability to restore motor and communication functions, such demonstrations have generally been confined to controlled experimental settings and have required bulky laboratory hardware. Here, we developed and evaluated a self-contained portable iBCI that enabled the user to interact with various computer programs. The iBCI, which weighs 1.5 kg, consists of digital headstages, a small signal processing hub, and a tablet PC. A human participant tested the portable iBCI in laboratory and home settings under an FDA Investigational Device Exemption (NCT01894802). The participant successfully completed 96% of trials in a 2D cursor center-out task with the portable iBCI, a rate indistinguishable from that achieved with the standard laboratory iBCI. The participant also completed a variety of free-form tasks, including drawing, gaming, and typing.

14: Sensory stimulation enhances phantom limb perception and movement decoding
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Posted 25 May 2020

Sensory stimulation enhances phantom limb perception and movement decoding
959 downloads medRxiv rehabilitation medicine and physical therapy

Luke Osborn, Keqin Ding, Mark A Hays, Rohit Bose, Mark M Iskarous, Andrei Dragomir, Zied Tayeb, György M Lèvay, Christopher L Hunt, Gordon Cheng, Robert S Armiger, Anastasios Bezerianos, Matthew Fifer, Nitish V Thakor

Objective. A major challenge for controlling a prosthetic arm is communication between the device and the user's phantom limb. We show the ability to enhance amputees' phantom limb perception and improve movement decoding through targeted transcutaneous electrical nerve stimulation (tTENS). Approach. Transcutaneous nerve stimulation experiments were performed with four amputee participants to map phantom limb perception. We measured myoelectric signals during phantom hand movements before and after amputees received sensory stimulation. Using electroencephalogram (EEG) monitoring, we measure the neural activity in sensorimotor regions during phantom movements and stimulation. In one participant, we also tracked sensory mapping over 2 years and movement decoding performance over 1 year. Main results. Results show improvements in the amputees' ability to perceive and move the phantom hand as a result of sensory stimulation, which leads to improved movement decoding. In the extended study with one amputee, we found that sensory mapping remains stable over 2 years. Remarkably, sensory stimulation improves within-day movement decoding while performance remains stable over 1 year. From the EEG, we observed cortical correlates of sensorimotor integration and increased motor-related neural activity as a result of enhanced phantom limb perception. Significance. This work demonstrates that phantom limb perception influences prosthesis control and can benefit from targeted nerve stimulation. These findings have implications for improving prosthesis usability and function due to a heightened sense of the phantom hand.

15: Comparing a novel neuroanimation experience to conventional therapy for high-dose, intensive upper-limb training in subacute stroke: The SMARTS2 randomized trial
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Posted 07 Aug 2020

Comparing a novel neuroanimation experience to conventional therapy for high-dose, intensive upper-limb training in subacute stroke: The SMARTS2 randomized trial
921 downloads medRxiv rehabilitation medicine and physical therapy

John W. Krakauer, Tomoko Kitago, Jeff Goldsmith, Omar Ahmad, Promit Roy, Joel Stein, Lauri Bishop, Kelly Casey, Belen Valladares, Michelle D Harran, Juan Camilo Cortes, Alexander Forrence, Jing Xu, Sandra Deluzio, Jeremia Held, Anne Schwarz, Levke Steiner, Mario Widmer, Kelly Jordan, Daniel Ludwig, Meghan Moore, Marlena Barbera, Isha Vora, Rachel Stockley, Pablo Celnik, Steven Zeiler, Meret Branscheidt, Gert Kwakkel, Andreas Luft

Background: Evidence from animal studies suggests that greater reductions in post-stroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, post-stroke period. Objective: To compare two approaches of delivering high-intensity, high-dose upper limb therapy in patients with subacute stroke: a novel exploratory neuro-animation therapy (NAT), and modified conventional occupational therapy (COT). Methods: Twenty-four patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included: Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale (SIS) hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 post-training. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper limb therapy per day. Results: There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 {+/-}2.9 pts, p=0.011), but not the FM-UE (1.4 {+/-}2.6 pts, p =0.564) when compared to the HC. Conclusions: Two forms of high-dose intensive upper limb therapy produced greater activity but not impairment improvements compared with regular care. Neuroanimation may offer a new enjoyable, efficient and scalable way to deliver increased upper limb therapy.

16: Upper Limb Motor Improvement after TBI: Systematic Review of Interventions
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Posted 13 Nov 2020

Upper Limb Motor Improvement after TBI: Systematic Review of Interventions
900 downloads medRxiv rehabilitation medicine and physical therapy

Sandeep K Subramanian, Melinda Fountain, Ashley Hood, Monica Verduzco-Gutierrez

Background: Traumatic Brain Injury (TBI) is a leading cause of adult morbidity and mortality. Individuals with TBI have impairments in both cognitive and motor domains. Motor improvements post-TBI are attributable to adaptive neuroplasticity and motor learning. Majority of the studies focus on remediation of balance and mobility issues. There is limited understanding on the use of interventions for upper limb (UL) motor improvements in this population. Objective: We examined the evidence regarding the effectiveness of different interventions to augment UL motor improvement after a TBI. Methods: We systematically examined the evidence published in English from 1990-2020. The modified Downs and Black checklist helped assess study quality (total score:28). Studies were classified as excellent:24-28, good:19-23, fair:14-18 and poor:[&le;]13 in quality. Effect sizes helped quantify intervention effectiveness. Results: Twenty-three studies were retrieved. Study quality was excellent(n=1), good(n=5) or fair(n=17). Interventions used included strategies to decrease muscle tone (n=6), constraint induced movement therapy (n=4), virtual reality gaming (n=5), noninvasive stimulation (n=3), arm motor ability training (n=1), stem-cell transplant (n=1); task-oriented training (n=2) and feedback provision (n=1). Motor impairment outcomes included Fugl-Meyer Assessment, Modified Ashworth Scale, and kinematic outcomes (error and movement straightness). Activity limitation outcomes included Wolf Motor Function Test and Motor Activity Log. Effect sizes for majority of the interventions ranged from medium(0.5-0.79) to large([&ge;]0.8). Only ten studies included retention testing. Conclusion: There is preliminary evidence that using some interventions may enhance UL motor improvement after a TBI. Answers to emergent questions can help select the most appropriate interventions in this population.

17: The prevalence and risk factors for phantom limb pain in people with amputations: a systematic review and meta-analysis.
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Posted 18 Oct 2019

The prevalence and risk factors for phantom limb pain in people with amputations: a systematic review and meta-analysis.
894 downloads medRxiv rehabilitation medicine and physical therapy

K. Limakatso, G. J. Bedwell, V. J. Madden, R Parker

Background and objectivePhantom limb pain (PLP) is a common complication in people with limb amputations. There are conflicting reports in the literature regarding the prevalence of PLP in people with limb amputations. Therefore, this review aimed to determine the estimated pooled prevalence of PLP, and risk factors associated with this complication. MethodsArticles published between 1980 and July 2019 were identified through a systematic search of the following electronic databases: MEDLINE/PubMed, PsycINFO, PsycArticles, Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Health Source: Nursing/Academic Edition, SCOPUS, Web of Science and Academic Search Premier. Grey literature was searched on databases for preprints. Two reviewers independently performed the screening of articles, data extraction and risk of bias assessment. The meta-analyses were conducted using the random-effects model. A statistically significant level for the analyses was set at p>0.05. ResultsThe pooling of all studies demonstrated a prevalence estimate of 63% [95% CI: 58.23-67.05] with high heterogeneity [I2=95.70% (95% CI: 95.10-96.20)]. The prevalence of PLP was significantly lower in developing countries compared to developed countries [53.98% vs 64.55%; p=0.04]. Persistent pre-operative pain, proximal site of amputation, lower limb amputation, stump pain and phantom sensations were identified as risk factors for PLP. ConclusionThis systematic review and meta-analysis estimates that six of every 10 people with an amputation report PLP - a high and important prevalence of PLP. Health care professionals ought to be aware of the high rates of PLP and implement strategies to reduce PLP by addressing known risk factors, specifically those identified by the current study.

18: Effects of supervised high-intensity hardstyle kettlebell training on grip strength and health-related physical fitness in insufficiently active older adults: The BELL pragmatic controlled trial
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Posted 02 Jul 2021

Effects of supervised high-intensity hardstyle kettlebell training on grip strength and health-related physical fitness in insufficiently active older adults: The BELL pragmatic controlled trial
890 downloads medRxiv rehabilitation medicine and physical therapy

Neil J Meigh, Justin W.L. Keogh, Ben J. Schram, Wayne Hing, Evelyne N. Rathbone

The Ballistic Exercise of the Lower Limb (BELL) trial examined efficacy and safety of a pragmatic hardstyle kettlebell training program in older adults. Insufficiently active men and women aged 59-79 years, were recruited to a 6-month repeated measures study, involving 3-months usual activity and 3-months progressive hardstyle kettlebell training. Health-related physical fitness outcomes included: grip strength [GS], 6-min walk distance [6MWD], resting heart rate [HR], stair-climb [SC], leg extensor strength [LES], hip extensor strength [HES], Sit-To-Stand [STS], vertical jump [CMVJ], five-times floor transfer [5xFT], 1RM deadlift, body composition (DXA), attendance, and adverse events. Sixteen males (68.8 {+/-} 4.6 yrs, 176.2 {+/-} 7.8 cm, 90.7 {+/-} 11.0 kg, 29.2 {+/-} 2.6 kg/m2) and sixteen females (68.6 {+/-} 4.7 yrs, 163.9 {+/-} 5.4 cm, 70.4 {+/-} 12.7 kg, 26.3 {+/-} 4.9 kg/m2) were recruited. Compliance to the supervised exercise program was very high (91.5%). Kettlebell training increased GS (R: MD = 7.1 kg 95% CI [4.9, 9.3], p < 0.001, L: MD = 6.3 kg 95% CI [4.1, 8.4], p < 0.001), 6MWD (41.7 m, 95% CI [17.9, 65.5], p < .001), 1RM (16.2 kg, 95% CI [2.4, 30.0], p = 0.013), 30s STS (3.3 reps, 95% CI [0.9, 5.7], p = 0.003), LES (R: MD = 61.6 N, 95% CI [4.4, 118.8], p = 0.028), HES (L: MD = 21.0 N, 95% CI [4.2, 37.8], p = 0.007), appendicular skeletal lean mass (MD = 0.65 kg, 95% CI [0.08, 1.22], p = 0.016), self-reported health change (17.1%, 95% CI [4.4, 29.8], p = 0.002) and decreased SC time (2.7 sec, 95% CI [0.2, 5.2], p = 0.025), 5xFT time (6.0 sec, 95% CI [2.2, 9.8], p < 0.001) and resting HR (7.4 bpm, 95% CI [0.7, 14.1], p = 0.032). There were four non-serious adverse events. Mean individual training load for group training sessions during the trial was 100,977 {+/-} 9,050 kg. High-intensity hardstyle kettlebell training was well tolerated and improved grip strength and measures of health-related physical fitness in insufficiently active older adults.

19: Safety and efficacy of Pulmonary physiotherapy in hospitalized patients with severe COVID-19 pneumonia (PPTCOVID): A prospective, randomised, single-blind, controlled trial
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Posted 25 Apr 2021

Safety and efficacy of Pulmonary physiotherapy in hospitalized patients with severe COVID-19 pneumonia (PPTCOVID): A prospective, randomised, single-blind, controlled trial
866 downloads medRxiv rehabilitation medicine and physical therapy

Mohammad Javaherian, Azadeh Shadmehr, Abbasali Keshtkar, Mohammad Taghi Beigmohammadi, Narges Dabbaghipour, Aabis Syed, Behrouz Attarbashi Moghaddam

Background: Pulmonary physiotherapy (PPT) is an important therapeutic tool in the management of patients with different types of pulmonary disorders. We aimed to evaluate safety and efficacy of PPT in hospitalized patients with severe COVID-19 pneumonia. Methods: In this randomised, single-blind, controlled trial, we enrolled hospitalized, non-intubated patients (18 to 75 years with oxygen saturation(Spo2) in free-air breathing [&le;]90%) with COVID-19 pneumonia at a referral hospital. Participants were randomly assigned (1:1) to receive PPT (six sessions PPT with breathing exercises and airway clearance techniques) or basic care. The primary outcomes were venous blood O2 (pO2) and CO2 (pCO2) pressures, Spo2, and three-minute walking test (3MWT) that were assessed before and end of sixth session. Secondary outcomes included level of dyspnea, venous blood PH, one-month mortality, three-month mortality and short form-36 (SF-36) after one and three months. The assessor was blinded to the assignment. This trial is registered with ClinicalTrials.gov (NCT04357340). Findings: In April 2020, 40 participants were randomly assigned to PPT or basic care groups. At the end of intervention, pO2mortality rates wererence to baseline measure (AMD) 6-43mmHg [95%CI 2-8,10-07],P<0.0001), pCO2(AMD -2-1mmHg [95%CI-6-36,2-21],P=0.0011), Spo2(AMD 4-43% [95%CI 2-04,6-83],P=0.0011), and 3MTW (AMD 91-44m [95%CI 68-88,113-99],P<0.0001) were different between groups. While the mortality rate was not different at one month, at three months it was 25% lower in the PPT group (P=.05). This result needs to be reviewed overall though within the manuscript as it is also reported as insignificant "after considering baseline Spo2 as a covariate: OR=.16 [.26,1.05], P=.07;table 4). There were no significant difference in all SF-36 domains scores between groups after one and three months except body pain domain which was higher in PPT group than basic group significantly(P=.01). No serious adverse event was observed during PPT sessions. Conclusion: Early PPT can be considered as a safe and effective therapeutic choice for patients with severe COVID-19. Clinical Trial Registration ID #NCT04357340.

20: Pushing the limits of recovery in chronic stroke survivors: User perceptions of the Queen Square Upper Limb Neurorehabilitation Programme.
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Posted 13 Jan 2020

Pushing the limits of recovery in chronic stroke survivors: User perceptions of the Queen Square Upper Limb Neurorehabilitation Programme.
855 downloads medRxiv rehabilitation medicine and physical therapy

K Kelly, F Brander, A Strawson, NS Ward, Kathryn S Hayward

IntroductionThe Queen Square Upper Limb (QSUL) Neurorehabilitation Programme is a clinical service within the National Health Service in the United Kingdom that provides 90 hours of therapy over three weeks to stroke survivors with persistent upper limb impairment. This study aimed to explore the perceptions of participants of this programme, including clinicians, stroke survivors and carers. DesignDescriptive qualitative. SettingClinical outpatient neurorehabilitation service. ParticipantsClinicians (physiotherapists, occupational therapists, rehabilitation assistants) involved in the delivery of the QSUL Programme, as well as stroke survivors and carers who had participated in the programme were purposively sampled. Each focus group followed a series of semi-structured, open questions that were tailored to the clinical or stroke group. One independent researcher facilitated all focus groups, which were audio-recorded, transcribed verbatim and analysed by four researchers using a thematic approach to identify main themes. ResultsFour focus groups were completed: three including stroke survivors (n = 16) and carers (n =2), and one including clinicians (n = 11). The main stroke survivor themes related to psychosocial aspects of the programme ("you feel valued as an individual"), as well as the behavioural training provided ("gruelling, yet rewarding"). The main clinician themes also included psychosocial aspects of the programme ("patient driven ethos - no barriers, no rules"), and knowledge, skills and resources of clinicians ("it is more than intensity, it is complex"). ConclusionsAs an intervention, the QSUL Programme is both comprehensive and complex. The impact of participation in the programme spans psychosocial and behavioural domains from the perspectives of both the stroke survivor and clinician. Strengths and limitationsO_LIDescriptive qualitative study of the perception of users (stroke survivor, carer, clinician) engaged in the delivery of the Queen Square Upper Limb Neurorehabilitation Programme, which is run at a single centre in the United Kingdom. C_LIO_LIFocus groups were completed by a researcher independent of the programme, without the involvement of senior management to facilitate open discussion and critical reflection of the programme. C_LIO_LIThis study involved a sample of users that were involved in the programme in the previous 12-months. C_LIO_LIData coding was performed by four researchers enhancing the validity of the results. C_LIO_LIAs only two carers were included in the focus groups, their experience has limited representation in the results. C_LI

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