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Bajuaifer S, Grey MJ, Hancock NJ, Chandler E, Pomeroy VM. Maximum tolerable daily dose of mirror movement therapy ankle exercises after stroke: an early phase dose screening study. Physiotherapy 2024; 122:30-39. [PMID: 38237263 DOI: 10.1016/j.physio.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 09/28/2023] [Accepted: 10/29/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Mirror movement therapy may reduce lower limb motor impairment after stroke. The dose is unknown. OBJECTIVE identify the maximum tolerable dose a day (MTD) of lower limb mirror movement therapy DESIGN: 3 + 3 cohort rule-based, dose escalation/de-escalation study. After undertaking baseline measures participants performed mirror movement therapy for 14 consecutive days. Participants then undertook outcome measures. Cohort One trained for 15 minutes daily. Subsequent cohorts exercised at a dose set according to pre-set rules and the modified Fibonacci sequence. The study stopped when the difference between set doses for consecutive cohorts was 10% or less. SETTING Participants' homes (intervention) and a movement analysis laboratory (measures). PARTICIPANTS Adults discharged from statutory stroke rehabilitation services. INTERVENTION Mirror movement therapy ankle exercises. OUTCOME MEASURES Motricity Index (primary) and bilateral time symmetry from movement onset to peak activation of Tibialis Anterior muscles during standardised sit-to-stand (secondary). RESULTS Five cohorts of three participants were included (n = 15). Mean (SD) age and time after stroke were 61 (9) years and 35 (42) months respectively. Set daily doses for the five cohorts were: 15, 30, 50, 40 then 35 minutes. The set dose for a subsequent cohort (six) would have been 38 minutes thus the difference from cohort five would have been three minutes i.e., 9% different. Therefore, the study stopped CONCLUSION: The identified MTD of lower limb mirror therapy was 35 minutes daily when frequency was set at seven days a week and duration as two weeks. CLINICAL TRIAL REGISTRATION NUMBER NCT04339803 (ClinicalTrials.gov) CONTRIBUTION OF THE PAPER: This early phase study found that the maximum tolerable dose per day (MTD) of mirror movement therapy ankle exercises was 35 minutes when frequency was set at seven days a week and duration as two weeks. The optimal therapeutic dose will therefore be somewhere in the range of 15 (starting dose) to 35 minutes per day. Further dose articulation studies are required to identify the optimal therapeutic dose before use of findings in clinical practice. This study is the first step in that research process.
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Alt Murphy M, Pradhan S, Levin MF, Hancock NJ. Uptake of Technology for Neurorehabilitation in Clinical Practice: A Scoping Review. Phys Ther 2024; 104:pzad140. [PMID: 37856528 PMCID: PMC10851848 DOI: 10.1093/ptj/pzad140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Technology-based interventions offer many opportunities to enhance neurorehabilitation, with associated research activity gathering pace. Despite this fact, translation for use in clinical practice has lagged research innovation. An overview of the current "state of play" regarding the extent of clinical uptake and factors that might influence use of technologies is required. This scoping review explored the uptake of technologies as neurorehabilitation interventions in clinical practice and factors that are reported to influence their uptake. METHODS This systematic scoping review was conducted with narrative synthesis and evidence mapping. Studies of any design reporting uptake or implementation of technology (wearable devices, virtual reality, robotics, and exergaming) for movement neurorehabilitation after stroke and other neurological conditions were sought via a formal search strategy in MEDLINE (Ovid), CINAHL, AMED, and Embase. Full-text screening and data extraction were completed independently by 2 reviewers. RESULTS Of 609 studies returned, 25 studies were included after title, abstract, and full-text screening. Studies investigated a range of technologies at various stages of development. Only 4 of the included studies explored the sustained use of technology in practice. The following 5 themes representing experiences of technology use emerged: perceived usefulness, technology design, social interaction, integration with services, and suggested improvements to enhance uptake. CONCLUSION Reporting of uptake and use of neurorehabilitation technologies in clinical practice is limited. The synthesis provided comprehensive knowledge of barriers to and facilitators of uptake to be considered in future protocols, including a steep learning curve required to engage with technology, a need for a supportive organizational culture, and a need for user involvement in both design and development. IMPACT This scoping review has provided indicators from current evidence of important factors to consider in the planning of research into and clinical implementation of technologies for neurorehabilitation. It serves to support an evidence-based, user-centered platform for improved research on and translation of technologies in neurorehabilitation clinical practice.
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Affiliation(s)
- Margit Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sujata Pradhan
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Nicola J Hancock
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Hancock NJ, Houghton J, Jones F. Integrating an approach to personalised self-management support in stroke and neurorehabilitation service contexts: People1st - a quality improvement initiative. Disabil Rehabil 2023; 45:3034-3045. [PMID: 36301996 DOI: 10.1080/09638288.2022.2127930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE People living with stroke and neurological conditions access rehabilitation at different times but self-management is often viewed as what happens post-discharge. Personalised models that integrate self-management support within everyday care are now advocated but this may require practitioners to change their behaviour to adopt and sustain new ways of working. The People1st project evaluated integration of an existing Supported Self-Management programme ("Bridges") across varied stroke and neurorehabilitation service contexts. MATERIALS AND METHODS Mixed-method evaluation of training for groups of healthcare practitioners across 24 UK National Health Service (NHS) Trusts, exploring how learning from Bridges was assimilated and enacted in practice, on an individual and collective basis. RESULTS Staff growth in confidence and skill around supported self-management was demonstrated. Transformations to practice included changes to: the structure of, and language used in, patient interactions; induction/training processes to increase potential for sustainability; and sharing of successes. Bridges helped practitioners make changes that brought them closer to their professional ideals. Engaged leadership was considered important for successful integration. CONCLUSIONS Bridges was successfully integrated within a wide range of stroke and neurorehabilitation service contexts, enabled by an approach in line with practitioners' values-based motivations. Further work is required to explore sustainability and impact on service users. Implications for rehabilitationPersonalised models of care and support for self-management are advocated for people living with stroke and neurological conditions; this requires practitioners to be supported to change behaviour and practices to adopt and sustain new ways of working.Staff from a wide variety of backgrounds in neurorehabilitation and stroke can learn collaboratively about self-management practices via the Bridges programme and can integrate those practices into their service contexts.Bridges can take practitioners closer to their professional ideals of caring and making a difference and empowers them to initiate change.Organisational commitment and engaged leadership are required to facilitate a culture of support for self-management in practice.
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Affiliation(s)
- Nicola J Hancock
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Julie Houghton
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona Jones
- Population Health Research Institute, St George's University of London, London, UK
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Hancock NJ, Shepstone L, Rowe P, Pomeroy VM. Identification of neuromuscular targets for restoration of walking ability after stroke: Precursor to precision rehabilitation. Physiother Res Int 2019; 25:e1816. [PMID: 31758747 DOI: 10.1002/pri.1816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/19/2019] [Accepted: 10/03/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Restoration of walking is a priority for stroke survivors and key target for physical therapies. Upright pedalling (UP) can provide functional walking-like activity using a variety of muscle synergies; it is unclear which synergies might be most useful for recovery of walking. Objectives here were as follows: to examine whether neuromuscular measures derived during UP might identify targets for walking rehabilitation after stroke and to determine test-retest repeatability and concurrent validity of the measures. DESIGN This was a prospective correlational study. SETTING The study was carried out in a movement science laboratory. PARTICIPANTS The participants were 18 adults with stroke (StrS) and 10 healthy older adults (HOA). INTERVENTION/MEASUREMENT StrS and HOA took part in two identical measurement sessions. During UP, surface electromyography and kinematic data were recorded and then processed to derive three measures: reciprocal activity of quadriceps and hamstrings; percentage muscle activity "on" according to crank angle; and smoothness of movement. RESULTS HOA and StrS demonstrated differences in reciprocal muscle activity (p = .044) and quadriceps activity according to crank angle (p = .034) but pedalled similarly smoothly (p = .367). For muscle activation according to crank angle in StrS, intraclass correlation coefficients (95% confidence interval) showing acceptable repeatability were 0.46 [0.32, 0.58] affected quadriceps; 0.43 [0.28, 0.56] affected hamstrings; and 0.67 [0.56, 0.75] unaffected quadriceps. CONCLUSION Muscle activation according to crank angle is a promising measure of lower limb impairment during functional activity after stroke; subsequent investigation should determine magnitude of variance between testing sessions. Reciprocal activity of quadriceps and hamstrings muscles and quadriceps activity according to crank angle are both potential targets for physical therapies to improve motor recovery. Further investigations are warranted.
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Affiliation(s)
- Nicola J Hancock
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Philip Rowe
- Biomedical Engineering Department, University of Strathclyde, Glasgow, UK
| | - Valerie M Pomeroy
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
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Hancock NJ, Collins K, Dorer C, Wolf SL, Bayley M, Pomeroy VM. Evidence-based practice 'on-the-go': using ViaTherapy as a tool to enhance clinical decision making in upper limb rehabilitation after stroke, a quality improvement initiative. BMJ Open Qual 2019; 8:e000592. [PMID: 31523735 PMCID: PMC6711438 DOI: 10.1136/bmjoq-2018-000592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022] Open
Abstract
Recovery of upper limb function after stroke is currently sub-optimal, despite good quality evidence showing that interventions enabling repetitive practice of task-specific activity are effective in improving function. Therapists need to access and engage with such evidence to optimise outcomes with people with stroke, but this is challenging in fast-paced stroke rehabilitation services. This quality improvement project aimed to investigate acceptability and service impact of a new, international tool for accessing evidence on upper limb rehabilitation after stroke—‘ViaTherapy’—in a team of community rehabilitation therapists. Semi-structured interviews were undertaken at baseline to determine confidence in, and barriers to, evidence-based practice (EBP) to support clinical decision making. Reported barriers included time, lack of access to evidence and a research-practice disconnect. The clinicians then integrated use of ‘ViaTherapy’ into their practice for 4 weeks. Follow-up interviews explored the accessibility of the tool in community rehabilitation practice, and its impact on clinician confidence, treatment planning and provision. Clinicians found the tool, used predominantly in mobile device app format, to be concise and simple to use, providing evidence ‘on-the-go’. Confidence in accessing and using EBP grew by 22% from baseline. Clinicans reported changes in intensity of delivery of interventions, as rapid access to recommended doses via the tool was available. Following this work, the participating health and social care service provider changed provision of therapists’ technology to enable use of apps. Barriers to use of EBP in stroke rehabilitation persist; the baseline situation here supported the need for more accessible means of integrating best evidence into clinical processes. This quality improvement project successfully integrated ViaTherapy into clinical practice, and found that the tool has potential to underpin positive changes in upper limb therapy service delivery after stroke, by increasing accessibility to, use of and confidence in EBP. Definitive evaluation is now indicated.
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Affiliation(s)
- Nicola J Hancock
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Kathryn Collins
- Faculty of Health and Social Sciences, Department of Human Sciences and Public Health, Bournemouth University, Bournemouth, United Kingdom
| | - Charlie Dorer
- Integrated Neuro Rehabilitation and Stroke ESD Team, Cambridge and Peterborough Foundation Trust, Cambridge, UK
| | - Steven L Wolf
- Division of Physical Therapy, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Mark Bayley
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Valerie M Pomeroy
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
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Hughes RN, Hancock NJ. Effects of acute caffeine on anxiety-related behavior in rats chronically exposed to the drug, with some evidence of possible withdrawal-reversal. Behav Brain Res 2016; 321:87-98. [PMID: 28043898 DOI: 10.1016/j.bbr.2016.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/23/2016] [Accepted: 12/15/2016] [Indexed: 01/05/2023]
Abstract
For 20days male and female PVG/c hooded rats were provided with caffeinated (approximately 50mg/kg/day) or unadulterated drinking water, and then their anxiety-related behavior was observed in an open field and elevated plus maze. Their choices of a brightness change were also observed in a Y maze to assess any caffeine effects on spatial memory. 24h later, all rats were tested again following an intraperitoneal injection of 50mg/kg acute caffeine, or vehicle. Earlier chronic caffeine decreased ambulation, walking, rearing, center occupancy and increased immobility in the open field thereby suggesting increased anxiety. However, occupancy of the plus-maze open arms and the Y-maze novel arm were increased by caffeine for male rats, but decreased for females probably because of sex differences in control levels of the response rather than to drug effects on anxiety and memory respectively. Following caffeine withdrawal, acute caffeine had the opposite effect to chronic treatment namely, increased open-field ambulation, walking, center occupancy and decreased immobility and defecation for caffeine-naïve rats that were suggestive of decreased anxiety. Similar but more consistent effects (plus decreased emergence latencies from a darkened start box into the open field) also typified the caffeine-experienced rats which in this case may have been accentuated by caffeine withdrawal-reversal. There was no evidence of either chronic or acute caffeine affecting spatial memory measured in the Y maze. There were also examples of lower overall activity and higher anxiety in male rats, than in females, and some sex-dependent caffeine effects.
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Affiliation(s)
- Robert N Hughes
- Department of Psychology, University of Canterbury, Christchurch 8140, New Zealand.
| | - Nicola J Hancock
- Department of Psychology, University of Canterbury, Christchurch 8140, New Zealand
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Hancock NJ, de Joux NR, Wingreen SC, Kemp S, Thomas J, Helton WS. Positive post-disaster images: A daydream machine? Br J Psychol 2016; 108:528-543. [PMID: 27619916 DOI: 10.1111/bjop.12213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 06/09/2016] [Indexed: 11/30/2022]
Abstract
This study explores the impact of post-earthquake images inserted in a vigilance task, in terms of performance, self-reports of task-focus, and cerebral activity using functional near-infrared spectroscopy (fNIRS). Vigilance tasks present a sequence of stimuli in which only a few are pre-designated critical or target stimuli requiring an overt response from the participant. Seventy-one residents participated (51 women, 20 men) by taking part in a vigilance task with task-irrelevant images inserted in the sequence. There were three conditions consisting positive (emotive inducing), negative (emotive inducing), and control (devoid of meaning) images embedded in the vigilance task to assess possible impacts on vigilance performance. The images were obtained through crowdsourcing and represented parts of the city 3-4 years post-earthquake. Task performance was assessed with signal detection theory metrics of sensitivity A' and bias β''. This enables the separation of an individual's ability to accurately discriminate critical signals from non-critical stimuli (sensitivity) and shifts in their willingness to respond to any stimuli whether critical or not (bias). Individuals viewing the positive images, relating to progress, rebuild, or aesthetic aspects within the city, had a more conservative response bias (they responded less to both rare critical and distractor stimuli) than those in the other conditions. These individuals also reported lower task-focus, as would be expected. However, contrary to expectations, indicators of cerebral activity (fNIRS) did not differ significantly between the experimental groups. These results, when combined, suggest that mind wandering events may be being generated when exposed to positive post-earthquake images.
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Affiliation(s)
| | | | | | - Simon Kemp
- University of Canterbury, Christchurch, New Zealand
| | - Jared Thomas
- University of Canterbury, Christchurch, New Zealand.,Opus Central Laboratory, Wellington, New Zealand
| | - William S Helton
- University of Canterbury, Christchurch, New Zealand.,Department of Psychology, George Mason University, Fairfax, Virginia, USA
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Hughes RN, Hancock NJ. Strain-dependent effects of acute caffeine on anxiety-related behavior in PVG/c, Long–Evans and Wistar rats. Pharmacol Biochem Behav 2016; 140:51-61. [DOI: 10.1016/j.pbb.2015.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/16/2015] [Accepted: 11/10/2015] [Indexed: 12/15/2022]
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Sammon E, Hancock NJ, Kennedy NC, Pomeroy VM. Characterising lower limb muscle activity and test-retest repeatability of EMG measures in healthy adults during upright pedalling. International Journal of Therapy and Rehabilitation 2014. [DOI: 10.12968/ijtr.2014.21.sup7.s4a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Upright pedalling (UP) has similarities to walking in terms of both muscle activation and biomechanical activity. Therefore, UP is a potential rehabilitation therapy for enhancing walking recovery. The development of UP as a rehabilitation intervention requires understanding of muscle activity patterns elicited during pedalling in a range of participants, including young healthy adults. The aims of this study were: to characterise muscle activation patterns during UP in young healthy adults, and to investigate the test-retest repeatability of EMG-derived measures used to characterise activity patterns. Methods: Participants (total n=8, females: n=7) performed two UP sessions, separated by a 1-hour rest period. During UP, muscle activity of rectus femoris (RF) and biceps femoris (BF) was recorded using surface EMG. Lower limb muscle activity was characterised by average, integrated activity (iEMG) for each muscle group according to four 90° phases of the 360° wheel turn. This procedure provided a measure of muscle activity throughout the pedalling cycle. Testretest repeatability of mean iEMG values for each pedal revolution was calculated using an intraclass correlation coefficient (ICC) with 95% confidence intervals (CI). Results: Characterisation of activity: muscle activity for all participants during UP demonstrated reciprocal muscle activation of BF and RF. More specifically, RF exhibited double bursts of activity at 0–135° and 270–360°, whereas BF demonstrated a single burst at 135–270°. Test-retest repeatability: appeared high for RF when considering the point estimate (ICC=0.837), but the associated wide CIs (-0.224–1.39) mean that this finding is imprecise. A lack of repeatability observed for BF (ICC=0.02) was also inconclusive due to wide CI's (-0.258–0.737). Conclusions: UP elicited a reciprocal muscle activation pattern in RF and BF in a small sample of young healthy volunteers. Definitive test-retest repeatability of recorded measures was not established. Implications: This study has contributed normative data on muscle activation patterns during walking-like activity, and data to inform sample size for definitively testing intra-participant variance.
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Affiliation(s)
- E Sammon
- School of Rehabilitation Sciences Faculty of Medicine and Health Sciences University of East Anglia e-
| | - NJ Hancock
- School of Rehabilitation Sciences Faculty of Medicine and Health Sciences University of East Anglia e-
| | - NC Kennedy
- School of Rehabilitation Sciences Faculty of Medicine and Health Sciences University of East Anglia e-
| | - VM Pomeroy
- School of Rehabilitation Sciences Faculty of Medicine and Health Sciences University of East Anglia e-
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da Assunção RE, Hancock NJ, Bruce WJM, Walker P. The limits of precision in conventionally instrumented computer-navigated total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20:2528-34. [PMID: 22437656 DOI: 10.1007/s00167-012-1952-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Computer-navigated total knee arthroplasty (TKA) improves the accuracy of component implantation. However, the final implant alignment may not match planned alignment. The hypothesis of this study is that although computer navigation improves alignment, imprecision may not be completely eliminated. The aim of the study was to establish the incidence and sources of imprecision during TKA using computer navigation to measure deviations from planned alignment. METHODS Computer navigation was used to quantify changes in planned alignment at four steps during 136 TKA's: application of cutting blocks, addition of definitive pin fixation, bone cuts and after prosthesis application. Mean changes in alignment deviation at each step in each plane were measured and the number of significant outliers (>3° from the planned resection plane) were assessed in each plane. RESULTS Overall changes in planned alignment were small and non-cumulative between steps but the incidence of outliers (cuts measured as >3° from planned alignment at each step) increased through the steps, with 21.3 % (n = 29) of final implants outlying in the tibial sagittal plane, which was the least precise plane. The highest number of outliers occurred after bone resection and the addition of pins to cutting blocks was also identified as a source of imprecision. CONCLUSION Despite improved accuracy of bone resection with computer-navigated TKA, the precision of bone cuts may be affected at several steps of the procedure. Cutting block application, bone resection and prosthesis application may all affect accuracy. Bone cuts should be made with meticulous care, whether navigated or not, and navigated cuts should be checked and corrected, particularly in the tibial sagittal plane. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- R E da Assunção
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX37LD, UK.
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Hancock NJ, Shepstone L, Winterbotham W, Pomeroy V. Effects of Lower Limb Reciprocal Pedalling Exercise on Motor Function after Stroke: A Systematic Review of Randomized and Nonrandomized Studies. Int J Stroke 2011; 7:47-60. [DOI: 10.1111/j.1747-4949.2011.00728.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review systematically synthesized current evidence on the effects of lower limb reciprocal pedalling exercise on motor function poststroke. Detailed analysis of single studies in the review revealed multiple instances of heterogeneity including outcome measures; therefore we decided to avoid undertaking a single, potentially misleading meta-analysis. We found that despite beneficial (although nondefinitive) effects on balance, functional independence, and muscle strength, it is not possible to make clinical recommendations that support or refute the use of reciprocal pedalling exercise to enhance recovery of motor function after stroke. Our findings provide proof-of-concept for pedalling interventions and provide a foundation for subsequent research, suggesting a need for further standardized, controlled clinical trials of clearly described pedalling interventions for stroke survivors and with subsequent transparent reported findings.
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Affiliation(s)
- Nicola J. Hancock
- Restorative Neurology Group, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Restorative Neurology Group, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Will Winterbotham
- Physiotherapy Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Valerie Pomeroy
- Restorative Neurology Group, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Hancock NJ, Shepstone L, Rowe P, Myint PK, Pomeroy V. Clinical efficacy and prognostic indicators for lower limb pedalling exercise early after stroke: study protocol for a pilot randomised controlled trial. Trials 2011; 12:68. [PMID: 21385361 PMCID: PMC3061926 DOI: 10.1186/1745-6215-12-68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 03/07/2011] [Indexed: 11/18/2022] Open
Abstract
Background It is known that repetitive, skilled, functional movement is beneficial in driving functional reorganisation of the brain early after stroke. This study will investigate a) whether pedalling an upright, static exercise cycle, to provide such beneficial activity, will enhance recovery and b) which stroke survivors might be able to participate in pedalling. Methods/Design Participants (n = 24) will be up to 30 days since stroke onset, with unilateral weakness and unable to walk without assistance. This study will use a modified exercise bicycle fitted with a UniCam crank. All participants will give informed consent, then undergo baseline measurements, and then attempt to pedal. Those able to pedal will be entered into a single-centre, observer-blinded randomised controlled trial (RCT). All participants will receive routine rehabilitation. The experimental group will, in addition, pedal daily for up to ten minutes, for up to ten working days. Prognostic indicators, measured at baseline, will be: site of stroke lesion, trunk control, ability to ambulate, and severity of lower limb paresis. The primary outcome for the RCT is ability to voluntarily contract paretic lower limb muscle, measured by the Motricity Index. Secondary outcomes include ability to ambulate and timing of onset and offset of activity in antagonist muscle groups during pedalling, measured by EMG. Discussion This protocol is for a trial of a novel therapy intervention. Findings will establish whether there is sufficient evidence of benefit to justify proceeding with further research into clinical efficacy of upright pedalling exercise early after stroke. Information on potential prognostic indicators will suggest which stroke survivors could benefit from the intervention. Trial Registration ISRCTN: ISRCTN45392701
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Affiliation(s)
- Nicola J Hancock
- Institiute of Health and Social Sciences, Faculty of Health, University of East Anglia, Norwich, UK.
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Abstract
OBJECTIVE To assess the efficacy and safety of a tissue adhesive for wound closure in elective hand surgery. METHOD A prospective observational study of the use of Dermabond for wound closure was undertaken. The cohort consisted of a consecutive case series of 105 patients and 114 surgical wounds. Surgeon and patient assessment was undertaken at a mean of 20 days (10 to 56 days) postoperatively. RESULTS Wound complication rate was low (one adverse event) and all patients were satisfied (46%) or very satisfied (54%) with wound healing and cosmesis. CONCLUSION Dermabond use in hand surgery is safe and well tolerated by patients. Routine postoperative wound review in these patients may not be needed thereby saving time and resources.
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Affiliation(s)
- N J Hancock
- Royal Hampshire County Hospital, Eastleigh and Winchester Hospitals NHS Trust, Winchester, UK.
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