Effect of Home-based Pulmonary Rehabilitation on Fatigue, Dyspnea, and Activities of Daily Living of COVID-19 Patients

Background: The acute nature and complications of COVID-19, including fatigue and dyspnea, reduce the ability of the affected individuals to play individual and social roles and perform activities of daily living, and have adverse effects on the life quality and economic status of patients. Conducting pre-discharge rehabilitation programs following a home-based approach can be effective in reducing fatigue and dyspnea and improving the activities of daily living of COVID-19 patients. Objectives: This study aimed to investigate the effect of home-based pulmonary rehabilitation on fatigue, dyspnea, and activities of daily living of COVID-19 patients in the teaching hospitals of Zahedan University of Medical Sciences in 2020. Methods: The quasi-experimental study enrolled 60 patients with COVID-19 respiratory symptoms admitted to the COVID-19 intensive care units of teaching hospitals affiliated with Zahedan University of Medical Sciences in 2020. The patients who met the inclusion criteria were selected using convenience sampling and randomly divided into intervention and control groups with color cards. The instruments used to collect the data were the Fatigue Severity Scale (FSS), the Borg Dyspnea Scale, and the Barthel Index completed by the participants before, two weeks, and two months after the intervention. The rehabilitation training was provided to the patient and the primary caregiver in the intervention group in three 45-min sessions individually and using training videos during the hospital stay. After discharge, the patients were followed up in person or by phone for eight weeks to ensure the effectiveness of the rehabilitation program. The collected data were analyzed using SPSS-22 software through repeated measures analysis of variance (ANOVA), independent samples t-test, and chi-square test at a significance level of 0.05 (P < 0.05). Results: The repeated measures ANOVA showed that changes in the fatigue and dyspnea scores were significant over time (P < 0.001). Furthermore, the intervention effect was significant (P = 0.04), and more remarkable changes were observed in the intervention group than in the control group. Given the significance of the group-time interactive effect on the two given variables, the comparisons were made point by point and with Bonferroni correction again by time and group. There were significant differences in the mean fatigue scores in the second (P = 0.03) and third (P < 0.001) stages and the mean dyspnea scores (P < 0.001) between the two groups. The mean scores of activities of daily living two weeks and two months after the intervention were significantly different between the two groups, with higher scores in the intervention group than in the control group (P = 0.01). The repeated measures ANOVA confirmed a statistically significant difference between the two groups in terms of the effect of time (P < 0.001) and group (P = 0.03) on the patients’ activities of daily living. Conclusions: The study showed that home-based pulmonary rehabilitation measures were effective on fatigue, dyspnea, and activities of daily living of COVID-19 patients. Thus, this intervention approach by nurses for family participation can be practical for treating acute and chronic respiratory diseases.

Factors Influencing the Improvement of Activities of Daily Living during Inpatient Rehabilitation in Newly Diagnosed Patients with Glioblastoma Multiforme

Glioblastoma multiforme (GBM) is the most common and aggressive brain tumor. To identify the factors influencing the improvement of the activities of daily living (ADL) in newly diagnosed patients with GBM, we investigated the characteristics and variable factors and overall survival. A total of 105 patients with GBM were retrospectively analyzed and categorized into the following three groups according to the quartile of change of their Barthel index score from admission to discharge: deterioration (n = 25), no remarkable change (n = 55), and good recovery (n = 25). A statistical difference was observed in the pre-operative, intra-operative, post-operative, and rehabilitation-related factors between the deterioration and good recovery groups. Multiple regression analysis identified the following significant factors that may influence the improvement of ADL after surgery: the improvement of motor paralysis after surgery, mild fatigue during radio and chemotherapy, and length up to early walking training onset. The median overall survival was significantly different between the deterioration (10.6 months) and good recovery groups (18.9 months, p = 0.025). Our findings identified several factors that may be associated with post-operative functional improvement in patients with GBM. The inpatient rehabilitation during radio and chemotherapy may be encouraged without severe adverse events and can promote functional outcomes, which may contribute to the overall survival of newly diagnosed patients with GBM.

Apathy, Executive Function, and Emotion Recognition Are the Main Drivers of Functional Impairment in Behavioral Variant of Frontotemporal Dementia

Background: The cognitive and neuropsychiatric deficits present in patients with behavioral variant frontotemporal dementia (bvFTD) are associated with loss of functionality in the activities of daily living (ADLs). The main purpose of this study was to examine and explore the association between the cognitive and neuropsychiatric features that might prompt functional impairment of basic, instrumental, and advanced ADL domains in patients with bvFTD.Methods: A retrospective cross-sectional study was conducted with 27 patients with bvFTD in its early stage (&lt;2 years of evolution) and 32 healthy control subjects. A neuropsychological assessment was carried out wherein measures of cognitive function and neuropsychiatric symptoms were obtained. The informant-report Technology–Activities of Daily Living Questionnaire was used to assess the percentage of functional impairment in the different ADL domains. To identify the best determinants, three separate multiple regression analyses were performed, considering each functional impairment as the dependent variable and executive function, emotion recognition, disinhibition, and apathy as independent variables.Results: For the basic ADLs, a model that explains 28.2% of the variability was found, in which the presence of apathy (β = 0.33, p = 0.02) and disinhibition (β = 0.29, p = 0.04) were significant factors. Concerning instrumental ADLs, the model produced accounted for 63.7% of the functional variability, with the presence of apathy (β = 0.71, p &lt; 0.001), deficits in executive function (β = −0.36, p = 0.002), and lack of emotion recognition (β = 0.28, p = 0.017) as the main contributors. Finally, in terms of advanced ADLs, the model found explained 52.6% of the variance, wherein only the presence of apathy acted as a significant factor (β = 0.59, p &lt; 0.001).Conclusions: The results of this study show the prominent and transverse effect of apathy in the loss of functionality throughout all the ADL domains. Apart from that, this is the first study that shows that the factors associated with loss of functionality differ according to the functional domain in patients with bvFTD in its early stage. Finally, no other study has analyzed the impact of the lack of emotion recognition in the functionality of ADLs. These results could guide the planning of tailored interventions that might enhance everyday activities and the improvement of quality of life.

Can Social Resources Explain the Limitations in the Activities of Daily Living of Older Adults Classified by the Phenotype of Physical Frailty?

The objective is to investigate the mediating roles of living alone and personal network in the relationship between physical frailty and activities of daily living (ADL) limitations among older adults. 2271 individuals were classified as vulnerable (pre-frail or frail) or robust. Mediating variables were living alone and personal network. Katz Index and Lawton-Brody scale were used to assess ADL. Mediating effects were analyzed with beta coefficients from linear regression models using the bootstrapping method. Mediation analysis showed significant mediating effects of living alone (β = .011; 95% CI = .004; .018) and personal network (β = .005; 95% CI = .001; .010) on the relationship between physical frailty and basic ADL limitations. Mediation effects of living alone and personal network on the relationship between physical frailty and instrumental ADL limitations were β = −.074 (95% CI=−.101; −.046) and β = −.044 (95% CI = −.076; −.020), respectively. Physically vulnerable older adults who lived alone or had poor personal network were more dependent on basic and instrumental ADL.

Effectiveness of a Novel Contralaterally Controlled Neuromuscular Electrical Stimulation for Restoring Lower Limb Motor Performance and Activities of Daily Living in Stroke Survivors: A Randomized Controlled Trial

Background. Contralaterally controlled neuromuscular electrical stimulation (CCNMES) is a novel electrical stimulation treatment for stroke; however, reports on the efficacy of CCNMES on lower extremity function after stroke are scarce. Objective. To compare the effects of CCNMES versus NMES on lower extremity function and activities of daily living (ADL) in subacute stroke patients. Methods. Forty-four patients with a history of subacute stroke were randomly assigned to a CCNMES group and a NMES group ( n = 22 per group). Twenty-one patients in each group completed the study per protocol, with one subject lost in follow-up in each group. The CCNMES group received CCNMES to the tibialis anterior (TA) and the peroneus longus and brevis muscles to induce ankle dorsiflexion motion, whereas the NMES group received NMES. The stimulus current was a biphasic waveform with a pulse duration of 200 μs and a frequency of 60 Hz. Patients in both groups underwent five 15 min sessions of electrical stimulation per week for three weeks. Indicators of motor function and ADL were measured pre- and posttreatment, including the Fugl–Meyer assessment of the lower extremity (FMA-LE) and modified Barthel index (MBI). Surface electromyography (sEMG) assessments included average electromyography (aEMG), integrated electromyography (iEMG), and root mean square (RMS) of the paretic TA muscle. Results. Values for the FMA-LE, MBI, aEMG, iEMG, and RMS of the affected TA muscle were significantly increased in both groups after treatment ( p < 0.01 ). Patients in the CCNMES group showed significant improvements in all the measurements compared with the NMES group after treatment. Within-group differences in all post- and pretreatment indicators were significantly greater in the CCNMES group than in the NMES group ( p < 0.05 ). Conclusion. CCNMES improved motor function and ADL ability to a greater extent than the conventional NMES in subacute stroke patients.

Effect of Respiratory Training Combined with Core Muscle Training on the Overall Motor Function and Activities of Daily Living of Patients with Early and Midterm Stroke

Stroke is a cerebral ischemic or hemorrhagic disease with sudden onset and rapid progress. To analyze the effect of respiratory training combined with core muscle training on the overall motor function and activities of daily living of patients with early and midterm stroke, 90 cases with early and midterm stroke admitted to the neurological department of our hospital from April 2018 to April 2019 were chosen as the research objects. According to the odd or even hospitalization numbers, they were equally divided into the study group and the reference group. Both groups received basic drug treatment. On this basis, the reference group was given routine rehabilitation training, while the study group was given respiratory training combined with core muscle training. The clinical indexes of both groups before and after intervention were evaluated to analyze the effect of different training methods on the rehabilitation of patients with early and midterm stroke. There was no significant difference in gender ratio, average age, average BMI, average course of disease, stroke types, MAS grading, location of limb dysfunction, and combined disease between the two groups ( P < 0.05 ). The total clinical effective rate of the study group after intervention was obviously higher than that of the reference group ( P < 0.05 ). The MoCA scores of both groups after intervention were obviously higher than those before intervention, and the score of the study group after intervention was obviously higher than that of the reference group. The scores of limb motor function, activities of daily living, and balance function at T2, T3, and T4 in the study group were obviously higher than those in the reference group ( P < 0.001 ). At 4 and 8 weeks after intervention, the 10 m MWS of the study group was obviously higher than that of the reference group ( P < 0.001 ), while the TUGT was obviously lower ( P < 0.001 ). Respiratory training combined with core muscle training can obviously improve the activities of daily living, cognitive function, and limb motor function of patients with early and midterm stroke, which is worth popularizing and using.

EMG-Triggered Pedaling Training on Muscle Activation, Gait, and Motor Function for Stroke Patients

This study aimed to determine the effects of electromyography (EMG)-triggered pedaling training to improve motor functions in the lower extremities, muscle activation, gait, postural balance, and activities of daily living in stroke patients. Subjects were randomly allocated to two groups: the EMG-triggered pedaling training group (EMG-PTG, n = 21) and the traditional pedaling training group (TPTG, n = 20). Both groups trained five times per week for four weeks, with 50 min per session. Lower extremity motor function was assessed using the Fugl–Meyer Assessment (FMA). Muscle activation of the four muscles of the lower extremities was assessed using eight-channel electromyography, while gait ability was assessed using GaitRite. Postural balance was assessed using the Berg balance scale (BBS), the timed up and go (TUG), and functional reach tests (FRT). Daily activities were assessed using the Modified Barthel Index (MBI). For lower extremity motor function, gait ability, balance ability, and activities of daily living, the EMG-PTG showed significant improvement compared to TPTG (p < 0.05). These results suggest that EMG-triggered pedaling training effectively improves lower extremity motor function, muscle activation, gait, postural balance, and activities of daily living in stroke patients.

Gamified Virtual Environment and Interaction Design for Activities of Daily Living Training

Ludic games and gamification processes can extend functional skills in players as they integrate different intelligences and stimulate the cognitive, perceptual, and motor activities. Play can facilitate the work of occupational therapist since provides better cooperation of the patient, besides helping in its development, increasing its behavioral repertoire, mainly in the accomplishment of activities of daily living. This chapter addresses these issues, discussing the design of a gamified virtual environment that helps occupational therapists to develop the potential of children and adolescents with mild, moderate, and severe neuropsychomotor disorder. For that, the authors present an investigation of the use of a gamified virtual environment and interaction devices in the training of activities of daily living. As result, they note that games as assistive technology can encourage the integration of education, rehabilitation, and habilitation of people in situations of vulnerability and social risk, providing access and inclusion through playful and challenging activities.