Innovative Design and Development of Personalized Ankle-Foot Orthoses for Survivors of Stroke With Equinovarus Foot: Protocol for a Feasibility and Comparative Trial.

BACKGROUND: Ankle-foot orthoses (AFOs) are vital in gait rehabilitation for patients with stroke. However, many conventional AFO designs may not offer the required precision for optimized patient outcomes. With the advent of 3D scanning and printing technology, there is potential for more individualized AFO solutions, aiming to enhance the rehabilitative process. OBJECTIVE: This nonrandomized trial seeks to introduce and validate a novel system for AFO design tailored to patients with stroke. By leveraging the capabilities of 3D scanning and bespoke software solutions, the aim is to produce orthoses that might surpass conventional designs in terms of biomechanical effectiveness and patient satisfaction. METHODS: A distinctive 3D scanner, complemented by specialized software, will be developed to accurately capture the biomechanical data of leg movements during gait in patients with stroke. The acquired data will subsequently guide the creation of patient-specific AFO designs. These personalized orthoses will be provided to participants, and their efficacy will be compared with traditional AFO models. The qualitative dimensions of this experience will be evaluated using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST) assessment tool. Feedback from health care professionals and the participants will be considered throughout the trial to ensure a rounded understanding of the system's implications. RESULTS: Spatial-temporal parameters will be statistically compared using paired t tests to determine significant differences between walking with the personalized orthosis, the existing orthosis, and barefoot conditions. Significant differences will be identified based on P values, with P<.05 indicating statistical significance. The Statistical Parametric Mapping method will be applied to graphically compare kinematic and kinetic data across the entire gait cycle. QUEST responses will undergo statistical analysis to evaluate patient satisfaction, with scores ranging from 1 (not satisfied) to 5 (very satisfied). Satisfaction scores will be presented as mean and SD values. Significant variations in satisfaction levels between the personalized and existing orthosis will be assessed using a Wilcoxon signed rank test. The anticipation is that the AFOs crafted through this innovative system will either match or outperform existing orthoses in use, with higher patient satisfaction rates. CONCLUSIONS: Embracing the synergy of technology and biomechanics may hold the key to revolutionizing orthotic design, with the potential to set new standards in patient-centered orthotic solutions. However, as with all innovations, a balanced approach, considering both the technological possibilities and individual patient needs, will be paramount to achieving optimal outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52365.

Lessons learned from investigating patients' and physiotherapists' perspectives on the design of a telerehabilitation platform.

PURPOSE: Home self-rehabilitation exercises for musculoskeletal conditions are a valuable complement to rehabilitation plans. Telerehabilitation systems using artificial intelligence can provide reliable solutions and empower patients by providing them with guidance and motivating them to engage in rehabilitation plans and activities. This study aims to understand the patient's and physiotherapist's perspective on the requirements of effective face-to-face physiotherapy sessions to inspire the design of a telerehabilitation platform to be used in home settings. METHODS: The authors used an ethnography-informed approach through observation and semi-structured interviews with patients (n = 13) and physiotherapists (n = 10) in two outpatient rehabilitation clinics. The AEIOU framework was used to structure and analyse the observation. Thematic analysis was used to code and analyse the data collected from the observations and the interviews. RESULTS: Patients' and physiotherapists' perspectives emphasise the need for exercise instruction clarity, evolution monitoring, and feedback. In the absence of the physiotherapist, in home settings, patients feel insecure and fear execution difficulties and limited exercise instructions, while physiotherapists struggle with controlling patients' home exercise performance. Telerehabilitation is seen as an opportunity to move further into home self-rehabilitation programs. CONCLUSIONS: Besides home exercise monitoring and guidance, telerehabilitation platforms must allow personalization and effective communication between patients and physiotherapists.

This work makes three important contributions, in which it extends existing research:Presents insights into the requirements of effective remote physiotherapy sessions;Highlights the challenges and concerns of patients and physiotherapists regarding telerehabilitation;Provides guidance for developing telerehabilitation platforms.

Chronic stroke survivors' perspective on the use of serious games to motivate upper limb rehabilitation - a qualitative study.

Upper limb paresis occurs quite commonly after stroke and may result in the affected limb's disuse or learned non-use. As a result, its cortical representation may be suppressed, further inhibiting its spontaneous utilization, resulting in motor function deterioration, increase in spasticity, joint stiffness and pain.The aim of this work was to involve stroke survivors in a qualitative study within a user centred design process to better understand the perspectives of stroke survivors on virtual reality - based serious games (SG) for upper limb rehabilitation during the chronic phase and use those insights to design a VR-based serious games which promotes activation of the affected cortical area.A qualitative research method was performed using a multi professional focus group discussion, including a representative group of stroke survivors.With the insights of this work, the authors initiated the design of a VR-based SG prototype for upper limb rehabilitation with two modes, one version to be played with any arm to pick a virtual hammer and hit targeted objects, and other version, a mirror version based on mirror therapy.

Immersive virtual reality for upper limb rehabilitation: comparing hand and controller interaction.

Virtual reality shows great potential as an alternative to traditional therapies for motor rehabilitation given its ability to immerse the user in engaging scenarios that abstract them from medical facilities and tedious rehabilitation exercises. This paper presents a virtual reality application that includes three serious games and that was developed for motor rehabilitation. It uses a standalone headset and the user's hands without the need for any controller for interaction. Interacting with an immersive virtual reality environment using only natural hand gestures involves an interaction that is similar to that of real life, which would be especially desirable for patients with motor problems. A study involving 28 participants (4 with motor problems) was carried out to compare two types of interaction (hands vs. controllers). All of the participants completed the exercises. No significant differences were found in the number of attempts necessary to complete the games using the two types of interaction. The group that used controllers required less time to complete the exercise. The performance outcomes were independent of the gender and age of the participants. The subjective assessment of the participants with motor problems was not significantly different from the rest of the participants. With regard to the interaction type, the participants mostly preferred the interaction using their hands (78.5%). All four participants with motor problems preferred the hand interaction. These results suggest that the interaction with the user's hands together with standalone headsets could improve motivation, be well accepted by motor rehabilitation patients, and help to complete exercise therapy at home.

Oral condition as a predictor of risk for malnutrition during hospitalization: A cross-sectional study.

BACKGROUND: Malnutrition and poor oral health are common conditions in patients in the hospital. Both conditions are associated with poor systemic health. The present study aimed to assess the relationship between the oral condition and the nutrition status of individuals admitted to a large tertiary hospital. METHODS: This cross-sectional study evaluated 364 patients who received a comprehensive dental examination at their hospital bed. An examiner recorded visible plaque index, gingival bleeding index, plaque retentive factors, probing depth, clinical attachment loss, bleeding on probing, number of existing teeth, and prosthesis use. Medical status was assessed by the Charlson Comorbidity Index. The nutrition status was evaluated by the Subjective Global Assessment. Crude and adjusted prevalence ratios were estimated by Poisson regression analysis with robust variance. RESULTS: Patients with moderate to severe malnutrition presented worse oral hygiene (55.83 ± 25.16 vs 64.90 ± 24.28; P < 0.001), more gingival inflammation (24.31 ± 24.13 vs 33.43 ± 27.36; P < 0.001), higher levels of attachment loss (4.22 ± 1.81 vs 4.80 ± 1.83; P < 0.001), and a lower mean number of teeth (14.58 ± 7.45 vs 10.94 ± 6.85; P < 0.001) than patients without malnutrition. In the multivariable analysis, the number of teeth and higher comorbidity index were associated with malnutrition. CONCLUSIONS: Poor oral health and medical condition were associated with malnutrition in this single-institution study, and oral condition may be considered an indicator of malnutrition in patients in the hospital. The implications of this study include the need to raise awareness among health professionals of the importance of oral health and nutrition status in adults.

Telehealth Opportunities in the COVID-19 Pandemic Early Days: What Happened, Did Not Happen, Should Have Happened, and Must Happen in the Near Future?

The objective of this communication is to offer a better understanding of the value of telemedicine in health care, particularly its role in creating opportunities for continuity of care to patients in a complex and novel setting as were the circumstances of the early COVID-19 pandemic times. Crisis time is also a time for opportunities. With regard to telehealth, all players (providers, staff, and patients) should be informed about its benefits and should also become familiar with the use of the various telehealth options and this will only be achieved through large information campaigns necessary enriched by local teaching and training programs in both public and private institutions. The final aim is to launch the debate and foster ideas useful throughout the pandemic. This article covers the experiences of physicians as well as health professionals in the Iberian Peninsula (Spain and Portugal), to provide a clearer idea of what has happened and how we can improve it with the possibilities provided by telemedicine, while at the same time to put in evidence that public health systems need to be rethought to provide solutions to situations such as that we are experiencing.

Serious Games for Stroke Telerehabilitation of Upper Limb - A Review for Future Research.

Maintaining appropriate home rehabilitation programs after stroke, with proper adherence and remote monitoring is a challenging task. Virtual reality (VR) - based serious games could be a strategy used in telerehabilitation (TR) to engage patients in an enjoyable and therapeutic approach. The aim of this review was to analyze the background and quality of clinical research on this matter to guide future research. The review was based on research material obtained from PubMed and Cochrane up to April 2020 using the PRISMA approach. The use of VR serious games has shown evidence of efficacy on upper limb TR after stroke, but the evidence strength is still low due to a limited number of randomized controlled trials (RCT), a small number of participants involved, and heterogeneous samples. Although this is a promising strategy to complement conventional rehabilitation, further investigation is needed to strengthen the evidence of effectiveness and support the dissemination of the developed solutions.

Using Virtual Reality to Increase Motivation in Poststroke Rehabilitation.

Virtual reality (VR) applications meet fundamental principles of rehabilitation: intensity, task oriented training, biofeedback, environments rich in stimuli, and motivation, all pivotal factors for the success of rehabilitation programs. This paper describes the development process of a set of VR minigames developed to increase the motivation of stroke patients while performing repetitive upper limb movements.

An Exploratory Study on the use of Virtual Reality in Balance Rehabilitation.

Studies have shown the potential of Virtual Reality and motion tracking devices in physical rehabilitation. This paper addresses the topic of using non-immersive Virtual Reality therapeutic games with motion tracking in physical rehabilitation and describes an exploratory study performed in collaboration with a national public Rehabilitation Center about their use to motivate patients to perform exercises relevant for balance rehabilitation. The work involved developing and adapting mini-games to track patients posture; tests with patients recovering from Spinal Cord Injury suggest that this type of games can be helpful in the recovery process namely in patients' motivation for performing the therapeutic gestures.

STROKE34 Study Protocol: A Randomized Controlled Phase IIa Trial of Intra-Arterial CD34+ Cells in Acute Ischemic Stroke.

RATIONALE/AIM: Despite the increasing efficacy of recanalization therapies for acute ischemic stroke, a large number of patients are left with long-term functional impairment, devoid of efficacious treatments. CD34+ cells comprise a subset of bone marrow-derived mononuclear cells with the capacity to promote angiogenesis in ischemic lesions and have shown promising results in observational and in vitro studies. In this study, we aim to assess the efficacy of an autotransplant of CD34+ cells in acute ischemic stroke. SAMPLE SIZE ESTIMATES: 30 patients will be randomized for a power of 90% and alpha of 0.05 to detect a difference in 3 months infarct volume. METHODS AND DESIGN: We will screen 18-80 years old patients with acute ischemic stroke due to occlusion of a middle cerebral artery (MCA) for randomization. Persistent arterial occlusions, contra-indications to magnetic resonance imaging (MRI), premorbid dependency, or other severe diseases will be excluded. Treatment will involve bone marrow aspiration, selection of CD34+ cells, and their administration intra-arterially in the symptomatic MCA by angiography. Patients will be randomized for treatment at 7 (±2) days, 20 (±5 days) or sham procedure, 10 in each group. STUDY OUTCOMES: The primary outcome will be infarct volume in MRI performed at 3 months. Secondary outcomes will include adverse events and multidimensional functional and neurological measures. DISCUSSION/CONCLUSION: STROKE34 is a PROBE design phase IIa clinical trial to assess the efficacy of intra-arterial administration of CD34+ cells 7 and 20 days after acute ischemic stroke. TRIAL REGISTRATION EU CLINICAL TRIALS REGISTER: 2017-002456-88.

Relationship of nutritional status and oral health in elderly: Systematic review with meta-analysis.

This systematic review aimed to compare the nutritional status and oral health in older adults individuals. Three databases (Medline-Pubmed, Scopus and EMBASE) were searched up to October 28th 2016 for studies that performed the Subjective Global Assessment (SGA) or the Mini Nutritional Assessment (MNA) and an oral examination performed by a dental professional, either dental hygienist or a dentist. Both observational and interventional studies were screened for eligibility. Meta-analyses were performed comparing the malnourished/at risk of malnutrition and the normal nutrition subjects with three oral health parameters (edentulism, use of prosthesis and mean number of present teeth). Twenty-six studies were included in the systematic review, of which 23 were cross-sectional. It was showed that well-nourished subjects had a significantly higher number of pairs of teeth/Functional Teeth Units (FTU) in comparison to individuals with risk of malnutrition or malnutrition. The meta-analyses showed no statistically significant association between edentulism and use of prosthesis, as the pooled Relative Risk were, respectively, 1.072 (95% CI 0.957-1.200, p = 0.230) and 0.874 (95% CI 0.710-1.075, p = 0.202). On the other hand, the pooled Standard Mean Difference of mean number of present teeth were -0.141 (95% CI -0.278 to -0.005, p = 0.042) in subjects with at risk of malnutrition/malnourished. FTU and mean number of teeth present were significantly associated with nutritional status. Furthermore, more longitudinal studies in this field are needed.

Inter-relação da periodontia e outras especialidades odontológicas – revisão deliteratura / Interrelation between Periodontics and others dental specialties – Literature review

A Odontologia vem se desenvolvendo muito nos últimos anos e tem mostrado uma preocupação cada vez maior com a promoção da saúde do paciente, realização de diagnósticos mais corretos, atuação na prevenção e tratamentos mais modernos e efetivos priorizando a saúde e satisfação do paciente e segurança e conhecimento para o profissional. Este estudo, de natureza bibliográfica, tem como objetivo revisar a literatura de forma a elucidar a inter-relação entre a Periodontia e outras especialidades odontológicas, como a Prótese, a Ortodontia e a Dentística. O material empírico teve como base publicações oriundas de livros e artigos produzidos de 1989 a 2011, constou como base de dados o Scielo, LILACS e Bireme, utilizando os seguintes descritores: Dentística, Periodontia e Prótese Dentária. Conclui- se, portanto, que é fundamental a existência de uma parceria concreta e ativa entre as diversas áreas de especialidades odontológicas, em especial, com a Periodontia, já que esta representa a base do tratamento odontológico, por ser o alicerce de sustentação do dente ou do implante dentário

Dentistry has developed in recent years, and has shown an increasing concern with the promotion of health of the patient, performing more accurate diagnosis, prevention and treatment work in the most modern and effective prioritizing health and patient satisfaction and safety and knowledge for the professional. This study, bibliographic in nature, aims toreview the literature in order to elucidate the interrelationship between periodontal and other dental specialties, such as Periodontics, Orthodontics and Dentistry. The empirical material is formed in publications from books and articles produced from 1989 to 2011, as a database comprised the LILACS, BIREME and SciELO, using the following keywords: Dentistry, Periodontics, Dental Prosthesis. We conclude, therefore, it is essential to have a concrete and active partnership between the various areas of dental specialties, in particular, Periodontics, as this represents the basis of dental treatment, to be the bedrock of support of the tooth or dental implant.

Relação direta da doença periodontal com o nascimento de bebês de baixo peso e partos prematuros / Direct relationship between periodontal disease and low birth weight babies and premature births

A doença periodontal crônica é uma patologia infecciosa, desencadeada predominantemente por microrganismos anaeróbios gram negativos que colonizam a região subgengival, podendo disseminar para outras partes do organismo, atingindo níveis sistêmicos. As alterações hormonais, comportamentais, na composição da placa bacteriana e na resposta imunológica que caracterizam a gestação tornam mais propensos o aparecimento e o agravamento da doença periodontal. Nesse período, essa patologia oral pode ser apontada como fator de risco para a ocorrência de parto prematuro e nascimento de bebês de baixo peso. Este trabalho é uma revisão da literatura realizada a partir de artigos coletados em bases de dados Scielo e Bireme, com o objetivo de discutir de forma atual e clara as possíveis relações entre a doença periodontal e a ocorrência de nascimento de bebês de baixo peso e de partos prematuros. A partir dos estudos revisados, foi possível concluir que alguns autores evidenciam claramente a associação entre a doença periodontal e parto pré-termo e/ou bebês de baixo peso, porém, há outros estudos que afirmam não haver ligação direta.

Doença de Behçet / Behçet's disease

A síndrome de Behçet é uma desordem multissistêmica inflamatória crônica caracterizada por uma vasculitede vasos de grande (artéria pulmonar), médio (artérias cerebrais, veias superficiais) e pequeno calibre. Possui distribuição geográfica heterogênea, não sendo rara nos países do Mediterrâneo e no Japão, contrapondo-se à ínfima prevalência no norte da Europa e nas Américas. Não tem predileção por sexo, sendo a idade médio de início em torno de 20 a 35 anos; não se conhece a taxa de incidência anual. A etiologia e a patogenia continuam obscuras. Contudo, estão envolvidos fenômenos imunológicos, demonstrados pela presença de anticorpos contra células endoteliais a e mucosa oral. Dentre os possíveis fatores etiológicos ambientais, cita-se o Streptococcus sanguis, HSV-1, proteína de choque térmico bacteriana de 65kd. Parece haver ainda um componente genético, pois em certas populações há marcante relação entre o HLA-B51 e a doença. Possui características histopatológicas de vasculite, sem especificidade, sendo diagnosticada clínicamente, de acordo com os critérios elaborados pelo Grupo Internacional de Estudos para Síndrome de Behçet. Cursa com manifestações mucocutâneas, com típicas exacerbações e recorrências, além de acometimento do SNC, TGI, musculoesquelético e, sobretudo, ocular. Sintomas inespecíficos, como cansaço, perda de peso e febre baixa, também estão presentes. Devem ser considerados no diagnóstico diferencial: doença de Crohn, Stevens-Johnson, Reiter, pênfigos, líquen plano, mielodisplasias e Aids. No que concerne ao tratamento observam-se dúvidas e desafios, seja pelo curso irregular, ora benigno, ora grave, seja pela polissintomatologia, que requer tratamentos distintos, ou pelo fato de que os muitos esquemas terapêuticos utilizados carecem de indicações precisas; pode-se lançar mão de corticoides tópicos e sistêmicos, imunossupressores, talidomida, metotrexato, colchicina, dentre outros.

Behçet’s disease is a chronic multissistemic inflammatory disorder, characterized by a vasculitides of large (pulmonary artery), medium (cerebral arteries, superficial veins) and small-calibre vases. It has a heterogeneous geographic distribution, not being occasional in Mediterranean countries and in Japan, which is the opposite of the undermost prevalence in North Europe and in the Americas. The illness doesn’t present a sex predilection, and the medium starting age is about 20 to 35 years old, the annual incidence rate is not known. The etiology and pathogeny are still obscure; however, immunologic phenomenons are involved, being demonstrated by the presence of antibodies against endothelial cells and oral mucosa; among the possible etiologic factors, can be mentioned the Streptococcus sanguis, HSV-1 and thermic shock bacterial protein of 65kd. The existence of a genetic component is probable, because there is a marking connection in some populations with HLA-B51 and the disease. Is owns histopathologic characteristics of vasculitides without specification, being clinical diagnose according to the criterions developed by International Studying Group for Behçet’s Disease. The syndrome course presents mucocutaneous manifestation, with typical exacerbations and recurrences, beyond central nervous system, gastrointestinal tract, musculoskeletal and above all, ocular compromising. Inespecific symptoms, as tiredness, weight loss and small fever are also present. Must be considered in the differential diagnose: Crohn disease, Stevens-Johnson, Reiter, pemphigus, plane lichen, mielodisplasias and Aids. Concerning the treatment, doubts and challenges are observed, considering the irregular course of the disease, sometimes benign, and sometimes grave; besides the multiple symptoms, which request distinct treatments, or for the fact that the multiple therapeutic schemes used lacks exact indications, being mostly based in personal self opinions and experiences...

Saúde ocupacional dos professores: revisão da literatura / Occupational health of teachers: literature review

A profissão de docente é uma das que mais emprega trabalhadores no país. É uma classe pouco estudada perante aos seus processos de saúde e doença, o que gerou o presente estudo. Neste trabalho foram avaliadas 22 fontes bibliográficas que demonstraram que os professores são influenciados por diversos componentes em seu ambiente de trabalho no processo do adoecimento, como baixos salários, entre outros. Este grupo de profissionais apresenta acometimento de diferentes órgãos no organismo, como do aparelho neiropsiquico, vocal e músculo-esquelético. Foi observada a urgência de novos estudos para complementar a literatura sobre o assunto.

Avaliação das características sensoriais e físico-químicas de iogurte à base de polpa de caju elaborado artesanalmente / Evaluation of sensorial characteristics and physical chemical in hand-made yogurt caju pulp

Objetiva elaborar e analisar física, química e sensorialmente, um iogurte à base de polpa de caju elaborado artesanalmente, produzido no Laboratório de Análise Sensorial da Universidade do Estado da Bahia, avaliando a preferência entre as 3 formulações e a sua aceitabilidade. Os resultados da análise sensorial evidenciaram que a amostra 684 (amarelo com açúcar) obteve 53,33 por cento da preferência, a amostra 739 (vermelho com açúcar) obteve 36,67 por cento da preferência e a amostra 138 (amarelo com mel) obteve 10 por cento da preferência. Em relação à aceitação, verificou-se que 93,33 por cento dos provadores revelaram boa aceitabilidade e intenção de compra do produto. Quanto aos dados de prognóstico relativos à freqüência de consumo do produto, observou-se que 63,33 por cento dos provadores consumiriam semanalmente, 30 por cento mensalmente e 6,67 por cento não consumiriam esporadicamente. Quanto à composição centesimal foram obtidos os seguintes valores médios: umidade, 83,08 ± 0,06 por cento; proteínas, 2,63 ± 0,12 por cento; lipídios, 2,2 ± 0,01 por cento e resíduo mineral fixo, 0,60 ± 0,02 por cento e carboidratos, 1,55 ± 0,28 por cento. O pH variou de 4,0 a 4,3. Concluiu-se que o iogurte de caju elaborado artesanalmente apresentou atributos sensoriais aceitáveis pelo consumidor e características físico-químicas e nutricionais semelhantes aos produtos similares comercializados em supermercados.