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Accuracy and effectiveness of teledentistry: a systematic review of systematic reviews. Evid Based Dent 2022:10.1038/s41432-022-0257-8. [PMID: 35804195 PMCID: PMC9264296 DOI: 10.1038/s41432-022-0257-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/31/2021] [Indexed: 01/08/2023]
Abstract
Introduction The COVID-19 pandemic has urged healthcare systems to develop new ways to safely provide care. Telehealth has become a compelling alternative. Our purpose was to evaluate the accuracy and effectiveness of teledentistry for screening, diagnosis and therapeutic management of dental care in children and adults.Methods We conducted a systematic review (SR) of systematic reviews. Multiple databases, the grey literature and conference archives were searched. Eligible SRs included those reporting virtual screening, diagnostic investigations and therapeutic interventions. Two investigators independently reviewed abstracts, articles, critically appraised SRs and extracted the data.Results We identified 817 citations and included six SRs. The accepted SRs involved >7,000 participants, used primarily asynchronous communication for diagnostic/screening outcomes and used synchronous communication for treatment outcomes. SRs were of low quality and included 30 primary studies of our interest. Sensitivity and specificity for dental referrals and diagnostic treatment planning were higher than other index/reference tests, ranging from 80-88% and 73-95%, respectively. Treatment outcome measured patient compliance and professional supervision.Conclusion This SR provides the best existing evidence for clinical decision-making involving teledentistry. Current evidence supports teledentistry as an effective means for dental referrals, treatment planning and compliance and treatment viability. Asynchronous communication and the adoption of smartphones for image capturing are feasible and convenient for the implementation of teledentistry.
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Prevalence, Impact, and Treatment of Co-Occurring Osteoarthritis in Patients With Stroke Undergoing Rehabilitation: A Review. Stroke 2021; 52:e618-e621. [PMID: 34372669 DOI: 10.1161/strokeaha.121.034270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Early, frequent rehabilitation is an important factor for optimizing stroke recovery outcomes. Medical comorbidities, such as osteoarthritis, that affect the ability to participate in rehabilitation could therefore have a detrimental impact on such outcomes. Both stroke and osteoarthritis are becoming more common in developed nations as the population ages. First-line osteoarthritis treatments, such as oral nonsteroidal anti-inflammatory drugs, are often avoided poststroke due to interaction with secondary prevention stroke risk-factor management. Our objective was to summarize the current literature concerning co-occurring osteoarthritis and stroke prevalence, its functional impact, and treatment options. METHODS Narrative review using a comprehensive literature search of PubMed, osteoarthritis, and stroke guidelines. Outcomes related to co-occurrence prevalence, osteoarthritis as a stroke risk-factor, osteoarthritis-related imaging and treatment were extracted and summarized descriptively. Overall quality of the evidence was summarized using Grading of Recommendations Assessment, Development and Evaluation. RESULTS We identified 23 studies and guidelines related to our objective. Overall quality of the evidence was very low. CONCLUSIONS Few trials have investigated the relationship between osteoarthritis and stroke, nor osteoarthritis-specific pain and function management for stroke survivors. High-quality research evaluating the impact of osteoarthritis on stroke rehabilitation is needed.
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Development of a digital learning program for physiotherapists to enhance clinical implementation of aerobic exercise in stroke rehabilitation. Arch Physiother 2021; 11:17. [PMID: 34134785 PMCID: PMC8210353 DOI: 10.1186/s40945-021-00110-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper describes the initial development process of an eLearning continuing professional education program primarily for post-licensure physiotherapists -"Electronic Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke" (eAEROBICS). Our objective was to develop an evidence-based, clinically relevant, user-friendly eLearning program for online delivery tailored to facilitate prescription of aerobic exercise post-stroke by physiotherapists. The Demand Driven Learning Model guided curriculum design, delivery, and evaluation. Based on previously identified gaps in physiotherapists' knowledge of aerobic exercise, four learning modules were developed and delivered using an eLearning platform to maximize cost-effectiveness and flexibility. Five physiotherapists volunteered to pilot eAEROBICS, providing preliminary feedback on strengths and suggestions for improvement. RESULTS Theoretical information and clinical applications addressed the learning objectives of each module in a logical manner. All technical or administrative issues encountered during program delivery were addressed. The feedback from the pilot end-users informed modifications to the eAEROBICS program. CONCLUSIONS Processes used in developing eAEROBICS have the potential to serve as a model of electronic continuing professional education for other areas of physiotherapy practice. Further investigation of end-user perspectives and clinical impact of the program is warranted to determine the overall effectiveness of the program.
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Technology for maintaining oral care after stroke: considerations for patient-centered practice. Disabil Rehabil Assist Technol 2020; 17:916-926. [PMID: 32988252 DOI: 10.1080/17483107.2020.1822450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Activities of daily living including oral care may be challenging after stroke. Some stroke survivors are not able to complete oral care independently and need assistance from healthcare professionals and care partners. Poor oral hygiene may impact stroke recovery and rehabilitation possibly incurring issues such as aspiration pneumonia, malnutrition, and social isolation. The objective of this paper is to outline practical ways to apply oral care technology in daily use for stroke survivors. MATERIALS AND METHODS We reviewed the literature on i) stroke-related impairments impacting oral care, ii) oral hygiene dental devices, and iii) technology for oral care education. RESULTS Oral care activities involve integrated skills in the areas of motivation, energy, planning, body movement and sensation, and mental acuity and health. Post-stroke impairments such as fatigue, hemiparesis, and mental impairments may impact oral care activities. Technology may help survivors and caregivers overcome some barriers. Three types of technologies are available for facilitating post-stroke oral care: i) non-powered tools and adaptations; ii) powered oral care tools, and; iii) electronic aids to guide oral care activities. Particular choices should maximise patient safety and autonomy while ensuring accessibility and comfort during oral care tasks. CONCLUSION The available device and technologies may help substantially with the accommodations needed for post-stroke oral care, improving the oral health of stroke survivors. Good oral health confers benefit to overall health and well-being and could enhance recovery and rehabilitation outcomes. Nonetheless, more research is necessary to demonstrate the feasibility and effectiveness of technology in stroke contexts.IMPLICATIONS FOR REHABILITATIONOral care may be challenging after stroke due to patient fatigue, hemiparesis, cognitive impairments, and other impaired body functions.Poor oral hygiene may impact stroke recovery and rehabilitation due to risk of aspiration pneumonia, malnutrition, and social isolation.Powered oral care tools, non-powered tools, and adaptations to non-powered tools are some of the technology available to help overcome post-stroke barriers for oral care.Computer programs and online resources for education and guidance for oral care activities may help improve recommendation uptake and compliance.
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Predicting Falls Using the Stroke Assessment of Fall Risk Tool. PM R 2020; 13:274-281. [PMID: 32515060 DOI: 10.1002/pmrj.12434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Falls in the inpatient stroke population are common, resulting in increased morbidity and slow rehabilitation progress. Falls may result from stroke-specific neurologic deficits; however, assessment of these deficits is lacking in many fall screening tools. OBJECTIVE To compare the ability to predict falls of the Stroke Assessment of Fall Risk (SAFR) tool, which includes items related to stroke-specific neurologic deficits, and the commonly used Morse Fall Scale, which does not include these items. DESIGN Prospective cohort study. SETTING Inpatient tertiary stroke rehabilitation unit. PARTICIPANTS Patients (N = 220) with acute stroke. MAIN OUTCOME MEASURES Falls were captured by the medical records from January 2017 to September 2018. Logistic regression analysis evaluated both screening tools for predicting falls by calculating sensitivity, specificity, area under the receiver operating characteristic (AUC-ROC) curve, and odds ratio (OR). We compared SAFR and Morse mean scores between fallers and non-fallers using t-tests. RESULTS Forty-eight (21.8%) patients experienced ≥1 fall. SAFR, but not Morse, scores showed a statistically significant difference between fallers and non-fallers (P = .001 vs P = .24, respectively). Higher SAFR score was associated with higher odds of falls (OR 1.36, 95% CI [1.12, 1.64]), whereas Morse was not (OR 1.04, 95% CI [0.97, 1.12]). SAFR showed a statistically significant difference in hemi-neglect between fallers and non-fallers (P = .03). Sensitivity and specificity of SAFR were 47.9% and 76.7%, vs 45.8% and 68.0% for Morse, respectively. SAFR positive predictive value and negative predictive value were 36.5% and 84.1%, respectively, similar to Morse (28.6% and 81.8%). The AUC-ROC was 0.65 for SAFR and 0.56 for Morse. CONCLUSIONS SAFR was significantly associated with fall risk and had better discrimination between fallers and non-fallers than Morse. The neurologic-specific hemi-neglect component of SAFR, a component not present on the Morse, was a fall risk factor. Further research evaluating the predictive value of fall scales that include neurologic deficits is needed.
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Sitting Balance Exercise Performed Using Virtual Reality Training on a Stroke Rehabilitation Inpatient Service: A Randomized Controlled Study. PM R 2020; 12:754-765. [PMID: 31970898 DOI: 10.1002/pmrj.12331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/10/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Virtual reality training (VRT) is engaging and may enhance rehabilitation intensity. Only one previous study has looked at its use to improve sitting balance after stroke. OBJECTIVE To determine if supplemental sitting balance exercises, administered via VRT, improve control of sitting balance and upper extremity function in stroke rehabilitation inpatients. DESIGN Assessor-blinded, placebo-controlled randomized controlled trial. SETTING Stroke inpatient rehabilitation unit. PARTICIPANTS Seventy-six participants (out of 130 approached) with subacute stroke who could not stand independently were randomized to experimental and control groups. Sixty-nine completed the study. INTERVENTIONS The experimental group did VRT that required leaning and reaching, whereas the control group had their trunk restrained and performed VRT that involved only small upper extremity movements to minimize trunk movement. Both groups performed 10-12 sessions of 30-45 minutes. Participants were assessed pre, post, and 1 month after the sessions by a blinded examiner. OUTCOME MEASURES Function in Sitting Test (FIST, primary outcome measure); Ottawa Sitting Scale; Reaching Performance Scale; Wolf Motor Function Test (WMFT). RESULTS Thirty-three participants completed the experimental intervention and 36 the control. Pre/post differences for FIST were 3.4 (confidence interval [CI] 0.5;6.3) for the experimental group and 5.3 (2.9;7.7) for the control group. There was a significant improvement over time (adjusted for multiple comparisons, P < .006) on most outcome measures except the WMFT Performance Time Scale (control group; P = .007) and grip strength (P = .008); there were no differences between groups (P > .006). CONCLUSIONS Siting balance outcomes were similar for both groups; therefore, this study does not support the use of sitting balance exercises provided via VRT for the rehabilitation of sitting balance after stroke. However, because it is only the second study to investigate VRT for sitting balance and upper extremity function, more research, using more challenging exercises and a greater treatment intensity, is required before definitive conclusions are made.
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Centre of pressure displacements produced in sitting during virtual reality training in younger and older adults and patients who have had a stroke. Disabil Rehabil Assist Technol 2019; 15:924-932. [PMID: 31219364 DOI: 10.1080/17483107.2019.1629118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Poor sitting balance is common after stroke and makes leaning and reaching while sitting difficult and dangerous. Virtual reality training (VRT) uses computer hardware and software to track a person's movements and allow him or her to interact with a virtual environment. VRT games are available to train sitting balance after stroke; however, it is unknown how challenging they are. The objectives of this study were to characterize the centre of pressure displacements generated during the performance of VRT in stroke patients (ST) and compare their performance to that of young (YA) and older adults (OA).Materials and Methods: Eight ST participants who could stand for at least four minutes were recruited from an inpatient stroke rehabilitation unit for this cross-sectional, observational pilot study. Eight YA and eight OA were recruited from the community. Participants sat on a pressure mat and played 17 VRT game/difficulty combinations. The area, range and average velocity of centre of pressure displacement were determined for each game/difficulty.Results: Virtually manoeuvring a motorcycle around barriers and leaning to move a ball down a maze produced the greatest displacement of the centre of pressure, particularly in the mediolateral direction. OA moved further and faster in the mediolateral direction than YA. ST's performance was more variable.Conclusions: Some VRT games were more likely to push participants to challenge their limits of stability. Others required less displacement but more trunk stability. These results can guide which VRT games are used for the rehabilitation of sitting balance after stroke.Implications for rehabilitationSome virtual reality training games produce greater displacements of the centre of pressure in sitting than others, suggesting that careful matching between game challenge and desired therapeutic outcome is necessary when selecting games.Virtual reality training performed in sitting with feet on the floor challenges sitting balance in the frontal plane more so than in the sagittal plane.Older adults tend to lean more than younger adults while individuals with stroke move more or less than others, depending on the game.
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A systematic review of the risk of motor vehicle collision after stroke or transient ischemic attack. Top Stroke Rehabil 2019; 26:226-235. [PMID: 30614401 DOI: 10.1080/10749357.2018.1558634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Returning to driving after stroke is one of the key goals in stroke rehabilitation, and fitness to drive guidelines must be informed by evidence pertaining to risk of motor vehicle collision (MVC) in this population. OBJECTIVES The purpose of the present study was to determine whether stroke and/or transient ischemic attack (TIA) are associated with an increased MVC risk. METHODS We searched MEDLINE, CINAHL, EMBASE, PsycINFO, and TRID through December 2016. Pairs of reviewers came to consensus on inclusion, based on an iterative review of abstracts and full-text manuscripts, on data extraction, and on the quality of evidence. RESULTS Reviewers identified 5,605 citations, and 12 articles met inclusion criteria. Only one of three case-control studies showed an association between stroke and MVC (OR 1.9, 95% CI 1.0-3.9). Of five cohort reports, only one study, limited to self-report, found an increased risk of MVC associated with stroke or TIA (RR 2.71, 95% CI 1.11-6.61). Two of four cross-sectional studies using computerized driving simulators identified a more than two-fold risk of MVCs among participants with stroke compared with controls. The difference in one of the studies was restricted to those with middle cerebral artery stroke. CONCLUSIONS The evidence does not support a robust increase in risk of MVCs. While stroke clearly prevents some patients from driving at all and impairs driving performance in others, individualized assessment and clinical judgment must continue to be used in assessing and advising those stroke patients who return to driving about their MVC risk.
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Abstract
Assistive technology devices for computer access can facilitate social reintegration and promote independence for people who have had a stroke. This work describes the exploration of the usefulness and acceptability of a new computer access device called the Nouse™ (Nose-as-mouse). The device uses standard webcam and video recognition algorithms to map the movement of the user's nose to a computer cursor, thereby allowing hands-free computer operation. Ten participants receiving in- or outpatient stroke rehabilitation completed a series of standardized and everyday computer tasks using the Nouse™ and then completed a device usability questionnaire. Task completion rates were high (90%) for computer activities only in the absence of time constraints. Most of the participants were satisfied with ease of use (70%) and liked using the Nouse™ (60%), indicating they could resume most of their usual computer activities apart from word-processing using the device. The findings suggest that hands-free computer access devices like the Nouse™ may be an option for people who experience upper motor impairment caused by stroke and are highly motivated to resume personal computing. More research is necessary to further evaluate the effectiveness of this technology, especially in relation to other computer access assistive technology devices.
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Can technology-assisted toilets improve hygiene and independence in geriatric rehabilitation? A cohort study. Disabil Rehabil Assist Technol 2017; 13:626-633. [PMID: 28889764 DOI: 10.1080/17483107.2017.1358303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate whether technology-assisted toilets (TATs) could be used to improve toileting hygiene and independence for geriatric rehabilitation patients. TATs are commercially available toilet seats that use a stream of warm water to clean the user, have a fan for drying and are operated by a remote control. MATERIALS AND METHODS Twenty-five geriatric rehabilitation in-patients were recruited, six completed the study, and seven partially completed the study. Each participant had two trial bowel movements. One trial involved cleaning themselves with toilet paper; the other involved cleaning themselves with the TAT functions. After each trial, participants received a visual inspection for cleanliness and answered the Psychosocial Impact of Assistive Devices Scale (PIADS), a validated scale, to assess their sense of competence, adaptability and self-esteem in the bathroom. A toileting cleanliness scale, designed for this study, was completed by a nurse after TAT usage. Participants received a score from 1 (completely clean) to 4 (completely soiled) based on a visual inspection after cleaning. RESULTS TAT and toileting cleanliness scores were similar. PIADS scores showed a trend towards higher scores when using the TAT, but results were not statistically significant. CONCLUSIONS TATs cleaned as well as standard toileting in geriatric rehabilitation inpatients. Participants indicated that TATs improved their sense of competence, adaptability and self-esteem. Geriatricians and rehabilitation professionals should consider prescribing TATs in their practice as an assistive device in order to promote patient independence and dignity and reduce the burden of care for patients requiring toileting assistance. Implications for rehabilitation Technology-assisted toilets (TATs) are commercially-available toilet seats that could be used to allow rehabilitation patients to clean themselves more independently in the bathroom. Improved toileting independence can reduce burden of care of geriatric rehabilitation and reduce the impact of toileting assistance on patient dignity and self-esteem. Physiatrists should consider recommending TATs to their patients but should take into account whether a patient's particular set of disabilities will allow them to use a TAT effectively.
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Technology-assisted toilets: Improving independence and hygiene in stroke rehabilitation. J Rehabil Assist Technol Eng 2017; 4:2055668317725686. [PMID: 31186933 PMCID: PMC6453101 DOI: 10.1177/2055668317725686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/20/2017] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose Dependence on assistance for toileting is a widespread problem for persons
receiving healthcare. Technology-assisted toilets, which hygienically wash
and dry the perineal region, are devices that could improve toileting
independence in a variety of patients. The objective was to investigate
whether technology-assisted toilets improve toileting independence, quality
of life, and whether technology-assisted toilets can provide sufficient
toileting hygiene in stroke rehabilitation. Methods This pilot study was carried out in a stroke rehabilitation unit. Thirty
participants were recruited. Participants had a bowel movement and cleaned
themselves using the technology-assisted toilet on one to three occasions.
Participants rated their toileting before using the technology-assisted
toilet and after each technology-assisted toilet use with the Psychosocial
Impact of Assistive Devices Scale (PIADS). After each session, participants
were rated for cleanliness. Results PIADS scores were analyzed from eight individual participants, five of whom
completed the full protocol. PIADS scores were significantly higher with the
technology-assisted toilet than with the participants’ regular toileting
routine (p < 0.05). Technology-assisted toilets cleaned effectively in
73% of cases (16/22, p < 0.05). Conclusion Technology-assisted toilets improved stroke patients’ psychosocial outcomes
compared to standard toileting and completely cleaned participants in the
majority of cases. A larger study should confirm technology-assisted
toilet’s benefit in stroke rehabilitation through improved independence and
hygiene.
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Promoting Therapists' Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation. PLoS One 2016; 11:e0168311. [PMID: 27992492 PMCID: PMC5167266 DOI: 10.1371/journal.pone.0168311] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 11/30/2016] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. METHOD A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision. RESULTS The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists' clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. CONCLUSION The KT intervention improved therapists' confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.
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A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation. BMC Health Serv Res 2016; 16:557. [PMID: 27716179 PMCID: PMC5052802 DOI: 10.1186/s12913-016-1807-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 09/30/2016] [Indexed: 12/20/2022] Open
Abstract
Background Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills. Methods A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study. Results Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19th percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported that client motivation to engage with VR facilitated IREX use in practice but that environmental and IREX-specific barriers limited use. Conclusions Despite increased knowledge and skills in VR use, the KT intervention did not alter the number of perceived barriers to VR use, intention to use or actual use of VR. Poor perceived system usability had an impact on integration of this particular VR system into clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1807-6) contains supplementary material, which is available to authorized users.
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Does the addition of virtual reality training to a standard program of inpatient rehabilitation improve sitting balance ability and function after stroke? Protocol for a single-blind randomized controlled trial. BMC Neurol 2016; 16:42. [PMID: 27036515 PMCID: PMC4815206 DOI: 10.1186/s12883-016-0563-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/17/2016] [Indexed: 11/25/2022] Open
Abstract
Background Sitting ability and function are commonly impaired after stroke. Balance training has been shown to be helpful, but abundant repetitions are required for optimal recovery and patients must be motivated to perform rehabilitation exercises repeatedly to maximize treatment intensity. Virtual reality training (VRT), which allows patients to interact with a virtual environment using computer software and hardware, is enjoyable and may encourage greater repetition of therapeutic exercises. However, the potential for VRT to promote sitting balance has not yet been explored. The objective of this study is to determine if supplemental VRT-based sitting balance exercises improve sitting balance ability and function in stroke rehabilitation inpatients. Methods/Design This is a single-site, single-blind, parallel-group randomized control trial. Seventy six stroke rehabilitation inpatients who cannot stand independently for greater than one minute but can sit for at least 20 minutes (including at least one minute without support) are being recruited from a tertiary-care dedicated stroke rehabilitation unit. Participants are randomly allocated to experimental or control groups. Both participate in 10–12 sessions of 30–45 minutes of VRT performed in sitting administered by a single physiotherapist, in addition to their traditional therapy. The experimental group plays five games which challenge sitting balance while the control group plays five games which minimize trunk lean. Outcome measures of sitting balance ability (Function in Sitting Test, Ottawa Sitting Scale, quantitative measures of postural sway) and function (Reaching Performance Scale, Wolf Motor Function Test, quantitative measures of the limits of stability) are administered prior to, immediately following, and one month following the intervention by a second physiotherapist blind to the participant’s group allocation. Discussion The treatment of sitting balance post-stroke with VRT has not yet been explored. Results from the current study will provide important evidence for the use of low-cost, accessible VRT as an adjunct intervention to increase sitting balance in lower-functioning patients receiving inpatient rehabilitation. The motivating and enjoyable attributes of VRT may increase exercise dosage, leading to improved function and optimal results from rehabilitation. Trial Registration https://clinicaltrials.gov/; Identifier: NCT02285933. Registered 06 November 2014. Funded by the Heart & Stroke Foundation of Canada and a generous donation from Tony & Elizabeth Graham.
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Two-week virtual reality training for dementia: Single case feasibility study. ACTA ACUST UNITED AC 2015; 51:1069-76. [PMID: 25437527 DOI: 10.1682/jrrd.2013.10.0231] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 03/26/2014] [Indexed: 11/05/2022]
Abstract
Persons with dementia (PWD) are known to have difficulty with participation and focus during physical activity. Virtual reality (VR) offers a unique medium for motor learning but has only been used previously for cognitive assessment for PWD. Our study had two objectives: (1) investigate the feasibility and safety of an exercise-based VR training program in PWD, and (2) investigate its effects on balance and mobility. The intervention consisted of daily (5 d/wk, 1 h each) VR training sessions for 2 wk for a single research participant. Clinical balance and mobility measures were assessed 1 wk prior to, during, 1 wk following, and 1 mo after the intervention. Postintervention interviews provided qualitative feedback from the participant and his caregivers. Results indicate that VR training is feasible, safe, and enjoyable for PWD. However, balance and mobility measures were unaffected. VR training is well tolerated in a single research participant with dementia and is an engaging medium for participation in exercise.
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Abstract
Background and Purpose—
Exercise using virtual reality (VR) has improved balance in adults with traumatic brain injury and community-dwelling older adults. Rigorous randomized studies regarding its efficacy, safety, and applicability with individuals after stroke are lacking. The purpose of this study was to determine whether an adjunct VR therapy improves balance, mobility, and gait in stroke rehabilitation inpatients.
Methods—
A blinded randomized controlled trial studying 59 stroke survivors on an inpatient stroke rehabilitation unit was performed. The treatment group (n=30) received standard stroke rehabilitation therapy plus a program of VR exercises that challenged balance (eg, soccer goaltending, snowboarding) performed while standing. The control group (n=29) received standard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance (performed in sitting). VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period. Objective outcome measures of balance and mobility were assessed before, immediately after, and 1 month after training.
Results—
Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test, with both groups meeting minimal clinical important differences after training. More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain (
P
=0.04) immediately after training.
Conclusions—
This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes. Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR.
Clinical Trial Registration—
URL:
http://www.ANZCTR.org.au/
. Unique identifier: ACTRN12613000710729.
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Benefits of activity and virtual reality based balance exercise programmes for adults with traumatic brain injury: Perceptions of participants and their caregivers. Brain Inj 2009; 19:989-1000. [PMID: 16263641 DOI: 10.1080/02699050500109944] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore multi-dimensional benefits of exercise participation perceived by adults with traumatic brain injury (TBI) and their caregivers. METHODS Adults (n=27, aged 18-66) with moderate or severe TBI 6 months or more earlier participated in focus groups following 6 weeks of an activity-based (ABE) or a virtual reality (VR) delivered balance exercise programme. Family members and care providers participated in separate focus groups. Perceptions related to programme participation as well as balance confidence and lower extremity function were extracted from focus group verbatim and quantitative scales, respectively. OUTCOMES Benefits in three domains, psychosocial, physical and programme, were identified from transcription and analyses of focus group verbatim. Improvements were noted in balance confidence and function in both groups. Substantially greater enthusiasm and knowledge was expressed by participants in the VR group and their caregivers. CONCLUSIONS Both exercise programmes offered benefits in addition to improved balance. The VR participants had greater improvements on quantitative measures and provided more comments expressing enjoyment and improved confidence. Applications in terms of community reintegration and quality of life are discussed.
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Driving difficulties of brain-injured drivers in reaction to high-crash-risk simulated road events: A question of impaired divided attention? J Clin Exp Neuropsychol 2009; 31:472-82. [DOI: 10.1080/13803390802255627] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Outcomes of intervention programs using flatscreen virtual reality. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2004:4856-8. [PMID: 17271399 DOI: 10.1109/iembs.2004.1404343] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Virtual reality (VR) has the potential to offer experiences which are engaging and rewarding. In VR, the focus is shifted from the person's efforts in producing a movement or completing a task to that of interaction with the virtual environment. We have found that participants place value and meaning on and enjoy the activities programmed. Virtual reality interventions have been shown to improve cognitive function and concentration through an individual's interaction with a pleasant activity. Importantly, the enjoyment experienced while working with VR may increase the level of participation. In addition to generating realistic situations for testing, intervention and collection of data, the provision of immediate and positive feedback through VR has been shown to increase self esteem and empowerment. We will report outcomes from several intervention and feasibility trials using a flat screen virtual reality system with survivors of traumatic brain injury, community living older adults and children with spastic cerebral palsy. Gross motor movements were elicited through various game-like VR applications without the need for head-mounted displays or other peripherals. The impact of VR exercise participation ranged from improvements in clinical measures of functional balance and mobility, time on task, as well as participant and care provider perceptions of enjoyment, independence and confidence. Although still preliminary, our data suggest that simple applications of virtual reality have significant impacts on physical and psychosocial variables. Possibilities for and benefits of home and community-based access to virtual reality based programs will be explored.
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Energy and protein intakes of acute stroke patients. J Nutr Health Aging 2006; 10:171-5. [PMID: 16622579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Although protein-energy malnutrition has been cited as a frequent complication following stroke, there is very little data describing nutritional intake among hospitalized patients. OBJECTIVE To report: i) the level of protein and energy intake, ii) the adequacy of intake during the first 21 days of hospitalization and iii) to examine the differences in nutritional intake associated with diet type (regular texture, texture-modified and enteral feeding). DESIGN Prospective observational study of an inception cohort. The energy and protein intakes of well-nourished patients with recent onset of first time stroke were assessed at admission to hospital and at days 7, 11, 14 and 21. Adequacy of energy intake at each of these intervals was expressed as a percentage (actual intake/energy requirement assessed by indirect calorimetry x 100). Adequacy of protein intake was assessed in a similar manner, with 1 g/kg of actual or adjusted body weight used to estimate requirement. The nutritional intakes of patients receiving regular diets, dysphagia diets and enteral tube feedings were compared using one-way ANOVA. RESULTS The average energy intakes of the entire study group ranged from 19.4-22.3 Kcals/kg/day over five observation points, representing 80.3-90.9% of measured requirements; protein intake and ranged from 0.81-0.90 g/kg day yielding adequacy of intake of 81-90% of requirement. There were significant differences in energy intakes and/or adequacy of intake of patients receiving different diet types at days 11, 14 and 21 (p < 0.05) and differences in protein intake and/or adequacy of protein intake at all intervals except admission (p < 0.05). Patients receiving enteral tube feedings consumed more calories and protein compared to those patients on regular or dysphagia diets. CONCLUSIONS On average, newly diagnosed, well-nourished, hospitalized patients consumed 80-91% of their both their energy and protein requirements, in the early post stroke period.
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An exploratory study on the predictive elements of passing on-the-road tests for disabled persons. TRAFFIC INJURY PREVENTION 2005; 6:235-9. [PMID: 16087464 DOI: 10.1080/15389580590969184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Driving evaluations are performed by Occupational Therapists to evaluate drivers with disability. They include both off-road and on-road assessments. Many aspects of driving are examined during the on-road assessment. The main objective of this study is to identify the elements of the Occupational Therapy on-road driving assessment that are most predictive of the overall driving evaluation. METHODS This retrospective cohort study took place at a provincially approved Driving Assessment Program. Records of 700 participants with various disabilities who completed a driving assessment between 1995 and 2003 were reviewed. Only clients who completed the on-road assessment were included in the study. At our center, 11 driving elements comprised of 34 items were used as independent variables and rated as pass (acceptable or good) or fail (borderline or poor). Analysis was completed with descriptive statistics and use of logistic regression to identify elements that contributed most significantly to the overall driving evaluation. RESULTS A total of 628 clients completed the on-road assessment with an overall pass rate of 50%. Logistic regression modeling identified poor anticipation of road hazards, observation of environment, improper stopping position, poor visual scanning, poor knowledge of the rules of the road, and increasing age as predictive of failure for all participants. Further analysis grouped subjects according to disability to identify similarities and differences between pass/fail predictors. Both similarities and differences in predictive elements were found between cognitive and physical diagnostic groupings. Most notably, the physical diagnostic grouping showed that cognitive, not physical elements of the on-road test, predicted failure of the overall driving evaluation. CONCLUSIONS Of the 11 elements considered in the on-road evaluation, specific cognitive ones such as anticipates potential hazards, scanning, observes for pedestrians, and proper stopping position tend to contribute more to the prediction of pass or fail than others. These elements should be considered as components of on-road assessments by other Driving Assessment Programs.
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Experimental studies of virtual reality-delivered compared to conventional exercise programs for rehabilitation. CYBERPSYCHOLOGY & BEHAVIOR : THE IMPACT OF THE INTERNET, MULTIMEDIA AND VIRTUAL REALITY ON BEHAVIOR AND SOCIETY 2003; 6:245-9. [PMID: 12855079 DOI: 10.1089/109493103322011524] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper presents preliminary data from two clinical trials currently underway using flat screen virtual reality (VR) technology for physical rehabilitation. In the first study, we are comparing a VR-delivered exercise program to a conventional exercise program for the rehabilitation of shoulder joint range-of-motion in patients with chronic frozen shoulder. In the second study, we are comparing two exercise programs, VR and conventional, for balance retraining in subjects post-traumatic brain injury. Effective VR-based rehabilitation that is easily adapted for individuals to use both in inpatient, outpatient and home-based care could be used as a supplement or alternative to conventional therapy. If this new treatment approach is found to be effective, it could provide a way to encourage exercise and treatment compliance, provide safe and motivating therapy and could lead to the ability to provide exercises to clients in distant locations through telehealth applications of VR treatment. VR is a new technology and the possibilities for rehabilitation are only just beginning to be assessed.
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The incidence, management, and complications of dysphagia in patients with medullary strokes admitted to a rehabilitation unit. Dysphagia 2002; 17:115-20. [PMID: 11956836 DOI: 10.1007/s00455-001-0110-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2000] [Accepted: 08/22/2001] [Indexed: 11/30/2022]
Abstract
The objective of this study was to examine the frequency of dysphagia symptoms and related consequences in medullary stroke patients admitted to a stroke rehabilitation unit. A chart review of a cohort of 563 stroke patients admitted to a rehabilitation unit was used to identify patients with evidence of predominantly medullary lesions. The results of both initial and followup videofluoroscopic modified barium swallowing (VMBS) studies were also reviewed for evidence of aspiration and residuum in patients with dysphagia. Twenty of the 563 patients (3.6%) were diagnosed with a medullary stroke. Eleven of the 20 (55%) patients were identified clinically with dysphagia and nine had at least one (VMBS) study. All dysphagic patients demonstrated some degree of either aspiration or residuum on both initial and final swallowing studies and received some form of dietary modification. Comparisons between patients with and without dysphagia demonstrated significant differences with regard to length of hospital stay and the development of pneumonia (p < 0.05). More than half of the patients with medullary strokes presented with clinical indications of dysphagia, were more likely to develop aspiration pneumonia, and experienced longer hospital stays. Aspiration pneumonia appeared to be an early complication of stroke and dietary modifications did not prevent its development.
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Clinical characteristics of patients with brainstem strokes admitted to a rehabilitation unit. Arch Phys Med Rehabil 2002; 83:1013-6. [PMID: 12098164 DOI: 10.1053/apmr.2002.33102] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the clinical characteristics of patients with brainstem strokes admitted to a rehabilitation unit. DESIGN Retrospective cohort. SETTING Inpatient rehabilitation unit. PARTICIPANTS Eighty-five consecutive admissions (56 men, 29 women; mean age, 61.9+/-14.4y; range, 18-85y) with radiologically confirmed focal evidence of specific lesions within the pons, midbrain, cerebellum, and medulla. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Various clinical characteristics, including stroke-related deficits and stroke risk factors, were identified and compared between brainstem subgroups. The incidence of complications, including pneumonia, deep vein thrombosis, and seizure disorder, was also reported. RESULTS Seventy (82%) of the strokes resulted from infarctions and 15 (18%) were caused by hemorrhages. The functional deficits of hemiparesis, ataxia, and diplopia were present in 41 (48%), 73 (86%), and 32 (38%) patients, respectively. Dysarthria was reported in 42 patients (49%) and dysphagia in 40 (47%). Pneumonia during hospitalization was a complication in 9 (11%) of the patients with brainstem stroke. The risk factors of diabetes and hypertension were present in 22 (26%) and 47 (55%) patients, respectively. Fourteen (17%) of these patients had suffered a previous stroke. CONCLUSIONS Rehabilitation patients experience a variety of functional impairments as a consequence of brainstem stroke. These include hemiparesis, dysarthria and dysphagia, diplopia, and ataxia. A significant number of patients had pneumonia as a complication. The characteristics and impairment profiles of patients within the subgroups were similar, with the exception of the incidence of ataxia and hemiparesis.
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Use of percutaneous gastrojejunostomy feeding tubes in the rehabilitation of stroke patients. Arch Phys Med Rehabil 2001; 82:1412-5. [PMID: 11588746 DOI: 10.1053/apmr.2001.25076] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the characteristics of and complications in the rehabilitation of stroke patients in whom percutaneous gastrojejunostomy (PGJ) feeding tubes have been placed. DESIGN Retrospective cohort study. SETTING A rehabilitation unit in a tertiary care hospital. PARTICIPANTS Stroke patients (n = 563) admitted to a tertiary care hospital over a 10-year period. INTERVENTION PGJ feeding tubes. MAIN OUTCOME MEASURES Evidence of aspiration in all videofluoroscopic modified barium swallow (VMBS) studies was noted. For patients with a PGJ feeding tube, the following were recorded: stroke location; results of subsequent VMBS reports; length of time from stroke onset to PGJ feeding tube insertion; total time the PGJ feeding tube remained in situ; discharge disposition; and concurrent feeding status. Follow-up was at 1-year poststroke. Complications during the inpatient stay attributable to the PGJ feeding tube were recorded. RESULTS Thirty-two of all 563 (5.7%) stroke patients admitted and 28 of the 115 (24.3%) proven aspirators, as shown on VMBS studies, had a PGJ feeding tube inserted. Twenty-one of the 563 (3.7%) stroke patients were discharged to the community with PGJ feeding tubes in place. The tubes were inserted on average 37 days after stroke onset. Seventeen of all 88 (19.3%) brainstem stroke patients and 15 of all 29 (51.7%) brainstem stroke patients with documented aspiration had feeding tubes inserted, whereas only 15 of 475 (3.2%) hemispheric stroke rehabilitation patients received a tube. Eleven of 32 (34.3%) patients with a feeding tube were able to resume oral feedings at discharge; within 1 year of discharge, 24 of 32 (75%) had done so. Although there were no serious complications resulting from tube insertions, minor complications were documented in more than 50% of the cases. The tubes were associated with prolonged institutionalization in only 1 case; most patients were discharged on a home tube-feeding program. CONCLUSIONS PGJ feeding tubes were placed in approximately 1 of every 20 of our stroke rehabilitation patients. One third of the tubes were removed before the patients were discharged from rehabilitation and 75% were removed within 1 year. Insertion of the tubes was most common in patients with evidence of aspiration and in patients with brainstem strokes. Complications caused by the tube were minor and all patients but 1 who were discharged with feeding tubes were able to manage the home tube-feeding program.
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Hypofrontality and negative symptoms in patients with dementia of Alzheimer type. NEUROPSYCHIATRY, NEUROPSYCHOLOGY, AND BEHAVIORAL NEUROLOGY 2000; 13:53-9. [PMID: 10645737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE The purpose of the current study was to examine the relation between regional cerebral blood flow (rCBF) and negative symptoms (NS) in patients with dementia of Alzheimer type (DAT). BACKGROUND Negative symptoms in neuropsychiatric disorders were associated with altered rCBF in frontal cortex. METHODS Twenty-five subjects with a diagnosis of DAT were administered the Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative Symptom Scale, the Hamilton Rating Scale for Depression, and the Mini-Mental State Examination. The subjects were divided into two groups by means of a median split with regard to NS severity (high NS group, N = 12; low NS group, N = 13). Each patient underwent a single photon emission tomography scan using 99mTc-HMPAO at rest. Cortical and subcortical regions of interest were symmetrically defined in each hemisphere. Cortical-to-cerebellar perfusion ratios were established quantitatively using ADAC software. RESULTS High NS group subjects had a significantly lower rCBF than low NS group subjects in the frontal cortex and cingulate gyrus (MANOVA: p = 0.022) as a result of differences in the dorsolateral prefrontal cortex bilaterally (right: F = 12.12, p = 0.002; left: F = 6.55, p = 0.02) and in the frontal cortex, mainly in the right hemisphere (right: F = 6.33, p = 0.02; left: F = 3.26, p = 0.08). For all the subjects (N = 25), there were negative correlations between the SANS total score and rCBF, most prominently in the dorsolateral prefrontal cortex bilaterally (right: r = -0.48, p <0.01; left: r = -0.49, p = 0.01). No significant correlation was found between rCBF in any of the regions of interest and either the Mini-Mental State Examination or the Hamilton Rating Scale for Depression scores. CONCLUSIONS This study indicates that decreased perfusion in the frontal cortex is associated with NS severity but not with measures of cognitive impairment or depressive symptoms in DAT patients. These results support the hypothesis that the frontal lobes may be involved in the cause of NS in DAT, and they underscore the importance of NS evaluation in neuroimaging studies.
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Lack of uptake of tagged erythrocytes in a large hepatic hemangioma. Clin Nucl Med 1999; 24:606-8. [PMID: 10439186 DOI: 10.1097/00003072-199908000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Frequency of videofluoroscopic modified barium swallow studies and pneumonia in stroke rehabilitation patients: a comparative study. Arch Phys Med Rehabil 1999; 80:294-8. [PMID: 10084437 DOI: 10.1016/s0003-9993(99)90140-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To study the association between the frequency of videofluoroscopic modified barium swallow (VMBS) studies and the incidence of pneumonia in stroke rehabilitation patients. DESIGN Retrospective comparative study. SUBJECTS AND SETTING Five hundred sixty-three consecutive stroke patients admitted to one hospital rehabilitation unit in London, Ontario, Canada were compared with 461 consecutive stroke patients admitted to another hospital rehabilitation unit in the same city. INTERVENTIONS The number of initial and total VMBS studies and the timing from stroke onset to initial VMBS studies. MAIN OUTCOME MEASURE Incidence of pneumonia. RESULTS At the first hospital, 146 patients (25.9%) had 232 total VMBS studies performed, whereas at the second hospital 57 patients (12.4%) had 73 total studies (p<.001). For the first 15 days there was no significant difference in the number of initial VMBS studies performed (8.2% vs. 9.2%). There was a marked difference in the number of initial VMBS studies performed after 15 days (17.2% vs. 2.0%, p<.0001). The difference between the hospitals in the number of VMBS studies in patients with brain stem strokes was not statistically significant, but for patients with hemispheric stroke, the difference was statistically significant. Pneumonia developed in 12 patients at the first hospital (2.1%) and 10 patients at the second hospital (2.2%), a difference that was not significant. CONCLUSIONS The more frequent use of VMBS beyond 15 days after stroke was not associated with a change in the incidence of pneumonia among hemispheric stroke rehabilitation patients, assuming the two units were otherwise similar.
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Returning to work after stroke: Medical and socioeconomic influences. J Stroke Cerebrovasc Dis 1998. [DOI: 10.1016/s1052-3057(98)80076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Inadequate fluid intake in the dysphagic stroke patient. J Stroke Cerebrovasc Dis 1998. [DOI: 10.1016/s1052-3057(98)80094-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bioelectrical impedance analysis detects bilateral body composition in the stroke patient. J Stroke Cerebrovasc Dis 1998. [DOI: 10.1016/s1052-3057(98)80086-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hypofrontality and negative symptoms in major depressive disorder. J Nucl Med 1998; 39:608-12. [PMID: 9544664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED The purpose of the current study was to compare regional cerebral blood flow (rCBF) in patients with major depressive disorder (MDD) to that of healthy subjects and to examine the relationship between rCBF, depressive symptoms (DS) and negative symptoms (NS) in these patients. METHODS Eleven psychiatric inpatients with diagnosed (MDD) and 15 normal control subjects were administered the scale for the assessment of negative symptoms (SANS) and the modified Hamilton rating scale for depression with items descriptive of NS excluded (HRSD-DS). Each patient underwent a SPECT scan using 99mTc-HMPAO at rest. Cortical and subcortical regions of interest (ROIs) were symmetrically defined in each hemisphere. Cortical-to-cerebellar perfusion ratios were established quantitatively using ADAC software. RESULTS Subjects in the MDD group had significantly lower rCBF in the frontal cortex and cinglulate gyrus (MANOVA, p = 0.038) due to differences in dorsolateral prefrontal cortex bilaterally (right F = 7.69, p = 0.01; left F = 8.41, p = 0.01) in the right orbitofrontal cortex (F = 6.79, p = 0.02) and in the cingulate gyrus (F = 5.34, p = 0.03). The MDD group also had lower rCBF in the posterior cortical structures (MANOVA, p = 0.072), which was due to decreased perfusion in the right parietal cortex (F = 7.54, p = 0.01). There were negative correlations between the SANS total score and rCBF in both the left dorsolateral prefrontal cortex (Pearson's correlation coefficient r = .-67, p < 0.05) and the left anterior temporal cortex (r = -0.71, p < 0.01) in MDD patients. Additionally, there were positive correlations between HRSD scores and rCBF in the left anterior temporal (r = 0.71, p < 0.01), left dorsolateral prefrontal (r = 0.70, p < 0.01), right frontal (r = 0.82, p < 0.01) and right posterior temporal (r = 0.74, p < 0.01) cortices. Cerebral blood flow was not correlated with either mini-mental state examination scores or age. CONCLUSION This preliminary study replicates the finding of hypofrontality in MDD and indicates that decreased perfusion is associated specifically with negative symptom severity. These results support the hypothesis that, in MDD, negative symptoms and symptoms of depression are distinct phenomena and underscore the importance of negative symptom evaluation in neuroimaging studies of MDD and other disorders.
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Abstract
PURPOSE To evaluate the findings and usefulness of Ga-67 scanning in recent cases of tuberculosis (TB). MATERIALS AND METHODS The authors reviewed chest x-ray films and Ga-67 citrate scans of 52 patients with culture-confirmed infection caused by Mycobacterium tuberculosis treated after 1988. RESULTS Ga-67 scans were positive in every case, delineating upper lobe lung lesions in 6 patients, diffuse involvement or lower lobe disease in 34 patients, and intrathoracic adenopathy in 15 patients. Pulmonary parenchymal lesions were not detected on x-ray films in 3 patients, and nodal lesions were not apparent in 3 patients. In addition, in 6 patients cervical adenopathy was detected by Ga-67 scintigraphy; 4 underwent biopsy with culture confirmation. CONCLUSIONS Ga-67 scanning is more sensitive than routine chest radiography for detection of both TB parenchymal lung involvement and adenopathy. Ga-67 imaging facilitates the choice of biopsy sites by identifying accessible peripheral nodes. Typical patterns in recent cases of TB differ significantly from the upper lobe predilection of classical TB.
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ECT treatment and cerebral perfusion in Catatonia. J Nucl Med 1997; 38:251-4. [PMID: 9025749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A 40-yr-old woman with a diagnosis of schizoaffective disorder developed catatonia in the context of a depressive episode. A dramatic decrease in perfusion of the inferior frontal, posterior temporal and parietal lobes bilaterally and in posterior frontal lobes corresponding to the motor cortices was noted on the 99mTc-HMPAO SPECT scan obtained in the acute phase. The most dramatic decreases compared to normal control subjects were observed in the left parietal and left motor cortices. The patient was treated with a five-treatment course of electroconvulsive therapy (ECT), which resulted in a complete resolution of catatonia and some resolution of her symptoms of depression. The repeat HMPAO-SPECT scan showed improved perfusion in all areas. The most dramatic increases occurred in the left parietal and left motor cortices. Decreased perfusion in motor and parietal cortices could be state-specific to catatonia. Thus, SPECT imaging may be a useful method for monitoring catatonia treatment response.
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Pathophysiology of drug dependence. J Nucl Med 1996; 37:2098. [PMID: 8970542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Axillary lymph node uptake of technetium-99m-MDP. J Nucl Med 1995; 36:1797-9. [PMID: 7562045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
UNLABELLED We sought to determine the frequency and significance of axillary lymph node visualization on bone scans performed with diphosphonates. METHODS Consecutive 99mTc-methylene diphosphonate (99mTc-MDP) bone scans (2435) were inspected for axillary soft-tissue uptake. In positive cases, the results of physical examination, correlative imaging studies and serial bone scans were recorded, as was the site of venipuncture. RESULTS Forty-eight studies (2%) showed axillary uptake ipsilateral to the injection site. Extravasation of tracer, documented by focal activity near the injection site, was present in every case. There was no association with axillary adenopathy, mass, induration or radiographically visible calcification. On some images, foci adjacent to the axilla were superimposed on the rib, scapula, or humerus. The bone-to-background ratio was frequently reduced; repeat imaging after 1-2 hr usually improved osseous detail. CONCLUSION Ipsilateral axillary lymph node visualization due to extravasation of 99mTc-MDP is frequently associated with additional foci superimposed on osseous structures simulating pathology. Delayed skeletal uptake is common in such cases and necessitates a greater time interval between injection and imaging.
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Ventilation-perfusion imaging in sarcoidosis: potential for nonembolic segmental mismatch. J Nucl Med 1994; 35:476-8. [PMID: 8113902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We report a case of a postpartum female on oral contraceptives who presented with chest pain and was initially treated for pulmonary embolism on the basis of a lobar mismatch on ventilation-perfusion imaging. Subsequent angiography revealed that the pulmonary artery was extrinsically compressed. Gallium-67-citrate imaging documented sarcoidosis with uptake in bilateral hilar nodes, both lungs and parotid and salivary glands.
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Spray bottle epicondylitis. Diagnosing and treating workers in pain. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 1994; 40:336-7. [PMID: 8130679 PMCID: PMC2380019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Bilateral osteomyelitis due to intraosseous infusion: case report and review of the English-language literature. Pediatr Radiol 1994; 24:72-3. [PMID: 8008506 DOI: 10.1007/bf02017671] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Intraosseous infusion, a mode of peripheral access largely abandoned in the 1940s and 1950s, is becoming increasingly popular in the setting of pediatric crisis. While complications are rare when the procedure is properly performed, the risk of osteomyelitis increases with prolonged infusions. We present a case of bilateral osteomyelitis secondary to intraosseous infusion.
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Prompt diagnosis of acute cholecystitis in the critically ill. Am J Surg 1990; 160:235. [PMID: 2200294 DOI: 10.1016/s0002-9610(05)80315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Scintigraphic pattern of pneumothorax complicating Pneumocystis carinii pneumonia in patients with AIDS. Clin Nucl Med 1990; 15:566-8. [PMID: 2390822 DOI: 10.1097/00003072-199008000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Spontaneous pneumothorax is a serious though infrequently reported pulmonary complication of AIDS. An unsuspected lung collapse was discovered via gallium scintigraphy for the study of Pneumocystis carinii pneumonia. Neither the pneumonia nor the pneumothorax were apparent on the most recent chest roentgenogram. In evaluating gallium images during the work-up of AIDS patients with associated pulmonary pathology, the possible complication of lung collapse should be considered. If pneumothorax is suspected on gallium imaging, a chest roentgenogram in expiration must be obtained for prompt delineation of this serious, yet correctable, condition.
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Vesicoureteral reflux in boys. Radiology 1990. [DOI: 10.1148/radiology.176.1.2353107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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44
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Vesicoureteral reflux in boys. Radiology 1990; 176:288-9. [PMID: 2353107 DOI: 10.1148/radiology.176.1.288-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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45
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Scintigraphy of renal trauma. Radiology 1990; 174:896-7. [PMID: 2305079 DOI: 10.1148/radiology.174.3.896b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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46
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47
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Imaging investigation of urinary tract infection. AJR Am J Roentgenol 1990; 154:201-2. [PMID: 2104714 DOI: 10.2214/ajr.154.1.2104714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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48
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Temporomandibular joint imaging. AJR Am J Roentgenol 1989; 153:1315-6. [PMID: 2816652 DOI: 10.2214/ajr.153.6.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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49
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Review of methods for the detection of hepatic abscess. GASTROINTESTINAL RADIOLOGY 1989; 14:364. [PMID: 2806826 DOI: 10.1007/bf01889240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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50
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Effect of cirrhosis on accuracy of 99Tcm-tin colloid scintigraphy and ultrasound scanning in diagnosis of hepatocellular carcinoma. Br J Radiol 1989; 62:387. [PMID: 2540865 DOI: 10.1259/0007-1285-62-736-387-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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