scholarly journals Motor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experience

2020 ◽  
pp. neurintsurg-2020-016862
Author(s):  
Thomas J Oxley ◽  
Peter E Yoo ◽  
Gil S Rind ◽  
Stephen M Ronayne ◽  
C M Sarah Lee ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Minimally Invasive ◽  
Activities Of Daily Living ◽  
Text Messaging ◽  
Daily Living ◽  
Primary Motor Cortex ◽  
Functional Independence ◽  
Human Experience ◽  
Digital Devices ◽  
Selection Accuracy

BackgroundImplantable brain–computer interfaces (BCIs), functioning as motor neuroprostheses, have the potential to restore voluntary motor impulses to control digital devices and improve functional independence in patients with severe paralysis due to brain, spinal cord, peripheral nerve or muscle dysfunction. However, reports to date have had limited clinical translation.MethodsTwo participants with amyotrophic lateral sclerosis (ALS) underwent implant in a single-arm, open-label, prospective, early feasibility study. Using a minimally invasive neurointervention procedure, a novel endovascular Stentrode BCI was implanted in the superior sagittal sinus adjacent to primary motor cortex. The participants undertook machine-learning-assisted training to use wirelessly transmitted electrocorticography signal associated with attempted movements to control multiple mouse-click actions, including zoom and left-click. Used in combination with an eye-tracker for cursor navigation, participants achieved Windows 10 operating system control to conduct instrumental activities of daily living (IADL) tasks.ResultsUnsupervised home use commenced from day 86 onwards for participant 1, and day 71 for participant 2. Participant 1 achieved a typing task average click selection accuracy of 92.63% (100.00%, 87.50%–100.00%) (trial mean (median, Q1–Q3)) at a rate of 13.81 (13.44, 10.96–16.09) correct characters per minute (CCPM) with predictive text disabled. Participant 2 achieved an average click selection accuracy of 93.18% (100.00%, 88.19%–100.00%) at 20.10 (17.73, 12.27–26.50) CCPM. Completion of IADL tasks including text messaging, online shopping and managing finances independently was demonstrated in both participants.ConclusionWe describe the first-in-human experience of a minimally invasive, fully implanted, wireless, ambulatory motor neuroprosthesis using an endovascular stent-electrode array to transmit electrocorticography signals from the motor cortex for multiple command control of digital devices in two participants with flaccid upper limb paralysis.

Functional outcomes following inpatient rehabilitation of guillain-barré syndrome patients: Intravenous immunoglobulins versus plasma exchange

2021 ◽  
pp. 1-9
Author(s):  
Moshe Bondi ◽  
Einat Engel-Haber ◽  
Julie Wolff ◽  
Liza Grosman-Rimon ◽  
Ayala Bloch ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Plasma Exchange ◽  
Functional Outcomes ◽  
Daily Living ◽  
Functional Independence ◽  
Assessment Tools ◽  
Guillain Barre Syndrome ◽  
Disability Scale ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

BACKGROUND: Treatment with either Intravenous immunoglobulin (IVIg) or plasma exchange (PE) in patients with Guillain-Barré Syndrome (GBS) showed equivalent efficacy as attested by a commonly used disability scale. However, it has been suggested that this scale may not be sensitive enough to detect subtle functional changes between the two treatments since it mainly focuses on walking capability and respiratory function. OBJECTIVE: To evaluate functional outcomes following treatment with IVIg or PE using comprehensive scales that incorporate parameters of basic activities of daily living. METHODS: A retrospective cohort study was conducted between 2007 and 2013 in an inpatient neurologic rehabilitation department. The study group included 70 individuals with GBS: 39 were treated with PE and 31 with IVIg. A comparison of functional outcomes was performed using Functional Independence Measure (FIM), rehabilitation efficiency (REy), rehabilitation effectiveness (REs), and the GBS disability scale (GDS). RESULTS: Both treatments had a comparable effect on the various functional outcomes. Patients showed a significant increase in total FIM scores (30 points on average) during rehabilitation mainly as a result of an increase in motor sub-scores. A mean improvement of 1.23 (SD 0.9) in GDS was also observed. On average, individuals with GBS spent 20 days combined in the acute departments and 61 days in the rehabilitation department, with length of stay being similar for both treatments. CONCLUSIONS: IVIg and PE treatments have similar basic activities of daily living (ADL) functional outcomes. Nevertheless, due to the different mechanism of actions of these treatments and the multitude of GBS variants, it is possible that further comprehensive assessment tools may demonstrate differences in activity and participation of individuals with GBS.

Compliance with Prescribed Adaptive Equipment: A Literature Review

2000 ◽  
Vol 63 (2) ◽  
pp. 65-75 ◽  
Author(s):  
Trish Wielandt ◽  
Jenny Strong
Keyword(s):  
Occupational Therapy ◽  
Literature Review ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Current Practice ◽  
Functional Independence ◽  
Under Five ◽  
Functional Potential ◽  
And Training

This article describes a literature review that examined the topic of the postdischarge compliance of individuals with prescribed adaptive equipment. Assisting individuals to accomplish tasks relevant to their activities of daily living and thereby achieve functional independence is central to the role of occupational therapy. The prescription of adaptive equipment is a frequently used intervention. The rationale for prescribing adaptive equipment is that it maximises a client's functional potential, allows for independence in activities of daily living and fosters confidence as a result of being able to accomplish such tasks. All studies that surveyed compliance with prescribed adaptive equipment between 1963 and 1996 were reviewed. The factors that reportedly affect compliance by individuals can be considered under five discrete categories: medical-related, client-related, equipment-related, assessment-related and training-related. On the basis of the findings of this literature review, recommendations are made for further research, specifically investigating methods that therapists could incorporate into current practice to address the problem of non-compliance with prescribed adaptive equipment.

Abstract 170: Impact of Eloquent Motor Cortex-Tissue Reperfusion Beyond the Traditional TICI Scoring After Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Radoslav I Raychev ◽  
Jeffrey Saver ◽  
Scott Brown ◽  
Gary Duckwiler ◽  
Reza Jahan ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Multivariable Analysis ◽  
Functional Independence ◽  
Digital Subtraction ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Stroke Disability ◽  
The Impact

Background: Targeted eloquence-based tissue reperfusion within the primary motor cortex may have differential effect on disability as compared to the traditional volume-based (TICI) reperfusion after endovascular thrombectomy (EVT) in setting of acute ischemic stroke (AIS). Methods: We explored the impact of eloquent reperfusion (ER) within primary motor cortex (PMC) on clinical outcome (mRS) in AIS patients undergoing EVT. ER was defined as presence of flow on final digital subtraction angiography (DSA) within four main cortical branches, supplying the PMC (MCA - precentral, central, anterior parietal; ACA- pericallosal) and graded as absent (0), partial (1), and complete (2). Prospectively collected data from two centers were analyzed. Multivariable analysis was conducted to assess the impact of ER on 90-day disability (mRS) among patients with anterior circulation occlusion who achieved partial reperfusion (TICI 2 a and b). Results: Among the 125 patients who met study criteria, median age was 73, median NIHSS was 16, median ASPECTS was 7, 48% (60/125) were female, and 36.8% achieved functional independence (mRS 0-2) at 90 days. ER distribution was: Absent (0) in 19/125 (15.2%); Partial (1) in 52/125 (41.6%), and Complete (2) in 54/125 (43.2%). TICI 2b was achieved in 102/125 (81.6%) and ER was substantially higher in those patients (p<0.001). In multivariate analysis, in addition to age and sICH, ER had a profound independent impact on 90-day disability (OR 6.10, p=0.001 for ER 1 vs 0; and OR 9.87, p<0.001 for ER 2 vs 0). In contrast, extent of total partial reperfusion (TICI 2b vs 2a) was not related to 90-day disability. Conclusions: Our findings support that eloquent PMC-tissue reperfusion is a major determinant of functional outcome, more impactful than volume-based degree of partial reperfusion. More aggressive, PMC-targeted revascularization among patients with non-eloquent partial reperfusion may further improve post-stroke disability after EVT.

scholarly journals A Comparative Study of Conventional Physiotherapy versus Robot-Assisted Gait Training Associated to Physiotherapy in Individuals with Ataxia after Stroke

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Marcia Belas dos Santos ◽  
Clarissa Barros de Oliveira ◽  
Arly dos Santos ◽  
Cristhiane Garabello Pires ◽  
Viviana Dylewski ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Controlled Trial ◽  
Gait Training ◽  
Functional Independence ◽  
Chronic Stroke ◽  
Wilcoxon Test ◽  
Stroke Survivors ◽  
Registration Number ◽  
One Year

Objectives. To assess the influence of RAGT on balance, coordination, and functional independence in activities of daily living of chronic stroke survivors with ataxia at least one year of injury.Methods. It was a randomized controlled trial.The patients were allocated to either therapist-assisted gait training (TAGT) or robotic-assisted gait training (RAGT). Both groups received 3 weekly sessions of physiotherapy with an estimated duration of 60 minutes each and prescribed home exercises. The following outcome measures were evaluated prior to and after the completion of the 5-month protocol treatment: BBS, TUG test, FIM, and SARA. For intragroup comparisons, the Wilcoxon test was used, and the Mann–Whitney test was used for between-group comparison.Results. Nineteen stroke survivors with ataxia sequel after one year of injury were recruited. Both groups showed statistically significant improvement (P<0.05) in balance, functional independencein, and general ataxia symptoms. There were no statistically significant differences (P<0.05) for between-group comparisons both at baseline and after completion of the protocol.Conclusions. Chronic stroke patients with ataxia had significant improvements in balance and independence in activities of daily living after RAGT along with conventional therapy and home exercises. This trial was registered with trial registration number39862414.6.0000.5505.

The Relationship between Knee Extension Strength and Activities of Daily Living in Patients with Dementia

2011 ◽  
pp. 244-256
Author(s):  
Makoto Suzuki ◽  
Hikari Kirimoto ◽  
Atsushi Inamura ◽  
Yoshitsugu Omori ◽  
Sumio Yamada
Keyword(s):  
Lower Extremity ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Functional Independence Measure ◽  
Knee Extensor ◽  
Functional Independence ◽  
Knee Extension ◽  
Daily Activities ◽  
Lower Body ◽  
Knee Extensor Strength

The purpose of this study was to examine the test-retest reliability of hand-held dynamometer measurements in patients with dementia and determine if predictions about a patient’s ability to perform daily activities can be made from knee extension strength measurements. This study was composed of two rounds of data collection. Sixty patients with dementia were enrolled in the first round to assess the reliability of hand-held dynamometer measurements, and 54 patients with dementia were enrolled in the second round for predicting their ability to perform daily activities. Knee extensor strength was measured twice, separated by a three minute interval, with hand-held dynamometer. The authors also assessed daily activities related to the patient’s lower extremities, including dressing the lower body, using the toile, transferring to the bed/toilet/shower, and walking. Lower extremity activities of the Functional Independence Measure were assessed by the nursing home caregiver that had the most regular contact with each subject. When the Functional Independence Measure score of each lower extremity function was =6 points, the subject was considered to be independent. The intraclass correlation coefficient was 0.97. Bland-Altman plots showed the 95% difference value to be within 2 SDs of the mean. The curves of negative and positive predictive values revealed the following threshold levels: 0.8 Nm/kg was the best predictor for dressing the lower body and using the toilet; 1.2 Nm/kg was the best predictor for transferring to the bed/toilet/shower; and 0.6 Nm/kg was the best predictor for gait performance. Strength measurements taken with a hand-held dynamometer were reliable in patients with dementia, and normalized knee extensor strength was found to be a predictor of the ability to perform activities of daily living.

scholarly journals FUNCTIONAL INDEPENDENCE, ACCESS TO KIDNEY TRANSPLANTATION, AND WAITLIST MORTALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S494-S495
Author(s):  
Nadia M Chu ◽  
Stephanie Sison ◽  
Abimereki Muzaale ◽  
Christine Haugen ◽  
Jacqueline Garonzik Wang ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Activities Of Daily Living ◽  
Competing Risks ◽  
Mortality Risk ◽  
Daily Living ◽  
Functional Independence ◽  
End Stage Kidney Disease ◽  
End Stage ◽  
Waitlist Mortality

Abstract Although functional independence is a health priority for patients with advanced CKD, 50% of those who progress to end-stage kidney disease (ESKD) develop difficulties carrying-out essential day-to-day activities. Functional independence is not routinely assessed at kidney transplant (KT) evaluation; therefore, it is unclear what percentage of candidates are functionally independent and whether independence is associated with access to KT and waitlist mortality. We studied a prospective cohort of 3,168 ESKD participants (1/2009-6/2018) who self-reported functional independence in basic Activities of Daily Living (ADL) and more complex Instrumental Activities of Daily Living (IADL). We estimated adjusted associations between functional independence (separately) and listing (Cox), waitlist mortality (competing risks), and transplant rates (Poisson). At evaluation, 92.4% were independent in ADLs, but only 68.5% were independent in IADLs. Functionally independent participants had a higher chance of listing for KT (ADL:aHR=1.55,95%CI:1.30-1.87; IADL:aHR=1.39,95%CI 1.26-1.52). Among KT candidates, ADL independence was associated with lower waitlist mortality risk (SHR=0.66,95%CI:0.44-0.98) and higher rate of KT (IRR=1.58,95%CI:1.12-2.22); the same was not observed for IADL independence (SHR=0.86,95%CI:0.65-1.12; IRR=1.01,95%CI:0.97-1.19). ADL independence was associated with better KT access and lower waitlist mortality; clinicians should screen KT candidates for ADL independence, and identify interventions to maintain independence to improve waitlist outcomes.

scholarly journals Relationship between upper limb motor function and activities of daily living after removing the influence of lower limb motor function in subacute patients with stroke: A cross-sectional study

2020 ◽  
pp. 156918612092660
Author(s):  
Haruka Yamamoto ◽  
Kazuya Takeda ◽  
Soichiro Koyama ◽  
Keisuke Morishima ◽  
Yuichi Hirakawa ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Daily Living ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Motor Score ◽  
Cross Sectional ◽  
The Relationship

Background Previous studies have reported a relationship between upper limb motor function and activities of daily living. However, their relationship after removing the influence of lower limb motor function has not been clarified. Objective This study aimed to investigate the relationship between Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score and between Fugl-Meyer assessment upper limb and each item contained in Functional Independence Measure motor score after eliminating the influence of the motor function of the affected lower limb. Methods This retrospective cross-sectional study included 58 subacute stroke patients. To investigate the relationship between the Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score before and after removing the influence of Fugl-Meyer assessment lower limb, Spearman’s rank correlation coefficient and partial correlation analysis were used. Additionally, the relationship between Fugl-Meyer assessment upper limb and each item of Functional Independence Measure motor score after removing the influence was assessed. Results Before removing the influence of Fugl-Meyer assessment lower limb, Fugl-Meyer assessment upper limb was strongly correlated with total Functional Independence Measure motor score (r = 0.74, p < 0.001). However, it became weak after removing the influence (r = 0.27, p = 0.04). Regarding each item of Functional Independence Measure motor score, Fugl-Meyer assessment upper limb was correlated with grooming (r = 0.27, p = 0.04), bathing (r = 0.28, p = 0.03), dressing upper body (r = 0.33, p = 0.01), dressing lower body (r = 0.31, p = 0.02), and stair-climbing (r = 0.31, p = 0.02) after removing the influence. Conclusion These findings suggest that the relationship between the upper limb motor function and activities of daily living is strongly influenced by lower limb motor function.

scholarly journals Variation in Functional Independence among Stroke Survivors Having Fatigue and Depression

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Umaru Muhammad Badaru ◽  
Omoyemi Olubunmi Ogwumike ◽  
Ade Fatai Adeniyi ◽  
Olajide Olubanji Olowe
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Medical Center ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Functional Independence ◽  
Cross Sectional Survey ◽  
College Hospital ◽  
Cross Sectional ◽  
Significance Level

Objective. This study evaluated variation in functional independence in activities of daily living (ADL) and instrumental activities of daily living (IADL) among individuals with poststroke fatigue (PSF) and poststroke depression (PSD).Methods. A cross-sectional survey involved 65 consenting poststroke survivors who were purposively recruited from physiotherapy clinics of the University College Hospital, Ibadan, Adeoyo Maternity Teaching Hospital, Ibadan, and Federal Medical Center, Gusau. Participants were assessed for symptoms of PSD with short geriatric depression scale-15, PSF with fatigue severity scale, ADL with Barthel Index and IADL with Nottingham extended ADL scale. Data analysis was done using Chi-square and unpairedt-test with significance level being 0.05.Results. Participants’ age ranged from 58 to 80 years. PSD alone (P=0.002) and both PSF and PSD (P=0.02) were significantly associated with ADL, while PSF alone was not (P=0.233). PSD alone (P=0.001) and both PSF and PSD (P=0.001) significantly negatively affected IADL, while PSF alone had no significant effect (P=0.2).Conclusions. Participants with PSD alone and those with both PSF and PSD had lower functional independence in ADL and IADL.

scholarly journals Terapia Ocupacional na clínica médica: experiências práticas em estágio supervisionado/ Occupational therapy in the medical clinic: practical experiences in supervised internship

2020 ◽  
Vol 4 (1) ◽  
pp. 123-129
Author(s):  
Mariana De Pontes Santiago ◽  
Janaína Marcelino Rocha de Abreu ◽  
Raquel Costa Albuquerque
Keyword(s):  
Occupational Therapy ◽  
Activities Of Daily Living ◽  
Elderly People ◽  
Daily Living ◽  
Functional Independence ◽  
Occupational Therapist ◽  
Medical Clinic ◽  
Practical Experiences ◽  
De Medicina

O objetivo deste artigo é apresentar as vivências da Terapia Ocupacional na enfermaria de clínica médica do Instituto de Medicina Integral Professor Fernando Figueira, como práticas de estágio supervisionado, no ano de 2019. A experiência evidencia um perfil de adultos e idosos acometidos por múltiplas patologias, com perdas em seu nível de independência funcional e comprometimento das Atividades Básicas de Vida Diária após a hospitalização. As intervenções foram voltadas principalmente para o resgate da funcionalidade e demonstraram efetividade ao longo dos atendimentos. Portanto, reforça-se a importância do terapeuta ocupacional no hospital, para a recuperação da saúde e autonomia dos indivíduos. Abstract: The objective of this article is to present the Occupational Therapy experiences in the medical clinic ward of the Instituto de Medicina Integral Professor Fernando Figueira, as supervised internship practices, in 2019. The experience shows a profile of adults and elderly people with multiple pathologies, with losses in their level of functional independence and impairment of the Basic Activities of Daily Living after hospitalization. The interventions were mainly aimed at the rescue of functionality and demonstrated effectiveness throughout the care. Therefore, the importance of the occupational therapist in the hospital is reinforced for the recovery of health and autonomy of individuals.Key words: Internship; Functionality; Hospital; Occupational therapy. Resumen: El objetivo de este trabajo es presentar las experiencias de terapia ocupacional en el pabellón de la clínica médica del Instituto de Medicina Integral Professor Fernando Figueira, como prácticas supervisadas, en 2019. La experiencia muestra un perfil de adultos y ancianos con patologías múltiples, con pérdidas en su nivel de independencia funcional y deterioro de las Actividades Básicas de la Vida Diaria después de la hospitalización. Las intervenciones se dirigieron principalmente al rescate de la funcionalidad y la efectividad demostrada en toda la atención. Por lo tanto, la importancia del terapeuta ocupacional en el hospital se refuerza para la recuperación de la salud y la autonomía de las personas.Palabras clave: Funcionalidad; Hospital; Prácticas; Terapia ocupacional.

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