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Social work assessments underpin support plans for many people living with dementia in their own homes in England, but it is unclear how they acknowledge that dementia places people at greater risk of mouth and dental problems affecting their wellbeing. We explored if and how dental needs are addressed during care assessments and social workers' perceptions of this aspect of personal care. This study analysed (a) semi-structured interviews with 14 social workers providing support to people living with dementia in their own homes, (b) data from 39 care assessments and support plans from two English local authorities. Interviews were recorded online, transcribed, and thematically analysed. Documents were analysed descriptively and presented visually. Participants acknowledged that oral care may be overlooked during assessments and reflected on various reasons, including assumptions of responsibility and role restrictions, limited training, and poor links with dental services. This was further evident in the analysis of assessment documentation. Participants identified potential strategies and practice changes to better integrate oral care in social work practice. These included increased awareness and more discussions around dental needs, skills training and streamlining of support. The findings have implications for social workers, educators, and commissioners or funders engaging with people affected by dementia in social work and beyond.
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OBJECTIVE: People living with dementia are at risk of mouth and dental problems. Many receive help with this aspect of personal care from family carers or homecare workers. We explored the views of homecare providers and carers on how this aspect of personal care is addressed and implemented. MATERIALS AND METHODS: In this qualitative study we conducted semi-structured interviews with carers (all family members), homecare workers and managers providing support to people living with dementia in their own homes. Interview questions focused on daily care practices, exploring barriers and facilitators to oral care. Interviews were recorded online or over the telephone, transcribed, and thematically analysed. RESULTS: Carers (n = 8), homecare workers (n = 9) and homecare managers (n = 15) were recruited from across England in 2021-2022. Across interviews, two main themes were identified: (i) Missed opportunities to address oral care, which is not always seen as a priority despite the importance and potential risk of neglect. (ii) Challenges in delivering oral care, including factors related to the person living with dementia (such as cognitive and physical decline) and factors related to the care infrastructure and policies such as training, perception of roles, allocated time, and consistency of care. DISCUSSION: More emphasis could be given to the training and skills of homecare providers to identify and prevent dental problems and to assist carers. Several strategies and tools (oral care checklists, greater detail around oral care in care assessments and care plans) could be used to enhance this aspect of personal care for people living with dementia.
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Cuidadores , Demencia , Humanos , Cuidadores/psicología , Demencia/terapia , Demencia/psicología , Inglaterra , Investigación Cualitativa , Atención OdontológicaRESUMEN
Mice have become increasingly popular as genetic tools, facilitated by the production of advanced genetically engineered mouse models (GEMMs). GEMMs often require in-house breeding and production by research groups, which can be quite complex depending on the design of the GEMM. Identification of methods to increase the efficiency of breeding practices offers opportunities to optimize and reduce the number of animals bred for research while maintaining similar research output. We investigated the use of commercial automated genotyping and centralized breeding management on overall breeding colony productivity in a colony of multiple GEMM lines. This study involved a three-group study design, where the first group continued their standard breeding practices (group A), the second utilized standard breeding practices but outsourced genotyping in place of inhouse genotyping (group B), and a third group outsourced genotyping and had assistance with routine breeding practices from the laboratory animal care team (group C). Compared to standard practice (group A), groups B and C produced more cages and mice over time, which appeared to be driven primarily by an increase in the number of breeding cages in each colony. Higher numbers of breeders correlated with an increased number of litters and generation of new cages. The increases in colony productivity measures were further enhanced in group C compared to group B. The overall cost associated with producing new animals was lowest in group B, followed by groups A and C. Although, by the end of the study, cost to produce new mice was comparable between all three groups. These data suggest that by optimizing breeding practices and management, fewer animals could be utilized to produce the same amount of progeny and reduce overall animal usage and production.
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Importance: Few stroke survivors meet recommended cardiovascular goals, particularly among racial/ethnic minority populations, such as Black or Hispanic individuals, or socioeconomically disadvantaged populations. Objective: To determine if a chronic care model-based, community health worker (CHW), advanced practice clinician (APC; including nurse practitioners or physician assistants), and physician team intervention improves risk factor control after stroke in a safety-net setting (ie, health care setting where all individuals receive care, regardless of health insurance status or ability to pay). Design, Setting, and Participants: This randomized clinical trial included participants recruited from 5 hospitals serving low-income populations in Los Angeles County, California, as part of the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) clinical trial. Inclusion criteria were age 40 years or older; experience of ischemic or hemorrhagic stroke or transient ischemic attack (TIA) no more than 90 days prior; systolic blood pressure (BP) of 130 mm Hg or greater or 120 to 130 mm Hg with history of hypertension or using hypertensive medications; and English or Spanish language proficiency. The exclusion criterion was inability to consent. Among 887 individuals screened for eligibility, 542 individuals were eligible, and 487 individuals were enrolled and randomized, stratified by stroke type (ischemic or TIA vs hemorrhagic), language (English vs Spanish), and site to usual care vs intervention in a 1:1 fashion. The study was conducted from February 2014 to September 2018, and data were analyzed from October 2018 to November 2020. Interventions: Participants randomized to intervention were offered a multimodal coordinated care intervention, including hypothesized core components (ie, ≥3 APC clinic visits, ≥3 CHW home visits, and Chronic Disease Self-Management Program workshops), and additional telephone visits, protocol-driven risk factor management, culturally and linguistically tailored education materials, and self-management tools. Participants randomized to the control group received usual care, which varied by site but frequently included a free BP monitor, self-management tools, and linguistically tailored information materials. Main Outcomes and Measures: The primary outcome was change in systolic BP at 12 months. Secondary outcomes were non-high density lipoprotein cholesterol, hemoglobin A1c, and C-reactive protein (CRP) levels, body mass index, antithrombotic adherence, physical activity level, diet, and smoking status at 12 months. Potential mediators assessed included access to care, health and stroke literacy, self-efficacy, perceptions of care, and BP monitor use. Results: Among 487 participants included, the mean (SD) age was 57.1 (8.9) years; 317 (65.1%) were men, and 347 participants (71.3%) were Hispanic, 87 participants (18.3%) were Black, and 30 participants (6.3%) were Asian. A total of 246 participants were randomized to usual care, and 241 participants were randomized to the intervention. Mean (SD) systolic BP improved from 143 (17) mm Hg at baseline to 133 (20) mm Hg at 12 months in the intervention group and from 146 (19) mm Hg at baseline to 137 (22) mm Hg at 12 months in the usual care group, with no significant differences in the change between groups. Compared with the control group, participants in the intervention group had greater improvements in self-reported salt intake (difference, 15.4 [95% CI, 4.4 to 26.0]; P = .004) and serum CRP level (difference in log CRP, -0.4 [95% CI, -0.7 to -0.1] mg/dL; P = .003); there were no differences in other secondary outcomes. Although 216 participants (89.6%) in the intervention group received some of the 3 core components, only 35 participants (14.5%) received the intended full dose. Conclusions and Relevance: This randomized clinical trial of a complex multilevel, multimodal intervention did not find vascular risk factor improvements beyond that of usual care; however, further studies may consider testing the SUCCEED intervention with modifications to enhance implementation and participant engagement. Trial Registration: ClinicalTrials.gov Identifier: NCT01763203.
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Antihipertensivos/uso terapéutico , Presión Sanguínea , Accidente Cerebrovascular Hemorrágico/terapia , Hipertensión/tratamiento farmacológico , Ataque Isquémico Transitorio/terapia , Accidente Cerebrovascular Isquémico/terapia , Cumplimiento de la Medicación , Automanejo , Negro o Afroamericano , Anciano , Asiático , Proteína C-Reactiva/metabolismo , Agentes Comunitarios de Salud , Ejercicio Físico , Femenino , Accidente Cerebrovascular Hemorrágico/metabolismo , Hispánicos o Latinos , Humanos , Hipertensión/metabolismo , Ataque Isquémico Transitorio/metabolismo , Accidente Cerebrovascular Isquémico/metabolismo , Masculino , Persona de Mediana Edad , Enfermeras Practicantes , Grupo de Atención al Paciente , Asistentes Médicos , Médicos , Conducta de Reducción del Riesgo , Proveedores de Redes de Seguridad , Prevención Secundaria , Autoinforme , Cloruro de Sodio Dietético , Accidente Cerebrovascular/metabolismo , Accidente Cerebrovascular/terapia , Población BlancaRESUMEN
OBJECTIVES: Although healthy lifestyle practices mitigate recurrent stroke risk and mortality, few stroke survivors adhere to them, particularly among socioeconomically disadvantaged communities. We developed and pilot tested a occupational therapy-based lifestyle management intervention, Healthy Eating And Lifestyle after Stroke (HEALS), to improve stroke survivors' self-management skills relating to diet and physical activity and evaluated it in a diverse safety-net population. MATERIALS AND METHODS: One hundred English- or Spanish-speaking participants with stroke or transient ischemic attack were randomized to a 6-week occupational therapist-led group lifestyle intervention vs. usual care. Each of the six 2-h group sessions included didactic presentations on diet and physical activity, peer exchange, personal exploration with goal setting, and direct experience through participation in a relevant activity. Primary outcomes at 6 months were change in body mass index, fruit/vegetable intake, and physical activity. Secondary outcomes included change in waist circumference, smoking, blood pressure, high-density lipoprotein, low-density lipoprotein, triglyceride, total cholesterol, glycosylated hemoglobin levels, quality of care, and perceptions of care. Effect sizes were determined in preparation for a larger randomized controlled trial powered to detect a difference in primary outcomes. A nested formative evaluation assessed facilitators and barriers to implementation, acceptance, and intervention adherence. RESULTS: There were no significant changes in primary or secondary outcomes at 6 months. Effect sizes for all outcomes were small (< 0.2). Focus group participants recommended extending the intervention program duration with more sessions, additional information on stroke and vascular risk factors, an interdisciplinary approach, additional family involvement, and incentives. Providers recommended longer program duration, more training, fidelity checks to ensure standardized program delivery, and additional incentives for participants. CONCLUSIONS: The HEALS intervention was feasible in a safety-net setting, but effect sizes were small. A longer-duration intervention, with intervener fidelity checks may be warranted. TRIAL REGISTRATION: NCT01550822.
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Dieta Saludable , Terapia por Ejercicio , Ataque Isquémico Transitorio/rehabilitación , Conducta de Reducción del Riesgo , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/terapia , Anciano , Conducta Alimentaria , Femenino , Conocimientos, Actitudes y Práctica en Salud , Estado de Salud , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/fisiopatología , Ataque Isquémico Transitorio/psicología , Los Angeles , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Proyectos Piloto , Proveedores de Redes de Seguridad , Autocuidado , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Purpose: Medically underserved adults with spinal cord injury (SCI) remain at high risk of incurring medically serious pressure injuries even after receiving education in prevention techniques. The purpose of this research is to identify circumstances leading to medically serious pressure injury development in medically underserved adults with SCI during a lifestyle-based pressure injury prevention program, and provide recommendations for future rehabilitation approaches and intervention design.Methods: This study entailed a qualitative secondary case analysis of treatment notes from a randomized controlled trial. Participants were 25 community-dwelling, medically underserved adults with SCI who developed medically serious pressure injuries during the course of the intervention of the RCT.Results and conclusions: Among the 25 participants, 40 unique medically serious pressure injuries were detected. The six themes related to medically serious pressure injury development were: (1) lack of rudimentary knowledge pertaining to wound care; (2) equipment and supply issues; (3) comorbidities; (4) non-adherence to prescribed bed rest; (5) inactivity; and (6) circumstances beyond the intervention's reach. Together, these factors may have undermined the effectiveness of the intervention program. Modifications, such as assessing health literacy levels of patients prior to providing care, providing tailored wound care education, and focusing on equipment needs, have potential for altering future rehabilitation programs and improving health outcomes.Implications for rehabilitationTo provide patients with spinal cord injury with the necessary information to prevent medically serious pressure injury development, health care providers need to understand their patient's unique personal contexts, including socio-economic status, language skills, and mental/cognitive functioning.When providing wound care information to patients with spinal cord injury who have developed a medically serious pressure injury, practitioners should take into account the level of health literacy of their patient in order to provide education that is appropriate and understandable.Practitioners should be aware of how to help their patient advocate for outside services and care that address their equipment needs, such as finding funding or grants to pay for expensive medical equipment.
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Área sin Atención Médica , Úlcera por Presión , Traumatismos de la Médula Espinal , Adulto , Humanos , Comorbilidad , Estilo de Vida , Úlcera por Presión/complicacionesRESUMEN
Background: Pressure injuries negatively impact quality of life and participation for individuals with spinal cord injury (SCI). Objective: To examine the factors that may protect against the development of medically serious pressure injuries in adults with SCI. Methods: A qualitative analysis was conducted using treatment notes regarding 50 socioeconomically disadvantaged individuals who did not develop medically serious pressure injuries during a 12-month pressure injury prevention intervention program. Results: Eight types of potentially protective factors were identified: meaningful activity, motivation to prevent negative health outcomes, stability/resources, equipment, communication and self-advocacy skills, personal traits, physical factors, and behaviors/activities. Conclusions: Some protective factors (eg, personal traits) may be inherent to certain individuals and nonmodifiable. However, future interventions for this population may benefit from a focus on acquisition of medical equipment and facilitation of sustainable, health-promoting habits and routines. Substantive policy changes may be necessary to facilitate access to adequate resources, particularly housing and equipment, for socioeconomically disadvantaged individuals with SCI. Further research is needed to understand the complex interplay of risk and protective factors for pressure injuries in adults with SCI, particularly in underserved groups.
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Área sin Atención Médica , Úlcera por Presión/prevención & control , Traumatismos de la Médula Espinal/complicaciones , Adulto , Cuidadores , Femenino , Conductas Relacionadas con la Salud , Promoción de la Salud , Humanos , Masculino , Motivación , Terapia Ocupacional/estadística & datos numéricos , Defensa del Paciente , Úlcera por Presión/psicología , Calidad de Vida/psicología , Método Simple Ciego , Traumatismos de la Médula Espinal/psicologíaRESUMEN
BACKGROUND: Stroke survivors have high rates of subsequent cardiovascular and recurrent cerebrovascular events, and mortality. While healthy lifestyle practices - including a diet rich in fruits and vegetables, limited alcohol intake, and regular physical activity - can mitigate these outcomes, few stroke survivors adhere to them. Minorities from socioeconomically disadvantaged communities who obtain care in safety-net health systems experience the most barriers to implementing healthy lifestyle changes after stroke. PURPOSE: To report the design of Healthy Eating and Lifestyle After Stroke (HEALS), a randomized controlled trial (RCT) was designed to test the feasibility of using a manualized, lifestyle management intervention in a safety-net setting to improve lifestyle practices among ethnically diverse individuals with stroke or transient ischemic attack (TIA). METHODS: Design: Pilot RCT. PARTICIPANTS: Inclusion criteria: 1) Adults (≥40 years) with ischemic stroke or TIA (≥ 90 days prior); 2) English- or Spanish-speaking. SETTING: Outpatient clinic, safety-net setting. INTERVENTION: Weekly two-hour small group sessions led by an occupational therapist for six weeks. The sessions focused on implementing nutrition, physical activity, and self-management strategies tailored to each participant's goals. MAIN OUTCOME MEASURES: Body mass index, diet, and physical activity. CONCLUSIONS: Recruitment for this study is complete. If the HEALS intervention study is feasible and effective, it will serve as a platform for a large-scale RCT that will investigate the efficacy and cost-effectiveness of life management interventions for racially and ethnically diverse, low-income individuals with a history of stroke or TIA who seek healthcare in the safety-net system.
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Dieta Saludable , Ataque Isquémico Transitorio/terapia , Conducta de Reducción del Riesgo , Autocuidado , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Anciano , Consejo , Dieta Saludable/etnología , Estudios de Factibilidad , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Ataque Isquémico Transitorio/etnología , Ataque Isquémico Transitorio/mortalidad , Ataque Isquémico Transitorio/fisiopatología , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Educación del Paciente como Asunto , Proyectos Piloto , Factores Protectores , Recurrencia , Proyectos de Investigación , Factores de Riesgo , Proveedores de Redes de Seguridad , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente Cerebrovascular/efectos adversos , Rehabilitación de Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Recurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population. METHODS/DESIGN: In this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP <130 mmHg) at 1 year. Secondary outcomes include: (1) mean change in systolic BP; (2) control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial infarction (MI), and (7) cost-effectiveness of the intervention versus usual care. DISCUSSION: If this multi-component interdisciplinary intervention is shown to be effective in improving risk factor control after stroke, it may serve as a model that can be used internationally to reduce race/ethnic and socioeconomic disparities in stroke in resource-constrained settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01763203 .
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Hemorragia Cerebral/prevención & control , Servicios de Salud Comunitaria/métodos , Disparidades en Atención de Salud , Ataque Isquémico Transitorio/prevención & control , Evaluación de Resultado en la Atención de Salud/métodos , Proveedores de Redes de Seguridad/métodos , Prevención Secundaria/métodos , Accidente Cerebrovascular/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Los Angeles , Persona de Mediana Edad , Factores de Riesgo , Método Simple CiegoRESUMEN
OBJECTIVE: To determine the feasibility and impact of home-based, mental practice-triggered electrical stimulation among stroke survivors exhibiting moderate upper-extremity (UE) impairment. METHOD: Five participants with moderate, stable UE hemiparesis were administered the Fugl-Meyer Assessment, the Box and Block Test, and the Activities of Daily Living, Hand Function, and overall recovery domains of the Stroke Impact Scale (Version 3). They were then administered an 8-wk regimen consisting of 1 hr of mental practice-triggered electrical stimulation every weekday in their home. At the end of every 2 wk, participants attended supervised stimulation to progress therapeutic exercises and stimulation levels and monitor compliance. RESULTS: Six instances of device noncompliance were reported. Participants exhibited reduced UE motor impairment and increased UE dexterity and participation in valued activities. CONCLUSION: The regimen appears feasible and had a substantial impact on UE impairment, dexterity, and participation in valued activities as well as perceptions of recovery.
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Terapia por Estimulación Eléctrica/instrumentación , Imaginación , Paresia/rehabilitación , Práctica Psicológica , Rehabilitación de Accidente Cerebrovascular , Actividades Cotidianas/clasificación , Adulto , Enfermedad Crónica , Estudios de Cohortes , Evaluación de la Discapacidad , Electromiografía/instrumentación , Diseño de Equipo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Terapia Asistida por Computador/instrumentaciónRESUMEN
OBJECTIVE: To investigate the association between touch sensation of the affected hand and performance and satisfaction with performance of valued activities in individuals with chronic stroke. METHODS: Using a cross-sectional study design, this study correlated factors related to hand sensation and activity performance in individuals with chronic stroke. The Touch Test Evaluators and Canadian Occupational Performance Measure (COPM) were used. Correlations were used to determine the relationships between touch sensation of the affected hand and individuals' performance and satisfaction with performance of valued activities. RESULTS: There was a good to excellent relationship between sensation and performance and satisfaction with performance of valued activities for individuals with intact touch sensation of the affected hand who scored higher on the COPM. There was little to no relationship between touch sensation of the affected hand and performance of valued activities for individuals with impaired sensation. CONCLUSION: This is the first study to relate touch sensation of the affected hand and performance and satisfaction with performance of valued activities in individuals with stroke. The findings suggest that rehabilitation therapists need to continue to address sensory function in evaluation and intervention as it relates to performance in valued activities. This study serves as a foundation for future research in sensation and performance of valued activities in individuals with chronic stroke.
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Mano/fisiología , Terapia Ocupacional/métodos , Sensación/fisiología , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/fisiopatología , Tacto/fisiología , Actividades Cotidianas , Anciano , Enfermedad Crónica , Estudios Transversales , Interpretación Estadística de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estimulación Física , Desempeño Psicomotor/fisiología , Recuperación de la FunciónRESUMEN
OBJECTIVE: To compare the efficacy of a repetitive task-specific practice regimen integrating a portable, electromyography-controlled brace called the 'Myomo' versus usual care repetitive task-specific practice in subjects with chronic, moderate upper extremity impairment. SUBJECTS: Sixteen subjects (7 males; mean age 57.0 ± 11.02 years; mean time post stroke 75.0 ± 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upper extremity impairment. INTERVENTIONS: Subjects were administered repetitive task-specific practice in which they participated in valued, functional tasks using their paretic upper extremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30 minutes in duration, occurring 3 days/week for eight weeks. One group participated in repetitive task-specific practice entirely while wearing the portable robotic, while the other performed the same activity regimen manually. MAIN OUTCOME MEASURES: The upper extremity Fugl-Meyer, Canadian Occupational Performance Measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention. RESULTS: After intervention, groups exhibited nearly identical Fugl-Meyer score increases of ≈2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian Occupational Performance Measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale. CONCLUSIONS: Findings suggest that therapist-supervised repetitive task-specific practice integrating robotics is as efficacious as manual practice in subjects with moderate upper extremity impairment.
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Tirantes , Terapia por Ejercicio/instrumentación , Paresia/rehabilitación , Robótica , Rehabilitación de Accidente Cerebrovascular , Anciano , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paresia/etiología , Paresia/fisiopatología , Proyectos Piloto , Método Simple Ciego , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Resultado del Tratamiento , Extremidad SuperiorRESUMEN
INTRODUCTION: Stroke is the leading cause of disability. A need exists for an effective intervention to enhance upper extremity (UE) motor abilities and activities of daily living (ADL) performance. OBJECTIVE: The objectives of this pilot study were to (1) determine the feasibility of adding Interactive Metronome (IM) to an occupational therapy (OT) program; and (2) determine changes in UE impairments, function, quality of life, and perceived physical performance ability and satisfaction using a combined IM + OT regimen compared with OT alone for adults with chronic stroke. METHODS: This pilot study (n=10) used a 2-group (OT or IM+OT) pretest-posttest design. The intervention involved 60 minutes of IM + OT or OT alone, 3 days a week for 10 weeks. Outcome measures included the UE Fugl-Meyer (impairment), the Arm Motor Ability Test (function), the Box and Block Test (function), Stroke Impact Scale (quality of life), and the Canadian Occupational Performance Measure (perceived performance ability and satisfaction). RESULTS: It was feasible to add IM to OT. The IM+OT group demonstrated decreased impairment and increased quality of life. However, the OT-alone group demonstrated greater gains in function, perceived physical performance ability, and satisfaction. CONCLUSION: These findings suggest that rhythm and timing training using the IM is a feasible intervention to consider as part of therapy treatment. However, IM may fit best for prefunctional treatment, as it seemed to primarily decrease impairment. It may also serve as a supplement before or after treatment in order to maximize rehabilitation potential. Clinical implications and suggestions for future studies are provided.
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Terapia por Ejercicio/métodos , Trastornos del Movimiento/rehabilitación , Terapia Ocupacional/métodos , Periodicidad , Rehabilitación de Accidente Cerebrovascular , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Movimiento/etiología , Proyectos Piloto , Calidad de Vida , Estadísticas no Paramétricas , Accidente Cerebrovascular/complicaciones , Factores de Tiempo , Resultado del Tratamiento , Extremidad Superior/fisiopatología , Adulto JovenRESUMEN
PURPOSE: This case series pilot study evaluates the efficacy of the Core:Tx gaming device on 2 chronic stroke survivors. METHODS: Intervention was provided 3 times a week for 3 weeks. Outcome measures, administered 1 week before and 1 week after intervention, included the Stroke Impact Scale (SIS), the Canadian Occupational Performance Measure (COPM), the Fugl-Meyer Assessment of Motor Recovery (Fugl-Meyer [FM]), and the Box and Block Test (BB). RESULTS: Participant A exhibited an 11-point increase on the SIS, a 1.2-point change on each of the performance and satisfaction scores of the COPM, a 1-point increase on the FM, and no change on the BB. Participant B exhibited a 3-point increase on the SIS and no change on the COPM, FM, or BB. CONCLUSIONS: The participants experienced increased quality of life, a greater propensity to use their affected arm, and enhanced task performance without exhibiting motor changes. Additionally, the Core:Tx gaming device was reported by the participants to be a motivating modality in the therapy setting.
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Especialidad de Fisioterapia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/patología , Terapia Asistida por Computador/métodos , Extremidad Superior/fisiopatología , Juegos de Video , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/rehabilitación , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Escala del Estado Mental , Persona de Mediana Edad , Neurorretroalimentación/métodos , Calidad de Vida , Adulto JovenRESUMEN
An accurate and reproducible CD4 count is a fundamental clinical tool for monitoring and treating human immunodeficiency virus infection and its complications. Two methods exist for calculating absolute CD4 counts: dual-platform technology (DPT) and single-platform technology (SPT). Numerous studies have documented the unacceptably wide range of variation in absolute CD4 counts between laboratories. SPT was introduced in 1996 to reduce the interlaboratory variation in absolute CD4 counts. The aim of this study was to compare DPT with the BD Biosciences Trucount method (an SPT method). Both the percentages of CD4 (r = 0.986; P = 0.0541) and the absolute CD4 counts (r = 0.960; P = 0.0001) had very good correlation between the two methods. However, poor correlation was observed for the CD8(+) RO(-) (r = 0.314; P = 0.0002), CD8(+) DR(+) (r = 0.666; P = 0.0138), CD3(+) CD38(+) (r = 0.8000; P = 0.0004), CD3(+) CD25(+) (r = 0.464; P = 0.0082), and CD4(+) CD38(+) (r = 0.357; P = 0.0127) measurements.
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Inmunofenotipificación/métodos , Inmunofenotipificación/normas , Subgrupos Linfocitarios/inmunología , Subgrupos Linfocitarios/metabolismo , Biomarcadores/análisis , Linfocitos T CD4-Positivos/química , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/metabolismo , Humanos , Activación de Linfocitos/inmunología , Subgrupos Linfocitarios/químicaRESUMEN
Modified constraint-induced movement therapy (mCIMT) is a reimbursable regimen that improves the use and function of more-affected arms in patients who have had a stroke. To participate in this regimen, however, patients must exhibit active extension of the more-affected wrists and fingers, which renders many people ineligible. This study determined the efficacy of a mental practice program that preceded mCIMT in improving more-affected arm function in 4 patients with a stroke. Patients received therapy emphasizing activities of daily living (ADLs), followed by sessions of mental practice of the ADL. One week after completing mental practice, patients participated in mCIMT. After mental practice, patients exhibited marked changes on assessments and increased active wrist and finger extension, which qualified them for mCIMT. After mCIMT, participants exhibited additional functional gains, sustained 3 months later. Data suggest that mental practice provides a pathway whereby patients can participate in mCIMT, realize additional gains, and again perform valued ADLs.
Asunto(s)
Modalidades de Fisioterapia/psicología , Recuperación de la Función/fisiología , Rehabilitación de Accidente Cerebrovascular , Actividades Cotidianas , Anciano , Femenino , Dedos , Humanos , Masculino , Persona de Mediana Edad , Terapia Ocupacional/métodos , MuñecaRESUMEN
OBJECTIVES: To assess the validity of our observational experience that a short course of oral prednisolone therapy might be of value in the management of symptoms of chronic pelvic pain syndrome (CPPS) in men. PATIENTS AND METHODS: Twenty-one men with CPPS (inflammatory or non-inflammatory) for > or =6 months, and who had failed to improve with standard antibiotic therapy, were randomized to receive either a 1-month reducing course of oral prednisolone (nine) or an equivalent placebo regimen (12 men). The outcome measures used were the McGill Pain Questionnaire, the Hospital Anxiety and Depression Scale (HADS), General Health Questionnaire-30 (GHQ-30) and the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), which were completed at baseline and 3 months. RESULTS: Outcomes were analysed for the 18 patients (six treated, 12 placebo) who completed the 3 months of follow-up. At both baseline and 3 months, respectively, there was no statistically significant difference between the groups in the NIH-CPSI total score (P = 0.48 and 0.62; Mann-Whitney U-test), or in the HADS (anxiety, P = 0.85 and 0.67; depression P = 0.96 and 0.74), and there was no significant improvement or deterioration over time. Although not statistically significant, there was a trend to improvement in the depression score for the active group (P = 0.13). However, the clinical significance is doubtful, as both baseline and follow-up depression scores were within the normal range. No patient had clinically negative changes in depression. A 3-month follow-up analysis was not possible for the McGill Pain Questionnaire or GHQ-30 as not all patients completed the questionnaire. CONCLUSIONS: Whilst the study showed no clinical benefit of using corticosteroids in the management of CPPS, the few patients recruited limited the validity of firm conclusions from the data. There was a trend towards an improvement of depression levels amongst subjects. The study highlights the difficulties of recruitment and illustrates the complex psychological profiles of patients with CPPS.
Asunto(s)
Antiinflamatorios/uso terapéutico , Dolor Pélvico/tratamiento farmacológico , Prednisolona/uso terapéutico , Prostatitis/tratamiento farmacológico , Adulto , Enfermedad Crónica , Trastorno Depresivo/etiología , Método Doble Ciego , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Pélvico/psicología , Estudios Prospectivos , Prostatitis/psicología , Escalas de Valoración Psiquiátrica , Síndrome , Resultado del TratamientoRESUMEN
In the present study, the authors investigated age differences in children's understanding (a) that a person's behavior may contribute to the formation of a shared opinion within the peer group and (b) that origins of a reputation can be direct or indirect. The authors read stories in which a target character engaged in either prosocial or antisocial interactions with peers to children in kindergarten, 2nd, and 4th grade. They then asked the children to judge how various peers viewed the target character. Children's explanations indicated that children in all of those age groups understood that firsthand experience influenced peers' opinions, and by 2nd grade, children understood that indirect experience or gossip also might have contributed to an individual's reputation.