Rehabilitation practice for external ophthalmoplegia including voluntary training for patients with medial longitudinal fasciculus syndrome.

Watabe T, Suzuki H, Abe M, Uchibori K, Senga K. Rehabilitation practice for external ophthalmoplegia including voluntary training for patients with medial longitudinal fasciculus syndrome. Jpn J Compr Rehabil Sci 2022; 13: 36-40. Introduction: This report presents a case of external ophthalmoplegia caused by medial longitudinal fasciculus (MLF) syndrome. The patient underwent oculomotor rehabilitation by an occupational therapist during hospitalization and voluntary training supervised by the occupational therapist after discharge. Case: The patient presented with MLF syndrome due to bridge infarction. The left eye had a pronounced adduction disorder, and diplopia was observed in the median vision, resulting in severe discomfort in daily life. During the hospitalization, the patient underwent eye movement rehabilitation led by an occupational therapist that included pursuit, fixation, saccades, and convergence, and after discharge from the hospital, the patient underwent two sets of voluntary training for 10 min daily to induce pursuit, fixation, and convergence under the guidance of the occupational therapist. As a result, the angle of squint, degree of diplopia, and degree of inconvenience in daily life improved. Discussion: Eye movement rehabilitation, including voluntary training, improved external ophthalmoplegia.

Effect of an oculomotor rehabilitation program for subacute brain injury patients with ophthalmoplegia: a case-control study.

PURPOSE: Examining the effects of an oculomotor rehabilitation program in subacute brain injury patients presenting with external ophthalmoplegia. METHODS: This case-control study included 33 patients with subacute brain injury accompanied by external ophthalmoplegia (15 cases, 18 controls) from a hospital rehabilitation ward. Participants underwent comprehensive rehabilitation for 8 weeks. The patients participated in an oculomotor rehabilitation program, which involved inducing pursuit, fixation, saccade, and vergence for 20 min daily, 6 days a week for 8 weeks. We assessed improvements in the angle of strabismus; visual function index (VFI), which evaluates inconvenience in daily life; and diplopia after 8 weeks in the two groups using statistical methods. RESULTS: The program resulted in an immediate strabismus angle improvement (p < 0.001). Strabismus angle change over the 8-week period was significantly higher (p < 0.001) in patients (22.9 ± 12.3°) than in control participants (8.3 ± 7.6°). VFI change was significantly greater (p = 0.003) in patients (7.1 ± 5.1 points) than in control participants (2.7 ± 2.4 points). The patients exhibited significantly higher diplopia improvement rates while looking straight ahead and in the direction of paralysis than did control participants (p = 0.021 and p = 0.037, respectively). CONCLUSION: This program improved external ophthalmoplegia without any specialized environmental configurations or personnel, which ensures wide clinical applications.IMPLICATIONS FOR REHABILITATIONOur oculomotor rehabilitation program improved external ophthalmoplegia in subacute brain injury patients.The program promotes pursuit, fixation, saccades, and vergence. The patients lay in the supine position and it places a little burden on them.The program can be completed within 20 min daily, requires no special environmental configurations, and can be performed by anyone.

Association between external ophthalmoplegia with diplopia due to brain injury and FIM motor items: a case-control study.

Watabe T, Abe M, Sako R, Suzuki H, Yoda M, Kawate N. Association between external ophthalmoplegia with diplopia due to brain injury and FIM motor items: a case-control study. Jpn J Compr Rehabil Sci 2021; 12: 58-63. Objectives: This study aimed to determine the association between the presence of external ophthalmoplegia with diplopia due to brain injury and Functional Independence Measure (FIM) motor items in a case-control study. Methods: The subjects were patients with brain injury, admitted to a convalescent rehabilitation ward, who were able to walk under supervision and had preserved intellectual function. The correlation between the strabismus angle of the external ophthalmoplegia group and the total points of FIM motor items were examined. In addition, the total points and sub-items were compared between the external ophthalmoplegia group and control group using statistical processing. Results: There were 78 subjects: 34 in the external ophthalmoplegia group and 44 in the control group. Strabismus angle and the total points of FIM motor items of the external ophthalmoplegia group were significantly negatively correlated. Compared with the control group, the external ophthalmoplegia group had significantly lower levels of independence in bathing, dressing (lower body), toileting, transfer to the chair, transfer to the toilet, transfer to the bathroom, and locomotion (walking). Conclusions: External ophthalmoplegia with diplopia is associated with FIM motor items.

Systematic review of visual rehabilitation interventions for oculomotor deficits in patients with brain injury.

Purpose: Secondary to brain injury, many people develop eye movement disorders (oculomotor deficits). To clarify, optimize, and standardize the development of oculomotor rehabilitation programs, we systematically reviewed the literature on vision rehabilitation interventions for oculomotor deficits in brain injury, focusing on those with broad clinical feasibility.Materials and Methods: We searched MEDLINE (PubMed), CENTRAL, Scopus, and CINAHL databases for key title terms "oculomotor", "rehabilitation", or a related term, and "brain injury" or a related term in the title or abstract. We excluded case reports of a single patient, studies of non-oculomotor visual deficits, and articles in which the intervention and assessment methods were not explicitly identified.Results: Nine articles were included, six of which utilized computer-based training programs to elicit characteristic fixation, saccades, pursuit, vergence, and accommodative movements. Within the entire sample, interventions ranged from 3 to 10 weeks, and involved 2 to 5 training sessions per week.Conclusions: Oculomotor rehabilitation interventions showed some efficacy in treating patients with brain injury; however, there were very few studies overall. Several eye movement types - fixation, saccades, pursuit, vergence, and accommodation - can be elicited manually by therapists. We eagerly await the development and implementation of new intervention programs for broad-based clinical practice.

[Factors associated with physical restraint use in acute care hospitals: A comparison of patient characteristics between patients with and without restraints].

AIM: Physical restraints are defined as limitations on patients' freedom of movement, such as bed/chair belts and/or the use of mittens. Such restraints may be harmful, and the predictors of or factors reducing physical restraint use are unclear. This study investigated the factors determining physical restraint use in patients with stroke admitted to an acute care hospital. METHODS: This retrospective study analyzed patients' data obtained between August 2014 and September 2015. The variables analyzed were age, sex, physical restraint use, operations performed, presence of tubes, stroke severity, psychotropic medication use, disturbance of consciousness, motor paralysis, cognitive status, independence in activities of daily living, and presence of behavioral disorders. Patient characteristics associated with physical restraints were analyzed using the t-test, Fisher's exact test, and a logistic regression analysis. RESULTS: The analysis included 253 patients (179 in the non-restraint group and 74 in the restraint group). The prevalence of physical restraint use was 29.2%. The age, cognitive status, stroke severity, operations performed, presence of tubes, disturbance of consciousness, motor paralysis, independence in the activities of daily living, presence of behavioral disorders, and psychotropic medication use significantly differed between the two groups. A logistic regression analysis showed that the age, cognitive status, stroke severity, and presence of behavioral disorders were risk factors. CONCLUSION: Physical restraint use is more likely in elderly patients and those with cognitive impairment, behavioral disorders, or serious strokes. Physical restraints are also more likely to be applied in patients with cognitive impairment than in those with merely physical impairment.

What did first-year students experience during their interprofessional education? A qualitative analysis of e-portfolios.

Interprofessional collaboration is an essential approach to comprehensive patient care. As previous studies have argued, interprofessional education (IPE) must be integrated in a stepwise, systematic manner in undergraduate health profession education programmes. Given this perspective, first-year IPE is a critical opportunity for building the foundation of interprofessional collaborative practice. This study aims to explore the first-year students' learning processes and the longitudinal changes in their perceptions of learning in a year-long IPE programme. Data were collected at a Japanese medical university, in which different pedagogical approaches are adopted in the IPE programme. Some of these approaches include interprofessional problem-based learning, early exposure, and interactive lecture-based teaching. The students are required to submit written reflections as a formative assessment. This study conducted an inductive thematic analysis of 104 written reflections from a series of e-portfolios of 26 first-year students. The themes related to learning outcomes from student perspectives included communication (e.g., active listening and intelligible explanation), teams and teamwork (e.g., mutual engagement and leadership), roles/responsibilities as a group member (e.g., self-directed learning and information literacy), and roles/responsibilities as a health professional (e.g., understanding of the student's own professional and mutual respect in an interprofessional team). The study also indicated three perspectives of students' learning process at different stages of the IPE, i.e., processes by which students became active and responsible learners, emphasised the enhancement of teamwork, and developed their own interprofessional identities. This study revealed the first-year students' learning processes in the year-long IPE programme and clarified the role of the first-year IPE programme within the overall curriculum. The findings suggest that the students' active participation in the IPE programme facilitated their fundamental understanding of communication/teamwork and identity formation as a health professional in interprofessional collaborative practice.

Beneficial falls in stroke patients: evaluation using a mixed method design.

Purpose To use a mixed method design to evaluate how clinicians judge falls in stroke patients as a beneficial event, and to identify patient-specific characteristics associated with beneficial falls. Methods The definition of beneficial falls was based on interviews with six experienced clinicians in stroke rehabilitation. Interview data were analyzed using the grounded theory approach, with outcomes used to develop a checklist to judge falls as beneficial. We subsequently used the checklist to identify falls sustained by patients in our rehabilitation unit as beneficial events. The characteristics of beneficial fallers were investigated in this retrospective study. Results According to experienced clinicians, beneficial falls result from patient-specific factors and level of independence. Beneficial falls are not associated with after-effects or a diagnosis of cognitive impairment, do not result in physical injury and post-fall syndrome, and do not alter the course of rehabilitation. These falls are considered to enhance patients' self-awareness of their physical status and abilities. Among the 123 stroke patients who experienced a fall in our study group, 23 patients (18.7%) were identified as beneficial fallers according to our checklist. The majority had a left hemiplegia and perceptual impairments, and were at low risk of recurrent falls and made functional gains during rehabilitation. Conclusions Based on our results, we created a 10-item checklist to differentiate beneficial from adverse falls. This differentiation is important to target fall prevention programs to adverse fallers in rehabilitation units.