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BACKGROUND: Despite the robust body of evidence for the benefits of home-based physical exercise, there is still a paucity of data on the benefits of home-based cognitive training for older adults, especially in those at increased risk of clinical-functional vulnerability. As such, the present study aims to compare the chronic effects of a telehealth-delivered physical training intervention alone or combined with a cognitive training program in older adults at increased clinical-functional vulnerability risk. METHODS: A randomized clinical trial will be conducted including 62 sedentary older individuals classified as at increased risk of clinical-functional vulnerability based on their Clinical-Functional Vulnerability Index score. Participants will be randomly allocated in a 1:1 ratio to one of two groups, an intervention group including physical training combined with cognitive training, or an active control group including physical training alone. Both groups will receive home-based supervised training remotely for 12 weeks and will be assessed for the primary and secondary outcomes of the study before and after the training period. Primary outcomes include cognitive function and dynamic balance with a dual task. Secondary outcomes encompass physical, cognitive, and occupational performance, functional capacity, quality of life, and anxiety and depression symptoms, as well as hemodynamic measures. Data analysis will be performed by intention-to-treat and per protocol using mixed linear models and Bonferroni's post hoc (α = 0.05). DISCUSSION: Our conceptual hypothesis is that both groups will show improvements in the primary and secondary outcomes. Nevertheless, we expect physical combined with cognitive training to improve cognitive function, dual task, and occupational performance to a greater degree as compared to physical training alone. TRIAL REGISTRATION: NCT05309278. Registered on April 4, 2022.
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Treino Cognitivo , Qualidade de Vida , Humanos , Idoso , Ansiedade , Transtornos de Ansiedade , Cognição , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Background: Distal radius fractures are very frequent fractures in the world, so it is necessary to establish new rehabilitation strategies. Objective: To determine the effectiveness of tele rehabilitation versus supervised treatment in the functional recovery of patients with distal radius fracture. Method: A randomized clinical trial was conducted that included 91 patients with distal radius fractures grades AO23 A and AO23B, which were randomly assigned to a treatment group, the supervised rehabilitation group received for two weeks a program of 10 treatment sessions and the tele rehabilitation group received through the Moodle platform instructions to carry out the rehabilitation program. Outcome measures (functionality, active range of motion, hand grip strength, quality of life and pain) were measured at the time of admission to rehabilitation and at 1, 3 and 6 months. Results: In both treatment groups at 6 months, statistically significant intragroup differences in functionality were demonstrated, with no intergroup differences. Conclusions: At 6 months, both rehabilitation programs increase functionality, range of motion, quality of life and decrease pain, without statistically significant differences intergroup.
Antecedentes: Las fracturas de radio distal son fracturas muy frecuentes en el mundo, por lo que es necesario establecer nuevas estrategias de rehabilitación. Objetivo: Determinar la efectividad de la telerrehabilitación en comparación con el tratamiento supervisado en la recuperación funcional de los pacientes con fractura de radio distal. Método: Se realizó un ensayo clínico aleatorizado que incluyó 91 pacientes con fracturas de radio distal de grados AO23A y AO23B, los cuales se asignaron aleatoriamente a un grupo de rehabilitación supervisado que recibió durante 2 semanas un programa de 10 sesiones de tratamiento o un grupo de telerrehabilitación que mediante la plataforma de Moodle recibió instrucciones para realizar el programa de rehabilitación. Las medidas de resultado (funcionalidad, rango de movimiento activo, fuerza de prensión de la mano, calidad de vida y dolor) se midieron en el momento del ingreso a rehabilitación y a los 1, 3 y 6 meses. Resultados: A los 6 meses, ambos grupos de tratamiento demostraron diferencias estadísticamente significativas intragrupo en la funcionalidad, sin diferencias intergrupo. Conclusiones: A los 6 meses, ambos programas de rehabilitación aumentan la funcionalidad, el rango de movimiento y la calidad de vida, y disminuyen el dolor, sin diferencias estadísticamente significativas intergrupo.
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BACKGROUND: SATISPART-Stroke (SATIS-Stroke) is the most complete instrument for the assessment of activity and participation following a stroke. However, its use in a developing country has only been tested through in-person interviews. OBJECTIVE: To determine the validity, reproducibility and viability of the SATIS-Stroke scale administered in two tele-assessment modalities: self-assessment of an electronic form versus videoconference. METHODS: Methodological study with Brazilian chronic stroke survivors was conducted. Stage I comprised an in-person interview to apply the SATIS-Stroke and a self-assessment by completing an electronic form to respond to the SATIS-Stroke items. Step II occurred 6 to 8 months after Step I, during which SATIS-Stroke was administered again in-person and via videoconference. The order was randomized. RESULTS: Ninety-five stroke survivors were recruited, but only 50 answered the electronic form (adherence: 52.6%). Mean scores were higher in the self-administration of electronic form compared to the in-person interview (mean difference = -0.36 ± 0.93; P = 0.009). Adequate reliability was found in the comparison of the in-person and self-assessment of electronic form (ICC2,1 = 0.66; 95%CI: 0.40-0.81). Fifty stroke survivors participated in Step II, during which adequate reliability was found in the comparison of the in-person administration and videoconference (ICC2,1 = 0.55; 95%CI: 0.21-0.74) and a moderate correlation was found between the assessment methods (r = 0.43; P = 0.02). DISCUSSION: Adequate validity and reliability were found in the tele-assessment. Thus, this method is appropriate and viable for use in developing countries. Although reliable, the self-assessment did not have good adherence in the Brazilian population due to internet access problems, lack of familiarity with the digital form and lack of autonomy to answer the questions alone.
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Virtual Reality (VR) has emerged as a new treatment approach in neurorehabilitation (NR). REAVITELEM Study is a specific NR intervention program based on VR at center (VRC) and tele-rehabilitation (TR) in Argentina. Methods First national multicenter study with a 12-week program intervention of VRC and TR. Participants were assessed at baseline, at 6th and 12th week. Phase I: recruitment and gather of 5 NR Centers from Argentina by the coordinator center (INEBA) to unify evaluation and intervention criteria. Phase II, all centers completed VRC an TR programs. Intervention was 30-minute session, twice a week for 12 weeks. Outcome measures: Expanded Disability Status Scale (EDSS), Fist and Key Pinch Dynamometry, Beck Depression Inventory-Fast Screen, Fatigue Severity Scale, Functional Independence Measure (FIM), International Questionnaire investigating Quality of life in MS (MusiQol) and a Visual Analogue Scale (VAS) of satisfaction after treatment. Results A total of 54 PWMS (23 males) were recruited for VRC. Afterwards, 14 completed TR. The mean age for VRC was 44.72 (SD ± 13.74) and 41.71 (SD ± 10.5) for TR. The median EDSS was 4, 75 for VR. At VRC, 42 have RRMS, 8 have SPMS and 4 PPMS. At TR, 13 have RRMS and 1 have SPMS. The VAS reported an excellent level of satisfaction after treatment with an average of 9, 02 (SD±1.35) in VRC and 9.42 (SD±0.66) in TR. There were significant differences for MusiQol, which improved from baseline to the post-intervention assessment at VRC (p=<0.001) and at TR (p = 0.004) as well as FIM post-intervention assessment at VCR (p = 0.02) and TR (p = 0.04). Conclusion this study suggest that the NR treatment based on VR in MS in Argentina, is an additional effective tool, which favors improvements in the level of functioning in activities of daily living, quality of life, mood, and satisfaction with the treatment.
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Esclerose Múltipla , Telerreabilitação , Realidade Virtual , Masculino , Humanos , Esclerose Múltipla/reabilitação , Atividades Cotidianas , Argentina , Qualidade de VidaRESUMO
El COVID19 ha afectado a millones de personas a nivel mundial. Entre los pacientes contagiados que se agravan y requieren de cuidados intensivos avanzados; además de largas estadías de hospitalización, se encuentran quienes tienen obesidad. Debido a la gran prevalencia de personas con obesidad, tanto en países desarrollados como en en vías de desarrollo, y a las distintas secuelas que experimentan debido al efecto directo del virus como al tratamiento que reciben, es necesario comprender la fisiopatología asociada a la severidad del contagio. Otro aspecto importante a considerar es ¿cómo las secuelas del tratamiento en las unidades de pacientes críticos pueden afectar el estado de salud de estas personas? El propósito de esta revisión fue indagar en la literatura sobre la rehabilitación fisica en pacientes con obesidad que han padecido COVID19 con el objetivo de tener una mirada integral que apunte a potenciar los resultados de la rehabilitación durante todo el curso de la enfermedad. Se revisaron antecedentes en bases de datos como Pubmed, la literatura y ante la escasa evidencia sobre el proceso de rehabilitación en las personas con obesidad se realizó una revisión narrativa del paciente con obesidad que enferma de COVID19 y que luego de una hospitalización prolongada debe ser reintegrado a sus actividades habituales. Se enfatiza en la fisiopatología asociada a la inmovilización prolongada de un paciente con comorbilidades previas y se proponen estrategias de rehabilitación basadas en el entrenamiento físico adaptado a su nueva condición de salud.
ABSTRACT COVID19 is a pandemic that has affected all of humanity and is still far from being eradicated, despite efforts to vaccinate the population. Among infected patients whose symptoms worsen and require advanced intensive care; in addition to long hospital stays, there are people with obesity. Due to the high prevalence of people with obesity, both in developed and developing countries, and the different sequelae they experience due to the direct effect of the virus and the treatment they receive, it is necessary to understand the pathophysiology associated with the severity of the contagion, as well as treatment sequelae among intensive care patients with the goal of having a comprehensive view that aims to enhance the results of rehabilitation throughout the course of the disease. Post-discharge sequelae depend on the severity of the disease, previous comorbidities, and length of hospitalization. This review presents a global panorama of obese patients who become ill with COVID19 and who, after a prolonged hospitalization, return to normal daily routines. Emphasis is placed on the pathophysiology associated with prolonged immobilization of a patient with previous comorbidities and on rehabilitation strategies based on physical training adapted to the new health condition.
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Resumen La rehabilitación cardiaca es un tratamiento valioso para pacientes con enfermedades cardiacas establecidas, y en general para personas con riesgo cardiovascular elevado. La prescripción de la rehabilitación cardiaca debe ser progresiva y con metas individualizadas. Tradicionalmente se inicia en entornos hospitalarios luego de eventos cardiovasculares agudos y se continúa de manera ambulatoria en instituciones de menor complejidad. Se realizó una revisión no sistemática de la literatura sobre la evolución de la rehabilitación cardiaca en el tiempo, su relevancia en el cuidado de los pacientes con enfermedad cardiovascular, las diferentes modalidades en la prestación de este servicio con la tendencia a la rehabilitación cardiaca en casa y la telerrehabilitación, y su transformación acelerada durante la pandemia de COVID-19. Es fundamental garantizar la continuidad en el acceso, así como la suficiente participación de los pacientes en programas remodelados de rehabilitación cardiaca, capaces de transgredir hábitos en la prestación del servicio y de superar las barreras que puede representar la situación actual para la entrega de una atención de alta calidad.
Abstract Cardiac rehabilitation is a valuable treatment for patients with established heart disease, and in general, for people with high cardiovascular risk. The prescription of cardiac rehabilitation must be progressive and with individualized goals. Traditionally, it is performed in hospital settings after an acute cardiovascular event and it's continued as outpatient basis in less complex institutions. A non-systematic review of literature was conducted in terms of the evolution of cardiac rehabilitation over time, it's relevance in cardiovascular disease patient's care, different access modalities, including the evolving tendency towards home based cardiac rehabilitation and tele-rehabilitation, as well as its accelerated transformation during the COVID-19 pandemics. It is essential to guarantee continuity of access as well as sufficient participation of patients in restructured cardiac rehabilitation programs, capable of surpassing service delivery habits and overcoming the barriers that the current situation may represent for the delivery of a high-quality care.
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Humanos , Reabilitação Cardíaca , COVID-19 , Doença , TelerreabilitaçãoRESUMO
The COVID-19 pandemic resulted in limited access of post-stroke patients to their usual medical follow-up and rehabilitation. To continue these activities, we adopted a technology that is free and has universal access. We remotely followed 32 patients after discharge from the stroke unit during the mandatory lock-down. This allowed to continue with medical controls, physical therapy and speech pathology treatments. All patients fully complied with medical treatment and self-monitoring of vascular risk factors. Early discontinuation of rehabilitation therapies was identified and immediately compensated with tele-rehabilitation. All expressed their willingness to continue with this treatment modality. This strategy was successful to effectively continue medical follow-up and rehabilitation supervision with the collaboration of families, is an accessible and low-cost technology that could be replicated and used in health institutions that treat neurovascular diseases.
La pandemia COVID-19 limitó el acceso de los pacientes post accidente cerebro vascular a los controles de seguimiento médico y a la rehabilitación, por lo cual decidimos incorporar herramientas tecnológicas gratuitas y accesibles para su continuación. Realizamos seguimiento remoto a 32 pacientes dados de alta en los primeros tres meses del período de aislamiento social preventivo obligatorio con el objetivo de continuar controles médicos, rehabilitación física y fonoaudiológica. El 100% adhirió al tratamiento médico y al auto-monitoreo de factores de riesgo; detectamos en forma temprana la interrupción de las terapias de rehabilitación y mantuvimos la adherencia por medio de tele-rehabilitación. Los 32 pacientes mostraron disponibilidad para seguir con esta modalidad de atención, permitiendo continuar el seguimiento médico y supervisar la rehabilitación con la colaboración de las familias. Es una metodología accesible y de bajo costo que podría ser replicada y utilizada en instituciones de salud que traten enfermedades neurovasculares.
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COVID-19 , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Telemedicina , Controle de Doenças Transmissíveis , Humanos , Pandemias , SARS-CoV-2 , Prevenção Secundária , Acidente Vascular Cerebral/prevenção & controleRESUMO
Resumen La pandemia COVID-19 limitó el acceso de los pacientes post accidente cerebro vascular a los controles de seguimiento médico y a la rehabilitación, por lo cual decidimos incorporar herramientas tecnológicas gratuitas y accesibles para su continuación. Realizamos seguimiento remoto a 32 pacientes dados de alta en los primeros tres meses del período de aislamiento social preventivo obligatorio con el objetivo de continuar controles médicos, rehabilitación física y fonoaudiológica. El 100% adhirió al tratamiento médico y al auto-monitoreo de factores de riesgo; detectamos en forma temprana la interrupción de las terapias de rehabilita ción y mantuvimos la adherencia por medio de tele-rehabilitación. Los 32 pacientes mostraron disponibilidad para seguir con esta modalidad de atención, permitiendo continuar el seguimiento médico y supervisar la rehabilitación con la colaboración de las familias. Es una metodología accesible y de bajo costo que podría ser replicada y utilizada en instituciones de salud que traten enfermedades neurovasculares.
Abstract The COVID-19 pandemic resulted in limited access of post-stroke patients to their usual medical follow-up and rehabilitation. To continue these activities, we adopted a technology that is free and has universal access. We remotely followed 32 patients after discharge from the stroke unit during the mandatory lock-down. This allowed to continue with medical controls, physical therapy and speech pathology treatments. All patients fully complied with medical treatment and self-monitoring of vascular risk factors. Early discontinuation of rehabilitation therapies was identified and immediately compensated with tele-rehabilitation. All expressed their willingness to continue with this treatment modality. This strategy was successful to effectively continue medical follow-up and rehabilitation supervision with the collaboration of families, is an accessible and low-cost technology that could be replicated and used in health institutions that treat neurovascular diseases.
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Humanos , Telemedicina , Acidente Vascular Cerebral/prevenção & controle , Reabilitação do Acidente Vascular Cerebral , COVID-19 , Controle de Doenças Transmissíveis , Prevenção Secundária , Pandemias , SARS-CoV-2RESUMO
A virtual therapist (VT) capable of modeling visible speech and directing speech and language therapy is presented. Three perspectives of practical and clinical use are described. The first is a description of treatment and typical roles that the VT performs in directing participation, practice and performance. The second is a description of techniques for modeling visible speech and implementing tele-rehabilitation. The third is an analysis of performance of a system (AphasiaRx™) for delivering speech and language therapy to people with aphasia, with results presented from a randomized controlled cross-over study in which the VT provided two levels of cuing. Compared to low cue treatment, high cue treatment resulted in 2.3 times faster learning. The paper concludes with a discussion of the benefits of speech and language therapy delivered by the VT.