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This study aimed to investigate the effects of exercises by mechanical hippotherapy devices on postural control, balance, mobility, and Quality of Life in patients with stroke. This was a randomized controlled clinical trial with a total of 30 which were randomly divided into two groups. The participants in the mechanical hippotherapy group (MHG) (n = 15) were given exercises with a mechanical hippotherapy device for 15 min in addition to intensive conventional treatments (45 min), while the control group (CG) (n = 15) received additional 15 min of postural control and balance exercises for five days per week for four consecutive weeks. The primary outcome was The Berg Balance Scale (BBS). Secondary outcomes were the Fugl–Meyer (FM) Rating Scale, Biodex Balance Measurement (BBM), Trunk Impairment Scale (TIS), the Timed Up and Go Test (TUG) and quality of Life Short Form (SF-36). In the MHG, FM-Lower extremity score (−6.4, p = 0.024), FM-Upper extremity score (−12.87, p = 0.013), TIS (−5.87, p = 0.04) and TUG (5.73, p = 0.027) improved statistically significant compared to CG. Exercises using mechanical hippotherapy devices could improve postural control, functional mobility and balance in patients with stroke. It may also improve the quality of life. NCT03528993 NCT03528993 It was concluded from our results that mechanical hippotherapy could be included in the treatment programs of stroke patients. [ABSTRACT FROM AUTHOR]

Orthotic devices may be prescribed for the management of foot and ankle deformities caused by Charcot-Marie-Tooth disease (CMT). However, the actual use of these devices is variable. No studies have evaluated the impact of prescription, delivery and follow-up of orthotic devices on their use. We aimed to describe the relationship between the pathways followed by individuals with CMT and orthotic device use. Exploratory, cross-sectional, 35-item survey of orthotic device management. Individuals with CMT were recruited from CMT-France Association. Of the 940 respondents, 795 were included, mean age of 52.9 (SD 16.9) years. Rate of orthotic device use was 49.2% (391/795). The most frequent reason for non-use was a poor fit. Non-use was related to the orthotic device type, the health professionals consulted, and the severity of the CMT-related impairments. Follow-up visits (38.7%), re-evaluation of orthotic devices (25.3%) and consultations with the Physical and Rehabilitation Medicine physician were infrequent (28.3%). Orthotic devices are massively underused. Follow-up and re-evaluation are infrequent. Care pathways, prescription and delivery of orthotic devices must be optimized to meet the expectations of people with CMT. Device fitting, individual needs, and changes in the clinical state must be re-evaluated regularly by specialists to improve orthotic device use. Foot deformities and foot drop contribute to disability in people with Charcot Marie Tooth Disease but use of orthotic devices is poor. To improve orthotic device use, regular multidisciplinary consultations and regular re-evaluation of the device by specialists in neuro-orthopaedics are important. The device fit should be regularly re-evaluated by the prescribing doctor or the practitioner who made the device. Regular multimodal evaluation of foot deformity, including muscle strength and length, and the individual's needs and expectations is also important to improve orthotic device use. [ABSTRACT FROM AUTHOR]

To evaluate the immediate and 4-week effects of compression garments (CG) on balance using a force platform during 8 different visual, static, and dynamic conditions in hypermobile Ehlers-Danlos Syndrome (hEDS) patients. Thirty-six participants were randomly assigned to a group: physiotherapy alone (PT, n = 19) or physiotherapy and daily CG wearing for 4 weeks (PT + CG, n = 17). Both attended 12 physiotherapy sessions (strengthening, proprioception, and balance exercises) for 4 weeks. Primary outcome: sway velocity of the centre of pressure (COP) measured before, immediately with the CG, and at 4 weeks. Secondary outcomes: ellipse area, Romberg quotient, and pain. Sway velocity in dynamic conditions decreased immediately with the CG. After 4 weeks of intervention, sway velocity (95% CI 4.36–39.23, effect size 0.93) and area (95% CI 146–3274, effect size 0.45) on the laterally oscillating platform with eyes-closed improved more in the PT + CG group than the PT group. Romberg quotient on foam cushion improved more in the PT + CG than the PT group. Pain decreased in both groups after 4 weeks with no between-group difference. CG combined with physiotherapy improved dynamic balance measured with COP variables significantly more than physiotherapy alone in people with hEDS. NCT03359135 Compression garments immediately improve balance in people with hypermobile Ehlers-Danlos Syndrome (hEDS) Compression garments combined with regular physiotherapy improve balance in people with hEDS after 4 weeks of treatment Compression garments could compensate for proprioceptive impairment in hEDS [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of environment-based intervention on participation outcomes and parent efficacy in autistic children. Twenty-one autistic children 6–10 years old and their parents were randomized to environment-based intervention (n = 11) or usual care (n = 10). The environment-based intervention targets individualized participation goals in leisure and community activities through changing environment and activity demands. The study outcomes were Canadian Occupational Performance Measure (COPM), Goal attainment scaling (GAS), and Parent Empowerment and Efficacy Measure (PEEM). Assessments included baseline, 12 weeks (post-test), and 24 weeks (follow-up). Mixed ANOVAs were used to examine within-group and between-group effects in outcome variables. The COPM performance and satisfaction scores and GAS T-scores increased after environment-based intervention from baseline to 12 weeks and 24 weeks (p < 0.001) but did not significantly differ from usual care. The medium to large effect sizes of COPM performance and GAS T-scores favored the environment-based intervention. For the PEEM scores, no significant differences were found. Environment-based intervention may support school-age autistic children to participate in self-chosen activities over time. The intervention effects on participation goals and parent efficacy, however, were inconclusive and need further research. Environmental barriers are important attributes to participation restriction in autistic children. Interventions focusing on modifying the task and environment is viable in supporting the participation of autistic children. The environment-based intervention appears to improve the participation goals in leisure and community-based activities over time. The environment-focused strategies may include providing social support, enabling access to a sensory-friendly environment, finding inclusive programs, adapting task demands, and managing routines. [ABSTRACT FROM AUTHOR]

To explore the feasibility of an exergame prototype in residential individuals with major neurocognitive disorder (MNCD). Participants were randomly assigned to a 12-week stepping exergame training or traditional exercise (active control group). Semi-structured interviews were conducted after six and 12 weeks of exergaming. Qualitative data were thematically analysed using NVivo 12. The Short Physical Performance Battery, one minute sit-to-stand test, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, and Dementia Quality of Life were assessed at baseline and post intervention using a Quade's ANCOVA. Seven older adults with MNCD in the exergame and 11 in the active control group completed the study [mean age = 83.2 ± 6.5 years; 94.4% female; SPPB score = 7.3 ± 2.4]. Results indicated that the VITAAL exergame prototype was experienced as enjoyable and beneficial. The post-MMSE score was higher (η2=.02, p = 0.01, F = 8.1) following exergaming versus traditional exercise. The findings suggest that the exergame prototype is accepted by individuals with MNCD residing in a long-term care facility when they are able to participate and under the condition that they are extensively guided. The preliminary efficacy results revealed higher post-MMSE scores after exergaming versus traditional exercise. Future trials should confirm or refute these findings. The trial was registered in ClinicalTrials.gov (Identifier: NCT04436315) The VITAAL exergame prototype is accepted by individuals with MNCD residing in a long-term care facility who are able to participate. Supervision of exergaming by health professionals is essential for successful implementation. The VITAAL exergame prototype might maintain cognitive levels in major neurocognitive disorder longer than walking combined with standardised squatting and stepping exercises. [ABSTRACT FROM AUTHOR]

To assess the presence of upper extremity pain after stroke over time and the course of its intensity in patients with persistent pain. Patients with stroke completed a question on the presence of upper extremity pain (yes/no) and rated its intensity with a visual analogue scale (0–10) at 3, 18, and 30 months after starting multidisciplinary rehabilitation. The presence of upper extremity pain and its intensity over time were analysed with Generalized Estimating Equations models and Linear Mixed Models, respectively. 678 patients were included. The proportions of patients reporting upper extremity pain were 41.8, 36.0, and 32.7% at 3, 18, and 30 months, respectively, with the decline in proportions reaching statistical significance (odds ratio 0.82, 95% confidence interval 0.74–0.92, p < 0.001). At all time points, in those reporting pain the median intensity was 5.0 (interquartile ranges (IQR) 4.0–7.0 at 3 and 3.0–6.0 at 18 and 30 months). In the 73 patients with persistent pain, there was no significant change in intensity over time. The proportion of patients reporting upper extremity pain after stroke was considerable, despite a significant decrease in 2.5 years. In patients reporting persistent pain, the intensity did not change over time. About one-third of patients with stroke reported upper extremity pain at 30 months after starting rehabilitation. In patients with stroke who reported persistent upper extremity pain, there was no significant change in pain intensity over time. There is room for improvement of diagnosis and treatment of upper extremity pain in patients with stroke. [ABSTRACT FROM AUTHOR]

Purpose: To determine gait aid use and decision-making related to usage in people with dementia, and examine factors influencing (1) gait aid use or not; and (2) falls in past year. Materials and methods: A survey of informal carers of older people with dementia in the community. Closed questions on gait aid use, falls, timing and sources of gait aid acquisition, and advice received to support use were used. Chi-squared tests (Fisher's Exact) compared: (1) gait aid users vs non-users and carers' report of (i) unsteadiness in walking/turning, (ii) dementia severity, (iii) falls in past year, and (2) fallers vs non-fallers and (i) timing of gait aid commencement relative to dementia diagnosis, (ii) whether health professional advice was received regarding use, and iii) regularity of use. Results: Forty-seven completed surveys, 63.8% of care recipients used a gait aid; 56.9% had >2 falls in past year; 66.7% commenced use after dementia diagnosis; 25% acquired their aids from non-health professionals; and 37% did not receive advice regarding use. Gait aid users and non-users differed on carer ratings of unsteadiness in walking/turning (p=0.02). Conclusion: Carers reported important aspects regarding gait aid acquisition, safe gait aid use and benefits which warrant further investigation. [ABSTRACT FROM AUTHOR]

To determine the effects of Perturbation-based Balance Training (PBT) on postural responses and falls in people with multiple sclerosis (PwMS) and compare the results with conventional balance training (CBT). Thirty-four PwMS were randomized to receive 4 weeks of PBT or CBT. Latency of postural responses to external perturbations, Timed-Up-and-Go (TUG), 10-meter-walk (10MW), Berg Balance Scale (BBS), and Activities-specific Balance Confidence Scale (ABC) were measured at baseline and post-training. Also, the proportion of fallers and fall rate were assessed at a 3-month follow-up. The latency of postural responses significantly decreased in PBT compared to CBT. TUG, 10MW, BBS, and ABC, at post-training, and relative risk of falls and fall rate at 3-month follow-up had no statistically significant between-group differences. The results show that PBT is at least as effective as CBT in improving balance and decreasing falls, while it has superiority over CBT whenever the clinicians mainly aim to improve reactive balance strategies. Future studies with a larger sample size are warranted to complement the results of this study. Perturbation-based Balance Training is at least as effective as conventional balance training (CBT) in improving proactive postural control in people with multiple sclerosis (PwMS). Perturbation-based Balance Training has superiority over CBT in improving reactive postural control in PwMS. Perturbation-based Balance Training has no superiority over CBT in improving fall-related outcomes. [ABSTRACT FROM AUTHOR]

To describe the epidemiology of cerebral palsy (CP) among children in Gorkha, Nepal. We established the first population-based register of children with CP aged <18 y in Gorkha, Nepal (i.e., Nepal CP Register). Children with suspected CP underwent detailed neurodevelopmental assessment by a multidisciplinary assessment team. Socio-demographic, etiology, motor severity, rehabilitation, and educational status were documented. Between January and October 2018, 182 children with confirmed CP were registered (mean (standard deviation (SD)) age: 10 years 1 months (4 years 10 months), 37.4% females). The majority (88.3%) had CP acquired pre- or perinatally. Mean (SD) age of CP diagnosis was four years five months. Mothers who did not receive any formal schooling had 4.5, 3.1, and 6.3 times higher odds of having inadequate antenatal care, homebirth, and unskilled birth attendants, respectively, when adjusted for other factors. Most children had spastic CP (77.5%) and Gross Motor Function Classification System level III-V (54.9%). Overall, 45.8% had never received rehabilitation services, 58.0% of school-aged children were not attending schools. The median age of receiving rehabilitation services was three years zero months. The delayed diagnosis and clinical severity indicate the overall poor health status of children with CP in Nepal which could be improved by ensuring early diagnosis and intervention. The first population-based cerebral palsy register in Nepal suggests diagnosis of CP is considerably delayed among children. The high burden of severe motor impairment and poor communication skill with limited access to timely rehabilitation among children with CP in Nepal is concerning. Capacity development of community-based health workers and mothers of children with CP could help implementing community-based programs for prevention and early diagnosis of CP, and to promote early intervention for children with CP in remote Gorkha, Nepal. [ABSTRACT FROM AUTHOR]

This retrospective study investigates oral health and oral care in patients with neurodegenerative and cerebrovascular diseases (CVDs) treated in a dental facility for people with disabilities. Oral health indices decayed, missing, and filled teeth (DMFT), periodontal screening index (PSI), treatment spectrum, and oral hygiene were evaluated in 152 patients with multiple sclerosis, Parkinson's disease, dementia, and CVD and 30 controls. Regression analyses identified group differences and influencing factors on DMFT. Patients with neurodegenerative or CVD had a significantly higher DMFT (21.2 ± 5.8 vs. 18.3 ± 5.9), more decayed teeth (4.3 ± 4.8 vs. 1 ± 1.9), fewer filled teeth (7.9 ± 5.5 vs. 11 ± 5.6), and a higher number of surgical (39.5% vs. 20%) treatments but significantly less conservative (49.3% vs. 73.3%) and prosthetic (15.1% vs. 56.7%) treatments than the control group (p< 0.05). The frequency of toothbrushing and the use of an electric toothbrush were related to lower DMFT in patients with neurodegenerative and CVD. Smoking was associated with higher DMFT. Poor oral health was found in all individuals with disabilities, suggesting that limitations in oral care attributed to aging and neurological disorders negatively affect oral health. Oral rehabilitation of patients with disabilities requires awareness of oral health limitations and early intervention through dental care. Poor oral health and oral hygiene is common among older people with disabilities. To optimize oral rehabilitation of patients with disabilities, early intervention, individualized treatment plans and an adapted time frame for dental treatment are required. Education of dentists, caregivers, and family members is essential for oral rehabilitation and improvement of oral hygiene in patients with disabilities. [ABSTRACT FROM AUTHOR]

Nearly 50% of children with attention-deficit/hyperactivity disorder (ADHD) experience emotional dysregulation or sensory over-responsiveness; this study examines their association. This cross-sectional analysis (n = 124) used data from the Micronutrients for ADHD in Youth (MADDY) Study, which enrolled children aged 6–12 with ADHD and emotional dysregulation. Sensory responsiveness was assessed using two subscales from the factor-analyzed Temperament in Middle Childhood Questionnaire: Pain Sensitivity and Perceptual Sensitivity. Emotional dysregulation was assessed using the Emotional-Problems and Conduct-Problems subscales from the Strengths and Difficulties Questionnaire and a composite score from the Child & Adolescent Symptom Inventory-5. Multivariable linear regression measured the association of pain and perceptual sensitivity with the severity of emotional dysregulation. In adjusted models, pain sensitivity was positively associated with Emotional Problems (β = 0.97; 95% CI: 0.52, 1.41; p < 0.0001), Conduct Problems (β = 0.83; 95% CI: 0.44, 1.21; p = 0.0001), and CASI-5 composite (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Perceptual sensitivity was positively associated with Emotional Problems (β = 0.75; 95% CI: 0.15, 1.35; p = 0.01) but not Conduct Problems (β = 0.27; 95% CI: −0.24, 0.77; p = 0.30) or CASI-5 composite (β = 0.12; 95% CI: −0.01, 0.24; p = 0.07). Pain sensitivity was associated with the severity of emotional dysregulation in this ADHD sample. To better understand possible causal links, longitudinal studies are warranted. Emotional dysregulation and sensory over-responsiveness are both common in children with ADHD and contribute to added challenges in school and family life. Two types of sensory over-responsiveness, pain sensitivity and perceptual sensitivity, were associated with emotional dysregulation in children with ADHD in our study. Sensory over-responsiveness may be a modifiable treatment target. [ABSTRACT FROM AUTHOR]

To evaluate the effects of 24 weeks of Mat Pilates in breast cancer survivors (BCS) undergoing hormone therapy on lower and upper body muscle strength parameters and flexibility. Forty-three BCS (≥40 years) with confirmed breast cancer stage 0–III undergoing hormone therapy were included. Participants were randomized into Mat Pilates (three times/week, 60 min session) or control group (relaxation activities every two weeks). The difficulty and number of exercise repetitions were increased over the weeks. Assessments were performed at three times points (baseline, 12 weeks, and 24 weeks). The generalized estimating equations (GEE) model was used to compare each outcome measure during the analysis of intention to treat (ITT) and "Per protocol analysis" (PPA). The Pilates group presented significantly increased (p < 0.05) isometric flexor–extensor PT, and concentric and eccentric flexor PT and mechanical work (MW) after the intervention. Most of the upper body strength parameters, time to achieve maximal force (TFmax), maximal force (Fmax), and rapid force index (RFI) and right-left upper and lower body flexibility (p < 0.05) also improved. From our findings, we conclude that 24 and 12-weeks of Mat Pilates induced strength and flexibility gains for lower and upper body, respectively. Mat Pilates can be adapted to the fitness level of breast cancer survivors, with a great variety of exercises that can be performed using a mat only or a few pieces of equipment. Patients can practice at home to gain different health benefits (i.e., increasing strength, flexibility, and functional capacity level), which could positively impact on quality of life. Mat Pilates performed three times per week with systematized increments in exercise level, load, and volume throughout the intervention was effective to improve hip extensor–flexor muscles peak torque and mechanical work at different muscle contractions, as well as upper and lower body flexibility. Mat Pilates was also able to improve right-left shoulder abductor and trunk extensor muscles strength parameters after 12 weeks of intervention, as well as both surgery and non-surgery sides of the upper body. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the association between preoperative physical activity (PA) and postoperative functional recovery in gastrointestinal cancer patients. In this prospective study, we included 101 patients who underwent colorectal or gastric cancer surgery. Primary outcome was 6-minute walk distance (6MWD) decline ratio ((postoperative 6MWD value – preoperative 6MWD value)/preoperative 6MWD value × 100 (%)), which was determined as postoperative functional recovery. Patients were divided into two groups according to the median of 6MWD decline ratio: above the median (non-decline group) and below the median (decline group). The International Physical Activity Questionnaire (IPAQ-SV) (the usual seven-day short version) was used to assess preoperative PA and sedentary time. Multivariate logistic regression analysis was performed to identify predictive factors of postoperative functional recovery. Preoperative PA (odds ratio (OR): 3.812; 95% confidence interval (CI): 1.326–10.956; p = 0.01), 6MWD (OR: 1.006; 95% CI: 1.002–1.011; p < 0.01), C-reactive protein (OR: 4.138; 95% CI: 1.383–12.377; p = 0.01), and combined resection (OR: 3.425; 95% CI: 1.101–10.649; p = 0.03) were associated with postoperative functional recovery. Preoperative PA is a predictor of postoperative functional recovery in patients who undergoing gastrointestinal cancer surgery. The association between preoperative physical activity (PA) and postoperative functional recovery has been unclear in gastrointestinal cancer patients. We indicated that preoperative PA predicts postoperative functional recovery. Patients who low preoperative PA need to be monitored carefully in the postoperative course. Patients with low preoperative PA may need enhanced postoperative rehabilitation to reduce postoperative functional decline. [ABSTRACT FROM AUTHOR]

To determine any factors that predict how an individual will adapt to post-stroke hemianopic visual field loss, with close monitoring of the adaptation process from an early stage. The Hemianopia Adaptation Study (HAST) is a prospective observational longitudinal cohort clinical study. Adult stroke survivors (n = 144) with new onset homonymous hemianopia were monitored using standardised mobility assessment course (MAC) as the primary outcome measure of adaptation. Several baseline variables were found to be good predictors of adaptation. Three variables were associated with adaptation status at 12-weeks post-stroke: inferior % visual field, % total MAC omissions, and MAC completion time (seconds). Baseline measurements of these variables can predict the adaptation at 12 weeks with moderate to high accuracy (area under ROC curve, 0.82, 95% CI 0.74–0.90). A cut-off score of ≤25% target omissions is suggested to predict which individuals are likely to adapt by 12-weeks post-stroke following gold standard care. Adaptation to hemianopia is a personal journey with several factors being important for prediction of its presence, including MAC outcomes and extent of inferior visual field loss. A clinical recommendation is made for inclusion of the MAC as part of a functional assessment for hemianopia. The mobility assessment course (MAC) should be considered as an assessment of mobility/scanning in the rehabilitation of patients with homonymous hemianopia. A cut-off score of ≤25% omissions on MAC could be employed to determine those likely to adapt to hemianopia long-term. Targeted support and therapy for patients with significant visual loss in the inferior visual field area should be considered. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of manual therapy in reducing the frequency of clinical hemarthrosis, increasing range of motion and improving the perception of disability in the upper limbs in patients with hemophilic elbow arthropathy. Sixty-nine patients were randomized into experimental (N = 35) and control group (N = 34). The outcome measures were: frequency of clinical hemarthrosis, the elbow range of motion and the perception of disability in the upper limbs (DASH questionnaire). The intervention included one 50 min weekly session, for three weeks, of upper limb fascial therapy according to our treatment protocol. There were differences (p < 0.001) in the repeated measures analysis for frequency of elbow clinical hemarthrosis (F = 20.64) and range of motion in flexion (F = 17.37) and extension (F = 21.71). No differences were found in the overall perceived disability (F = 0.91; p =.37). We found group interaction with the (p < 0.001) in the frequency of elbow clinical hemarthrosis, range of motion and overall perceived disability. Manual therapy is safe in patients with hemophilia and elbow arthropathy. Fascial therapy reduces the frequency of hemarthrosis, increases the range of motion and improves the perceived disability in the upper limbs. Trial registration number: id NCT03009591 Impairments in the range of motion, pain and disability may occur in patients with hemophilic elbow arthropathy since early age. There is a need to validate safe and effectiveness protocols of rehabilitation to treat these patients. Prophylactic replacement is the most effective treatment for the prevention of hemarthrosis. Physiotherapists need to be trained in the specific management of patients with hemophilia. Manual therapy can be a safe and effective tool in the treatment of hemophilic arthropathy. [ABSTRACT FROM AUTHOR]

The best approach to delivering advanced gross motor skills interventions for children with cerebral palsy (CP) is unknown. This study's aim was to assess trial feasibility and compare effectiveness of sports skills movement training (Brain change after Fun, Athletic Sports skills Training [BeFAST]) to conventional lower limb strength training (Brain change after Strength Training focusing ON Gait [BeSTRONG]) for improving advanced gross motor skills of children with CP. Twenty independently ambulatory children with CP (mean age 12 ± 2.6 years) were randomly assigned to a 6-week programme of BeFAST or BeSTRONG, individualised to participant goals. Primary scientific outcome measures were the Challenge and Canadian Occupational Performance Measure (COPM) assessed pre/post and 4-month post-intervention. Process, resource, and management indicators assessed trial feasibility. There was no between group difference for the Challenge (p = 0.325), however significant post-intervention Challenge improvements were observed in BeFAST (p = 0.031) but not BeSTRONG (p = 0.055). Between group post-intervention scores were higher in BeFAST for COPM Performance (p = 0.001), and relative gains were maintained 4-month post-intervention. Pre-set criteria were met for 84% of feasibility indicators. Sports skills movement training may be an effective option to support advanced gross motor skill gains and target goals of independently ambulatory children with CP. Trial feasibility, including early evidence of effectiveness, indicates readiness for a full-scale randomised trial. Children with cerebral palsy have potential to improve advanced gross motor skills. Strength training is a commonly used approach in gross motor therapy programmes. Sports skill training may be an effective option that better targets children's goals. [ABSTRACT FROM AUTHOR]

In search of Kipling's six honest serving men in upper limb rehabilitation after stroke, we sought to investigate clinicians' perspective of when and where to begin therapy, how much and what therapy to provide, and who and why (or not) to provide therapy. Materials & methods: Within-participant case cross-over experiments were nested within an anonymous web-based questionnaire (21 questions, three cases). Graph theory-based voting to produce ranked ordered lists and mixed-effect logistic regression were performed. In total, 225 Australian stroke clinicians responded: 53% occupational therapists, 61% working in acute/inpatient stroke setting. Most respondents indicated they did not have a protocol/expectation regarding when (62%), how much (84%) or what (60%) therapy to provide in their setting. Respondents ranked 24-h to 7-days post-stroke as the optimal time to commence therapy, and 30- to 60-min per day as the optimal dose to provide. Within-participant experiments demonstrated that greater motor recovery as time progressed increased the odds of offering therapy, while lack of motor recovery, shoulder pain, neurological decline and sole therapist reduced the odds. We need to develop an evidence base concerning Kipling's six honest serving men and equip clinicians with clinical decision-making skills aligned with this focus. Most clinicians did not have access to a protocol / clinical pathway which defines when, how much and what upper limb therapy to provide after stroke, which may be improved by providing individual clinicians with organisational support to make therapy decisions. To improve the personalisation of upper limb rehabilitation in clinical practice, we need to understand when and where after stroke to begin therapy, how much and what therapy to provide, as well as who and why (clinical decision-making) to provide therapy. Clinicians perceive clinical trials as successful if the therapy can demonstrate recovery that is greater than a minimal clinical important difference (MCID). [ABSTRACT FROM AUTHOR]

To compare stroke-specific health related quality of life in two country-regions with organisational differences in subacute rehabilitation services, and to reveal whether organisational factors or individual factors impact outcome. A prospective multicentre study with one-year follow-up of 369 first-ever stroke survivors with ischaemic or haemorrhagic stroke, recruited from stroke units in North Norway (n = 208) and Central Denmark (n = 161). The 12-domain Stroke-Specific Quality of Life scale was the primary outcome-measure. The Norwegian participants were older than the Danish (Mage= 69.8 vs. 66.7 years, respectively), had higher initial stroke severity, and longer stroke unit stays. Both cohorts reported more problems with cognitive, social, and emotional functioning compared to physical functioning. Two scale components were revealed. Between-country differences in the cognitive-social-mental component showed slightly better function in the Norwegian participants. Depression, anxiety, pre-stroke dependency, initial stroke severity, and older age were substantially associated to scale scores. Successful improvements in one-year functioning in both country-regions may result from optimising long-term rehabilitation services to address cognitive, emotional, and social functioning. Stroke-Specific Quality of Life one-year post-stroke could be explained by individual factors, such as pre-stroke dependency and mental health, rather than differences in the organisation of subacute rehabilitation services. The stroke-specific health related quality of life (SS-QOL) assessment tool captures multidimensional effects of a stroke from the perspective of the patient, which is clinically important information for the rehabilitation services. The cognitive-social-mental component and the physical health component, indicate specific functional problems which may vary across and within countries and regions with different organisation of rehabilitation services. For persons with mild to moderate stroke, longer-term functional improvements may be better optimised if the rehabilitation services particularly address cognitive, emotional, and social functioning. [ABSTRACT FROM AUTHOR]

Trunk muscle endurance may be associated with balance and falls self-efficacy for people with osteoporosis. However, all previous studies have examined trunk muscle strength rather than endurance. To explore the relationships between trunk muscle endurance and standing balance and falls self-efficacy for women with vertebral fractures. This is an exploratory, secondary analysis of baseline data of a pilot randomized controlled trial in Ontario, Canada. Thirty-one women with osteoporosis, aged 65 years or older, with at least one vertebral fracture were included. The associations between balance (Balance Outcome Measure for Elder Rehabilitation) and trunk muscle endurance (Timed Loaded Standing Test) and falls self-efficacy (Falls Efficacy Scale International) and trunk muscle endurance were tested via Spearman rank order correlation with Fisher's z transformations. Trunk muscle endurance was correlated with better balance performance on the Balance Outcome Measure for Elder Rehabilitation [Spearman correlation coefficient, 0.71; 95% confidence interval: 0.47–0.85; p < 0.001], but not with falls self efficacy (Spearman correlation coefficient; –0.22; 95% confidence interval: –0.53 to 0.14; p = 0.23). Trunk muscle endurance was moderately associated with better standing balance performance but not falls self-efficacy, highlighting the importance of trunk muscle endurance for standing balance for older adults with osteoporosis and vertebral fractures. Older adults with osteoporosis and vertebral fractures who have better trunk muscle endurance may also have better standing balance. There was no association between trunk muscle endurance and how confident a person is that they will not fall while completing various activities of daily living. Trunk muscle endurance training could be included as part of a standing balance rehabilitation program for this population. [ABSTRACT FROM AUTHOR]

Purpose: Participation in activities of everyday life is seen as main goal of rehabilitation after a stroke and return to work is an important factor to consider for the substantial number of persons having a stroke at working age. The current study aims to investigate whether returning to work would predict self-perceived participation and autonomy in everyday life after a stroke, from a long-term perspective. Materials and methods: Persons with first-ever stroke at age 18–63 years in 2009–2010, Gothenburg, were included. As 5-year follow-up, the Impact on Participation and Autonomy questionnaire was sent out, investigating self-perceived participation/autonomy in five levels, and work status was investigated from national sick-absence registers. Prediction of work on participation/autonomy was investigated with logistic regression. Results: A total of 109 participants (49%) responded to the questionnaire. The majority (69–94%) perceived very good participation/autonomy in all domains and 59% were working 5 years after stroke. Working was a significant predictor of high participation/autonomy in all domains of the questionnaire. Conclusions: Being able to return to work after a stroke seems to be important for self-perceived participation/autonomy. This emphasizes the importance of work-oriented information and rehabilitation after a stroke at working age. The current study shows that the majority report high self-perceived participation and autonomy in everyday life and 59% are working 5 years after a stroke in working age. To work 5 years after a stroke was a significant predictor for self-perceived participation and autonomy in everyday life. Since stroke is becoming more common among working age persons and work seem important for perceived participation and autonomy, to optimize the return to work by for instance work-oriented information and vocational rehabilitation is important. [ABSTRACT FROM AUTHOR]

Purpose: To translate the Cumulated Ambulation Score into Spanish, and to examine its inter-rater reliability, agreement and internal consistency. Materials and Methods: Two occupational therapists independently used the Spanish version of the Cumulated Ambulation Score (three activities scored from 0–2 points) to assess 60 consecutive patients with hip fracture within the first post-surgery week at a traumatology service of a public hospital. We used linear weighted kappa (κ) statistics to determine inter-rater reliability, percent agreement to assess measurement error, Cronbach's α coefficient to establish the internal consistency, and the McNemar–Bowker test to evaluate for systematic between-rater differences. Results: The κ was ≥ 0.83 for the three individual activities and the total score, the percent agreement was ≥ 0.87, and Cronbach's α was 0.89 with no observed systematic between-rater difference. Conclusions: This study provides evidence for almost perfect inter-rater reliability, excellent internal consistency, and high percent agreement of the Spanish version of the Cumulated Ambulation Score. Due to the strong psychometric properties, and its ease of use, we suggest it be used in Spanish speaking countries to assess early basic mobility status of patients with hip fracture until independence is reached. The Spanish version of the Cumulated Ambulation Score is a reliable outcome measure to assess basic mobility of patients with hip fracture. We suggest the Spanish version of the Cumulated Ambulation Score be used in Spanish speaking settings to indicate small changes in basic mobility of patients with hip fracture until an independent level is reached. The Spanish version of the Cumulated Ambulation Score can be used with a high reliability by experienced and inexperienced occupational therapists, corresponding to the already established reliability when used by physicians and physiotherapists. [ABSTRACT FROM AUTHOR]

Aims: We hypothesised that a systematic functional assessment in a short stay unit at an emergency department (ED) and/or immediate rehabilitation after discharge will result in sustained or improved physical performance in comparison to a regimen in which neither of these interventions is offered. Methods: A two-way factorial randomised clinical trial was completed in an ED and the primary sector. We enrolled 336 nonsurgical patients of 65 years or older, scoring eight or less in the 30-s chair stand test. The interventions were: 1) Usual assessment; 2) Usual rehabilitation; 3) A systematic functional assessment performed within 48 h of admission, in order to identify those with loss of functional mobility, or at risk thereof; and 4) Immediate rehabilitation initiated within five days after discharge. The primary outcome was the 30-s chair stand test three weeks after admission. Secondary outcome measures were Barthel, EQ-5D-3L, and length of stay (LOS). Results: An intention-to-treat analysis showed no significant difference in the 30-s chair stand test score nor when analysed by groups or by intervention. The changes were approximately 1% when compared to the reference. No significant differences were found in the secondary outcomes. A per-protocol analysis showed that 99% had received assessment as assigned; however, the extent of mobilisation during hospitalisation was not disclosed. Of the patients, 48% were received the post-discharge rehabilitation they were assigned to. Conclusions: Systematic functional assessment and immediate rehabilitation led to no significant differences in physical performance. The study was weakened by the incomplete implementation of mobilisation during hospitalisation and low adherence to protocol on immediate rehabilitation. A systematic functional assessment within the first 48 h of hospital admission is suitable for the identification of older adults in need of post-discharge rehabilitation when compared to usual assessment. To sustain physical performance in older adults during acute hospitalisation, further research focusing on mobilisation or physical activation is needed in older adults with a loss of functional mobility, or at risk thereof. Further research focusing on physical activation during transition is needed to ameliorate tiredness and inactivity in older adults after acute hospitalisation. [ABSTRACT FROM AUTHOR]

Purpose: To assess the nutritional status and underlying risk factors for malnutrition among children with cerebral palsy in rural Bangladesh. Materials and methods: We used data from the Bangladesh Cerebral Palsy Register; a prospective population based surveillance of children with cerebral palsy aged 0–18 years in a rural subdistrict of Bangladesh (i.e., Shahjadpur). Socio-demographic, clinical and anthropometric measurements were collected using Bangladesh Cerebral Palsy Register record form. Z scores were calculated using World Health Organization Anthro and World Health Organization AnthroPlus software. Results: A total of 726 children with cerebral palsy were registered into the Bangladesh Cerebral Palsy Register (mean age 7.6 years, standard deviation 4.5, 38.1% female) between January 2015 and December 2016. More than two-third of children were underweight (70.0%) and stunted (73.1%). Mean z score for weight for age, height for age and weight for height were −2.8 (standard deviation 1.8), −3.1 (standard deviation 2.2) and −1.2 (standard deviation 2.3) respectively. Moderate to severe undernutrition (i.e., both underweight and stunting) were significantly associated with age, monthly family income, gross motor functional classification system and neurological type of cerebral palsy. Conclusions: The burden of undernutrition is high among children with cerebral palsy in rural Bangladesh which is augmented by both poverty and clinical severity. Enhancing clinical nutritional services for children with cerebral palsy should be a public health priority in Bangladesh. Population-based surveillance data on nutritional status of children with cerebral palsy in Bangladesh indicates substantially high burden of malnutrition among children with CP in rural Bangladesh. Children with severe form of cerebral palsy, for example, higher Gross Motor Function Classification System (GMFCS) level, tri/quadriplegic cerebral palsy presents the highest proportion of severe malnutrition; hence, these vulnerable groups should be focused in designing nutrition intervention and rehabilitation programs. Disability inclusive and focused nutrition intervention programme need to be kept as priority in national nutrition policies and nutrition action plans specially in low- and middle-income countries. Community-based management of malnutrition has the potential to overcome this poor nutritional scenario of children with disability (i.e., cerebral palsy). The global leaders such as World Health Organization, national and international organizations should take this in account and conduct further research to develop nutritional guidelines for this vulnerable group of population. [ABSTRACT FROM AUTHOR]

Purpose: Improved quality of life is an important outcome for adults with autism spectrum disorder. However, little research has examined factors associated with quality of life among adults with autism spectrum disorder. Method: This study comparing 66 adults with autism spectrum disorder (intelligence quotient > 70) aged 20–38 years with neuro-typical adults investigated their quality of life and related factors. All the participants were interviewed with questionnaires by a registered occupational therapist. Results: Participants with autism spectrum disorder scored significantly lower in all domains of quality of life than did the controls. Adults with autism spectrum disorder reported higher anxiety level, more loneliness, and higher scores on four sensory quadrants than neuro-typical adults. The predictors of the physical health domain were anxiety and sensation-sensitivity behaviors. Loneliness and sensation-sensitivity behaviors were predictive of the psychological health domain. Comorbid psychiatric disorders and loneliness were predictive of the social relationship domain. Conclusions: Adults with autism spectrum disorder need more supportive social contexts and interventions to improve their quality of life. Social relationships, psychological health, and sensory processing difficulty must be considered when designing treatment programs for adults with autism spectrum disorder. Adults with autism spectrum disorder scored significantly lower in all domains of quality of life than did the neuro-typical adults. Occupational therapy can provide more supportive social contexts and interventions on social relationship and sensory processing difficulty to improve their quality of life. Understanding factors associated with quality of life among adults with autism spectrum disorder can contribute to address their needs. Occupational therapy can facilitate health promotion through working with adults with autism spectrum disorder. Social relationships, psychological health, and sensory processing difficulty must be considered when designing treatment programs for adults with autism spectrum disorder. [ABSTRACT FROM AUTHOR]

Purpose: Spatial neglect (SN) impedes rehabilitation success and leaves long-term consequences. We asked experts to provide their opinions in addressing SN by scenario (ideal vs. reality) and by recovery phase (earliest, acute, subacute, and chronic). Experts were individuals who have assessed or treated patients with SN clinically. Materials and methods: This study was conducted using an anonymous survey on the Internet with 189 responders over 3 months. Located in 23 different countries, 127 experts of seven disciplines were included (occupational therapy, physical therapy, nursing, speech and language pathology or therapy, neurology, physical medicine and rehabilitation, and psychology or neuropsychology). Results: Comparing the two scenarios, more treatments were selected in the ideal than in the reality scenario for all recovery phases except for the chronic phase. In both scenarios, (1) more treatments were selected in acute and subacute phases than in earliest or chronic phases, (2) less experienced experts selected diverse treatment options more often, and (3) highly experienced experts were more likely to provide their reasons of treatment selection, suggestions of treatment delivery methods, and other insights. Finally, 83.7% reported obstacles in treating SN. Conclusions: Experts’ treatment selections are consistent with current evidence and practice guidelines. Recognizing the limitation of evidence, their opinions may help generate ideas in various topics (e.g., dosing, integrative intervention, and treatment implementation) to be examined in future studies. Implications for Rehabilitation: Clinicians with experience in treating people with spatial neglect (i.e., experts as defined in the present study) recognized the limitation of evidence but nonetheless suggested specific treatments by recovery phase. In both the reality and ideal scenarios, experts included visual scanning, active limb activation, and sustained attention training in the top-five selections. Prism adaptation was in the top-five selections in the ideal scenario, while in the reality scenario, it was in the top-five in all phases except for the earliest phase where it was the sixth most selected. They also shared their valuable opinions in when to use which treatment to address spatial neglect and how to deliver certain interventions, which may help to generate ideas in various topics (e.g., dosing, integrative intervention, knowledge dissemination, and treatment implementation) that can be examined in future studies. We suggest that (1) clinicians consider collective expert opinions reported here to enhance their clinical judgment and practices, (2) researchers develop studies focused on treatments with limited evidence but selected here by experts, and (3) funding agencies provide the means to research and implementation projects that will generate rich information for improving practice guidelines and rehabilitation outcomes for patients with spatial neglect. The majority of the experts reported some obstacles in providing treatment for spatial neglect, and time and equipment shortages were the most common barriers, which should be addressed at the system level to determine whether removing those barriers have long-term beneficial impacts on both patients and healthcare systems. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of different types of physical training on balance performance and whether improved balance correlates with improved walking performance. Methods: Forty eight participants with chronic stroke were randomly assigned to aerobic training on cycle ergometer (AT-group), resistance training of the lower extremities (RT-group), or sham training of upper extremities (ST-group). Participants exercised 3 d/week for 12 weeks. Balance (Berg Balance Scale), peak oxygen uptake rate, isometric knee extensor strength, maximal gait speed, and 6 minute walk test were measured at baseline and after 12 weeks. Results: Training specific effects were observed; the AT-group improved peak oxygen uptake rate by 15.5 (6.0-25.0)%, the RT-group improved non-paretic knee extensor strength by 35.1 (18.3-51.9)% and the ST-group improved non-paretic knee extensor strength by 8.9 (0.7-17.1)%. All groups improved balance (6.0 (95% CI: 3.2-8.8)%), maximal gait speed (10.2 (6.5-14.0)%), and 6 minute walk distance (12.4 (8.8-15.9)%) but balance improvements did not correlate with improvements in muscle strength, peak oxygen uptake rate, or walking. Conclusions: Physical exercise improves balance and walking performance, but improved balance is not a prerequisite for functional improvements in chronic stroke. Implications for Rehabilitation: Aerobic training and progressive resistance training show small significant improvements in balance and walking, indicating a possible clinical relevance of these training modalities. Improvements in balance may not be a prerequisite for improvements in walking distance when assistive devices are allowed during walking tests. [ABSTRACT FROM AUTHOR]

Purpose:To describe the choice-making abilities of girls and women with Rett syndrome. Method:Females with Rett syndrome registered with the Australian Rett Syndrome Database with a pathogenicMECP2mutation were included in this study. Video clips showing choice making in 64 females at a median age of 11.6 years (range 2.3–35.6 years) were analysed. Video clips were coded for the location and nature of the choice-making interaction, and the actions of the communication partner and female with Rett syndrome. Results:The majority (82.8%, 53/64) of females made a choice, most using eye gaze. Just under half (24/53) used one modality to communicate their choice, 52.8% used two modalities and one used three modalities. Of those who made a choice, 50% did so within 8 s. The length of time to make a choice did not appear to vary with age. During choice making, 57.8% (37/64) of communication partners used language and gestures, 39.1% (25/64) used only language and two used language, gestures and symbols within the interaction. Conclusions:The provision of adequate time allowing for a response and observation for the use of multiple modalities could promote effective choice making in females with Rett syndrome.Implications for RehabilitationThe provision of adequate time allowing for a response will promote effective choice making in girls and women with Rett syndrome.Although almost all girls and women with Rett syndrome used eye gaze to indicate their choice, communication partners also need to recognise and respond to other communication modalities that are sometimes used like body movements. [ABSTRACT FROM PUBLISHER]

Purpose: The Relational Neurobehavioral Approach (RNA) is a set of non-aversive intervention methods to manage individuals with brain injury-related aggression. New data on interventions used in the RNA and on how the RNA interventions can be used with patients with acquired brain injury (ABI) who have differing levels of functional impairment are provided in this paper. Method: The study was conducted over a 6-week period in a secure 65-bed program for individuals with ABI that is housed in two units of a skilled nursing facility (SNF). Implementation of the RNA was compared between two units that housed patients with differing levels of functional impairment (n¼65 adults). Since this was a hierarchical clustered dataset, Generalized Estimating Equations regression was used in the analyses. Results: RNA interventions used to manage the 495 aggressive incidents included the following: Aggression ignored, Closer observation, Talking to patient, Reassurance, Physical distraction, Isolation without seclusion, Immediate medication by mouth, Holding patient. Different interventions were implemented differentially by staff based on level of functional impairment and without use of seclusion or mechanical restraint. Conclusions: The RNA can be used to non-aversively manage aggression in patients with brain injury and with differing levels of functional impairment. Programs adopting the RNA can potentially manage brain injury-related aggression without seclusion or mechanical restraint. [ABSTRACT FROM AUTHOR]

Purpose: Because the oral hygiene is poorly prioritized in the immediate post-stroke period, we implemented an oral hygiene care program (OHCP) for stroke in-patients and evaluated its persistence after discharge. Method: In all, 62 patients with stroke who were admitted to the rehabilitation ward were randomly assigned to two groups: 33 patients to the intervention group and 29 to the control group. The OHCP, including tooth brushing education and professional tooth cleaning, was administered to the intervention group twice a week six times during in-hospital rehabilitation. Oral health status was examined both at baseline and three months after discharge from the hospital. Oral hygiene status was examined at threeto four-day intervals five times during the hospitalization period. Results: After OHCP, oral hygiene status including the plaque index, calculus index, and O'Leary plaque index improved significantly in the intervention group, compared to the control group (p<0.05). In the intervention group, after administration of the OHCP for the fourth time, the O'Leary index improved significantly, and remained high when checked three months after discharge (p<0.001). Conclusions: An OHCP conducted during in-hospital rehabilitation was effective in improving oral health and plaque control performance among patients with stroke, with effects still seen three months after discharge from the hospital. [ABSTRACT FROM AUTHOR]

Purpose: To report on the distribution and test-retest reliability of Antonovsky's 13-item Sense of Coherence (SOC-13) Scale in patients with hand-related disorders (HRD). Links between the SOC-13 score and factors such as age, number of days between date of injury and start of rehabilitation, gender and educational level were explored. Method: Survey with test-retest, using self-administered questionnaire. SOC-13 was completed before starting rehabilitation at an outpatient clinic after 14 days and three months. Adult patients with HRD were included. Results: A total of 170 participants completed the SOC-13 at baseline (median SOC 71, range 30-91). The Intra-class Correlation Coefficient between baseline and 14 days was 0.84 (n=151), and baseline and three months was 0.79 (n=113). Weak correlations were found between SOC and age rs=0.17, p<0.03. No correlation was found between SOC and number of days since injury rs=0.01, p>0.92. No difference was found in SOC score related to gender or educational level. Conclusions: The SOC-13 scale showed reliability for patients with HRD. There was a weak connection between age and SOC without clinical relevance. SOC-13 has the potential to be a powerful tool to measure the ICF component personal factors, which could have an impact on patients' rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

Purpose:The aim of this study was to determine whether and how real-time feedback of dynamic foot pressure index (DFPI) could be used to correct toe-walking gait in spastic diplegic children with dynamic equinus. Methods:Thirteen spastic diplegic children with dynamic equinus were asked to wear a monitoring device to record their ambulation during daily gait, conventional training gait, and feedback training gait. Parameters based on their DFPI and stride duration were compared among the three test conditions. Results:The results with feedback training were significantly better for all DFPI parameters in comparison to patients’ daily gait and showed significant improvements in DFPI for toe-walking gait and percentage of normal gait in comparison to conventional training methods. Moreover, stride duration under two training gaits was longer than patient’s daily gait, but there was no significant difference between the two training gaits. Conclusions:Although the stride duration for the two training gaits was similar, gait training with real-time feedback of DFPI did produce noticeably superior results by increasing heel-loading impulse of toe-walking gait and percentage of normal gait in comparison to convention training methods. However, its effectiveness was still impacted by the motion limitations of diplegic children.Implications for RehabilitationThe DFPI-based gait training feedback system introduced in this study was shown to be more effective at toe-walking gait rehabilitation training over conventional training methods.The feedback system accomplished superior improvement in correcting toe-walking gait, but its effectiveness in an increasing heel-loading impulse in normal gait was still limited by the motion limitations of diplegic children.Stride duration of normal gait and toe-walking gait was similar under conventional and feedback gait training. [ABSTRACT FROM PUBLISHER]

Purpose:Exercise is effective for reducing knee osteoarthritis (OA) pain but effect sizes vary widely. Moreover, not all knee OA patients perceive beneficial effects. Tailoring specific exercises to subgroups of knee OA patients may increase effectivity. Bone marrow lesions (BMLs) have been suggested as a criterion to define such subgroups. This study aimed to investigate whether BMLs’ presence/absence is related to treatment outcomes in a group of knee OA patients who exercised for 18 weeks. Methods: Subjects with symptomatic knee OA started a strength or walking exercise program. BMLs’ presence at baseline was assessed. Pain was assessed before and after the intervention with the intermittent and constant osteoarthritis pain (ICOAP) questionnaire. Also the global perceived effect (GPE) on the patient’s complaints was rated. Results: Thirty-five patients (strength (N = 17) and walking (N = 18)) were analyzed for BMLs. BMLs were present in 25 (71%) knees. Five (14%) patients dropped out and 19 (54%) improved (GPE ≥5). All dropouts had BMLs, but no difference was seen between dropouts and retainers (p > 0.05). Pain scores did not differ between intervention groups (p > 0.05) or between patients with BMLs and without BMLs (p > 0.05). Conclusions: Pain scores and GPE was not different between knee OA patients with and without baseline BMLs in this sample.Implications for RehabilitationBoth walking and strengthening exercises are effective means of improving pain in patients with knee osteoarthritis.In a relatively small sample, this study shows that the presence or absence of subchondral bone marrow lesions, as seen on magnetic resonance images, is not related to treatment outcomes. [ABSTRACT FROM AUTHOR]

Purpose:To investigate between-leg differences in hip and thigh muscle strength and leg extensor power in patients with unilateral hip osteoarthritis. Further, to compare between-leg differences in knee extensor strength and leg extensor power between patients and healthy peers. Methods:Seventy-two patients (60–87 years) with radiographic and symptomatic hip osteoarthritis not awaiting hip replacement and 35 healthy peers (63–82 years) were included. Hip and thigh muscle strength and leg extensor power were measured in patients and knee extensor strength and leg extensor power in healthy. Results:The symptomatic extremity in patients was significantly (p < 0.05, pairedt-test) weaker compared with the non-symptomatic extremity for five hip muscles (8–17%), knee extensors (11%) and leg extensor power (19%). Healthy older adults had asymmetry in knee extensor strength (6%,p < 0.05) comparable to that found in patients, but had no asymmetry in leg extensor power. Conclusions:Patients had generalized weakening of the affected lower extremity and numerically the largest asymmetry was evident for leg extensor power. In contrast, healthy peers had no asymmetry in leg extensor power. These results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with hip osteoarthritis.Implications for RehabilitationEven in patients with mild symptoms not awaiting hip replacement a generalized muscle weakening of the symptomatic lower extremity seems to be present.Between-leg differences in leg extensor power (force × velocity) appears to be relatively large (19%) in patients with unilateral hip osteoarthritis in contrast to healthy peers who show no asymmetry.Compared to muscle strength the relationship between functional performance and leg extensor power seems to be stronger, and more strongly related to power of the symptomatic lower extremity.Our results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with mild symptoms not awaiting hip replacement. [ABSTRACT FROM AUTHOR]

Purpose: To study relationships between fatigue and objective and subjective cognitive functioning, mood and comorbidity in the long term after perimesencephalic subarachnoid haemorrhage (PM-SAH). Methods: Cross-sectional study. Objective cognitive functioning was measured with: Trail Making Test; Symbol Substitution; D2; Verbal and Semantic Fluency; Tower Test; Digit Span; 15-Words Test; Rey Complex Figure. Subjective cognitive functioning: Cognitive Failure Questionnaire. Fatigue: Fatigue Severity Scale. Mood: Hospital Anxiety and Depression Scale. Results: Forty-six patients, mean age 50.4 (SD = 9.4), mean time after PM-SAH 4.7 (SD = 1.6) years participated. Patients with fatigue (33%) had significantly lower scores than patients without fatigue on most objective cognitive functioning tests (p < 0.05). Fatigue score was significantly associated with subjective and objective cognitive functioning, mood and comorbidity. After adjustment for mood and comorbidity, fatigue remained associated with attention and executive functioning. Conclusions: This study supports our previous findings that a third of patients with PM-SAH experience fatigue and problems of cognitive functioning, also in the long term. Future research should investigate whether these patients would benefit from long-term follow-up and/or cognitive rehabilitation programmes. Consequences for patients with PM-SAH are underestimated. One in every three patients suffered from fatigue in the long term after onset of PM-SAH. Patients with PM-SAH should be screened for problems of cognitive functioning, fatigue and mood in outpatient clinic just as patients with aneurysmal SAH. [ABSTRACT FROM AUTHOR]

Purpose:This study aims to determine the life satisfaction and strain on informal caregivers when caring for traumatic brain injury (TBI) patients and to examine the factors predicting the level of strain among the informal caregivers. Method:A cross-sectional survey on a purposive sampling was performed in a single centre in Malaysia recruiting caregivers of patients with TBI. Life Satisfaction Questionnaire-9 and Caregiver Strain Index questionnaires were used to ascertain the life satisfaction and strain of caregivers respectively. Relationship between life satisfaction and strain was analysed, together with factors significantly associated with strain. Results:A total of 141 caregivers (77.3% women, average age of 46.1 years ±12.8 and mean duration of caregiving of 24.8 months ± 14.3) were included in the analysis. Most caregivers (75%) were satisfied with their lives but more than half claimed to have strain (57%). There was a significant relationship between life satisfaction and strain among the caregivers (p < 0.001). From a multiple linear regression analysis, a caregiver’s monthly income of less than RM3000 (OR 6.48, 95% CI 1.48–28.40,p = 0.04), presence of patient’s neurobehavioural disturbances (OR 4.48, 95% CI 1.60–12.55,p = 0.004) and cognitive dysfunctions (OR 31.72, 95% CI 10.27–97.96,p < 0.001) were significant predictors of caregiver’s strain. Conclusion:Caregivers with lower monthly income and caring for TBI patients with cognitive and neurobehavioural disturbances are at higher risk of developing strain. Rehabilitation interventions post-discharge should aim at supporting the caregivers at risk.Implications for RehabilitationInformal caregivers of patients with traumatic brain injury who are not satisfied with their lives are most likely experiencing strain.Caregivers in Malaysia who are at high risk of experiencing strain are those with lower monthly income and care for patients with significant cognitive and neurobehavioural disturbances.Efforts to reduce strain in caregivers at risk should be included in the post-discharge rehabilitation programme in Malaysia. [ABSTRACT FROM PUBLISHER]

Purpose:We investigated whether active video gaming (AVG) could bring about regular, enjoyable, physical exercise in children treated for brain tumours, what level of physical activity could be reached and if the children’s physical functioning improved. Methods:Thirteen children, aged 7–17 years, were randomised to either AVG or waiting-list. After 10–12 weeks they crossed-over. Weekly Internet coaching sessions were used to sustain motivation and evaluate enjoyment. Energy expenditure (EE) levels were measured as Metabolic Equivalent of Task (MET), using a multisensory activity monitor. Single-blinded assessments of physical functioning were done, using the Bruininks–Osteretsky Test of Motor Performance, second edition, evaluating participants before and after the intervention period, as well as comparing the randomisation groups after the first period. Results:All patients completed the study. AVG sessions (mean duration 47 minutes) were performed on 72% of all days. Mean EE level during AVG sessions was 3.0 MET, corresponding to moderate physical activity. The Body Coordination score improved by 15% (p = 0.021) over the intervention period. Conclusions:In this group of childhood brain tumour survivors, home-based AVG, supported by a coach, was a feasible, enjoyable and moderately intense form of exercise that improved Body Coordination.Implications for RehabilitationChildhood brain tumour survivors frequently have cognitive problems, inferior physical functioning and are less physically active compared to their healthy peers.Active video gaming (AVG), supported by Internet coaching, is a feasible home-based intervention in children treated for brain tumours, promoting enjoyable, regular physical exercise of moderate intensity.In this pilot study, AVG with Nintendo Wii improved Body Coordination. [ABSTRACT FROM AUTHOR]

Purpose:To describe clinical features, issues related to school life and health-related quality of life (HRQOL) for children with congenital limb deficiency (CLD) and compare these children to Norwegian school children on HRQOL. Method:Cross-sectional study. In 2010, a postal questionnaire, designed for this study and the Paediatric Quality of Life Inventory (PedsQL), was sent to 154 eligible parents of children with CLD, aged 6–18 years and registered at TRS National Resource Centre for Rare Disorders in Norway. Results:Response rate 44% (n = 67), median age 11 years, 42% were girls. Of the total group, 46 had unilateral upper limb deficiency (UULD) and 21 had multiple/lower limb deficiency (MLD/LLD). The most common UULD was below-elbow deficiency, of these, 65% used grip-improving devices, and 35% used prostheses. Children with UULD-reported PedsQL score similar to Norwegian schoolchildren (NSC). The MLD/LLD group was heterogeneous; most had below-elbow/knee deficiency. In this group, PedsQL scores were reduced for physical and social functioning compared with NSC. Compared with children with UULD, more children with MLD/LLD were restricted in participation because of pain and fewer participated in physical education with peers. Conclusions:Most children with CLD participated with their peers and managed well in everyday life. Children with MLD/LLD seemed to have more challenges than children with UULD. Approximately one-third of all the children had assistive devices and/or practical assistance in school.Implications for RehabilitationMost children with upper-limb deficiency (UULD) in Norway manage well in everyday life and have HRQOL equal to other Norwegian children. Many choose grip-improving devices instead of prostheses. Their preferences should be respected and taken into account as the need for new assistive devices arise.For children with pronounced disabilities, access to, and use of, assistive devices, adaptions and practical assistance may be important for participation. Cooperation with the child and the parents is necessary to find useful measures.Physical education and practical subjects may provide special challenges, both for children and their teachers. Children themselves often find good solutions and the tasks should be planned ahead in cooperation with them. [ABSTRACT FROM AUTHOR]

Purpose: To classify the self-identified goals of individuals post-stroke with chronic upper extremity (UE) paresis, and determine if age, UE functional capacity and pre-stroke hand dominance influence overall goal selection.Method: Sixty-five subjects participated. Using the Canadian Occupational Performance Measure (COPM) to establish treatment goals, the top five goals were categorized using the Occupational Therapy Practice Framework into five categories: activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure, work and general UE movement. A Chi-square analysis determined if age, UE functional capacity (measured by the Action Research Arm Test) and UE hand dominance influenced individual goal selection.Results: The majority of goals were in the ADL (37%) and IADL (40%) categories. A small percentage (12%) was related to general UE movement. Individuals with moderate UE functional capacity identified more ADL goals than those with higher UE functional capacity. There was not a difference between age and UE dominance across all five goal areas.Conclusions: Individuals with chronic UE paresis had specific goals that were not influenced by age or hand dominance, but partially influenced by severity. General UE movement goals were identified less than goals related to specific activities.Implications for RehabilitationConsidering the specificity of individual goals following stroke, it is recommended that clinicians regularly utilize a goal setting tool to help establish client goals.It is recommended that clinicians further inquire about general goals in order to link upper extremity deficits to functional activity limitations.Age, upper extremity functional capacity and hand dominance have little influence on the rehabilitation goals for individuals with chronic paresis after stroke. [ABSTRACT FROM PUBLISHER]

Purpose: The objective of this study was to generate expert consensus on best evaluative practices for community-based rehabilitation (CBR). This consensus includes key features of the evaluation process and methods, and discussion of whether a shared framework should be used to report findings and, if so, which framework should play this role.Method: A Delphi study with two predefined rounds was conducted. Experts in CBR from a wide range of geographical areas and disciplinary backgrounds were recruited to complete the questionnaires. Both quantitative and qualitative analyses were performed to generate the recommendations for best practices in CBR evaluation.Results: A panel of 42 experts reached consensus on 13 recommendations for best evaluative practices in CBR. In regard to the critical qualities of sound CBR evaluation processes, panellists emphasized that these processes should be inclusive, participatory, empowering and respectful of local cultures and languages. The group agreed that evaluators should consider the use of mixed methods and participatory tools, and should combine indicators from a universal list of CBR indicators with locally generated ones. The group also agreed that a common framework should guide CBR evaluations, and that this framework should be a flexible combination between the CBR Matrix and the CBR Principles.Conclusions: An expert panel reached consensus on key features of best evaluative practices in CBR. Knowledge transfer initiatives are now required to develop guidelines, tools and training opportunities to facilitate CBR program evaluations.Implications for RehabilitationCBR evaluation processes should strive to be inclusive, participatory, empowering and respectful of local cultures and languages.CBR evaluators should strongly consider using mixed methods, participatory tools, a combination of indicators generated with the local community and with others from a bank of CBR indicators.CBR evaluations should be situated within a shared, but flexible, framework. This shared framework could combine the CBR Matrix and the CBR Principles. [ABSTRACT FROM PUBLISHER]

Purpose: To describe an adult population with congenital limb deficiency (CLD) recruited through the National Resource Centre for Rare Disorders (TRS) in Norway: (1) demographic factors, (2) clinical features, (3) pain and (4) use of health care and welfare services.Methods: Cross-sectional study. In 2012, a postal questionnaire was sent to 186 eligible persons with CLD, age 20 years and older.Results: Ninety-seven respondents, median-age 39 years (range: 20–82); 71% were women. The population was divided into two subgroups: (1) unilateral upper-limb deficiency (UULD)n = 77, (2) multiple and/or lower-limb deficiency (MLD/LLD). About 40% worked full-time, 18% received disability pensions and 64% reported chronic pain, mostly bilateral pain. Grip-improving devices were used more often than prostheses; 23% were previous prosthesis users. Use of health care and welfare services are described. No significant differences were found between the subgroups regarding pain or employment status.Conclusions: Persons with CLD reported increased prevalence of chronic pain, mostly bilateral, and increased prevalence of early retirement. A greater focus on the benefits of the use of assistive devices, the consequences of overuse and vocational guidance may moderate pain and prevent early retirement. Further studies of more representative samples should be conducted to confirm our findings.Implications for RehabilitationMost adults with congenital limb deficiency (CLD) live ordinary lives and experience normal life events. However, several report chronic pain and retire before normal retirement age.In spite of free and accessible prosthetic services, a large fraction chooses not to use prosthesis, more use grip-improving devices for specific activities. These preferences should be acknowledged by rehabilitation specialists.Focus on individually adapted environments, more information about the consequences of overuse, and vocational guidance may moderate pain and prevent early retirement. [ABSTRACT FROM AUTHOR]

Purpose: Personality disorders (PDs) are associated with significant distress, disability, and cause great difficulties in life. PDs have been suggested to influence adaptation after major burns, but the potential relationship has not been fully elucidated. This study aimed to describe the prevalence of PDs in 107 patients with major burn injury, and to identify the impact of PDs on perceived patient outcome assessed as health-related quality of life (HRQoL) one year after burn. Methods: One burn-specific instrument (Burn Specific Health Scale-Brief (BSHS-B)) and two generic instruments (EuroQol Five Dimensions and Short Form 36 Health Survey) were used, and Psychiatric Axis I and II disorders were assessed one year post burn. Results: This study identified an above normal prevalence of PDs among individuals afflicted by burn, and participants with PD had a significantly larger lifetime burden of Axis I disorders compared to participants without PD. Participants with PDs scored significantly lower than those without PD in the BSHS-B domain Skin involvement, and the effect of having a PD was related to the subscale Treatment regimens. There was no relationship between the presence of PD and generic HRQoL. Conclusions: An implication of these observations is that special rehabilitation efforts including more tailored interventions must be offered to these patients to ensure that the obstacles they perceive to caring for themselves in this respect are eliminated. [ABSTRACT FROM AUTHOR]

Purpose: Clinicians' actions impact the patient care process and pathway. This study identified clinicians' actions associated with successful care processes in one community healthcare setting, children's occupational therapy. Method: A secondary analysis in a form of a quantitative content analysis was conducted of 47 interview transcripts, describing outcomes and therapists' (n = 25) self-reported actions in 25 'successful' and 22 'unsuccessful' care processes. The successful processes were those with positive outcomes (clear and coherent process with easy discharge; achieved patient goals and positive patient-clinician relationships). The transcripts were coded for presence of therapists' actions and non-actions using content analysis; and actions associated with success of the process were identified by Pearson Chi-square test. Results: In total 207 actions were identified. These clustered around six areas: assessment, setting goals and planning actions, treatment, review, discharging, and managing processes and relationships. The key actions associated with successful processes were: gather perspectives from others at assessment (χ2 = 6.65, p < 0.01); identify therapy goals (13.16, p < 0.01); agree/communicate plans, roles and responsibilities (9.10, p < 0.01); involve the child and parents in treatment (6.36, p = 0.01); adapt physical environment (6.01, p = 0.01) and make comparisons between the baseline, current and target levels when reviewing progress (6.36, p = 0.01). Conclusions: The actions identified are congruent with literatures about patient involvement and goal achievement. Specific hypotheses about the mechanisms by which the identified actions may relate to care process are presented. [ABSTRACT FROM AUTHOR]