Investigating the Benefits of Using 3D Camera Technology to Improve Wound Measurements in a Tissue Viability Service: Outcomes of a Pilot Implementation Study

Sub-optimal experience and outcomes for people with stalled wounds is common. Clinicians have limited methods for reliably and accurately measure wounds. Depth measurement is an important indicator of healing, and digital methods of imaging the wound may offer increased accuracy and enable clinical decision-making. This study aimed to implement a Panasonic FZ-M1 toughpad with WoundCareLite software version 1.5.0.0, to enable three-dimensional measurements in Tissue Viability (TV) service. Length, width, and depth measurement were compared with usual manual measurement using a paper ruler alongside a 2D photographic image. Statistical analysis included the comparison of wound dimension measures and a presentation of visual healing trajectories over 4 weeks using run-charts. 30 patients were recruited over five weeks (13 female and 17 male), representing 4% of the usual caseload. Manual measurement and 3D software automatic method demonstrated that the width and depth 3D auto measures were more accurate than manual measures but depth measures were often wrong thus making volumetric measures inaccurate. Consistent wound size measurement was feasible, and healing trajectories provide a useful means of continuous assessment. Technology guided measurement has potential benefits over manual measurement as a means of more accurately monitoring healing. In this case, depth measurement could not be accurately assessed in practice and further software innovation is indicated to enable outcome measurement in tissue viability services.

Reliability of a Cycle Sprint Test to Measure Lower Limb Muscle Power

This study examined the reliability of a cycle sprint test for measuring lower limb muscle power. Twenty asymptomatic volunteers completed the test on two occasions, with one week between test sessions. Participants sat on a stationary road bicycle with commercial power meters in the pedal cranks. Maximum and average muscle power was measured during three, 10-second sprint efforts. The test demonstrated excellent within- and between-day reliability for both maximum and average power measurement (ICC=0.93 to 0.97). The within-day Standard Error of Measurement (SEM) was between 25.9W (6.1%) and 35.1W (8.5%), and 24.8 (6.5%) and 28.6W (7.7%) for maximum and average power respectively. The between-day SEM was 34.3W (7.8%) for maximum power and 26.4W (7.1%) for average power. Reliability of the cycle sprint test has been established, along with thresholds for significant change. The cycle sprint test may have relevance in clinical populations to evaluate lower limb muscle power following injury, or to measure rehabilitation outcomes.

A Student Society Bridges the Gap between Interest and Involvement in the NICU by Creating a Cuddler Guide and Program

A group of occupational therapy students, who serve as executive board members of the National Perinatal Association Student Society (NPASS) chapter at The State University of New York (SUNY) Downstate Health Sciences University created a Cuddler Guide and Program. They worked with National Perinatal Association (NPA) Board Members Jessica Restivo, MS, OTR/L and Brigitte Desport DPS, OTR/L, BCP, ATP on these projects to contribute to the welfare and development of babies in the Neonatal Intensive Care Unit (NICU). To understand how this NPASS chapter embarked on such an initiative, below outlines the student organization’s connection to its parent organization (National Perinatal Association), its development and experiences, and finally the creation of the Cuddler Guide and Program.

Long-Term Quality of Life after Decompressive Craniectomy in Severe Traumatic Brain Injury and Stroke

Purpose: Decompressive Craniectomy (DC) can rapidly reduce intracranial pressure and save lives in the acute phase of severe Traumatic Brain Injury (TBI) or stroke, but little is known about the long-term outcome after DC. We evaluated Quality of Life (QoL) a few years after DC for severe TBI/stroke. Methods: The following data were collected for stroke/TBI patients hospitalized for neurorehabilitation after DC: 1) at discharge, motor and cognitive sub-scores of the Functional Independence Measure (motor-FIM (score 13-91) and cognitive-FIM (score 5-35)) and 2) more than 4 years after discharge, the QOLIBRI health-related QoL (HR-QoL) score (0-100; <60 representing low or impaired QoL) and the return to work (RTW: 0%, partial, 100%). Results: We included 88 patients (66 males, median age 38 (interquartile range 26.3-51.0), 65 with TBI/23 stroke); 46 responded to the HR-QoL questionnaire. Responders and non-responders had similar characteristics (age, sex, functional levels upon discharge). Median motor-FIM and cognitive- FIM scores were 85/91 and 27/35, with no significant difference between TBI and stroke patients. Long-term QoL was borderline low for TBI patients and within normal values for stroke patients (score 58.0 (42.0-69.0) vs. 67.0 (54.0- 81.5), p=0.052). RTW was comparable between the groups (62% full time). Conclusion: We already knew that DC can save the lives of TBI or stroke patients in the acute phase and this study suggests that their long-term quality of life is generally quite acceptable.

Distractibility When Suffering from Mental Fatigue after a Mild Traumatic Brain Injury

Most Traumatic Brain Injuries are mild (mTBI) yet many people suffer from long-term mental fatigue and cognitive impairment. Despite comments from patients, cognitive difficulties can go undetected. Distractibility is commonly reported but is seldom included in standard neuropsychological assessment. This study was designed to investigate the effect distraction may induce in topdown and bottom-up attention among people who suffer from mental fatigue after mTBI. Thirty mTBI patients suffering from mental fatigue and 30 healthy controls performed a computerized test, including Simple Reaction Time, Choice Reaction Time and Attentional Capture tasks with a salient distractor. A slower processing speed was found in all subtests for the mTBI group and was particularly noticeable for the decision-making task. The distraction stimulus reduced processing speed for both groups, while the mTBI group made more omissions when a distractor emerged, indicating increased distractibility. However, no effect in top-down and bottom-up attention was found. Response time in the presence of a distractor was a predictor for mental fatigue, while depression and anxiety were not, showing the importance to carefully distinguish between emotional distress and mental fatigue. In conclusion, it is suggested that people suffering from mental fatigue after mTBI are slower at processing information, and this is more pronounced when a cognitive demand is added to the task. Distractibility was indicated with more omissions during distraction, but a distinction between top-down and bottom-up systems was not found. Further research is needed to better understand the link between distractibility and mental fatigue after a brain injury.

A Pilot Study to Assess the Immediate Effect of Dynamic Carbon Ground Reaction Ankle Foot Orthoses on Balance in Individuals with Charcot-Marie-Tooth in a Clinical Setting

Charcot-Marie-Tooth (CMT) causes muscle weakness and atrophy generally in distal extremities, with or without sensory changes. These impairments contribute to impaired balance and gait and increase risk for falls and secondary injuries. Dynamic Carbon Ground Reaction Ankle Foot Orthoses (DCGR-AFOs) are one type of lower extremity orthosis that can be prescribed to help improve gait and balance in this patient population. To our knowledge, no studies have evaluated the immediate impact of DCGR-AFOs on gait and balance in this population. In this pilot study, 9 individuals with CMT and gait impairment were seen in clinical setting by a physical therapist and orthotist. Participants were asked to complete the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) and tasks on the 4-Item Dynamic Gait Index (DGI) with and without bilateral DCGR-AFOs to assess static and dynamic balance. The average DGI scores were 6/12 without the DCGR-AFOs and 10/12 with the DCGR-AFOs. Improvements on the mCTSIB varied. The findings in this study suggest an immediate improvement in dynamic balance during ambulation with the use of DCGR-AFOs, as assessed by the 4-Item DGI. Data on static balance did not reach significance suggesting the need for future studies to further assess the effects of DCGR-AFOs on static standing balance, as well as the impact of training with physical therapists. This pilot study demonstrates that it is possible to demonstrate potential benefits of DCGR-AFOs with a gross fitting in a clinical setting, prior to referral to an orthotist for custom fitting.

Plantar Pressure Distribution during Standing in Female Patients with Hip Osteoarthritis Who Underwent Total Hip Arthroplasty

Introduction: Assessment of plantar pressure indicates the manner in which the plantar region contacts the ground as the first point in a leg-linked kinetic chain, and receives force from the ground. However, few studies have examined the changes in plantar pressure distribution in patients who underwent Total Hip Arthroplasty (THA) before and after THA, or compared plantar pressure distribution between THA patients and healthy adults. Objective: Plantar pressure distribution in patients with end-stage hip osteoarthritis who undergo THA may be adjusted to that in healthy adults by correcting leg length discrepancy. Herein, our objective was to find out if the plantar pressure distribution during standing differs before and after THA, and between healthy adults and THA patients. Design: Case control study. Setting: Single orthopedic clinic in Japan. Participants: THA patients (n=58; THA group) and healthy adults (n=53; control group). Interventions: Not applicable. Main outcome measure(s): The maximum plantar pressure under each foot measured during standing for 20 s was assessed for location, symmetry, and leg length discrepancy. Results: The distribution plantar pressure in the THA group differed preand postoperatively. The maximum plantar pressure region was the heel in approximately 80% of the patients three months after THA; it was not different in THA patients three months postoperatively and in healthy adults. Patients with asymmetrical maximum plantar pressure regions were those whose postoperative maximum plantar pressure region in the affected leg was the forefoot and those whose maximum plantar pressure region in the affected leg shifted to the heel. The leg length discrepancies decreased significantly after THA. Conclusions: The plantar pressure distribution during standing in female patients adjusted to that in healthy adults after THA. Patients with asymmetrical distribution of maximum plantar pressure may benefit from balance assessment and physical therapy.

Construct Validity and Validity to Change of the Patient-Specific Functional Scale in Patients with Shoulder and Low Back Pain: A Clinimetric Study

Background: Patient-specific and condition-specific measures are widely used in clinical practice and research to measure disability or change over time. While condition-specific outcome measures comprise a range of restrictions generally relevant for all patients, the Patient-Specific Functional Scale measures restrictions chosen by the individual patient. Objectives: Based on the hypothesis that patient-specific and conditionspecific scales deliver comparable results when used on group level. The aim of this study was to test for floor and ceiling effects, to evaluate construct validity and validity to change of the Patient-Specific Functional Scale when compared to condition-specific outcome measures. For this purpose, two datasets from patients with shoulder pain and low back pain were analyzed. Methods: Patient-Specific Functional Scale scores were compared to the Shoulder Pain and Disability Index and the Roland Morris Disability Questionnaire at 4 time-points using stem-and-leaf-plots and correlations using Pearson’s r. Hypothesis-driven correlation levels for data interpretation were predefined, with r ≥0.75=high, r ≥0.5=moderate, r ≥0.25=low. Results: Patient-Specific Functional Scale floor effects were comparable to condition-specific outcome measures in both samples. At none of the timepoints did the Patient-Specific Functional Scale correlate with the conditionspecific outcome measures in the expected manner. Conclusion: Hypotheses regarding expected ranges of correlation between the Patient-Specific Functional Scale and the condition-specific outcome measures for construct validity and validity to change were not met. While the use of the Patient-Specific Functional Scale in a clinical context has its advantages, the measure is not recommended for group-level evaluations.

Simple Asana: Yoga and the Elderly

Yoga is becoming very popular among young people, however it is also exceptionally beneficial for the elderly to improve mobility, strength and combat chronic ailments. It is an alternative form of medicine and can be ancillary tool for treating pain, cardiovascular issues, weight problems, depression, sleep disorders and many more. The practice goal of yoga is to challenge oneself but not be overwhelmed, develop inner awareness without judgement. In contrast to many other programs it does not involve strenuous workouts or expensive equipment and is not competitive. The simple form involves series of static positions that use isometric contraction and relaxation of different muscle groups to create specific body alignments with coordinated breathing and deep meditative relaxation. The best yoga practice for elderly or a person with limitations are that uses supporting props as blankets, pillows or chairs during asana to overcome the limitations that are coordinated with breathing exercise and meditation.

A Conceptual Framework of Forest Therapy as an Innovative Health Approach Combined with Local Health Resort Medicine in Alpine Regions to Increase Mental Health and Well-Being

Introduction: There has been a constant increase in mental health disorders in Western industrialized nations, and the current Covid 19 pandemic is increasingly exacerbating the problem. The health resorts in Germany are well equipped to improve mental, emotional and physical health with their local remedies and procedures to improve the individual health status. Method: The available alpine health resort procedures/interventions as well as the novel forest therapy with their various effects are described in order to develop a novel health resort concept for the treatment of mental-health disorders and well-being. Result: Based on the principles of health resort medicine and the available alpine interventions, a three-week treatment concept has been developed. Different procedures such as climatotherapy, balneotherapy, forest therapy & nature connection, mindfulness practice and physiotherapy have been combined in a healthy manner. Alpine health resorts are particularly well suited because of their excellent health-promoting climate factors. Conclusion: The novel combination of HRM with forest therapy will to lead to stress reduction and an increase in mental health and general well-being. This new approach shows promising benefits for future health resort treatments. Studies on this new approach are needed to confirm the effectiveness of the conceptual framework.