scholarly journals Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care

2021 ◽  
pp. 154596832110413
Author(s):  
Michelle Broderick ◽  
Leeza Almedom ◽  
Etienne Burdet ◽  
Jane Burridge ◽  
Paul Bentley
Keyword(s):  
Upper Limb ◽  
Real World ◽  
Conventional Therapy ◽  
Standard Care ◽  
Exercise Duration ◽  
Single Session ◽  
Rehabilitation Outcome ◽  
Professional Supervision ◽  
Exercise Dose ◽  
Stroke Centre

Background. One of the strongest modifiable determinants of rehabilitation outcome is exercise dose. Technologies enabling self-directed exercise offer a pragmatic means to increase dose, but the extent to which they achieve this in unselected cohorts, under real-world constraints, is poorly understood. Objective. Here we quantify the exercise dose achieved by inpatient stroke survivors using an adapted upper limb (UL) exercise gaming (exergaming) device and compare this with conventional (supervised) therapy. Methods. Over 4 months, patients presenting with acute stroke and associated UL impairment were screened at a single stroke centre. Participants were trained in a single session and provided with the device for unsupervised use during their inpatient admission. Results. From 75 patients referred for inpatient UL therapy, we recruited 30 (40%), of whom 26 (35%) were able to use the device meaningfully with their affected UL. Over a median enrolment time of 8 days (IQR: 5–14), self-directed UL exercise duration using the device was 26 minutes per day (median; IQR: 16–31), in addition to 25 minutes daily conventional UL therapy (IQR: 12–34; same cohort plus standard care audit; joint n = 50); thereby doubling total exercise duration (51 minutes; IQR: 32–64) relative to standard care (Z = 4.0, P <.001). The device enabled 104 UL repetitions per day (IQR: 38–393), whereas conventional therapy achieved 15 UL repetitions per day (IQR: 11–23; Z = 4.3, P <.001). Conclusion. Self-directed adapted exergaming enabled participants in our stroke inpatient cohort to increase exercise duration 2-fold, and repetitions 8-fold, compared to standard care, without requiring additional professional supervision.

Sequentially applied myoelectrically controlled FES in a task-oriented approach and robotic therapy for the recovery of upper limb in post-stroke patients: A randomized controlled pilot study

2020 ◽  
pp. 1-11
Author(s):  
Gloria Perini ◽  
Rita Bertoni ◽  
Rune Thorsen ◽  
Ilaria Carpinella ◽  
Tiziana Lencioni ◽  
...  
Keyword(s):  
Upper Limb ◽  
Standard Care ◽  
Experimental Treatment ◽  
Stroke Patients ◽  
Rehabilitation Care ◽  
Post Stroke ◽  
Robotic Therapy ◽  
Arm Rehabilitation ◽  
Point Increase ◽  
Task Oriented

BACKGROUND: Functional recovery of the plegic upper limb in post-stroke patients may be enhanced by sequentially applying a myoelectrically controlled FES (MeCFES), which allows the patient to voluntarily control the muscle contraction during a functional movement and robotic therapy which allows many repetitions of movements. OBJECTIVE: Evaluate the efficacy of MeCFES followed by robotic therapy compared to standard care arm rehabilitation for post-stroke patients. METHODS: Eighteen stroke subjects (onset ⩾ 3 months, age 60.1 ± 15.5) were recruited and randomized to receive an experimental combination of MeCFES during task-oriented reaching followed by robot therapy (MRG) or same intensity conventional rehabilitation care (CG) aimed at the recovery of the upper limb (20 sessions/45 minutes). Change was evaluated through Fugl-Meyer upperextremity (FMA-UE), Reaching Performance Scale and Box and Block Test. RESULTS: The experimental treatment resulted in higher improvement on the FMA-UE compared with CG (P= 0.04), with a 10 point increase following intervention. Effect sizes were moderate in favor of the MRG group on FMA-UE, FMA-UE proximal and RPS (0.37–0.56). CONCLUSIONS: Preliminary findings indicate that a combination of MeCFES and robotic treatment may be more effective than standard care for recovery of the plegic arm in persons > 3 months after stroke. The mix of motor learning techniques may be important for successful rehabilitation of arm function.

Patterns and predictors of treatment in muscle-invasive bladder cancer (MIBC): A real-world study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16531-e16531
Author(s):  
Zengqi Lu ◽  
Jessica M. Clement ◽  
Qi Pan ◽  
Helen Swede ◽  
Rajni Mehta ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Real World ◽  
Alternative Treatment ◽  
Standard Care ◽  
Strong Predictor ◽  
Treatment Patterns ◽  
Cancer Center ◽  
Data Set ◽  
Adoption Rate ◽  
To Receive

e16531 Background: Among the approaches to curative-intent therapy for MIBC, neoadjuvant cisplatin-based chemotherapy (NAC) is recognized as the gold standard. The combined modality approach of concurrent chemo-radiation is also considered a standard of care. Despite guidelines recommending multidisciplinary care, studies have shown a low adoption rate of multidisciplinary approaches for MIBC. This study aimed to describe the treatment patterns for MIBC pts using real world data. Methods: Following the appropriate IRB approvals, investigators followed a common protocol under the auspices of the Rapid Case Ascertainment at the Yale Cancer Center. Manual chart review was performed on MIBC pts diagnosed in Connecticut from 2004 –2015 and treated at investigator-affiliated hospitals. Information on medical history, comorbidity, and treatment types were recorded. This data set was linked to the Surveillance, Epidemiology, and End Results (SEER) database for demographic information. The descriptive and logistic regression were used to analyze treatment patterns and predicators in each treatment lines: surgery alone, chemotherapy alone, radiation alone and standard care (NAC followed by surgery; surgery followed by adjuvant chemotherapy and concurrent chemo-radiation). Results: The number of adult MIBC pts in the cohort was 1,198. Among them, 290 (24.2%) received surgery as the only treatment; 117 (9.8%) received chemotherapy only; 100 (8.3%) received concurrent chemo-radiation; 96 (8.0%) received NAC followed by surgery. Besides age ( OR: 0.546, 95% CI: 0.289-0.986), when comparing female to male patients on the likelihood of receiving NAC to the alternative treatment types (radiation or surgery), female pts were less likely to receive NAC than males (OR: 0.421, 95% CI: 0.184-0.930). Conclusions: Regardless of demographics, the overall adoption rate of standard care was low, consisting of 236 pts (19.7%) of the population. From the logistic regression results, age was consistently shown as a predictor for receiving NAC over the alternative treatment types, and sex was identified as another strong predictor. Older and female patients were less likely to receive NAC than younger males.[Table: see text]

Armed forces: Intrasexual selection for upper limb length in Homo sapiens

2021 ◽  
Author(s):  
Neil Robert Caton ◽  
David M. G. Lewis
Keyword(s):  
Sexual Dimorphism ◽  
Upper Limb ◽  
Real World ◽  
Lower Limb ◽  
Homo Sapiens ◽  
Armed Forces ◽  
Outcome Data ◽  
Resource Provisioning ◽  
Limb Length ◽  
Intrasexual Selection

Numerous taxa have evolved physiological appendage-based weaponry to increase damage output in violent fights, but no research has empirically shown that Homo sapiens upper appendages have uniquely evolved to increase resource-provisioning potential in real-world combat. In Study 1, we used actual fight outcome data (N = 715 fighters) to examine multiple competing hypotheses—the striker, defender, grappler, and knockout hypotheses—for the evolution of Homo sapiens upper limb length, controlling for approximately a dozen confounding variables (e.g., biacromial width, lower limb length, age, weight, height). There was exclusive support for the knockout hypothesis: upper limb length increases fighting success through knockout power. There was also evidence for a real-world association between biacromial width and knockout power. Because sexual dimorphism often emerges from selection on morphological structures that improve male’s fighting success, we consequently expected sexual dimorphism in upper limb length. Studies 2a-2d provided powerful evidence for this new universal sexual dimorphism in upper limb length. Even after controlling for weight, height, and lower limb length, males exhibited longer upper limbs than females across the globe: from mixed-martial-artists (Study 2a) and Croatian adolescents (but not pre-pubertal children; Study 2b) to older Singaporean adults (Study 2c) and over 6,000 United States Army personnel (Study 2d) born across seven major world regions (Africa, Europe, Asia, Oceania, and North, Central, and South America). Combined, our results provide comprehensive support for the argument that intrasexual selection has uniquely shaped Homo sapiens upper limb length to enhance fighting performance in real-world combat.

scholarly journals Addressing Sexuality as Standard Care in People with an Upper Limb Deficiency: Taboo or Necessary Topic?

2013 ◽  
Vol 31 (2) ◽  
pp. 167-177 ◽  
Author(s):  
J. E. A. Verschuren ◽  
J. H. B. Geertzen ◽  
P. Enzlin ◽  
P. U. Dijkstra ◽  
R. Dekker ◽  
...  
Keyword(s):  
Upper Limb ◽  
Standard Care ◽  
Limb Deficiency

scholarly journals A physical activity program is no more effective than standard care at maintaining upper limb activity in community-dwelling people with stroke: secondary outcomes from a randomized trial

2019 ◽  
Vol 33 (10) ◽  
pp. 1607-1613
Author(s):  
Birgitta Langhammer ◽  
Louise Ada ◽  
Mari Gunnes ◽  
Hege Ihle-Hansen ◽  
Bent Indredavik ◽  
...  
Keyword(s):  
Physical Activity ◽  
Upper Limb ◽  
Standard Care ◽  
Community Dwelling ◽  
Assessment Scale ◽  
Minor Stroke ◽  
Control Group ◽  
Motor Assessment ◽  
Significant Difference ◽  
Secondary Outcomes

Objective: To evaluate whether an 18-month, physical activity coaching program is more effective than standard care in terms of upper-limb activity. Design: A prospective, randomized controlled trial. Setting: Three municipalities in Norway. Population: A total of 380 persons with stroke. Intervention: The intervention group received follow-up visits and coaching on physical activity and exercise each month for 18 months after inclusion, by a physiotherapist. The control group received standard care. Main measures: The primary outcome, in this secondary analysis, was Motor Assessment Scale items 6, 7, and 8. Secondary outcomes were National Institute of Health Stroke Scale item 5, the Stroke Impact Scale domain 7, and the Modified Ashworth Scale in flexion/extension of the elbow. Results: In total, 380 persons with stroke were recruited, with mean (SD) age 72 (11) years, and baseline scores total National Institute of Health Stroke Scale was 1.4 (2.2)/1.6 (2.4) and Motor Assessment Scale items 6, 7 and 8 in the intervention/control group was 5.5 (1.2)/5.5 (1.2), 5.4 (1.4)/5.4 (1.3), and 3.6 (2)/3.5 (2), respectively. There was no significant difference between groups in terms of upper limb function in any of the Motor Assessment Scale items. In this population with minor stroke, upper-limb activity was good at three months post-stroke (74% of the maximum) and remained good 18 months later (77% of maximum). Conclusion: After intervention, there was no difference between the groups in terms of upper-limb activity.

Quantifying Real-World Activity and Upper-Limb Use in Children with Cerebral Palsy Using Accelerometers

2016 ◽  
Vol 70 (4_Supplement_1) ◽  
pp. 7011500060p1
Author(s):  
Patty Coker-Bolt ◽  
Jackie Connelly ◽  
Na Jin Seo ◽  
Reagin Hoover ◽  
Ryan Downey ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Upper Limb ◽  
Real World ◽  
Children With Cerebral Palsy

scholarly journals Effectiveness of the Virtual Reality System Toyra on Upper Limb Function in People with Tetraplegia: A Pilot Randomized Clinical Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
I. Dimbwadyo-Terrer ◽  
A. Gil-Agudo ◽  
A. Segura-Fragoso ◽  
A. de los Reyes-Guzmán ◽  
F. Trincado-Alonso ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Upper Limb ◽  
Conventional Therapy ◽  
Control Group ◽  
Virtual Reality System ◽  
Limb Function ◽  
Upper Limb Function ◽  
Level Of Satisfaction ◽  
High Level

The aim of this study was to investigate the effects of a virtual reality program combined with conventional therapy in upper limb function in people with tetraplegia and to provide data about patients’ satisfaction with the virtual reality system. Thirty-one people with subacute complete cervical tetraplegia participated in the study. Experimental group received 15 sessions with Toyra®virtual reality system for 5 weeks, 30 minutes/day, 3 days/week in addition to conventional therapy, while control group only received conventional therapy. All patients were assessed at baseline, after intervention, and at three-month follow-up with a battery of clinical, functional, and satisfaction scales. Control group showed significant improvements in the manual muscle test (p= 0,043, partialη2= 0,22) in the follow-up evaluation. Both groups demonstrated clinical, but nonsignificant, changes to their arm function in 4 of the 5 scales used. All patients showed a high level of satisfaction with the virtual reality system. This study showed that virtual reality added to conventional therapy produces similar results in upper limb function compared to only conventional therapy. Moreover, the gaming aspects incorporated in conventional rehabilitation appear to produce high motivation during execution of the assigned tasks. This trial is registered with EudraCT number2015-002157-35.

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