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Purpose: This study utilized virtual focus group discussions to document the facilitators and barriers reported by the parents as part of the tele?rehabilitation service delivery model in India. Methods: This study included 17 participants who were enrolled into the Tele?rehabilitation program (16 mothers, 1 father) and the virtual focus group discussion (V?FGD) were conducted through a WhatsApp video call. Three V?FGDs were conducted involving two moderators and a note taker. The V?FGD, focused at extracting the perceptions of parents pertaining to facilitators, barriers and coping mechanisms to barriers related to the tele?rehabilitation model. Results: Thematic analysis resulted in four themes for barriers that included: family and support, time, parent and care taker, child and place of living related; facilitators reported included: continuous monitoring, accessibility to professional services, provision of resource materials and parental empowerment. Themes “family and support” and “child” were most reported by parents with children >3 years and ?3 years respectively. Finally, the barriers and facilitators were aligned with the chapters and codes of International Classification of Functioning, children and youth version (ICF?CY) environment and personal factors. Conclusion: This V?FGD highlights the importance of parental?centred and structured Tele?rehabilitation among children with CVI in India. The outcome of this study opens avenues for creating effective intervention.
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El COVID19 ha afectado a millones de personas a nivel mundial. Entre los pacientes contagiados que se agravan y requieren de cuidados intensivos avanzados; además de largas estadías de hospitalización, se encuentran quienes tienen obesidad. Debido a la gran prevalencia de personas con obesidad, tanto en países desarrollados como en en vías de desarrollo, y a las distintas secuelas que experimentan debido al efecto directo del virus como al tratamiento que reciben, es necesario comprender la fisiopatología asociada a la severidad del contagio. Otro aspecto importante a considerar es ¿cómo las secuelas del tratamiento en las unidades de pacientes críticos pueden afectar el estado de salud de estas personas? El propósito de esta revisión fue indagar en la literatura sobre la rehabilitación fisica en pacientes con obesidad que han padecido COVID19 con el objetivo de tener una mirada integral que apunte a potenciar los resultados de la rehabilitación durante todo el curso de la enfermedad. Se revisaron antecedentes en bases de datos como Pubmed, la literatura y ante la escasa evidencia sobre el proceso de rehabilitación en las personas con obesidad se realizó una revisión narrativa del paciente con obesidad que enferma de COVID19 y que luego de una hospitalización prolongada debe ser reintegrado a sus actividades habituales. Se enfatiza en la fisiopatología asociada a la inmovilización prolongada de un paciente con comorbilidades previas y se proponen estrategias de rehabilitación basadas en el entrenamiento físico adaptado a su nueva condición de salud.
ABSTRACT COVID19 is a pandemic that has affected all of humanity and is still far from being eradicated, despite efforts to vaccinate the population. Among infected patients whose symptoms worsen and require advanced intensive care; in addition to long hospital stays, there are people with obesity. Due to the high prevalence of people with obesity, both in developed and developing countries, and the different sequelae they experience due to the direct effect of the virus and the treatment they receive, it is necessary to understand the pathophysiology associated with the severity of the contagion, as well as treatment sequelae among intensive care patients with the goal of having a comprehensive view that aims to enhance the results of rehabilitation throughout the course of the disease. Post-discharge sequelae depend on the severity of the disease, previous comorbidities, and length of hospitalization. This review presents a global panorama of obese patients who become ill with COVID19 and who, after a prolonged hospitalization, return to normal daily routines. Emphasis is placed on the pathophysiology associated with prolonged immobilization of a patient with previous comorbidities and on rehabilitation strategies based on physical training adapted to the new health condition.
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Resumen La rehabilitación cardiaca es un tratamiento valioso para pacientes con enfermedades cardiacas establecidas, y en general para personas con riesgo cardiovascular elevado. La prescripción de la rehabilitación cardiaca debe ser progresiva y con metas individualizadas. Tradicionalmente se inicia en entornos hospitalarios luego de eventos cardiovasculares agudos y se continúa de manera ambulatoria en instituciones de menor complejidad. Se realizó una revisión no sistemática de la literatura sobre la evolución de la rehabilitación cardiaca en el tiempo, su relevancia en el cuidado de los pacientes con enfermedad cardiovascular, las diferentes modalidades en la prestación de este servicio con la tendencia a la rehabilitación cardiaca en casa y la telerrehabilitación, y su transformación acelerada durante la pandemia de COVID-19. Es fundamental garantizar la continuidad en el acceso, así como la suficiente participación de los pacientes en programas remodelados de rehabilitación cardiaca, capaces de transgredir hábitos en la prestación del servicio y de superar las barreras que puede representar la situación actual para la entrega de una atención de alta calidad.
Abstract Cardiac rehabilitation is a valuable treatment for patients with established heart disease, and in general, for people with high cardiovascular risk. The prescription of cardiac rehabilitation must be progressive and with individualized goals. Traditionally, it is performed in hospital settings after an acute cardiovascular event and it's continued as outpatient basis in less complex institutions. A non-systematic review of literature was conducted in terms of the evolution of cardiac rehabilitation over time, it's relevance in cardiovascular disease patient's care, different access modalities, including the evolving tendency towards home based cardiac rehabilitation and tele-rehabilitation, as well as its accelerated transformation during the COVID-19 pandemics. It is essential to guarantee continuity of access as well as sufficient participation of patients in restructured cardiac rehabilitation programs, capable of surpassing service delivery habits and overcoming the barriers that the current situation may represent for the delivery of a high-quality care.
Subject(s)
Humans , Cardiac Rehabilitation , COVID-19 , Disease , TelerehabilitationABSTRACT
Resumen La pandemia COVID-19 limitó el acceso de los pacientes post accidente cerebro vascular a los controles de seguimiento médico y a la rehabilitación, por lo cual decidimos incorporar herramientas tecnológicas gratuitas y accesibles para su continuación. Realizamos seguimiento remoto a 32 pacientes dados de alta en los primeros tres meses del período de aislamiento social preventivo obligatorio con el objetivo de continuar controles médicos, rehabilitación física y fonoaudiológica. El 100% adhirió al tratamiento médico y al auto-monitoreo de factores de riesgo; detectamos en forma temprana la interrupción de las terapias de rehabilita ción y mantuvimos la adherencia por medio de tele-rehabilitación. Los 32 pacientes mostraron disponibilidad para seguir con esta modalidad de atención, permitiendo continuar el seguimiento médico y supervisar la rehabilitación con la colaboración de las familias. Es una metodología accesible y de bajo costo que podría ser replicada y utilizada en instituciones de salud que traten enfermedades neurovasculares.
Abstract The COVID-19 pandemic resulted in limited access of post-stroke patients to their usual medical follow-up and rehabilitation. To continue these activities, we adopted a technology that is free and has universal access. We remotely followed 32 patients after discharge from the stroke unit during the mandatory lock-down. This allowed to continue with medical controls, physical therapy and speech pathology treatments. All patients fully complied with medical treatment and self-monitoring of vascular risk factors. Early discontinuation of rehabilitation therapies was identified and immediately compensated with tele-rehabilitation. All expressed their willingness to continue with this treatment modality. This strategy was successful to effectively continue medical follow-up and rehabilitation supervision with the collaboration of families, is an accessible and low-cost technology that could be replicated and used in health institutions that treat neurovascular diseases.
Subject(s)
Humans , Telemedicine , Stroke/prevention & control , Stroke Rehabilitation , COVID-19 , Communicable Disease Control , Secondary Prevention , Pandemics , SARS-CoV-2ABSTRACT
The rapid spread of Coronavirus disease (COVID-19) has led to global pandemic affecting mental and physical well-being of people around the world. Given the highly contagious nature of COVID-19, public authorities in order to restrict the escalation of the virus ordered social lockdown and asked people to self-quarantine at homes if they develop any symptoms. As a result, these new social regulations have changed how individuals live and carry out everyday tasks in the general society. Reduced physical activity during lockdown has enhanced vulnerability to develop infections and non-communicable diseases. While on the other side, due to absence of routine medical surveillance, the condition of people with existing chronic conditions has deteriorated. Re-allocation of health care resources to treat COVID-19 patients put forward unprecedented challenge for the healthcare system in terms of providing medical support to non-infected out-patients. Extended social lockdowns are also causing adverse repercussions for physiotherapy and rehabilitation out-patient services. COVID-19 restrictions have hampered the in-person interaction of therapists and patients for in-person consultations and therapy sessions. Thus, leading to overall delay in the management and recovery of patients, especially those who are at a critical stage of treatment. During these unprecedented times of COVID-19 pandemic, provision of telehealth appeared to be the guiding light to tackle these evolving challenges of public health. Focusing on the out-patients who need close supervision for therapies and counselling, in this piece, “I” am arguing that methods of telemedicine and tele-rehabilitation should be actively adopted in the healthcare services to bridge the gap caused due to COVID-19.
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In order to overcome the defects of the motor function evaluation systems contained in current tele-rehabilitation devices, such as inconvenient, incomplete of measurement position, nonstandard and lacking of humanized design, we designed and developed a tele-rehabilitation gradient motor function self-evaluating system in this paper. Based on Brunnstrom stage, this system which was competitive comparing to manual evaluations, common tele-rehabilitation assessments and similar nonmedical products, realized the quantitative motor assessment for both limbs of stroke patients using the self-developed algorithms. The clinical trials proved that the system was feasible and accurate.
Subject(s)
Humans , Algorithms , Clinical Trials as Topic , Research Design , Stroke , Stroke Rehabilitation , TelerehabilitationABSTRACT
Objective To investigate the effect of home-based motor imagery training on the lower extremity motor function,balance ability and activities of daily living in post-stroke patients. Methods Fifty-six stroke survivors were divided into the control group and the intervention group by random number table method.All the patients got the conventional nursing, rehabilitation booklets and the video tapes which contained physical therapy and occupational therapy. Furthermore, the patients in the intervention group received 6 weeks motor imagery (MI) therapy through an instant messaging client (Tencent QQ), three times a week, 30mins per time. The outcomes were measured before discharge (T0), immediately after the intervention (T1), and 6 weeks (T2) after the intervention using the Fugl-Meyer Motor Assessment Scale (FMA), Berg Balance Scale (BBS), Barthel Index (BI). Results At baseline, the scores of FMA、BBS、BI in the intervention group were (15.12 ± 4.19), (24.50 ± 2.72), (54.04 ± 17.44) points, while in the control group were (14.23 ± 3.67), (23.92 ± 2.82), (49.46 ± 15.09) points. There were no differences on any scale between the two groups at baseline (t=0.810, 0.750, 1.012, P>0.05). At 6 weeks,the scores of FMA, BB, BI in the control group were (14.81 ± 3.50), (29.31 ± 2.43), (50.77 ± 14.47) points, and were significantly lower than (17.38 ± 4.10), (37.38 ± 4.30), (74.62 ± 11.22) pointsin the interventiongroup (t=2.438, 8.326, 6.641, P<0.05 or 0.01). At 12 weeks, the scores of FMA, BB, BI in the control group were (15.54±3.44), (32.35±1.98), (59.08±13.85) points, and were significantly lower than (18.58±4.19), (41.19±3.96), (86.54± 9.88) points in the intervention group (t=2.858, 10.189, 8.233, P<0.01). A main effect of intervention (F=4.158, 63.716, 30.379, P < 0.05) and an interactive effect of time and intervention (F=47.941, 61.029, 29.685, P=0.000) were observed in the model of FMA, BBS, BI using ANOVA of repeated measures. The factors were compared with each other and the difference was statistically significant (P=0.000). Conclusions The home-based MI training can improve the lower extremity motor function, balance ability and activities of daily living in patients with stroke.
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@#Objective To observe the effects of the home tele-rehabilitation guidance on activities of daily living and motor function in patients after cerebral infarction. Methods 101 cases with cerebral infarction at recovery stage were divided into control (n=50) and rehabilitation (n=51) group. The rehabilitation group received home tele-rehabilitation guidance. They were assessed with the Barthel index (BI) and the simplified Fugl-Meyer assessment (FMA) before and 3 month after treatment. Results There is no significant difference in both the BI and FMA between these groups before treatment, and the rehabilitation group improved more after treatment (P<0.05). ConclusionHome tele-rehabilitation guidance can facilitate the recovery of activities of daily living and motor function in cerebral infarction patients.
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@# The article describes the development of an Internet-based tele-rehabilitation system for patients with cognitive deficits,including overall idea,design and structure of the system,role-based authorization of operations for the patients and doctors and the procedures for patients' receiving rehabilitation treatment through the system.It is a new and convenient mode for rehabilitation service delivery to patients with cognitive deficits.Implementation of the Internet-based tele-cognitive rehabilitation system is helpful to the patients who live far from hospitals and have difficulty seeing doctors due to physical impairments,and is helpful to solving the problem with lack of medical staffs specialized in cognitive rehabilitation.Furthermore,it will also profit pushing out the spread and development of cognitive rehabilitation in China.