Technology Utilization in Fall Prevention.

ABSTRACT: Falls, defined as unplanned descents to the floor with or without injury to an individual, remain to be one of the most challenging health conditions. Fall rate is a key quality metric of acute care hospitals, rehabilitation settings, and long-term care facilities. Fall prevention policies with proper implementation have been the focus of surveys by regulatory bodies, including The Joint Commission and the Centers for Medicare and Medicaid Services, for all healthcare settings. Since October 2008, the Centers for Medicare and Medicaid Services has stopped reimbursing hospitals for the costs related to patient falls, shifting the accountability for fall prevention to the healthcare providers. Research shows that almost one-third of falls can be prevented and extensive fall prevention interventions exist. Recently, technology-based applications have been introduced in healthcare to obtain superior patient care outcomes and experience via efficiency, access, and reliability. Several areas in fall prevention deploy technology, including predictive and prescriptive analytics using big data, video monitoring and alarm technology, wearable sensors, exergame and virtual reality, robotics in home environment assessment, and personal coaching. This review discusses an overview of these technology-based applications in various settings, focusing on the outcomes of fall reductions, cost, and other benefits.

Effects of innovative hip-knee-ankle interlimb coordinated robot training on ambulation, cardiopulmonary function, depression, and fall confidence in acute hemiplegia.

BACKGROUND: While Walkbot-assisted locomotor training (WLT) provided ample evidence on balance and gait improvements, the therapeutic effects on cardiopulmonary and psychological elements as well as fall confidence are unknown in stroke survivors. OBJECTIVE: The present study aimed to compare the effects of Walkbot locomotor training (WLT) with conventional locomotor training (CLT) on balance and gait, cardiopulmonary and psychological functions and fall confidence in acute hemiparetic stroke. METHODS: Fourteen patients with acute hemiparetic stroke were randomized into either the WLT (60 min physical therapy + 30 min Walkbot-assisted gait training) or CLT (60 min physical therapy + 30 min gait training) groups, 7 days/week over 2 weeks. Clinical outcomes included the Berg Balance Scale (BBS), Functional Ambulation Category (FAC), heart rate (HR), Borg Rating of Perceived Exertion (BRPE), Beck Depression Inventory-II (BDI-II), and the activities-specific balance confidence (ABC) scale. The analysis of covariance (ANCOVA) was conducted at P < 0.05. RESULTS: ANCOVA showed that WLT showed superior effects, compared to CLT, on FAC, HR, BRPE, BDI-II, and ABC scale (P < 0.05), but not on BBS (P = 0.061). CONCLUSIONS: Our results provide novel, promising clinical evidence that WLT improved balance and gait function as well as cardiopulmonary and psychological functions, and fall confidence in acute stroke survivors who were unable to ambulate independently.

Redefining Pathways into Acute Rehabilitation during the COVID-19 Crisis.

The coronavirus disease 2019 (COVID-19) pandemic has necessitated drastic changes across the spectrum of health care, all of which have occurred with unprecedented rapidity. The need to accommodate change on such a large scale has required ingenuity and decisive thinking. The field of physical medicine and rehabilitation has been faced with many of these challenges. Healthcare practitioners in New York City, the epicenter of the pandemic in the United States, were among the first to encounter many of these challenges. One of the largest lessons included learning how to streamline admissions and transfer process into an acute rehabilitation hospital as part of a concerted effort to make acute care hospital beds available as quickly as possible.

Historical trend toward improved long-term outcome in childhood absence epilepsy.

We retrospectively analyzed published studies to investigate historical trends in outcome of childhood absence epilepsy (CAE). We included patients based on onset of absence seizures in childhood, 3 Hz bilateral spike-wave discharges on EEG, and availability of seizure-free outcome data. The primary endpoint was seizure-freedom off medications by study publication year. We also analyzed relationships between seizure-freedom and 1. treatment medication, and 2. CAE diagnostic criteria. We included 29 studies published 1945-2013, encompassing 2416 patients. Seizure-freedom off medications was higher for studies after 1985 versus before 1975 (82% versus 35%; p < 0.001). Ethosuximide and valproate were used more commonly after 1985, and patients previously treated with ethosuximide or valproate had higher seizure-freedom off medications than those treated only with other medications (64% versus 32%; χ2>10; p < 0.001). Although differences in diagnostic criteria for early vs. later studies did not reach statistical significance, later studies tended to use normal EEG background (p = 0.09) and absence of comorbid disorders (p = 0.09) as criteria more commonly. These findings demonstrate that seizure-freedom off medications has improved in published CAE studies after 1985. Our results are limited due to retrospective analysis. Further work is needed with prospective, controlled trials to establish factors leading to improved long-term prognosis in CAE.

Muscle Overactivity in the Upper Motor Neuron Syndrome: Conceptualizing a Treatment Plan and Establishing Meaningful Goals.

Spasticity is a major physical complication of many neurologic and traumatic conditions of the brain and spine and can lead to muscle contracture, joint stiffness, reduced range of movement, skin breakdown, and pain. The management of spasticity includes a range of pharmacologic and nonpharmacologic interventions, often used in combination to optimize outcomes. However, it is important to identify and prioritize the patient's and clinician's goals, in order to create common attainable goals. These goals should be reviewed and revised at regular intervals.

Pilot study of a robotic protocol to treat shoulder subluxation in patients with chronic stroke.

BACKGROUND: Shoulder subluxation is a frequent complication of motor impairment after stroke, leading to soft tissue damage, stretching of the joint capsule, rotator cuff injury, and in some cases pain, thus limiting use of the affected extremity beyond weakness. In this pilot study, we determined whether robotic treatment of chronic shoulder subluxation can lead to functional improvement and whether any improvement was robust. METHODS: 18 patients with chronic stroke (3.9 ± 2.9 years from acute stroke), completed 6 weeks of robotic training using the linear shoulder robot. Training was performed 3 times per week on alternate days. Each session consisted of 3 sets of 320 repetitions of the affected arm, and the robotic protocol alternated between training vertical arm movements, shoulder flexion and extension, in an anti-gravity plane, and training horizontal arm movements, scapular protraction and retraction, in a gravity eliminated plane. RESULTS: Training with the linear robot improved shoulder stability, motor power, and resulted in improved functional outcomes that were robust 3 months after training. CONCLUSION: In this uncontrolled pilot study, the robotic protocol effectively treated shoulder subluxation in chronic stroke patients. Treatment of subluxation can lead to improved functional use of the affected arm, likely by increasing motor power in the trained muscles.

Management of medical complications.

Medical comorbidities and complications are expected following stroke, traumatic brain injury, and spinal cord injury. The neurorehabilitation physician's role is to manage these comorbidities, prevent complications, and serve as a medical and neurologic resource for the patient, family, and neurorehabilitation team. The most common comorbidities are similar to those found in the general population, namely hypertension, dyslipidemia, diabetes mellitus, and ischemic heart disease. Frequent complications encountered in the neurorehabilitation unit relate to medication side effects, medical comorbidities, and the direct effect of the neurologic injury. They include orthostatic hypotension; syncope or presyncope; cardiac arrhythmia; bowel and bladder dysfunction; seizures; pressure sores; dysphagia-related pneumonia, dehydration, and malnutrition; venous thromboembolism; falls; and sexual dysfunction. This article discusses strategies for managing comorbidities and avoiding complications.

Spatial distribution of long-term potentiation in the surround of visual cortex lesions in vitro.

Focal visual cortex lesions lead to functional changes in the surrounding cortical network, possibly mediated through synaptic long-term potentiation (LTP). Although a post-lesional facilitation of LTP has been observed, nothing is known about the spatial profile of LTP in the normal and focally lesioned visual cortex of rats. We used a 64-multielectrode array to characterise the spread of LTP induced by theta-burst stimulation in layer IV. Measurements were made at comparable distances from the midline in the visual cortex of controls, sham-operated and lesioned animals. In control rats, LTP was elicited in projections to all visual cortex layers. However, we completely failed to observe LTP in sham-operated animals 1-4 days after surgery. At comparable survival times, no LTP could be elicited in the lesion-treated rats in direct vicinity of the border of the injury, while LTP was successfully induced at larger distances from the lesion. The maximal reach of this restored post-lesion LTP was spatially more limited than in controls and equal in all directions, accordingly absolute distance and not maximal length or density of connections seems to rule local lesion-induced functional remodelling.

Leukoencephalopathy in adults: is it adrenoleukodystrophy? A case report and molecular analysis.

Adult onset cerebral X-ALD (AOCALD) is a rare disease, but should be considered an important differential diagnosis in adults presenting with leukencephalopathy. We here report the case of a 40-year-old man with a history of progressive cognitive decline who presented with a first-time seizure. Initial workup included magnetic resonance imaging (MRI) of the brain which showed extensive frontotemporal leukoencephalopathy. A subsequent brain biopsy showed demyelination and perivascular macrophages. Further workup included serum very long chain fatty acid concentration (VLCFA), which was found to be elevated. An MRI of the total spine showed diffuse atrophy, but no intrinsic cord signal changes, and the diagnosis of AOCALD was established. Genomic sequencing revealed a nonsense mutation in exon 8 (2188G-->A, W601X), to our knowledge not reported in context with AOCALD. A family pedigree was obtained, and other family members at risk were identified and underwent genetic counseling. In conclusion, AOCALD is an important differential diagnosis in adults presenting with cognitive decline. While treatment for affected patients is often supportive only, molecular diagnosis serves as a basis for genetic counseling, identification of relatives at risk and timely referral to a treatment program.

Midbrain serotonergic neurons are central pH chemoreceptors.

Serotonergic neurons in the medulla are central respiratory chemoreceptors. Here we show that serotonergic neurons in the midbrain of rats are also highly chemosensitive to small changes in CO2/pH and are closely associated with large penetrating arteries. We propose that midbrain raphé neurons are sensors of blood CO2 that maintain pH homeostasis by inducing arousal, anxiety and changes in cerebrovascular tone in response to respiratory acidosis.