Exploring attitudes towards use of technology to support stroke survivors living at home: A quantitative and qualitative content analysis study in Spain.

PURPOSE: The aim of this study was to better understand the attitudes towards the use of technology to support chronic stroke survivors in a home-based setting. METHODS: A quantitative study was used on the data obtained from a face to face survey with the sample group, incorporating quantitative statistical analysis. RESULTS: Participants reported positive attitudes towards using technology for their own independent health management. The purpose of the home-based technology was different: source of information, supporting self-management, pharmacological treatment reminders… and differed according to age, educational level and survivor disability. Installing devices and sharing information remains a challenge. CONCLUSIONS: 100% of stroke survivors living in the community with any type of disability, reported that they would like to use technology as a tool to help improve their health status.

Efficacy and Usability of eHealth Technologies in Stroke Survivors for Prevention of a New Stroke and Improvement of Self-Management: Phase III Randomized Control Trial.

BACKGROUND: Stroke is a leading cause of severe and long-term disability in developed countries. Around 15 million people suffer a stroke each year, being most of them ischemic due to modifiable risk factors. Adequate self-management abilities may help to manage the consequences of stroke, but it is unknown which specific intervention could be effective to booster these self-management abilities. OBJECTIVE: To evaluate the improvement of self-management in chronic stroke survivors using decision support and self-management system (STARR). METHODS: A randomized, prospective, parallel group, open, and the unicentric pilot trial will be performed. Stroke survivors and their caregivers will be randomly allocated to STARR management or standard of care. Main inclusion criteria are mild to moderate disabled first stroke adult survivor, living at home, able to cope and follow the guidelines and devices, without socio-familial exclusion. All will get a conventional treatment in the acute and subacute phase; however, in the chronic period, cases will use the developed STARR App and Decision Support System. Measurements will be performed at baseline, at 3 months, and at 6 months. Outcome measures are patient-report outcome measure of self-management competency, physical function, risk factor reduction, healthcare resource utilization, knowledge of the condition, mood, and social isolation. DISCUSSION: If effective, the results of this study will enable stroke patients and their caregivers to deal better with the everyday life obstacles of stroke, improve the adherence of the treatment, improve the control of cardiovascular risk, and, in consequence, reduce the recurrence of secondary strokes, the number of complications, the number of consultations, and readmissions; to ultimately reduce the health systems costs. Taking into consideration that the number of stroke survivors is increasing around the world, a large number of individuals could profit from this intervention.

Stroke and Universal Design.

Universal Design (UD) is usually stated to be "for all ages and abilities". Given that stroke is a major source of disability, it is important that UD recommendations take stroke-specific problems into account. Within the framework of EU project STARR, we have investigated user requirements of stroke survivors. In this project we have used a mix of interviews, focus groups, design workshops and technology tests to come up with a set of design recommendations, which we present as a first step towards universal design recommendations which are inclusive for stroke survivors. Our general recommendations are: make it fun, do not make people fail, empower and encourage. The technology needs to be highly adaptable to different sets of abilities. Safety, but also aesthetics and simplicity is important, but it is pointed out that designs should not be "childish" - this can be felt to be degrading. It is important to be able to see and follow your progress and win small victories often. Consider social applications and activities - being able to connect to others in the same situation can enable discussions and provide peer support. More stroke consequence specific recommendations are to design to allow one-sided use (hemiplegia), avoid sensory and activity overload (fatigue), complement speech with images (aphasia), limit demand on memory, support learning and avoid errors (memory problems), and include multiple modalities in your design (reduced vision or hearing).

Tratamiento de la disfagia y la disglosia tras glosectomía total y reconstrucción con colgajo libre fasciocutáneo anterolateral de muslo: a propósito de un caso / Treatment of dysphagia and dysglossia after total glossectomy and reconstruction with anterolateral thigh fasciocutaneous free flap: a case report

La cirugía oncológica en lesiones extensas de carcinoma lingual obliga a realizar resecciones amplias que precisan reconstrucción con colgajo libre periférico. Los colgajos libres permiten un aspecto físico más semejante al normal, pero debido a la especialización de la lengua, no es fácil restituir su funcionalidad. Ello compromete la dinámica deglutoria en la fase oral y de transporte, además de la comunicación hablada. La terapia logopédica convencional precisa una media de 3-12 meses. Presentamos el caso clínico de un varón de 64 años con carcinoma epidermoide lingual estadio IVA (T4aN0M0) al que se le practicó glosectomía total con mandibulectomía marginal sinfisaria, reconstrucción con colgajo fasciocutáneo libre perforante anterolateral del muslo y vaciamiento ganglionar funcional bilateral. Precisó traqueostomía y sonda nasogástrica para alimentación. Valoramos al octavo día posquirúrgico e iniciamos rehabilitación por disfagia orofaríngea mecánica y disglosia precozmente a pie de cama. Los objetivos fueron: favorecer el sello labial, tragar saliva, manejo de secreciones, decanulación, coordinación neumofónica, inteligibilidad, deglución segura y eficaz, prevenir complicaciones y mejorar la calidad de vida. El paciente era capaz de comunicarse con su entorno directo en la sesión quinta y realizar una ingesta oral con dieta blanda y líquidos espesados en la octava sesión, siendo retirada la sonda nasogástrica y derivado a domicilio el día 20 del postoperatorio. Se concluye que la rehabilitación precoz e individualizada dentro de un equipo multidisciplinar es indispensable para restituir la deglución y el habla, mejorando la calidad de vida del paciente. Además, esta modalidad de actuación reduce los costes sociosanitarios (AU)

Oncological surgery in extensive lingual carcinoma lesions requires wide resection and reconstruction with a peripheral free flap. Free flaps can provide a fairly normal physical appearance but, due to the specialization of the tongue, it is not easy to restore its functionality. This compromises the dynamics of swallowing in the oral and transport phase and spoken communication. Conventional speech-language therapy requires an average of 3-12 months. We present the case of a 64-year-old man with lingual epidermoid carcinoma stage IVA (T4aN0M0) who underwent total glossectomy with marginal mandibulectomy of the symphysis, reconstruction with an anterolateral thigh fasciocutaneous free flap, and bilateral functional lymphadenectomy. The patient required tracheostomy and a nasogastric catheter for feeding. We evaluated the patient on the eighth postsurgical day and initiated rehabilitation of mechanical oropharyngeal dysphagia and dysglossia at the bedside. The objectives were to encourage labial seal, swallowing of saliva, handling of secretions, decannulation, breathing and speaking coordination, speech intelligibility, and safe and effective swallowing and to prevent complications and improve quality of life. The patient was able to communicate with his direct surrounding in the fifth session and was able to make an oral ingestion with a soft diet and thickened liquids in the eighth session. The nasogastric catheter was removed and the patient was sent home on the 20th postoperative day. We conclude that early and individualized speech-language therapy within a multidisciplinary team is indispensable to restore swallowing and speech, improving the patient's quality of life. In addition, this kind of intervention reduces social and healthcare costs (AU)

Primary bone lymphoma: polyostotic disease presenting as a cauda equina syndrome.

We report a patient with B-cell primary bone lymphoma with involvement of multiple vertebrae at presentation and rapid development of cauda equina syndrome. The patient presented subacute low-back pain, initially with good response to corticosteroid treatment.Primary bone lymphoma is a very unusual disease, commonly affecting only 1 vertebra. Despite this, our case involved multiple levels at the onset; furthermore, there were no adenopathies. Because of the information of the magnetic resonance imaging, an open biopsy of the vertebrae was performed for diagnosis. The reported cases of radicular syndromes secondary to a lymphoma as an initial symptom are extremely infrequently reported in the literature, above all for a B-cell lymphoma.