scholarly journals Prism adaptation treatment to address spatial neglect in an intensive rehabilitation program: A randomized pilot and feasibility trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245425
Author(s):  
Tomas Vilimovsky ◽  
Peii Chen ◽  
Kristyna Hoidekrova ◽  
Jakub Petioky ◽  
Pavel Harsa
Keyword(s):  
Brain Injury ◽  
Large Scale ◽  
Statistical Significance ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Program ◽  
Prism Adaptation ◽  
Spatial Neglect ◽  
Feasibility Trial ◽  
Control Group ◽  
Rehabilitation Care

Spatial neglect (SN) is a common cognitive disorder after brain injury. Prism adaptation treatment (PAT) is one of the promising interventions for SN albeit inconsistent results from previous studies. We carried out a comparison intervention (PAT vs. Sham) and aimed to evaluate the efficacy of PAT on visuospatial symptoms of SN in an inpatient rehabilitation setting that offered a highly intensive comprehensive brain injury rehabilitation program. A total of 34 patients with moderate-to-severe SN secondary to stroke or traumatic brain injury were randomized to the PAT group and the Sham group (an active control group). Both groups received 10 sessions of treatment, over two weeks, in addition to the rehabilitation therapies provided by their rehabilitation care teams. Outcomes were measured using an ecological instrument (the Catherine Bergego Scale) and paper-and-pencil tests (the Bells Test, the Line Bisection Test and the Scene Copying Test). Patients were assessed at baseline, immediately after treatment, two weeks after treatment, and four weeks after treatment. 23 (67.6%) patients completed treatment and all the assessment sessions and were included in the final analyses using mixed linear modeling. While SN symptoms reduced in both groups, we found no difference between the two groups in the degree of improvement. In addition, the average SN recovery rates were 39.1% and 28.6% in the PAT and Sham groups, respectively, but this discrepancy did not reach statistical significance. Thus, the present study suggests that PAT may contribute little to SN care in the context of a highly intensive inpatient rehabilitation program. Further large-scale investigation is required to uncover the mechanisms underlying PAT and Sham in order to refine the treatment or create new interventions.

scholarly journals Portable neuromodulation induces neuroplasticity to re-activate motor function recovery from brain injury: A high-density MEG case study

2020 ◽  
Author(s):  
Ryan C.N. D'Arcy ◽  
Trevor Greene ◽  
Debbie Greene ◽  
Zack Frehlick ◽  
Shaun D. Fickling ◽  
...  
Keyword(s):  
Brain Injury ◽  
Motor Function ◽  
Large Scale ◽  
Rehabilitation Program ◽  
High Density ◽  
Cortical Activation ◽  
Valuable Insight ◽  
Large Scale Network ◽  
Scale Network

Abstract Background: In a recent high-profile case study, we used functional magnetic resonance imaging (fMRI) to monitor improvements in motor function related to neuroplasticity following rehabilitation for severe traumatic brain injury (TBI). The findings demonstrated that motor function improvements can occur years beyond current established limits. The current study extends the functional imaging investigation to characterize neuromodulation effects on neuroplasticity to further push the limits.Methods: Canadian Soldier Captain (retired) Trevor Greene (TG) survived a severe open-TBI when attacked with an axe during a 2006 combat tour in Afghanistan. TG has since continued intensive daily rehabilitation to recover motor function, experiencing an extended plateau using conventional physical therapy. To overcome this plateau, we paired translingual neurostimulation (TLNS) with the continuing rehabilitation program. Results: Combining TLNS with rehabilitation resulted in demonstrable clinical improvements along with corresponding changes in movement evoked electro-encephalography (EEG) activity. High-density magneto-encephalography (MEG) characterized cortical activation changes in corresponding beta frequency range (27Hz). MEG activation changes corresponded with reduced interhemispheric inhibition in the post-central gyri regions together with increased right superior/middle frontal activation suggesting large scale network level changes. Conclusions: The findings provide valuable insight into the potential importance of non-invasive neuromodulation to enhance neuroplasticity mechanisms for recovery beyond the perceived limits of rehabilitation.

scholarly journals Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka – An Observational Study

2020 ◽  
Vol 2 (6) ◽  
Author(s):  
Mohammed Tarek Alam ◽  
Rubaiul Murshed ◽  
Pauline Francisca Gomes ◽  
Zafor Md. Masud ◽  
Sadia Saber ◽  
...  
Keyword(s):  
Observational Study ◽  
Large Scale ◽  
Statistical Significance ◽  
Healthcare Providers ◽  
Tertiary Hospital ◽  
Control Group ◽  
P Value ◽  
Chi Square ◽  
Exposure Prophylaxis ◽  
Experimental Group

Introduction: While multiple vaccines are undergoing clinical trial across the globe, we yearn for an FDA approved drug to protect us from the devastating pandemic for the time being. This study aims to determine the effectiveness of Ivermectin when administered as pre-exposure prophylaxis for COVID-19. Method: An observational study, with 118 healthcare providers who were enrolled purposively, was conducted in a tertiary hospital in Dhaka from May 2020 to August 2020. The subjects were divided into experimental and control groups; and the experimental group received an oral monthly dose of Ivermectin 12mg for 4 months. Both groups were exposed to COVID-19 positive patients admitted in the hospital during the course of study. The symptomatic subjects were evaluated by physical examination, COVID-19 RT-PCR and/or HRCT of chest. Differences between the variables were determined using the Chi-square test and the level of statistical significance was reached when p<0.05. Result: 73.3% (44 out of 60) subjects in control group were positive for COVID-19, whereas only 6.9% (4 out of 58) of the experimental group were diagnosed with COVID-19 (p-value < 0.05). Conclusion: Ivermectin, an FDA-approved, safe, cheap and widely available drug, should be subjected to large-scale trials all over the world to ascertain its effectiveness as pre-exposure prophylaxis for COVID-19.

scholarly journals Assessment of Intensive Inpatient Rehabilitation Program in Acquired Brain Injury Patients using UK FIM+FAM Scale: A Retrospective Study

2021 ◽  
Author(s):  
Harleen Uppal ◽  
Shipra Chaudhary ◽  
Siddharth Rai
Keyword(s):  
Brain Injury ◽  
Functional Outcome ◽  
Outcome Measure ◽  
Acquired Brain Injury ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
P Value ◽  
Functional Outcome Measure ◽  
The Uk

Introduction: Acquired Brain Injury (ABI) can lead to a combination of physical, cognitive, and behavioural impairments and requires comprehensive and structured inpatient rehabilitation program. A multidisciplinary rehabilitation program can deal comprehensively with all these issues together rather than focussing on a single aspect like motor function. Number of people suffering from Traumatic Brain Injury (TBI) in India has been documented to be between 1.5 million to two million per year whereas out of this approximately one million die due to TBI. The rationale of the present study was to document the outcome of multidisciplinary inpatient rehabilitation program objectively using a standard functional outcome measure. Aim: To determine the change in functional outcomes of ABI patients being rehabilitated with a multidisciplinary inpatient neurorehabilitation program using UK version of Functional Independence Measure and Functional Assessment Measure (UK FIM+FAM). Materials and Methods: The retrospective observational study was conducted in Medanta Hospital, Gurugram, Haryana, India, from September 2017 to June 2018. Retrospective analysis of previously maintained data was done from June 2018 to November 2018. Data was collected from the Department of Neurorehabilitation. Demographic data was collected including age, sex, type of injury, time from injury to admission and duration of stay in the neurorehabilitation unit. Functional outcome measure used in the study was the UK FIM+FAM. Data was collected in paper forms and collated in Microsoft Excel and transferred to IBM® Statistical Package for the Social Sciences (SPSS)® version 22.0 (IBM Corp., Armonk, NY) for analysis. The UK FIM+FAM data was analysed as aggregate total scores and motor and cognitive subscales. Non parametric tests were used as UK FIM+FAM is an ordinal scale. The test used to measure the change in score was Wilcoxon Test. The p-value <0.05 was considered statistically significant. Results: Total number of patients who were analysed in the study were 45. Motor subset of scores showed significant improvement from admission (50) to discharge (72) (p-value=0.001). Similarly, the cognitive subset of scores also showed a significant improvement from admission (58) to discharge (68, p value=0.002). Apart from motor and cognitive subscales of UK FIM+FAM, change in score in sub divisions of self-care and transfers showed the maximum change with p-value=0.001. Other sub divisions of locomotion, sphincter, communication, psychological and cognition also showed a significant difference of p-value <0.05. Conclusion: A physiatrist led intensive interdisciplinary inpatient rehabilitation program for patients with ABI may significantly reduce residual disability and improve functional independence. Such a program is not only effective in high income countries but also in Low Middle Income Countries (LMIC).

scholarly journals Outcome of COVID-19 in patients with chronic myeloid leukemia receiving tyrosine kinase inhibitors

2020 ◽  
Vol 26 (7) ◽  
pp. 1676-1682 ◽  
Author(s):  
Semih Başcı ◽  
Naim Ata ◽  
Fevzi Altuntaş ◽  
Tuğçe Nur Yiğenoğlu ◽  
Mehmet Sinan Dal ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Tyrosine Kinase ◽  
Myeloid Leukemia ◽  
Large Scale ◽  
Kinase Inhibitor ◽  
Statistical Significance ◽  
Case Fatality ◽  
Control Group ◽  
Icu Admission ◽  
Significant Difference

Introduction In this study, we aim to report the outcome of COVID-19 in chronic myeloid leukemia (CML) patients receiving tyrosine kinase inhibitor (TKI). Method The data of 16 laboratory-confirmed COVID-19 patients with CML receiving TKI and age, gender, and comorbid disease matched COVID-19 patients without cancer at a 3/1 ratio (n = 48), diagnosed between March 11, 2020 and May 22, 2020 and included in the Republic of Turkey, Ministry of Health database, were analyzed retrospectively. Results The rates of intensive care unit (ICU) admission, and mechanical ventilation (MV) support were lower in CML patients compared to the control group, however, these differences did not achieve statistical significance (p = 0.1, and p = 0.2, respectively). The length of hospital stay was shorter in CML patients compared with the control group; however, it was not statistically significant (p = 0.8). The case fatality rate (CFR) in COVID-19 patients with CML was 6.3%, and it was 12.8% in the control group. Although the CFR in CML patients with COVID-19 was lower compared to the control group, this difference did not achieve statistical significance (p = 0.5). When CML patients were divided into 3 groups according to the TKI, no significant difference was observed regarding the rate of ICU admission, MV support, CFR, the length of stay in both hospital and ICU (all p > 0.05). Conclusion This study highlights that large scale prospective and randomized studies should be conducted in order to investigate the role of TKIs in the treatment of COVID-19.

31 Measuring Initiation Impairments Post Brain Injury: Behavioural Initiation Rating Scale (BIRS)

2020 ◽  
Vol 91 (8) ◽  
pp. e20.3-e21
Author(s):  
Joseph Lam ◽  
Dennis Minioza ◽  
Himanshu Tyagi
Keyword(s):  
Brain Injury ◽  
Focus Groups ◽  
Nursing Staff ◽  
Rating Scale ◽  
Inpatient Rehabilitation ◽  
Feasibility Trial ◽  
Routine Practice ◽  
Cultural Shift ◽  
Promising Tool ◽  
High Prevalence

ObjectivesBehavioural Initiation is defined as the innate ability to trigger action. There is rich literature describing the high prevalence of motivational disorders and poor behavioural initiation during rehabilitation following acquired brain injury. This is not only due to their neurological conditions, but also that they might have spent many weeks in the wrong environment, with no stimulation other than receiving essential care. There is no established measure for behaviour initiation specific for a rehabilitation setting. This project aim to develop a tool that is sensitive to patients’ level of behavioural initiation, and support evidence-based decision making in formulating treatments in the Multi-Disciplinary Teams (MDT).MethodsWe proposed the 10-item nurse-rated Behavioural Initiation Rating Scale (BIRS). BIRS items were tailored to measure patient behaviour in day-to-day scenarios in inpatient rehabilitation. Included statements were shortlisted from a large pool of comments and observations from the MDT, and a review of literature on the topic. Following basic training with the nursing staff, we piloted a feasibility trial of BIRS for 4 weeks at an 18-bed Neurorehabilitation Unit. We arranged two focus-groups with MDT therapists and the nursing team, to reflect on the implementation of BIRS, and further refinement of scale items. Opinions from the focus-groups were used to revise the current version of BIRS.ResultsIt takes less than 2 minutes to administer and score BIRS. BIRS appears to be sensitive to improvement in behavioural initiation, and in agreement with clinical impressions from MDT and feedback from carers. BIRS has been well-implemented into routine practice, and has resulted a cultural shift in the unit. We identified some levels of between-rating variation in using BIRS, which was addressed by clarifying the instruction manual and giving specific examples for the ambiguous items.Secondary to our aim, the implementation of BIRS has improved the communication between nursing staff and therapists in delivering cohesive neurorehabilitation.ConclusionsBIRS appears to be a promising tool to evaluate patient behavioural initiation in a rehabilitation setting. A multi-centre trial of BIRS is currently being planned to establish its psychometric properties.

Prevention of Fungal Peritonitis with Nystatin Prophylaxis in Patients Receiving CAPD

2007 ◽  
Vol 27 (5) ◽  
pp. 531-536 ◽  
Author(s):  
Ping-Nam Wong ◽  
Kin-Yee Lo ◽  
Gensy M.W. Tong ◽  
Shuk-Fan Chan ◽  
Man-Wai Lo ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Large Scale ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Control Group ◽  
Fungal Peritonitis ◽  
Kaplan Meier ◽  
Prospective Randomized Controlled Trial ◽  
And Control

Objective Fungal peritonitis (FP) is a serious complication of continuous ambulatory peritoneal dialysis (CAPD), being associated with significant morbidity and mortality. The role of nystatin prophylaxis during antibiotic therapy in the prevention of FP remains controversial, especially in programs with a modest or low baseline FP rate. The aim of the present study was to evaluate the effect of nystatin prophylaxis on the occurrence of FP in programs with a relatively modest baseline FP rate. Patients and Methods Incident and prevalent patients receiving CAPD between April 1995 and April 2005 at our center were included and divided into 2 groups. The control group included 320 patients (total follow-up 8875 patient-months) being treated without nystatin before October 1999; the nystatin group included 481 patients (total follow-up 13725 patient-months) being treated after October 1999. Nystatin tablets (500000 units, 4 times per day) were given orally during whatever use of antibiotics to cover the whole course of antibiotic therapy. Occurrence of FP and antibiotic-related FP (AR-FP) in patients with and without nystatin prophylaxis was compared. Results The two groups were of similar age but the nystatin group had a significantly higher percentage of diabetics. In addition, the nystatin group had a higher proportion of patients using disconnecting twin-bag exchange systems and had a significantly lower peritonitis rate compared with the control. There were 13 and 14 episodes of FP in the nystatin and control groups respectively. The fungal peritonitis rate of the nystatin group was slightly lower than that of the control group (0.011 vs 0.019 per patient-year) but it did not reach statistical significance. There was, however, a significant decrease in the incidence and proportion of AR-FP in the nystatin group compared with the control group, which persisted even after adjustment for the peritonitis rate. Kaplan–Meier analysis further demonstrated significantly better AR-FP-free survival in the nystatin group compared with the control group. No significant side effects were observed for nystatin. Subgroup analyses in patients of the 2 different connecting systems revealed a similar but nonsignificant trend toward reduction of AR-FP in patients given nystatin prophylaxis. Conclusion Oral nystatin prophylaxis might prevent the occurrence of AR-FP in CAPD patients, resulting in a trend toward reduction in the incidence of FP even in programs with a modest baseline FP rate. A large scale, prospective, randomized controlled trial is needed to further examine this issue.

scholarly journals Portable neuromodulation induces neuroplasticity to re-activate motor function recovery from brain injury: A high-density MEG case study

2020 ◽  
Author(s):  
Ryan C.N. D'Arcy ◽  
Trevor Greene ◽  
Debbie Greene ◽  
Zack Frehlick ◽  
Shaun D. Fickling ◽  
...  
Keyword(s):  
Brain Injury ◽  
Motor Function ◽  
Large Scale ◽  
Rehabilitation Program ◽  
High Density ◽  
Cortical Activation ◽  
Valuable Insight ◽  
Large Scale Network ◽  
Scale Network

Abstract Background: In a recent high-profile case study, we used functional magnetic resonance imaging (fMRI) to monitor improvements in motor function related to neuroplasticity following rehabilitation for severe traumatic brain injury (TBI). The findings demonstrated that motor function improvements can occur years beyond current established limits. The current study extends the functional imaging investigation to characterize neuromodulation effects on neuroplasticity to further push the limits.Methods: Canadian Soldier Captain (retired) Trevor Greene (TG) survived a severe open-TBI when attacked with an axe during a 2006 combat tour in Afghanistan. TG has since continued intensive daily rehabilitation to recover motor function, experiencing an extended plateau using conventional physical therapy. To overcome this plateau, we paired translingual neurostimulation (TLNS) with the continuing rehabilitation program.Results: Combining TLNS with rehabilitation resulted in demonstrable clinical improvements along with corresponding changes in movement evoked electro-encephalography (EEG) activity. High-density magneto-encephalography (MEG) characterized cortical activation changes in corresponding beta frequency range (27Hz). MEG activation changes corresponded with reduced interhemispheric inhibition in the post-central gyri regions together with increased right superior/middle frontal activation suggesting large scale network level changes.Conclusions: The findings provide valuable insight into the potential importance of non-invasive neuromodulation to enhance neuroplasticity mechanisms for recovery beyond the perceived limits of rehabilitation.

scholarly journals Feasibility of Cognitive-Motor Exergames in Geriatric Inpatient Rehabilitation: A Pilot Randomized Controlled Study

2021 ◽  
Vol 13 ◽  
Author(s):  
Patrizia Altorfer ◽  
Manuela Adcock ◽  
Eling D. de Bruin ◽  
Florian Graf ◽  
Eleftheria Giannouli
Keyword(s):  
Walking Speed ◽  
Intervention Group ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Program ◽  
Adherence Rate ◽  
Control Group ◽  
System Usability Scale ◽  
Time Test ◽  
The Mean ◽  
Reaction Time Test

Objective: The aim of this pilot randomized clinical trial was to test the feasibility and efficacy of an exergame-based cognitive-motor training program in geriatric inpatients.Methods: The study participants were randomly allocated to either the exergame intervention group or the control group. The control group received the standard rehabilitation treatment offered in the clinic. In addition to the standard rehabilitation program, the intervention group conducted supervised exergame training on 5 days per week using the Dividat Senso, an exergame system specifically designed for older adults. The primary outcome was feasibility, as measured by e.g., adherence rate, attrition rate, occurrence of adverse events, System Usability Scale (SUS) and NASA-TLX score. Secondary outcomes included measures of physical and cognitive functioning such as comfortable walking speed, maximal walking speed, dual task walking speed, Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), Color-Word Interference test (D-KEFS), Trail Making test A and B (TMT), Go/No-Go test and Step Reaction Time test (SRTT). All secondary outcome measures were assessed pre- and post-intervention.Results: Thirty-nine persons were included in the study. Average adherence rate was 99%, there were no intervention-related dropouts and no adverse events. The mean System Usability Scale (SUS) score was 83.6 and the mean NASA-TLX score 45.5. Significant time-group interaction effects were found for the dual task walking speed, the Go/No-Go test and Step Reaction Time test (SRTT).Conclusion: Exergaming is a feasible, safe and effective cognitive-motor training approach in inpatient rehabilitation of geriatric patients. Incorporating exergaming in the rehabilitation program of geriatric patients offers potential to reduce fall risk factors and to increase patients’ exercise motivation and rehabilitation success.

Sign in / Sign up

Export Citation Format

Share Document