Special Issue:
Challenges and Opportunities in Rehabilitation
Abstract
Cognitive rehabilitation is a critical component of intervention for many individuals with both short- and long-term impairments associated with traumatic brain injury (TBI). By focusing on major cognitive domains, emotional processing, and behavioral strategies, clinicians use cognitive rehabilitation to improve cognitive related functional outcomes, quality of life, and social relationships. Cognitive rehabilitation is traditionally divided into restorative and compensatory approaches, though increasingly combined approaches within the larger medical, multidisciplinary team are being incorporated and explored. Literature related to cognitive rehabilitation within the TBI population continues to be needed in order to assist clinicians in developing evidence-based intervention protocols and therapy plans. This paper details current approaches to cognitive rehabilitation and provides an updated review of the literature associated with the efficacy of cognitive rehabilitation. Reviewed evidence supports the use of cognitive rehabilitation to improve multiple cognitive domains, including attention, memory, executive function, and metacognitive skills. The long-term outcomes of continued cognitive rehabilitation services post-TBI are not as comprehensively documented as the relative short-term outcomes. The efficacy of cognitive rehabilitation is impacted by patient-specific variables, timing and intensity of treatment. This paper concludes with noted information related to the limitations of the current evidence of cognitive rehabilitation, including study design concerns, and reduced generalizability of the relevant research.
Sheer Shabat
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Anat Marmor
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Jeanna Tsenter
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Isabella Schwartz
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Zeev Meiner
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Shimon Shiri
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Abstract
Background and aims: Emotional distress is widespread among individuals recovering from COVID-19. The present study examined the relationships between illness severity and emotional distress and the outcomes of a general and cognitive rehabilitation program.
Methods: Participants were 61 post-acute COVID-19 patients who participated in a multidisciplinary rehabilitation program. Data were collected at admission and discharge, 6 months later. Medical evaluations and self-reported emotional, neuropsychological and functional measures were used.
Results: Mild illness was associated with higher levels of self-reported anxiety and depression and with lower self-reported executive functioning. Elevated anxiety levels and lower cognitive profile at admission were significantly linked to poorer cognitive outcomes, but not to motor or general functioning level at discharge.
Conclusions: The results of the study indicate the significance of monitoring emotional characteristics, particularly anxiety, in post-COVID-19 individuals during multidisciplinary rehabilitation.
Moon Fai Chan
Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University
Senthilkumar Ravindran
Department of Physiotherapy & Rehabilitation, Sultan Qaboos University Hospital, Oman
Hammad Al-Subhi
Department of Physiotherapy & Rehabilitation, Sultan Qaboos University Hospital, Oman
Saif Al-Riyami
Department of Physiotherapy & Rehabilitation, Sultan Qaboos University Hospital, Oman
Abstract
Rehabilitation training for stroke patients is mostly based on face-to-face contact. This affects the routine training during the coronavirus disease outbreak in many hospitals worldwide, including Oman. Perhaps, this problem can be overcome using a virtual reality system. This protocol study aims to compare the outcome measures of the two groups of stroke patients (virtual reality intervention vs. conventional control) on these two modes of rehabilitation training. A randomized controlled trial with pre-/post-study of 42 stroke patients (21 control vs. 21 intervention) with upper limb motor impairments, aged 18-65 years old, newly admitted to the rehabilitation clinic in Oman, will be recruited. Basic demographic data and three major outcome assessments will be collected pre-/post-period. Baseline assessment (pre) on admission to the stroke rehabilitation program and after completion (post). Participants will be assessed by Barthel Index, Action Research Arm scale, and time spent per session with costs involved by the workforce in training. Repeated measures general linear model will examine the within, between, and interaction effects while adjusted by demographic data. All analyses will use IBM SPSS software, and a statistical significance level of p<0.05 will be employed. This research protocol aims to evaluate the feasibility and effectiveness of VR in improving motor control in stroke patients with upper limb weakness by comparing a low-cost VR platform with face-to-face training. If the proposed training protocol is helpful and easy to use, it could become a reliable tool to assist healthcare professionals for stroke patients during their rehabilitation training. This protocol will contribute to the theoretical discussion of integrating high-tech equipment with healthcare theory for stroke patients with learning disabilities. Also, adopting a virtual reality system could aid if a sudden pandemic outbreak. It could continue offering its services while maintaining a high standard of care for stroke sufferers.
Mellanie Geijen
Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands
Rob Smeets
Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands
Eugene Rameckers
Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands; Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands; Rehabilitation Science, Pediatric Physical Therapy, Hasselt
Andrew Gordon
Department of Biobehavioral Science, Teachers College, Columbia University, New York, NY, USA
Caroline Bastiaenen
Department of Epidemiology, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands
Abstract
Aim: Investigate aspects of construct validity of parameters “mean peak force” and “number of successful attempts” of the press button task using the Task-oriented Arm-hAnd Capacity (TAAC) in children with unilateral cerebral palsy (CP) by comparing them to outcomes of comparative measures using Consensus-based Standards for the selection of health Measurement INstruments guidelines.
Methods: 118 children with unilateral CP (mean age 1 year 2 months, standard deviation 3 year 5 months) were included. Fourteen a priori hypotheses were formulated for each parameter of the TAAC. Strength and direction of the relationship between the TAAC and comparative measures were investigated by calculating Pearson correlation coefficients.
Results: For the parameter “mean peak force” 8/14 (57%) hypotheses could be supported. For the parameter “number of successful attempts” 13/14 (93%) hypotheses could be supported.
Conclusion: The hypothesized construct of the parameter “mean peak force” is only partially in line with our idea about the potential relationship of the compared constructs. The relationship needs to be reconsidered to some extent. The hypothesized construct of the parameter “number of successful attempts” is in line with our idea about the potential relationship of the compared constructs and can be considered to have good validity compared to the other measures. Thus, the construct of this parameter adds new and meaningful information as an outcome measure for functional strength measurements.
Eleni A. Kortianou
Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Greece.
Aspasia S. Mavronasou
Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Greece; 1st Department of Critical Care and Pulmonary Medicine, Pulmonary Rehabilitation Unit, National and Kapodistrian University of Athens, Evangelismos General Hospital, Greece
Vaia Sapouna
Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Greece.
Abstract
Many COVID-19 survivors worldwide suffer from persistent symptoms, impaired functional capacity and quality of life. Rehabilitation exercise interventions for the long-term physical consequences of coronavirus disease 2019 (COVID-19) are currently being reported. As a result, the clinical practice and research focus on interventions that support recovery from ongoing symptomatology, independently to hospitalization. To date, the outpatient rehabilitation programs offer various exercise modes and training intensities for people recovering from long-term symptomatology of COVID-19.
This narrative review summarizes previous studies that used exercise training protocols at the outpatient rehabilitation setting, presents the effectiveness of training on the functional outcomes and provides practical issues of the application of exercise training which overcome possible respiratory and peripheral muscle limiting factors of exercise and functional capacity for patients with Long-COVID-19. To this end we make recommendations on how better to implement exercise training in future studies so as to maximize training effects.
Due to lack of randomized trials, more research is needed in the field of the exercise training modalities that are more effective and in parallel more tolerable for patients with persistent post-COVID-19 symptoms. In this context, interval training mode with short exercise periods can prevent high lactate accumulation and allow more intense exercise stimuli to the deconditioned peripheral muscles with minimal cardiac strain and exercise-induced hyperventilation, thus improving exercise capacity in this patients’ population.
Amy J. Armstrong
Department of Rehabilitation Counseling, College of Health Professions, Virginia Commonwealth University, VA, USA.
Carolyn E. Hawley
Department of Rehabilitation Counseling, College of Health Professions, Virginia Commonwealth University, VA, USA.
Ya Su
Department of Statistical Sciences and Operations Research, College of Humanities and Sciences, Virginia Commonwealth University
Anat Marmor
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hebrew, University of Jerusalem, Jerusalem, Israel.
Sigal Sviri
Internal Medicine Intensive Care Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
Isabella Schwartz
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hebrew, University of Jerusalem, Jerusalem, Israel.
Shimon Siri
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hebrew, University of Jerusalem, Jerusalem, Israel.
Zeev Meiner
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hebrew, University of Jerusalem, Jerusalem, Israel.
Abstract
While COVID-19 has had a detrimental impact on most of the world’s population, it has especially affected health care workers (HCWs) who are on the front lines fighting the virus. How HCWs cope with the pandemic have recently been explored. Differences across cultural and health care system settings related to fear of COVID 19 and measures of wellbeing may provide further insight to the coping mechanisms and experiences of HCWs during this worldwide pandemic. The overall subjective well-being and meaning in life scores are noticeably higher for the American participants whereas the fear of COVID and resilience scores are close in both studies, with slightly higher resilience and lower fear in the Israeli HCWs. Age, ethnicity and lower resilience were found to be significantly associated with higher fear of COVID-19 in both cohorts. In the Israeli participants, education level and life satisfaction were also associated with lower fear of COVID19 whereas in the American cohort, gender and relationship were also associated. These results suggest that albeit the cultural differences, similar mechanisms namely age and resilience, are important in coping with fear of the COVID-19 pandemic among both cohorts of HCWs. Therefore, it is important to enhance resilience in order to reduce the psychological burden of the pandemic among HCWs. This study was conducted prior to the availability of a vaccine.
Eugene Rameckers, Ph.D., pediatric PT
Adelante, Centre of Expertise, pediatric Rehabilitation, The Netherlands; Department of Rehabilitation, Maastricht University, The Netherlands; Rehabilitation Science and Physical Therapy, Hasselt University, Belgium
Coen de Haan, pediatric PT
Adelante, Centre of Expertise, pediatric Rehabilitation, The Netherlands
Ingrid Meeuwsen, paediatric PT
Adelante, Centre of Expertise, pediatric Rehabilitation, The Netherlands
Abstract
Objective: To compare the effectiveness of Task-Oriented Arm Strength training in children with Cerebral Palsy (TOAST-CP), using Progressive Resistance Exercise principles with manual skill learning in improving the performance of manual daily activities in children with spastic Cerebral Palsy.
Methods/Design: This multicenter randomized controlled trial investigates the effectiveness of TOAST-CP in children with spastic Cerebral Palsy, involving 50 participants aged 8-18 years. Participants are recruited from rehabilitation centers. Eligible participants are randomly allocated to either TOAST-CP or usual care related to manual skill learning.
Intervention: The participants of the intervention group performed a TOAST-CP program, based on individual goals and guided by a progressive resistance exercise algorithm. The control group receives the usual care related to the manual skill learning program. TOAST-CP consists of an individual-based 30-minute session, three times a week over 16 weeks. A specific exercise program is developed.
Outcome: Outcome is measured at baseline at eight weeks, 16 weeks (end of training), three, and six months after training.
As a primary outcome, the Assisting Hand Assessment is used. Secondary outcomes are task-oriented strength measures and muscle strength measures of the upper limb. The Observation and Scoring of Arm Hand Skills (performance and amount of use of both hands), the ABILHAND (-Kids), and the Jebsen Taylor Hand Function test (speed of hand use) are measured. The most important needs and goals for the child and his/her parents are scored by Canadian Occupational Performance Measure and Goal Attainment Scaling.
George W. Kukurin
KCANN
Corissa D. Audren
Abstract
The number of literature reports suggesting that various types of electrical, optokinetic, caloric, and mechanical vestibular stimulation may enhance recovery of function in patients suffering from traumatic and degenerative brain disorders is growing. This case report describes the integration of vestibular stimulation techniques into a rehabilitation treatment plan of a traumatically brain injured 16-year-old patient who had failed to sustain recovery after a course of standard care. His intractable signs and symptoms included headache, brain fog/mild cognitive impairment and disequilibrium which made participation in his chosen sport, hockey, virtually impossible. His symptoms developed following a concussion while playing hockey. He was treated by the team’s designated sports specialist and eventually cleared to return to play, however he was rapidly re-concussed. At the time he presented for evaluation, a battery of tests was conducted and clearly supported the reoccurrence of his symptoms. His baseline scores were Graded Symptom Checklist symptom severity 46, Standard Assessment of Concussion 25/30, BESS Balance Score 14, Trails Test A 15.0, Trails Test B 27.4, Processing Speed Task 63, Reaction time simple 255 and Reaction time choice 469. Standard methods of rehabilitation including Gaze Stabilization Exercises and Progressive Balance Exercises were augmented with vestibular stimulation through the use of skull vibrations and optokinetic stimulation. After 18 treatments over approximately six weeks of rehabilitation augmented with vestibular stimulation, findings associated with mTBI normalized and he was able to resume his full participation in sporting activities. His post treatment scores were. Graded Symptom Checklist symptom severity 1, Standard Assessment of Concussion 24/30, BESS Balance Score 5, Trails Test A 12.4, Trails Test B 34.0, Processing Speed Task 64, Reaction time simple 245 and Reaction time choice 385. He remained asymptomatic at 4 months follow-up post discharge and is participating fully in team hockey activities. This case report describes the integration of vestibular stimulation into neurorehabilitation protocols which appeared to be associated with sustained reduction in disability and improved treatment-refractory symptoms in a patient with traumatic brain injury. It adds to the growing knowledgebase supporting the role of vestibular stimulation as an adjunct modality in the rehabilitation of brain disorders.
Ellen Ricke, PhD
Longfonds, Amersfoort, The Netherlands
Abstract
Chronic obstructive pulmonary disease is one highly prevalent chronic disease that demands increasing care; it is already the third leading cause of death worldwide. There is accumulating evidence that in patients with chronic obstructive pulmonary disease pulmonary rehabilitation is effective in improving the prognostic risk factor profile and in delaying mortality. In order to benefit from pulmonary rehabilitation, exercise adherence plays a crucial role. The present review discusses the current evidence on exercise adherence in chronic obstructive pulmonary disease and provides practical tips for assessing and adopting strategies to improve adherence in the Dutch context.
Studies from the Netherlands identify varying rates of exercise adherence depending on the complexity of the disease, such as comorbidities, and its treatment. Multiple factors determine exercise adherence in chronic obstructive pulmonary disease. In the Netherlands, factors such as perceived behavioral control, self-efficacy, exercise history, motivation, education, physical health, comorbidities, depressive symptoms and fatigue determine exercise adherence.
The Dutch version of the Rehabilitation Adherence Measure for Athletic training and a prediction model, the Predicting Adherence in paTients with CHronic diseases tool, can be used to identify poor adherence. Improving exercise adherence requires a multifaceted approach with strategies targeting healthcare providers, patients and healthcare systems. In the Dutch context, raising awareness of the patient’s context, emphasizing the importance of the patient-therapist relationship, providing clearer information, and enhancing social support within the patient’s environment are essential for improving exercise adherence and chronic obstructive pulmonary disease control.
Jan Kersschot
Private Practice, Lindelei 38, Aartselaar, Belgium
King Hei Stanley Lam
The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong
Teinny Suryadi
Department of Physical Medicine and Rehabilitation, Hermina Podomoro Hospital. Jakarta, Indonesia
Lisa Nurhasanah
Physical Medicine and Rehabilitation, Diponegoro University, Indonesia
Tanti Atjoe Kesoema
Physical Medicine and Rehabilitation, Diponegoro University, Indonesia
Abstract
Failed back surgery syndrome is a chronic pain condition that persists despite or after surgical intervention. It presents a disabling condition that is difficult to manage. Over the last decade, regional sugar water injections have become popular for the treatment of musculoskeletal and neuropathic pain syndromes. This article describes the case of a patient with persistent pseudo-sciatica despite surgery who underwent multiple sessions of sugar water injections. This study aimed to share this experience with the global medical community. Further clinical investigations are required to confirm whether this novel approach can effectively treat patients with this condition.
Matteo Varini
Centro Puzzle, Turin, Italy, ; Department of Psychology, University of Turin, Turin, Italy
Marina Zettin
Centro Puzzle, Turin, Italy, Department of Psychology, University of Turin, Turin, Italy
Marta Gai
Centro Puzzle, Turin, Italy,
Danilo Dimitri
Centro Puzzle, Turin, Italy; Department of Psychology, University of Turin, Turin, Italy
Abstract
Background. One of the most used non-invasive brain stimulation (NIBS) techniques in aphasia rehabilitation is Anodal Transcranial Direct Current Stimulation (A-tDCS). Its application is supported by the fact that brain plasticity, when facilitated by language intervention, can be improved by non-invasive brain stimulation. The effects of neuromodulation combined with various language and communication therapies have led to promising results in the rehabilitation of patients presenting with acquired aphasia. An Action Observation Therapy such as IMITAF seems to contribute to improvements in language skills, mainly in naming. This experimental clinical protocol aims to investigate the rehabilitative potential of A-tDCS on perilesional areas, combined with computerized neuropsychological training.
Method. Participant: Mr. V., 66-year old right-handed male, Italian native speaker. The patient suffered an ischemic stroke due to left carotid artery dissection which resulted in right hemiparesis, mixed transcortical aphasia, characterized by non-fluent speech and dysarthric and disfluent speech. Treatment: The subject underwent unipolar montage stimulation, with anode placed in F5 and intra-cephalic reference on Fp2. For safety reasons, a stimulation intensity of 1.5 mA was applied for 20 minutes once a day in combination with IMITAF level I, which required the subject to repeat bisyllabic words.
Procedure: The stimulation protocol lasted a total of 4 weeks and was divided into 2 different modes. Clinical Training: 40-minute treatments (no.10 sessions) and involved the combined administration of a-tDCS (20-minute online mode) and 40-minute training. Home-Based Training: 40-minutes trainig carried out at the patient’s home, via PC (no. 8 sessions). Results. Mr. V. completed the protocol treatment sessions without reporting any adverse effects, such as scalp redness, tingling or headache. The results showed an improvement in the auditory/visual comprehension of words/sentences after A-tDCS and Action Observation Therapy, which has maintained one month after treatment.
Conclusions. Together with IMTAF neuropsychological training, the constant and repeated use of A-tDCS, on the perilesional areas, contributed to improvements in language skills thus promoting an overall recovery of communicative skills in an individual with chronic post-stroke non-fluent aphasia.
Vasiliki S. Raidou
School of Medicine, National and Kapodistrian University of Athens, Greece
Stilliani Andreadou
General Hospital of Chalkida, Greece
Anna Christakou
Biomechanics Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Peloponnese, Greece
Eleni A. Kortianou
Clinical Exercise Physiology and Rehabilitation Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Greece
Abstract
The coronavirus disease 2019 pandemic increased the need for alternative disease monitoring, medication management, and rehabilitation approaches. During this period, significant adjustments were made to integrate telemedicine into various aspects of healthcare.
This critical review describes the use and effectiveness of digital health approaches adopted for the care of people with chronic respiratory diseases during and beyond the COVID-19 pandemic. A thorough search was conducted in the PubMed database from January 2020 up to December 2022. A total of thirty studies were retrieved and reviewed for the utilization of telehealth services for education, monitoring, assessment, self-management, and rehabilitation in comparison to standard care or not.
During the lockdown patients with chronic obstructive pulmonary disease, asthma, cystic fibrosis, interstitial lung diseases, lung cancer, and neuromuscular disorders indicated positive perception towards remote healthcare delivery. They expressed high levels of satisfaction and achieved self-management in chronic obstructive pulmonary disease and asthma. Remote visits decreased exacerbations of asthma and reinforced smoke cessation in patients with chronic obstructive pulmonary disease. Teleassessment and monitoring increased the percentage of cystic fibrosis and Duchenne Muscular Dystrophy patients seen via telemedicine. Web platforms and mobile applications supported telehealth interventions to reduce stress, depression, and anxiety in patients with cystic fibrosis, assessed the quality of life and physical activity of patients with sarcoidosis, and pursued health education in adolescents with asthma. A few studies carried out telerehabilitation programs in patients with chronic obstructive pulmonary disease, cystic fibrosis, Duchenne Muscular Dystrophy, and sarcoidosis. Findings advocate the feasibility of online exercises, the improvement of exercise capacity, muscle strength, respiratory muscle strength, and the reduction of dyspnea and fatigue.
