Experiences of pregnant women and healthcare professionals of participating in a digital antenatal CMV education intervention.

OBJECTIVE: The study aimed to explore the perspectives of participating pregnant women and Health Care Professionals (HCPs) towards receiving and providing cytomegalovirus (CMV) education so that barriers and facilitators towards incorporating CMV in routine antenatal care could be better understood. DESIGN: This process evaluation phase employed a qualitative design using individual, semi-structured, face-to-face interviews. SETTING: Recruitment and interviews took place within a large teaching hospital from an ethnically diverse area of South-west London PARTICIPANTS: The study sample included 20 participants: 15 pregnant women, and five HCPs. All participants were involved in a single centre randomized controlled trial of a digital CMV educational intervention in pregnancy. FINDINGS: Pregnant participants expressed a strong desire to receive information about CMV as part of routine antenatal care. Although HCPs were accepting of the need for CMV education, it was evident that they felt unequipped to provide this; reasons included lack of time, uncertainty about clinical pathways and concern about the potential emotive impact of CMV education. Pregnant women suggested that expressing behaviour changes as risk reduction rather than prevention, made the behaviours feel more achievable and realistic. The support of partners was considered a key factor in the successful adoption of behavioural changes by pregnant women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: There is an onus on HCPs to consider how CMV can be included as part of antenatal education, with messaging framed as risk reducing rather than prevention.

Effects of a robot-aided somatosensory training on proprioception and motor function in stroke survivors.

BACKGROUND: Proprioceptive deficits after stroke are associated with poor upper limb function, slower motor recovery, and decreased self-care ability. Improving proprioception should enhance motor control in stroke survivors, but current evidence is inconclusive. Thus, this study examined whether a robot-aided somatosensory-based training requiring increasingly accurate active wrist movements improves proprioceptive acuity as well as motor performance in chronic stroke. METHODS: Twelve adults with chronic stroke completed a 2-day training (age range: 42-74 years; median time-after-stroke: 12 months; median Fugl-Meyer UE: 65). Retention was assessed at Day 5. Grasping the handle of a wrist-robotic exoskeleton, participants trained to roll a virtual ball to a target through continuous wrist adduction/abduction movements. During training vision was occluded, but participants received real-time, vibro-tactile feedback on their forearm about ball position and speed. Primary outcome was the just-noticeable-difference (JND) wrist position sense threshold as a measure of proprioceptive acuity. Secondary outcomes were spatial error in an untrained wrist tracing task and somatosensory-evoked potentials (SEP) as a neural correlate of proprioceptive function. Ten neurologically-intact adults were recruited to serve as non-stroke controls for matched age, gender and hand dominance (age range: 44 to 79 years; 6 women, 4 men). RESULTS: Participants significantly reduced JND thresholds at posttest and retention (Stroke group: pretest: mean: 1.77° [SD: 0.54°] to posttest mean: 1.38° [0.34°]; Control group: 1.50° [0.46°] to posttest mean: 1.45° [SD: 0.54°]; F[2,37] = 4.54, p = 0.017, ηp2 = 0.20) in both groups. A higher pretest JND threshold was associated with a higher threshold reduction at posttest and retention (r = - 0.86, - 0.90, p ≤ 0.001) among the stroke participants. Error in the untrained tracing task was reduced by 22 % at posttest, yielding an effect size of w = 0.13. Stroke participants exhibited significantly reduced P27-N30 peak-to-peak SEP amplitude at pretest (U = 11, p = 0.03) compared to the non-stroke group. SEP measures did not change systematically with training. CONCLUSIONS: This study provides proof-of-concept that non-visual, proprioceptive training can induce fast, measurable improvements in proprioceptive function in chronic stroke survivors. There is encouraging but inconclusive evidence that such somatosensory learning transfers to untrained motor tasks. Trial registration Clinicaltrials.gov; Registration ID: NCT02565407; Date of registration: 01/10/2015; URL: https://clinicaltrials.gov/ct2/show/NCT02565407 .

Laryngeal vibration as a non-invasive neuromodulation therapy for spasmodic dysphonia.

Spasmodic dysphonia (SD) is an incurable focal dystonia of the larynx that impairs speech and communication. Vibro-tactile stimulation (VTS) alters afferent proprioceptive input to sensorimotor cortex that controls speech. This proof-of-concept study examined the effect of laryngeal VTS on speech quality and cortical activity in 13 SD participants who vocalized the vowel /a/ while receiving VTS for 29 minutes. In response to VTS, 9 participants (69%) exhibited a reduction of voice breaks and/or a meaningful increase in smoothed cepstral peak prominence, an acoustic measure of voice/speech quality. Symptom improvements persisted for 20 minutes past VTS. Application of VTS induced a significant suppression of theta band power over the left somatosensory-motor cortex and a significant rise of gamma rhythm over right somatosensory-motor cortex. Such suppression of theta oscillations is observed in patients with cervical dystonia who apply effective sensory tricks, suggesting that VTS in SD may activate a similar neurophysiological mechanism. Results of this feasibility study indicate that laryngeal VTS modulates neuronal synchronization over sensorimotor cortex, which can induce short-term improvements in voice quality. The effects of long-term VTS and its optimal dosage for treating voice symptoms in SD are still unknown and require further systematic study.

A robot-assisted sensorimotor training program can improve proprioception and motor function in stroke survivors.

Proprioceptive deficits are common among stroke survivors and are associated with slower motor recovery, poorer upper limb motor function, and decreased self-care ability. Somatosensory feedback augmenting proprioception should enhance motor control after stroke, but available evidence is inconclusive. This study evaluated the effects of a robot-aided, somatosensory-focused training on proprioceptive acuity and motor performance in individuals with sub-acute and chronic stroke. Twelve stroke survivors completed two training sessions on two consecutive days. During training, participants used a haptic robotic wrist exoskeleton and made continuous, goal-directed wrist ab/adduction movements to a visual target while receiving vibro-tactile feedback. Proprioceptive acuity and active movement errors were assessed before, immediately after, and two days after intervention. Results showed significantly improved proprioceptive acuity at posttest and retention. Motor accuracy measures showed improvements, however these were not statistically significant. This study demonstrates the feasibility of robot-aided somatosensory rehabilitation training in stroke survivors.

Atypical somatosensory-motor cortical response during vowel vocalization in spasmodic dysphonia.

OBJECTIVE: Spasmodic dysphonia (SD) is a debilitating voice/speech disorder without an effective cure. To obtain a better understanding of the underlying cortical neural mechanism of the disease we analyzed electroencephalographic (EEG) signals of people with SD during voice production. METHOD: Ten SD individuals and 10 healthy volunteers produced 50 vowel vocalization epochs of 2500 ms duration. Two EEG features were derived: (1) event-related change in spectral power during vocalization relative to rest, (2) inter-regional spectral coherence. RESULTS: During early vocalization (500-1000 ms) the SD group showed significantly larger alpha band spectral power over the left motor cortex. During late vocalization (1000-2500 ms) SD patients showed a significantly larger gamma band coherence between left somatosensory and premotor cortical areas. CONCLUSIONS: Two atypical patterns of cortical activity characterize the pathophysiology of spasmodic dysphonia during voice production: (1) a reduced movement-related desynchronization of motor cortical networks, (2) an excessively large synchronization between left somatosensory and premotor cortical areas. SIGNIFICANCE: The pathophysiology of SD is characterized by an abnormally high synchronous activity within and across cortical neural networks involved in voice production that is mainly lateralized in the left hemisphere.

Vibration-Damping technology in tennis racquets: Effects on vibration transfer to the arm, muscle fatigue and tennis performance.

High vibration transfer from a tennis racquet to the player may cause discomfort, and is hypothesized to influence performance and the onset of muscle fatigue. This study examined a racquet with a novel vibration damping technology (VDT) designed to mitigate frame vibration. Racquet vibration, post-impact vibration transfer to the player, arm electromyographic activity and tennis performance were compared to a non-VDT racquet. Nineteen young adult, competitive tennis players hit forehands and serves until near exhaustion on two days; using one of the two racquets each day. Tri-axial accelerometers mounted to racquet shaft, hand and forearm recorded vibration behaviour. Surface electromyography recorded activity of five arm muscles. In comparison to the non-VDT racquet, the VDT design showed: 1) A significantly lower mean normalised acceleration signal energy at the racquet during unfatigued play (-40%) and at near exhaustion (-34%), which corresponded to a 20-25% lower signal energy at the hand. 2) Reduced signs of arm muscle fatigue at near exhaustion, which was most pronounced in biceps and wrist extensors. 3) Players hit 11% more forehands and placed 40% more hits in the target area at near exhaustion. Conclusion: VDT effectively reduces racquet vibration. Initial evidence indicates that it may delay muscle fatigue, which was associated with increased ball placement accuracy.

Constituents of effective support for homecare workers providing care to people with dementia at end of life.

OBJECTIVE: The aim of this study was to enhance understanding about homecare workers providing care to people with dementia at end of life by exploring homecare workers' perceptions of challenges and the support they needed and sometimes received. METHODS: Qualitative semi-structured interviews were conducted with 29 homecare workers and 13 homecare managers in England. Framework analysis was used to analyse the data. FINDINGS: Four overarching challenges were identified: working with clients with dementia, including clients' sometimes unpredictable responses, communication difficulties, and mood changes; caring for the dying; conflict with family members; and working alone, which often left homecare workers at risk of exhaustion, fatigue, and a sense of isolation. When their work entailed high levels of emotion, such as a client's death or getting embroiled in a client's family conflict, they felt emotionally drained, under-prepared, and overwhelmed. Supportive elements include receiving encouragement and learning from experienced peers and their feelings being acknowledged by managers at their employing homecare agency. Some workers were offered time off or encouraged to attend the client's funeral as a means of supporting the process of bereavement. CONCLUSIONS: Peer and manager support are essential and effective in coping with work pressures. There is a need to develop models of effective support to alleviate staff's practical, emotional, and interpersonal pressures. However, due to the isolating nature of homecare work, managers may not recognise early signs of their staff finding stress unmanageable and miss the opportunity to mitigate these negative effects.

Development of Proprioceptive Acuity in Typically Developing Children: Normative Data on Forearm Position Sense.

This study mapped the development of proprioception in healthy, typically developing children by objectively measuring forearm position sense acuity. We assessed position sense acuity in a cross-sectional sample of 308 children (5-17 years old; M/F = 127/181) and a reference group of 26 healthy adults (18-25 years old; M/F = 12/14) using a body-scalable bimanual manipulandum that allowed forearm flexion/extension in the horizontal plane. The non-dominant forearm was passively displaced to one of three target positions. Then participants actively matched the target limb position with their dominant forearm. Each of three positions was matched five times. Position error (PE), calculated as the mean difference between the angular positions of the matching and reference arms, measured position sense bias or systematic error. The respective standard deviation of the differences between the match and reference arm angular positions (SDPdiff) indicated position sense precision or random error. The main results are as follows: First, systematic error, measured by PE, did not change significantly from early childhood to late adolescence (Median PE at 90° target: -2.85° in early childhood; -2.28° in adolescence; and 1.30° in adults). Second, response variability as measured by SDPdiff significantly decreased with age (Median SDPdiff at 90° target: 9.66° in early childhood; 5.30° in late adolescence; and 3.97° in adults). The data of this large cross-sectional sample of children document that proprioceptive development in typically developing children is characterized as an age-related improvement in precision, not as a development or change in bias. In other words, it is the reliability of the perceptual response that improves between early childhood and adulthood. This study provides normative data against which position sense acuity in pediatric patient populations can be compared. The underlying neurophysiological processes that could explain the observed proprioceptive development include changes in the tuning of muscle spindles at the spinal level, the maturation of supraspinal somatosensory pathways and the development of interhemispheric callosal connections responsible for the transfer of somatosensory information.

The effectiveness of proprioceptive training for improving motor function: a systematic review.

OBJECTIVE: Numerous reports advocate that training of the proprioceptive sense is a viable behavioral therapy for improving impaired motor function. However, there is little agreement of what constitutes proprioceptive training and how effective it is. We therefore conducted a comprehensive, systematic review of the available literature in order to provide clarity to the notion of training the proprioceptive system. METHODS: Four major scientific databases were searched. The following criteria were subsequently applied: (1) A quantified pre- and post-treatment measure of proprioceptive function. (2) An intervention or training program believed to influence or enhance proprioceptive function. (3) Contained at least one form of treatment or outcome measure that is indicative of somatosensory function. From a total of 1284 articles, 51 studies fulfilled all criteria and were selected for further review. RESULTS: Overall, proprioceptive training resulted in an average improvement of 52% across all outcome measures. Applying muscle vibration above 30 Hz for longer durations (i.e., min vs. s) induced outcome improvements of up to 60%. Joint position and target reaching training consistently enhanced joint position sense (up to 109%) showing an average improvement of 48%. Cortical stroke was the most studied disease entity but no clear evidence indicated that proprioceptive training is differentially beneficial across the reported diseases. CONCLUSIONS: There is converging evidence that proprioceptive training can yield meaningful improvements in somatosensory and sensorimotor function. However, there is a clear need for further work. Those forms of training utilizing both passive and active movements with and without visual feedback tended to be most beneficial. There is also initial evidence suggesting that proprioceptive training induces cortical reorganization, reinforcing the notion that proprioceptive training is a viable method for improving sensorimotor function.

Pilot trial of distributed constraint-induced therapy with trunk restraint to improve poststroke reach to grasp and trunk kinematics.

BACKGROUND: Constraint-induced therapy (CIT) is effective in improving upper extremity motor function, but evidence is lacking about effectiveness grasp and trunk control. OBJECTIVE: This study investigated whether distributed CIT combined with trunk restraint (dCIT + TR) benefited movement kinematics of grasping and the trunk, as well as motor ability of the upper extremity, more than dCIT alone. METHODS: A total of 45 stroke participants received 2 hours of dCIT + TR, dCIT, or the dose-matched control intervention for 3 weeks. Movement kinematics, motor ability, and daily function were the outcome measures. Movement kinematics included grasping, joint range, and trunk movement at various phases of reach-to-grasp tasks. Motor ability and daily function of all participants were evaluated using the Fugl-Meyer Assessment and the Motor Activity Log. RESULTS: Four to 5 participants in each group were not included for kinematic analysis because of their inability to grasp a can. The dCIT + TR group showed better preplanned grasping movement and less trunk motion at the early phase of the reach-to-grasp movements than the dCIT or control groups. Compared with the controls, the dCIT + TR participants showed better motor ability in the overall and distal arm scores of the Fugl-Meyer Assessment. The dCIT + TR and dCIT participants demonstrated significantly greater functional use of the affected arm. CONCLUSIONS: Administering dCIT + TR produced additional benefits by improving grasping control and reversing the compensatory trunk movement at the early phase of a reach-to-grasp movement. The use of experimental tasks beyond and within arm's length might improve our understanding of optimal upper extremity rehabilitation.