Gamification in Stroke Rehabilitation

Stroke rehabilitation aims to improve patients' abilities to realize daily life activities and, consequently, regain their self-confidence and improve independence and quality of life. Gamification can be defined as the application of game-design elements, dynamics, and principles such as competition, narratives, point-scoring, and awards in non-game contexts, including rehabilitation. It has emerged as a therapeutic alternative or complement to traditional rehabilitation to make motor practice more intense and increase a person's motivation, interest, and satisfaction by bringing meaningful and intrinsically motivational playful experiences. Compared to the same amount of conventional therapy, gamification can increase the number of movements and involve safe and intensive rehabilitation exercises, essential for a successful rehabilitation process.

Mauri Tu, Mauri Ora: A Process Evaluation

<p>Rates of violent reoffending amongst young offenders has been a cause of concern for those involved in the youth justice (YJ) system in New Zealand (NZ), and across the world. Although, the rates of youth offending in NZ appear to be declining, there is a trend of increasing violent youth offending (Ministry of Justice; MOJ, 2010, 2012). Therefore, the search for effective and generalisable treatment programmes for violent young offenders has been a focus for those involved in juvenile offending research (Caldwell & Van Rybroek, 2013). The Mauri Tu Mauri Ora programme (MTMO; Kilgour & Borg, 2016), was developed in 2014 to provide an “intensive rehabilitation option for youth between 16 and 20 years of age who are deemed to be at a high risk of re-offending” (p. 27). However, since its implementation, there has been no systematic evaluation of its effectiveness. This process evaluation investigated how the MTMO programme was operating so its strengths and areas of improvement could be better understood. This was achieved by detailing the characteristics of the programme; the extent to which it met the needs of key stakeholders; evaluating the specific components of the programme; the working relationship between staff; how well the programme was delivered; and identifying possible areas of improvement. The perspectives of participants resulting in 28 subthemes associated with: initial engagement and assessment; treatment delivery and engagement; the transition phase; unit environment; and staff services. Along with a discussion, these findings identify areas the MTMO programme can build on its strengths and areas it can make improvements.</p>

Mauri Tu, Mauri Ora: A Process Evaluation

<p>Rates of violent reoffending amongst young offenders has been a cause of concern for those involved in the youth justice (YJ) system in New Zealand (NZ), and across the world. Although, the rates of youth offending in NZ appear to be declining, there is a trend of increasing violent youth offending (Ministry of Justice; MOJ, 2010, 2012). Therefore, the search for effective and generalisable treatment programmes for violent young offenders has been a focus for those involved in juvenile offending research (Caldwell & Van Rybroek, 2013). The Mauri Tu Mauri Ora programme (MTMO; Kilgour & Borg, 2016), was developed in 2014 to provide an “intensive rehabilitation option for youth between 16 and 20 years of age who are deemed to be at a high risk of re-offending” (p. 27). However, since its implementation, there has been no systematic evaluation of its effectiveness. This process evaluation investigated how the MTMO programme was operating so its strengths and areas of improvement could be better understood. This was achieved by detailing the characteristics of the programme; the extent to which it met the needs of key stakeholders; evaluating the specific components of the programme; the working relationship between staff; how well the programme was delivered; and identifying possible areas of improvement. The perspectives of participants resulting in 28 subthemes associated with: initial engagement and assessment; treatment delivery and engagement; the transition phase; unit environment; and staff services. Along with a discussion, these findings identify areas the MTMO programme can build on its strengths and areas it can make improvements.</p>

Rehabilitation after Allogeneic Haematopoietic Stem Cell Transplantation: A Special Challenge

The general population is getting older and suffer more haematological malignancies despite being physically fit. These malignancies are mainly only curable via an alloHCT, and they are now carried out more frequently. Patients benefit from intensive rehabilitation earlier and may need it repeatedly in cases of severe side effects (e.g., graft-versus-host disease). They can suffer many problems that other cancer patients do not experience, such as severe infections, continued immunosuppression, nutritional restrictions, acute or chronic GvHD, or organ impairments (e.g., lung, eyes). They may also encounter various associated psychological problems, e.g., feeling like a chimera. Rehabilitation centres willing to care for patients after alloHCT should have an experienced multidisciplinary team and should work in close co-operation with the primary transplant centre.

NQPC-3 A short-time intensive rehabilitation for brain tumor patients with Karnofsky Performance Status of 60-30

OBJECTIVE: Brain tumor patients with KPS of 60 to 30 after the initial treatment are not able to spend independent life at home. The goal of this study is to return these patients to their home with minimal family support by delivering intensive rehabilitation to them. Seventy-five brain patients were evaluated every 10 days from the beginning to the end of rehabilitation treatment, according to clinical scales of Functional Independence Measure (FIM) of 1–7 points depending on the degree of independence. The rehabilitation effect was judged by the degree of improvement of 11 out of 13 motor FIM items, excluding stair climbing and bathing movements. When more than half number of the 11 motor FIM items requiring physical assistance (4 points or less) improved up to non-assistance (5 points or more), it was judged as a significant effect. In addition, when all 11 items present with 6 points (independence possible) or more and all 5 of FIM recognition items are 5 points or more (understand the domestic rules), it was judged that the patients acquired independent living ability. RESULTS: 1. Of the 75 patients, 54 (72%) showed a significant effect, and 38 of them (50.7% of the total) aquired independence at home. The acquisition-rate of independent living ability by tumor was 44.7% for 38 malignant gliomas, 53.8% for 13 metastatic tumors, 50% for 14 meningiomas, and 71.4% for 7 vascular tumors, and there was no significant difference between them. 2. The median time to reach the maximum rehabilitation effect was 35 days. CONCLUSION: Intensive rehabilitation for brain tumor patients with KPS of 60 to 30 is effective and should be incorporated into the palliative treatments in the brain tumor treatment guidelines.

Functional Recovery and Serum Angiogenin Changes According to Intensity of Rehabilitation Therapy After Stroke

Background: Rehabilitation is still the only treatment available to improve functional status after the acute phase of stroke. Most clinical guidelines highlight the need to design rehabilitation treatments considering starting time, intensity, and frequency, according to the tolerance of the patient. However, there are no homogeneous protocols and the biological effects are under investigation.Objective: To investigate the impact of rehabilitation intensity (hours) after stroke on functional improvement and serum angiogenin (ANG) in a 6-month follow-up study.Methods: A prospective, observational, longitudinal, and multicenter study with three cohorts: strokes in intensive rehabilitation therapy (IRT, minimum 15 h/week) vs. conventional therapy (NO-IRT, &lt;15 h/week), and controls subjects (without known neurological, malignant, or inflammatory diseases). A total of seven centers participated, with functional evaluations and blood sampling during follow-up. The final cohort includes 62 strokes and 43 controls with demographic, clinical, blood samples, and exhaustive functional monitoring.Results: The median (IQR) number of weekly hours of therapy was different: IRT 15 (15–16) vs. NO-IRT 7.5 (5–9), p &lt; 0.01, with progressive and significant improvements in both groups. However, IRT patients showed earlier improvements (within 1 month) on several scales (CAHAI, FMA, and FAC; p &lt; 0.001) and the earliest community ambulation achievements (0.89 m/s at 3 months). There was a significant difference in ANG temporal profile between the IRT and NO-IRT groups (p &lt; 0.01). Additionally, ANG was elevated at 1 month only in the IRT group (p &lt; 0.05) whereas it decreased in the NO-IRT group (p &lt; 0.05).Conclusions: Our results suggest an association of rehabilitation intensity with early functional improvements, and connect the rehabilitation process with blood biomarkers.

A Rare Case of Necrotizing Fasciitis as Side Effect of Methimazole Administration for Basedow Disease

A rare case of agranulocytosis due to Methimazole administration for Basedow disease is presented. After 30 days since the therapy beginning a 45 year old female patient has developed a necrotizing fasciitis on both legs, with muscle bellies and Achille’s tendon exposure. Immediate surgical debridement was necessary to save her life and control the progression of infection. Several plastic surgery procedures were performed to accomplish wounds healing (vacuum-assisted closure therapy, dermal substitute, free flap, skin graft), and after 75 days the patient was discharged. An intensive rehabilitation program permitted a complete functional recovery. After 12 months a reshaping procedure was performed to improve right leg and ankle contour. The close cooperation between endocrinologist and surgeon revealed to be essential to perform a safe surgery and to permit the return to the job and daily activities.

Intensive rehabilitation programme for patients with subacute stroke in an inpatient rehabilitation facility: describing a protocol of a prospective cohort study

IntroductionRehabilitation is recognised as a cornerstone of multidisciplinary stroke care. Intensity of therapy is related to functional recovery although there is high variability on the amount of time and techniques applied in therapy sessions. There is a need to better describe stroke rehabilitation protocols to develop a better understanding of current practice increasing the internal validity and generalisation of clinical trial results. The aim of this study is to describe an intensive rehabilitation programme for patients with stroke in an inpatient rehabilitation facility, measuring the amount and type of therapies (physical, occupational and speech therapy) provided and reporting functional outcomes.Methods and analysisThis will be a prospective observational cohort study of patients with subacute stroke admitted to our inpatient rehabilitation facility during 2 years. A therapy recording tool was developed in order to describe the rehabilitation interventions performed in our unit. This tool was designed using the Delphi method, literature search and collaboration with senior clinicians. Therapists will record the time spent on different activities available in our unit during specific therapy sessions. Afterwards, the total time spent in each activity, and the total rehabilitation time for all activities, will be averaged for all patients. Outcome variables were divided into three different domains: body structure and function outcomes, activity outcomes and participation outcomes and will be assessed at baseline (admission at the rehabilitation unit), at discharge from the rehabilitation unit and at 3 and 6 months after stroke.Ethics and disseminationThis study was approved by the Medical Research Committee at Hospital del Mar Research Institute (Project ID: 34/C/2017). The results of this study will be presented at national and international congress and submitted for publication in peer-reviewed journals.Trial registration numberNCT04191109.