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1.
European Stroke Journal ; 7(1 SUPPL):162-163, 2022.
Article in English | EMBASE | ID: covidwho-1928085

ABSTRACT

Background: In this multicenter, randomized, placebo-controlled trial we study whether Levodopa given in addition to usual rehabilitative therapies is associated with a patient-relevant enhancement of motor recovery after acute stroke. Methods: ESTREL (Enhancement of Stroke REhabilitation with Levodopa) is a multicenter, placebo-controlled randomized superiority trial. Patients with an acute ischemic or hemorrhagic stroke ≤7 days leading to a clinically meaningful hemiparesis in need of in-hospital rehabilitation are enrolled in stroke units and later transferred to experienced neurorehabilitation centers. Participants receive Levodopa 100mg/Carbidopa 25mg three times daily or matching placebo for 5 weeks in addition to standardized rehabilitative therapy. The primary outcome is the Fugl-Meyer- Motor Assessment score 3 months after randomization. We present the characteristics of the first 200 of 610 patients to be enrolled. Results: 13 certified stroke units and 13 neurorehabilitation centers are involved (“stroke-pathway-trial”). The first 200 participants had a median age of 73 [IQR 64-82] years and 43.5 % were female. 169 patients (84.5%) had ischemic stroke. At baseline, the median NIH-Stroke scale score was 8 [5-10]. Successful 3-month assessment was performed in 183 patients (91.5%);11 (5%) died, 5 (2.5%) withdrew from the study and 1 patient missed the clinical 3 months-visit due to the COVID-19 pandemic. Conclusions: The ESTREL study will provide evidence whether the additional use of Levodopa in the rehabilitation process of stroke patients is safe and effective. The ESTREL-study started successfully due to the good cooperation between acute stroke units and rehabilitation centers, as well as the high acceptance rate among patients.

2.
Front Neurol ; 13: 906402, 2022.
Article in English | MEDLINE | ID: covidwho-1924130

ABSTRACT

Background: The COVID-19 disease can affect subjects suffering from myasthenia gravis (MG) and worsen its clinical course, leading to intensive care unit (ICU) admission. Critically ill subjects can develop a neuromuscular complication called ICU-acquired weakness (ICUAW). This disorder has also been detected in ICU subjects with COVID-19, but the association between MG and ICUAW has never been described in critically ill patients. We describe the case and functional outcome of a COVID-19 patient suffering from MG who developed critical illness polyneuropathy (CIP). Case Presentation: A 66-year-old man with a history of hypertension and ocular MG had COVID-19 and required ICU admission. The patient underwent mechanical ventilation and tracheotomy and was treated with remdesivir and corticosteroids. Fifteen days after admission, he complained of tetraparesis without the ocular involvement that remained unchanged despite the increase in anticholinesterase therapy. The length of stay (LOS) in ICU was 35 days. On day 2 of admission, the patient underwent a frontal muscle jitter study that confirmed the MG, and electroneurography (ENG) and electromyography (EMG) that showed overlapping ICUAW with electrophysiological signs characteristic of CIP. The cerebrospinal fluid (CSF) showed normal pressure, cell count, and protein levels (<45 mg/dl) without albumin-cytologic disassociation. The CSF/serum glucose ratio was normal. The CSF culture for possible organisms, laboratory tests for autoimmune disorders, the panel of antiganglioside antibodies, and the paraneoplastic syndrome were negative. Strength and functional outcomes were tested with the MRC scale, the DRS, Barthel scale, and the Functional Independence Measure (FIM) at admission, discharge, and follow-up. Muscular strength improved progressively, and the MRC scale sum-score was 50 at discharge. Anticholinesterase therapy with pyridostigmine at a dosage of 30 mg 3 times daily, which the patient was taking before COVID-19, was resumed. His motor abilities recovered, and functional evaluations showed full recovery at follow-up. Conclusion: In the described subject, the coexistence of both neuromuscular disorders did not affect the clinical course and recovery, but the question remains about generalization to all patients with MG. The rehabilitation interventions might have facilitated the outcome.

3.
Developmental Medicine and Child Neurology ; 64(SUPPL 3):32-33, 2022.
Article in English | EMBASE | ID: covidwho-1916113

ABSTRACT

Introduction: COVID-19 has placed major demands on healthcare services and practitioners (HCP's). Research has highlighted resilience, new skills and new ways of working. However, little attention has been paid as to whether challenges faced may have demonstrated or influenced effective change in working practices of individuals and teams delivering neurorehabilitation services to children and young people following an acquired brain injury. Patients and Methods: Exploratory qualitative study. Fourteen HCP's (10 female, 4 male) across 6 occupational disciplines participated in semi-structured interviews (February-May 2021). Transcriptions analysed using thematic content analysis managed in NVivo. Five broad topic areas explored (1) professional roles, role identity and professional autonomy, (2) role boundaries, (3) team working, (4) collective identity in relation to organisational challenges, (5) working practices. Results: A wealth of data was retrieved, analysis of findings from three of the key theme categories presented: Individual Professionalism, Working as Team and, Delivery of Rehabilitation services. Although there was much uncertainty, rapidly changing information and constraints imposed by the pandemic, the professionalism of the team was evident as HCP's regrouped and reviewed how service provision could continue. Personal and professional growth saw teams collectively flourish. Creative solutions led to teams working differently and more cohesively. A greater appreciation of team roles and goals within the specialist environment of paediatric rehabilitation emerged. Conclusions: Changes in structure, processes and provision of services necessitated greater interdisciplinary team integration and sharing of skills and expertise. As confidence and competencies of HCP's grew the potential for a more 24/7 approach to rehabilitation gained wide staff acceptance.

4.
Swiss Medical Weekly ; 152(SUPPL 258):31S, 2022.
Article in English | EMBASE | ID: covidwho-1913215

ABSTRACT

We report a 15-year-old boy presenting at our emergency department with acute onset of dysarthria and prior headache, rotary vertigo, nausea, vomiting and gait disturbance for 2 days. 18 days earlier he was tested positive for SARS CoV-19. Physical examination showed pronounced dys-arthria, nystagmus, absent reflexes, dysmetria and ataxia. Laboratory findings showed relative lymphocytosis with a negative C-reactive pro-tein, normal coagulation and elevated liver enzymes (AST, ALT, GGT). Drug screening was negative. First suspicion was postinfectious cerebellitis and he was admitted to IMC for observation. Subsequently, vomiting fre-quency rose, hence cMRI was performed, but showed no abnormalities. Miller-Fisher syndrome was suspected, however CSF examination showed no cytoalbumin dissociation, but discrete mononuclear cell count eleva-tion. Ceftriaxone and acyclovir were administered empirically. In addition, intravenous immunoglobulin and corticosteroids were given to treat viral cerebellitis/encephalitis. Due to suggestive atypical lymphocytes in the blood count, EBV testing was performed and serologies were positive. Multiple CSF viral/bacterial testings (Borrelia burgdorferi, Enterovirus, VZV, HSV 1/2) showed slightly positive EBV (PCR), congruent with blood results. Additionally, SARS-CoV-19 IgG were positive. The patient's condi-tion barely improved, a follow up cMRI showed no changes. Mobilization was fostered with a wheel chair and physical therapy. After two and a half weeks, he was discharged to pediatric neurorehabilitation in order to im-prove dysarthria, ataxia and address neuropsychological abnormalities. Two months after the diagnosis he is walking without aids but still shows trunk ataxia and dysarthria. He is still making constant progress and will hopefully recover completely. Neurological manifestation of EBV infection is extremely rare with the ma-jority of cases described in children. Nevertheless, some neurological manifestations have already been described including encephalitis, cere-bellitis, meningitis, transverse myelitis, and Guillain-Barré syndrome. These manifestations can occur alone or in the setting of infectious mon-onucleosis. In our case a co-infection of SARS-Cov-19 and EBV or a reactivation of EBV due to SARS-Cov-19 is possible as cause of the cerebellitis. Treatment op-tions were fully employed, but the recovery presented a slow course.

5.
Brain Injury ; 36(SUPPL 1):3, 2022.
Article in English | EMBASE | ID: covidwho-1815747

ABSTRACT

Acquired Brain Injury (ABI) consists of any trauma to the brain. While the world has been dealing with the Covid-19 pandemic, the prevalence of ABI is a pandemic of a silent nature which is nonetheless an emerging health burden. Global estimates suggest that traumatic brain injury (injury caused by an external force) affects 10 million people annually (Hyder et al., 2007). In light of Covid-19, those working in the field of Neuro-rehabilitation had to adapt in order to provide vital support and continued rehabilitation for those with ABI. Many services switched to a Tele-Rehabilitation (TR) strategy to allow rehab to continue remotely while maintaining physical distancing. TR has been widely utilized in countries such as the United States, and Australia, and has a strong evidence base for its efficacy. This presentation will use case studies to explore the adaptation of TR by an ABI Neuro-rehabilitation service, and discuss how we can use this time as an opportunity to reconceptualize the way we structure neuro-rehabilitation in Ireland to combat service shortages, and in doing so improve outcomes for our clients.

6.
Brain Injury ; 36(SUPPL 1):100-101, 2022.
Article in English | EMBASE | ID: covidwho-1815745

ABSTRACT

Objective: Early neurorehabilitation improves outcomes in patients with disorders of consciousness after brain injury, but its applicability in COVID-19 is unknown. We demonstrate the feasibility of an early neurorehabilitation protocol for patients with COVID-19-associated disorders of consciousness in the intensive care unit (ICU) and evaluate factors associated with recovery. Methods: Between March 10 and May 20, 2020, we prospectively enrolled 21 ICU patients with delayed recovery of consciousness after severe COVID-19 in a pilot early neurorehabilitation protocol including serial Coma Recovery Scale - Revised (CRS-R) assessments and multimodal treatment. We retrospectively compared clinical features of patients who did and did not achieve a CRS-R total score (TS) ≥8, consistent with minimally conscious state, before discharge. We additionally present preliminary 6-month follow-up data for 8 patients who survived to discharge. Results: Patients underwent CRS-R a median of 6 (interquartile range [IQR] 3-10) times before discharge, beginning a median of 48 days (IQR 40-55) from admission. Twelve (57%) patients achieved at least one CRS-R TS ≥8, after a median of 8 days (IQR 2-14) off continuous sedation;they had lower body mass index (p = 0.009), lower peak serum C-reactive protein (p = 0.023), higher minimum arterial partial pressure of oxygen (p = 0.028) and earlier fentanyl discontinuation (p = 0.018). CRS-R scores fluctuated over time and best CRS-R TS was significantly higher than last CRS-R TS (median 8 [IQR 5- 23] vs 5 [IQR 3-18], p = 0.002). Earlier fentanyl (p = 0.001) and neuromuscular blockade (p = 0.015) discontinuation correlated with higher last CRS-R TS. Six-month follow-up data was obtained for 8 of 12 patients who survived to hospital discharge: of these, one patient (13%) had expired;3 (38%) remained in a disorder of consciousness;one (13%) was conscious but moderately disabled;and 3 (38%) achieved functional independence. Conclusion: It is feasible to provide early neurorehabilitation to patients with impaired consciousness after severe COVID-19 in the ICU. These patients can recover, but hypoxia, systemic inflammation, sedation and neuromuscular blockade may impact CRS-R scores and short-term outcomes. Return to functional independence is possible for some patients. Further research should evaluate factors influencing longer-term neurologic recovery and benefits of early rehabilitation in patients with severe COVID-19.

7.
Brain Injury ; 36(SUPPL 1):1, 2022.
Article in English | EMBASE | ID: covidwho-1815740

ABSTRACT

Objective: A Research Prioritization Exercise (RPE) was conducted to determine research focus for the coming years in an adult neurorehabilitation service. As best practice guidelines in health research highlight that Public and Patient Involvement (PPI) should be a key component, particular emphasis was placed on including the perspectives of clients and family members in the RPE. Design: Due to COVID-19 restrictions, the planned focus groups with clients and family members were altered to telephone and zoom contact and questionnaires were distributed through an online system. Method: Following a literature review and scoping, a research prioritization questionnaire to all stakeholders was designed with input from clients on the content. The results were analyzed with client and family member involvement. Results: The following research priority themes were agreed from 259 responses: 'Effective rehabilitation,' 'Access to services and the rehabilitation pathway,' 'The impact of brain injury' and 'The facts and figures.' Clients and families suggested the themes were interlinked. The involvement of clients throughout the research process, rather than as solely 'research participants,' was highlighted as crucial. Conclusions: The themes now form the core part of our research work for this strategic phase of our service. Our clients and their families are at the center of these priorities. Researchers will have to provide evidence of their PPI plan to our Ethics Committee and we will examine how we can support our clients in this process of being more prominent stakeholders in service research.

8.
Brain Injury ; 36(SUPPL 1):76, 2022.
Article in English | EMBASE | ID: covidwho-1815739

ABSTRACT

Background: Describe the impact of one-year COVID-19 pandemic on subacute rehabilitation of brain injured patients. In this study we propose an analysis of critical points and possible solutions to carry out intensive rehabilitation while preventing the infection spreading. Methods: We delivered an individualized rehabilitation plan that relies on a multidisciplinary and inter-professional teamwork to develop neuromotor, cognitive, occupational and recreational activities. Our facility is based on a 40-beds ward that admits patients from acute care units. During the COVID- 19 outbreak, a deep reorganization of rehabilitative activities was done to prevent the risk of infection. Infection spreading prevention: education of health-care professionals, patients and care givers to the correct use of personal protective equipment;symptomatic surveillance and periodic screening;rearrangement of care pathways and spaces. Redefinition of rehabilitation activities: reduction of the patients' number in the therapeutic setting;redistribution of the treatments throughout the day;introduction of activities in small groups and specific protocols for robotics. In the early phase, music-therapy, pet-therapy, sports activities, in-hospital school, return-to-work projects were temporary interrupted but later restored. Technology-assisted communications: participation of care givers through video-calls to stimulate interaction and reduce isolation;online periodic team meetings for clinical and rehabilitative updating;virtual home visits to prepare discharge. We maintained caregiver direct participation for patients with disorders of consciousness, severe cognitive-behavioral disorders, pediatric patients;we maintained caregivers' training before discharge. Results: From March 2020 to March 2021, we admitted 166 patients (59 females, 107 males;mean age 58,11 years), 104 of which with severe brain injury. Bed occupancy rate was 93,80%;mean length of stay was 63,73 days. Etiology was hemorrhagic in 53, anoxic in 7, traumatic in 38, neoplastic in 11, ischemic in 45, infectious in 8, neuropathic in 4 cases. Delta-FIM (Functional Independence Measure) was 1,42;delta-BI (Barthel Index) was 33,68;delta-DRS (DisabilityRating Scale) was -2,13;delta-RCS -E (Rehabilitation Complexity Scale-Extended) was 6,56. Only five patients and eight health-care professionals resulted COVID-19 positive during this period. Conclusions: Despite COVID-19 pandemic we provided intensive rehabilitation treatment, without reducing the beds and maintaining a COVID-19 free ward. Bed occupancy rate was similar to that of 2019 (92,13%). We had only 13 positive cases over a year. The complexity and intensity of the treatment was maintained. All activities have been guaranteed although with some adjustments. We developed adaptability and a proactive attitude in the continuous search for new solutions. Despite the efforts, COVID-19 pandemic inevitably impacted on the continuum of care and rehabilitation of brain injuries, especially on complex and fragile cases. Future goals could be further personalization of the treatment and implementation of caregiver participation through technology-assisted communication.

9.
Neuroepidemiology ; 56(SUPPL 1):32, 2022.
Article in English | EMBASE | ID: covidwho-1812731

ABSTRACT

The COVID19 pandemic posed unprecedented challenges towards the delivery of neuro-rehabilitation services across the globe. A nation-wide lockdown made the accessibility to neuro-rehab facilities especially difficult for people with disabilities. Since there was not much data available on practices of neuro rehab during the COVID-19 pandemic, a cross sectional observational study was conducted to evaluate the changes in neuro rehabilitation practices in India during this pandemic using an online survey. The pandemic affected the people with disabilities in not merely the physical domains but also social effects, participation restriction and psychological effects and yet majority of both hospital and home-based physiotherapists reported a decrease in referrals and number of therapy sessions provided to the patients. Tele-rehabilitation has emerged as a new model of rehabilitation for delivery of neuro rehabilitation. It offers an alternate way of facilitating communication between the rehab professional and the patient. This includes strategies like low cost virtual reality gaming for rehab in children, mobile based rehab, etc. However, the shift to telerehab provides a tremendous learning opportunity and a huge scope for innovation in improving its accessibility to the community, especially in LMICs. Majority of both Hospital and Home-based Physiotherapists reported a decrease in referrals and number of therapy sessions provided to the patients. Despite evidence on the need for physiotherapy for respiratory care, most respondents did not implement the same. No protocols/guidelines for therapy delivery were implemented or used by our sample of respondents. This paper highlights the needs under three main categories, (1) Development and implementation of suitable clinical-practice-guidelines, clinical-monitoring systems for Neurological Physiotherapy, (2) incorporation of evidence-based respiratory care as part of neurological physiotherapy especially during such pandemics, (3) changes in policies at government and private sectors for inclusion and appropriate implementation of neurophysiotherapy along with public awareness programmes on the need for continued physiotherapy.

10.
Brain Injury ; 36(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1812571

ABSTRACT

The proceedings contain 258 papers. The topics discussed include: spontaneous migration of a falling bullet in the cerebellum reveals the importance of intraoperative skull X-Ray;concussion in women?s flat-track roller Derby;using PPI (public and patient involvement) in neurorehabilitation service research prioritization;emergency preparedness and ensuring the safety of persons with brain injuries;brain injury: voices of a silent epidemic;evaluating a compassion focused therapy group for adults with acquired brain injury;post-covid growth in neuro-rehabilitation services in Ireland - Covid-19 as a potential catalyst for change in the field of neuro-rehabilitation for those with an acquired brain injury?;and prevalence, predictors, and outcomes of traumatic brain injury in young offenders.

11.
NeuroRehabilitation ; 2022 Apr 02.
Article in English | MEDLINE | ID: covidwho-1779913

ABSTRACT

BACKGROUND: The SARS-CoV-2 infection (COVID-19) has generated a threat to global health, determining the need for healthcare for large numbers of people in an extremely short timeOBJECTIVE:To investigate the management changes in the neurorehabilitation services during the COVID-19 pandemic. METHODS: An electronic search was conducted in September 2021 by 2 independent reviewers in the following databases: MEDLINE (PubMed), the Physiotherapy Evidence Database, and the Cochrane Database of Systematic Reviews. All studies on organizational and welfare changes resulting from the COVID-19 pandemic in neurorehabilitation services were included. Screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. RESULTS: The summary of results was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.Electronic searches after the screening of title and abstract identified 80 studies, 13 studies met the inclusion criteria. A narrative summary of results of all included studies were reported in a tabular format. CONCLUSIONS: Different organizational models were adopted in neurorehabilitation during the COVID-19 pandemic impacting the therapies time frame, the physical and mental health of healthcare professionals and the caregiver's workload. There is still uncertainty about the effectiveness of these new therapeutic strategies on the management of neurorehabilitation services and future studies should explore the effect on the patients' needs.

12.
Biological Psychiatry ; 91(9):S27, 2022.
Article in English | EMBASE | ID: covidwho-1777993

ABSTRACT

Drug addiction is on the rise during these COVID-19 times that intensify the factors contributing to relapse and overdose across drugs of abuse and continents. Using a multimodal approach (neuropsychology, fMRI, ERP), human neuroimaging studies in my lab have elucidated core mechanisms underlying drug addiction, with a focus on the role of the dopaminergic mesocorticolimbic circuit, especially the prefrontal cortex, in higher-order cognitive and emotional dysfunction in this population. Our theoretical model is called iRISA (Impaired Response Inhibition and Salience Attribution), postulating that abnormalities in the orbitofrontal cortex and anterior cingulate cortex (and other cortical regions underlying higher order executive function), contribute to the core clinical symptoms in addiction. Specifically, our program of research is guided by the working hypothesis that drug addicted individuals disproportionately attribute salience and value to their drug of choice at the expense of other reinforcing stimuli, with a concomitant decrease in the ability to inhibit maladaptive drug use. Our complex and multifaceted dataset has allowed us to study the impact of abstinence on recovery in these brain-behavior compromises in treatment-seeking addicted individuals, where non-linear relationships exemplify incubation of craving while other trajectories of change, including in white matter tracks and for small subcortical regions (such as the habenula), are also explored. Novel paradigm shifts in the lab include the use of naturalistic and dynamic stimuli for enhanced generalizability and validity, in addition to development of effective neurorehabilitation strategies (including cognitive reappraisal, mindfulness, and transcranial direct current stimulation) in drug addiction. Keywords: Neuroimaging, drug addiction

13.
Balneo and Prm Research Journal ; 13(1):4, 2022.
Article in English | Web of Science | ID: covidwho-1771797

ABSTRACT

The traumatic brain injury remains a current research topic considering the severity and the increased incidence of this pathology. Both physical and neuro-psychological sequelae require a complex rehabilitation program. Material and methods. We describe the evolution of a 20-year-old case, victim of a severe traumatic brain injury due to physical aggression, with spastic tetraplegia, extended ischemia in the left cerebral hemisphere, mixed aphasia, post-traumatic encephalopathy, left eyelid ptosis, right paresis of nerve III, post remitted status of left subdural hematoma, post remitted status of right fronto-parietal subarachnoid hemorrhage, severe joint stiffness (right elbow and fist, bilateral hips and knees), cachexia and SARS-COV-2 infection. In our clinic the patient followed medical, complex kinetotherapeutic treatments and was functionally assessed using the following scales: modified Ashworth, Penn Spasm Frequency Scale (Penn), Life Quality Assessment (QOL), Montreal Cognitive Assessment (MoCA), FAC International Scale, Glasgow Outcome Scale-Extended (GOS-E), modified Rankin scale (mRS). Results. During the hospitalization, the patient presented a favorable late evolution with a great improvement of motor and neurological deficit, aphasia in remision, improvement of eyelid ptosis and joint stiffness, fact also confirmed by the increasing scores from the evaluated scales. Conclusions. Consequently in traumatic brain injury the proper medication, personalized rehabilitation program, ergotherapy, speech therapy, a great deal of involvement and documentation of current information is required to improve the patient's quality of life.

14.
Dissertation Abstracts International: Section B: The Sciences and Engineering ; 83(5-B):No Pagination Specified, 2022.
Article in English | APA PsycInfo | ID: covidwho-1766597

ABSTRACT

Older adults often show declines in subjective and objective memory performance relative to younger adults. One potential path for helping older adults with memory may be compensatory memory training programs. Compensatory memory training programs teach strategies to manage memory impairment. Traditional compensatory memory training programs tend to be highly specific to a task and often do not generalize to other memory tasks. Ecologically Oriented Neurorehabilitation of Memory (EON-Mem) is a method for teaching memory strategies that may generalize for efficient use in everyday contexts. We performed a feasibility study to determine the value of pursuing a group-based version of EON-Mem with older adults in a future larger-scale randomized controlled trial. The current feasibility study took place in two phases with two separate samples. The first sample consisted of five separate groups of healthy young adults (n=39). The second sample consisted of three separate groups of older adults (n=26). We collected data on recruitment, treatment adherence, memory improvement, drop-out rate, cost, time spent, and participant-report data on barriers to successful implementation of EON-Mem treatment. We also collected data on memory performance and overall cognitive functioning. In order to assess improvement before and after treatment within our sample, reliable change indices were calculated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) delayed memory index score. Participants first performed a baseline assessment (traditional and ecological memory tasks, general cognition tasks, emotional functioning, demographics). After the baseline assessment, participants attended one treatment session (90 minutes) per week for a total of seven group-based EON-Mem treatment sessions. Thirty-nine young adults and 26 older adults enrolled in the study;20 young adults and 10 older adults completed the treatment sessions. We prematurely ended older adult group treatment sessions due to the COVID-19 pandemic. All participants performed a post-intervention assessment using alternate versions when available. Attendance rates were low for the young adult sample (51% completed the treatment) and as expected for the older adult sample when accounting for COVID-related changes (77% eligible for completer status prior to cancelling sessions). Twenty percent of each sample reliably improved on the RBANS delayed memory index score before and after treatment. Costs were higher than expected ($345 and 18.6 research hours for each young adult participant;$319 and 16.9 research hours for each older adult participant). Subjectively, both samples reported enjoying the interactions with others and the presentation of the treatment, but disliked peg words. Overall, although a randomized controlled trial of group-format EON-Mem in older adults is feasible, such a study may or may not be cost-effective depending on the resources and goals of the researcher. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

15.
Critical Reviews in Physical and Rehabilitation Medicine ; 33(1):v-vii, 2021.
Article in English | EMBASE | ID: covidwho-1745249
16.
Int J Mol Sci ; 23(6)2022 Mar 13.
Article in English | MEDLINE | ID: covidwho-1745035

ABSTRACT

Cerebrovascular events, notably acute ischemic strokes (AIS), have been reported in the setting of novel coronavirus disease (COVID-19) infection. Commonly regarded as cryptogenic, to date, the etiology is thought to be multifactorial and remains obscure; it is linked either to a direct viral invasion or to an indirect virus-induced prothrombotic state, with or without the presence of conventional cerebrovascular risk factors. In addition, patients are at a greater risk of developing long-term negative sequelae, i.e., long-COVID-related neurological problems, when compared to non-COVID-19 stroke patients. Central to the underlying neurobiology of stroke recovery in the context of COVID-19 infection is reduced angiotensin-converting enzyme 2 (ACE2) expression, which is known to lead to thrombo-inflammation and ACE2/angiotensin-(1-7)/mitochondrial assembly receptor (MasR) (ACE2/Ang-(1-7)/MasR) axis inhibition. Moreover, after AIS, the activated nucleotide-binding oligomerization domain (NOD)-like receptor (NLR) family pyrin domain-containing 3 (NLRP3) inflammasome may heighten the production of numerous proinflammatory cytokines, mediating neuro-glial cell dysfunction, ultimately leading to nerve-cell death. Therefore, potential neuroprotective therapies targeting the molecular mechanisms of the aforementioned mediators may help to inform rehabilitation strategies to improve brain reorganization (i.e., neuro-gliogenesis and synaptogenesis) and secondary prevention among AIS patients with or without COVID-19. Therefore, this narrative review aims to evaluate the mediating role of the ACE2/Ang- (1-7)/MasR axis and NLRP3 inflammasome in COVID-19-mediated AIS, as well as the prospects of these neuroinflammation mediators for brain repair and in secondary prevention strategies against AIS in stroke rehabilitation.


Subject(s)
Angiotensin-Converting Enzyme 2/metabolism , COVID-19/metabolism , Inflammasomes/metabolism , Ischemic Stroke/metabolism , Proteins/metabolism , Angiotensin I/metabolism , COVID-19/complications , COVID-19/virology , Humans , Ischemic Stroke/complications , NLR Family, Pyrin Domain-Containing 3 Protein/metabolism , Peptide Fragments/metabolism , SARS-CoV-2/metabolism , SARS-CoV-2/physiology , Signal Transduction
17.
International Conference on Industrial Instrumentation and Control,ICI2C 2021 ; 815:11-20, 2022.
Article in English | Scopus | ID: covidwho-1718605

ABSTRACT

COVID-19 pandemic adversely challenged the healthcare system in an unprecedented way. Access to neurorehabilitation programme for patients with stroke and other neurological disability was severely restricted including shutting down of most community-based and outpatient facilities. There is hardly any organised virtual programme of exploring any potential of stretching and exercising of muscles needed in a rehabilitation programme. There is an impetus to innovate service developments, while the risks and fear of contracting the coronavirus remain prevalent. We propose a framework for developing a novel tele-neurorehabilitation system that will guide the patients to perform therapeutic exercises, as proposed by the clinicians, remotely. The system will allow patients to directly interact with doctors through a secure audio–video online portal. Wearable motion tracking sensors will be integrated within a hardware-based home setting for gathering performance data live from patients while they are performing exercises. The paper describes the design components of the framework justifying the tools, hardware, and protocols required to implement a secure online portal for tele-neurorehabilitation. Specifications of the core architectural layers have been reported. Some preliminary work demonstrates how the framework specifies capturing and analysing of physiological data using wearable sensors, as well as displaying of gait parameters on a software dashboard. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

18.
Physiotherapy (United Kingdom) ; 114:e190-e191, 2022.
Article in English | EMBASE | ID: covidwho-1700813

ABSTRACT

Keywords: Rehabilitation;Neurosurgery;Tracheostomy Purpose: During the first wave of the COVID pandemic many physiotherapists were redeployed to the acute wards within the Leeds Teaching Hospitals NHS Trust (LTHT). An audit of patients with a tracheostomy within the Neurosurgery Unit was completed in order to evaluate patient outcomes with baseline staffing levels (time period one) compared to a period with enhanced physiotherapy capacity (time period two). Methods: An audit of all patients undergoing active tracheostomy weaning admitted during two 15-week time periods was undertaken (9 patients in each time period). Exclusion criteria: • Patients who passed away • Patients discharged with a tracheostomy in situ Outcome measures: • Number of physiotherapy rehabilitation sessions per week • Number of days the tracheostomy was in situ • Total length of stay (LOS) • Functional status on discharge from the Neurosurgery Unit Results: A 50% increase in physiotherapy staffing (from 14 to 21 whole time equivalent) resulted in a 153% increase in the number of weekly rehabilitation sessions per patient. An increase in rehabilitation frequency in time period two resulted in a mean reduction of 11 tracheostomy days (from insertion to decannulation) and a mean reduction in the total LOS on the Neurosurgery Unit by 22 days. In time period two, 77% of patients were able to mobilise on discharge from the Neurosurgery Unit with 33% requiring hoist for transfers. This can be compared with 33% of patients mobilising on discharge in time period one, with 77% requiring hoist for transfers. Analysis of costings conducted demonstrated significant cost-savings when considering physiotherapy staffing, tracheostomy bed days and reduction in LOS, resulting in an overall cost-saving of £501,404.41. Conclusion(s): With increased physiotherapy staffing and frequency of rehabilitation, the length of time patients had a tracheostomy in situ and LOS both reduced. This resulted in significant cost-savings for the Trust. With increased rehabilitation, a positive impact on patients’ functional status on discharge was also found. Impact: The impact of this audit includes the effect on individual patients, the Neurosurgery Unit and the Physiotherapy service within the Trust. A shorter time with tracheostomy in situ will not only allow patients to access specialist rehabilitation services sooner but also help to reduce complications that can appear with a prolonged tube placement (Quinones-Ossa et al., 2020). In addition, earlier tracheostomy decannulation equates to significant improvements in quality of life, including regaining the ability to talk and independence. The results of this audit demonstrate improved patient outcomes with increased physiotherapy staffing and subsequent increased rehabilitation frequency, alongside significant cost-savings. Results will contribute to the evidence base for the development of a hyper-acute rehabilitation unit within the LTHT Neurosurgery Unit. Future work will analyse the long-term impact including patient outcomes following discharge from the hyper-acute setting. “Neurorehabilitation is one of the most cost-effective interventions available to the NHS” (Bryant, 2018) Funding acknowledgements: Not funded.

19.
Brain Sci ; 12(2)2022 Feb 03.
Article in English | MEDLINE | ID: covidwho-1699372

ABSTRACT

This pilot study aimed to investigate the initial effect of a remotely delivered performance-based client-centered intervention on activity performance and participation among adults in the chronic phase after acquired brain injury (ABI). Sixteen participants living at home with little to no assistance in basic daily activities were allocated into intervention or waitlist control groups. Assessments were conducted at the baseline, after the 3-month intervention/wait period, and at a 3-month follow-up. The primary outcomes were activity performance using the Canadian Occupational Performance Measure (COPM) and the Performance Quality Rating Scale (PQRS) and participation using the Mayo-Portland Adaptability Inventory-4 (MPAI-4). The intervention included weekly videoconferencing sessions using the Cognitive Orientation to Daily Occupational Performance approach (tele-CO-OP). The participants identified five functional goals, of which three were directly addressed. Wilcoxon signed-ranks test results showed no significant improvements in the control group at the end of the 3-month wait period. Pooled data from both groups showed significant improvements in COPM scores for trained and untrained goals following the intervention. Significant improvements were also found in the PQRS and MPAI-4 scores. Improvements were partially maintained at follow-up. Our preliminary results suggest that tele-CO-OP may positively impact the lives of adults after ABI who are coping with long-term disability.

20.
Wellcome Open Res ; 6: 130, 2021.
Article in English | MEDLINE | ID: covidwho-1675247

ABSTRACT

Background: People with neurological dysfunction have been significantly affected by the ongoing coronavirus disease 2019 (COVID-19) crisis in receiving adequate and quality rehabilitation services. There are no clear guidelines or recommendations for rehabilitation providers in dealing with patients with neurological dysfunction during a pandemic situation especially in low- and middle-income countries. The objective of this paper was to develop consensus-based expert recommendations for in-hospital based neurorehabilitation during the COVID-19 pandemic for low- and middle-income countries based on available evidence.  Methods: A group of experts in neurorehabilitation consisting of neurologists, physiotherapists and occupational therapists were identified for the consensus groups. A scoping review was conducted to identify existing evidence and recommendations for neurorehabilitation during COVID-19. Specific statements with level 2b evidence from studies identified were developed. These statements were circulated to 13 experts for consensus. The statements that received ≥80% agreement were grouped in different themes and the recommendations were developed.  Results: 75 statements for expert consensus were generated. 72 statements received consensus from 13 experts. These statements were thematically grouped as recommendations for neurorehabilitation service providers, patients, formal and informal caregivers of affected individuals, rehabilitation service organizations, and administrators.  Conclusions: The development of this consensus statement is of fundamental significance to neurological rehabilitation service providers and people living with neurological disabilities. It is crucial that governments, health systems, clinicians and stakeholders involved in upholding the standard of neurorehabilitation practice in low- and middle-income countries consider conversion of the consensus statement to minimum standard requirements within the context of the pandemic as well as for the future.

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