The relationship between rehabilitation motivation and upper limb motor function in stroke patients.

Objective: Insufficient motivation among post-stroke survivors may be an important factor affecting their motor function recovery. This study seeks to investigate the relationship between motivation and functional recovery in stroke patients undergoing rehabilitation training. Materials and methods: 103 stroke patients with upper limb impairments were studied during their hospital stays. Assessments were done before and after rehabilitation training to measure motivation, emotional state, motor function, and independence in daily activities. Data analysis was conducted to examine the distribution of these factors among the participants. Pearson and Spearman correlation analyses were used to study the relationships between motivation, emotional state, and motor function. Patients were divided into high and low motivation groups based on the Rehabilitation Motivation Scale (RMS), and chi-square and rank-sum tests were used to compare functional differences before and after treatment among patients with varying levels of motivation. Results: 66 participants were found to have low motivation in the initial assessment of the RMS (64.08%). Consistency in motivation levels was observed among patients with high motivation (r = 0.648, P<0.001). Apathy was identified as the main factor affecting motivation in patients with low motivation (p = 0.027), while depression and anxiety were not significantly correlated. Motivation was strongly linked to improvements in upper limb motor function, daily living activities, and self-exercise duration (p < 0.001) for stroke patients undergoing rehabilitation. Post-training, there was a notable increase in motivation, motor function, and independence in daily activities (p < 0.001). Increased rehabilitation motivation was linked to better upper limb motor function and daily independence in patients, particularly those with low motivation. This correlation was significant for both the FMA-UE and FIM scores. Discussion: Old patients with poor upper limb motor function often have low motivation, which hinders their recovery. Using strategies to boost motivation in stroke patients with impaired upper limb function could greatly improve their rehabilitation and motor skills. It is crucial to prioritize these intervention strategies. Conclusion: Enhancing rehabilitation motivation in stroke patients with low motivation and upper limb motor impairments can foster the restoration of their functional capabilities.

Resilience and Its Association With Activities of Daily Living 3 Months After Stroke.

Independence in basic activities of daily living (ADL) is an important outcome after stroke. Identifying factors associated with independence can contribute to improve post-stroke rehabilitation. Resilience, which is the ability of coping with a serious event, might be such a factor. Still, the impact of resilience and its role in rehabilitation after stroke is poorly investigated. Hence, the purpose of this study was to assess whether resilience assessed early after stroke can be associated with independence in basic ADL 3 months later. Hospitalized patients with a diagnosed acute stroke and a modified Rankin Scale score ≤ 4 were included. Bivariate and multivariate linear regression were applied to assess whether resilience as measured by the Brief Resilience Scale within the first 2 weeks after stroke was associated with basic ADL measured by Barthel Index at 3-month follow-up. Age, sex, fatigue, stroke severity at admission and pre-stroke disability were added as covariates. Sixty-four participants (35 (54.7%) male), aged 75.9 (SD 8.6) years were included 4.3 (SD 2.8) days after stroke. There was no significant change in resilience from baseline 3.1 (SD 0.3) to 3 months later 3.2 (SD 0.5). Resilience was not associated with basic ADL in neither the bivariate (b = 2.01, 95% CI -5.21, 9.23, p = 0.580) nor in the multivariate regression models (b = 0.50, 95% CI -4.87, 6.88, p = 0.853). Our results showed that resilience remained stable during follow-up. Early measurement of resilience was not associated with independence in basic activities of daily living 3 months after stroke. These results, indicate that resilience is a personal trait not associated with the outcome of physical adversity. However, future research should investigate whether resilience is related to the outcomes of psychosocial adversity after a stroke.

NT-FDS-A Noise Tolerant Fall Detection System Using Deep Learning on Wearable Devices.

Given the high prevalence and detrimental effects of unintentional falls in the elderly, fall detection has become a pertinent public concern. A Fall Detection System (FDS) gathers information from sensors to distinguish falls from routine activities in order to provide immediate medical assistance. Hence, the integrity of collected data becomes imperative. Presence of missing values in data, caused by unreliable data delivery, lossy sensors, local interference and synchronization disturbances and so forth, greatly hamper the credibility and usefulness of data making it unfit for reliable fall detection. This paper presents a noise tolerant FDS performing in presence of missing values in data. The work focuses on Deep Learning (DL) particularly Recurrent Neural Networks (RNNs) with an underlying Bidirectional Long Short-Term Memory (BiLSTM) stack to implement FDS based on wearable sensors. The proposed technique is evaluated on two publicly available datasets-SisFall and UP-Fall Detection. Our system produces an accuracy of 97.21% and 97.41%, sensitivity of 96.97% and 99.77% and specificity of 93.18% and 91.45% on SisFall and UP-Fall Detection respectively, thus outperforming the existing state of the art on these benchmark datasets. The resultant outcomes suggest that the ability of BiLSTM to retain long term dependencies from past and future make it an appropriate model choice to handle missing values for wearable fall detection systems.

Comparing Objective and Subjective Measures of Parkinson's Disease Using the Parkinson's KinetiGraph.

Background: Parkinson's disease (PD) is a neurodegenerative disease that can lead to impaired motor function and execution of activities of daily living (ADL). Since clinicians typically can only observe patients' symptoms during visits, prescribed medication schedules may not reflect the full range of symptoms experienced throughout the day. Therefore, objective tools are needed to provide comprehensive symptom data to optimize treatment. One such tool is the Parkinson's KinetiGraph® (PKG), a wearable sensor that measures motor symptoms of Parkinson's disease. Objective: To build a mathematical model to determine if PKG data measuring Parkinson's patients' motor symptoms can predict patients' ADL impairment. Methods: Thirty-four patients with PD wore the PKG device for 6 days while performing their ADL. Patients' PKG scores for bradykinesia and dyskinesia, as well as their responses to a questionnaire asking if their ADL-level had been impacted by various motor symptoms, were used to build a multiple regression model predicting the patients' Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part II scores. Results: Calculation of bradykinesia score response to medication showed that using a dosage response time of 30 min yielded a greater bradykinesia response than when the response time was set to 40, 50, 60, 70, 80, or 90 min. The overall multiple regression model predicting MDS-UPDRS part II score was significant (R 2 = 0.546, p < 0.001). Conclusion: The PKG's ability to provide motor symptom data that correlates with clinical measures of ADL impairment suggests that it has strong potential as a tool for the assessment and management of Parkinson's disease motor symptoms.

Money Management in Multiple Sclerosis: The Role of Cognitive, Motor, and Affective Factors.

Introduction: Few studies have examined the motor, cognitive, and emotional factors involved in effective money management in persons with multiple sclerosis (MS). The aim of this study was to assess money management in persons MS and examine whether cognitive, motor, and emotional processes can predict money management. Methods: This study included 72 persons with MS and 26 healthy controls (HC). Using an a priori definition of efficient vs. inefficient money management skills, based on the money management questionnaire (self and others), and performance on Actual Reality™ (AR) money management items, MS participants were divided into two groups: efficient or inefficient money management (MS Efficient- MM, n = 34 vs. MS Inefficient-MM, n = 38). These groups were compared on cognitive, motor, and emotional variables. Results: Participants in the MS efficient MM group performed significantly better on executive function and processing speed measures, as well as performance on the 25WT. The MS Efficient -MM group also showed significantly less affective symptomatology (depressive and state anxiety). Importantly, HC performed similarly to the Efficient MM group on these tests. Good executive functioning and low depressive symptomatology predicted efficient money management. Conclusions: This study characterizes some of the major problems and underlying impairments persons with MS are encountering in money management. Practitioners working with persons with MS should be aware that executive function impairments together with depressive symptomatology could signal possible money management dysfunction. The early identification of at-risk persons for money management difficulties could have a profound impact on the quality of life for this subsample of the MS population.

Melatonin modulates inflammatory mediators and improves olanzapine-induced hepatic steatosis in rat model of schizophrenia.

BACKGROUND: Melatonin (Mel) has lower levels and can be used as monotherapy in schizophrenia. Mel alleviated liver steatosis induced by atypical antipsychotics. GOALS: To investigate Mel effect as monotherapy and addon treatment on ketamine-induced behavioral changes in rat schizophrenia model and olanzapine (Ola)-induced metabolic derangement. METHODS: 24 male rats divided into four groups; C: control; O: Ola; OM: Ola plus Mel and M: Mel. All groups treated orally daily for 25 days. We measured activities of daily life (ADL) and rat performance in radial arm water maze (RAWM) before and after ketamine (Ket) injection, serum level of liver enzymes, lipoproteins, sugar, inflammatory markers and liver histopathology. RESULTS: Ket significantly reduced burrowing and hoarding behavior, increased working memory errors (WME) and time to reach target (TRT). Ola antagonized the deleterious effects of Ket on ADL, WME and TRT. Mel monotherapy significantly reduced burrowing and doesn't affect hoarding, WME or TRT in RAWM. Significant rise in ALT, AST, IL-1 beta, IL-6, IL-10, TNF-alpha, LDL, TGs and hepatic steatosis score (HSS) in O compared to C group. Co administration of Mel significantly decreased ALT, AST, IL-1 beta, IL-6 and TNF alpha. Insignificant difference in IL-10, TGs or LDL and significant improvement in HSS in OM compared to O group. Insignificant change in HDL or blood sugar in both O and OM groups compared to C group detected. CONCLUSION: Although ineffective as monotherapy, Mel co administration provides promising natural way to improve Ola-induced hepatic derangement in psychotic disorders.

Positive effects of systemic sodium benzoate and olanzapine treatment on activities of daily life, spatial learning and working memory in ketamine-induced rat model of schizophrenia.

BACKGROUND: Sodium Benzoate (SB) significantly improved positive, negative, and cognitive symptoms as add on treatment in schizophrenia. Olanzapine (Ola), the most effective atypical antipsychotic drug, has been linked to hepatic steatosis, acute kidney injury, reproductive side effects and poor effect on negative symptoms in some patients. GOALS: is to compare the efficacy and check the safety of long-term monotherapy with SB 0.01 mg/Kg versus Ola on male cognitive, memory, hepatic, renal and testicular functions in rat model of schizophrenia. METHODS: 48 young adult male rats were divided into 6 groups; C: control; O: received Ola; SB: received SB; K: received single IP ketamine (Ket) injection; K+O: received Ola and Ket and K+SB: received SB and Ket. Ola and SB given orally for 3 or 10 weeks for behavioral or serological studies respectively. We measured activities of daily life (ADL), spatial learning and memory in radial arm water maze (RAWM), serum parameters of hepatic, renal and testicular functions. RESULTS: Both Ola and SB significantly improved hoarding and burrowing, caused significant decrease in time to reach target (TRT), working memory errors (WME) in K+O and K+SB groups compared to K group. Ola caused significant increase in ALT, AST and creatinine and decrease in serum LH, testosterone compared to controls. SB caused significant rise in serum LH, ALT, AST and decrease in protein and albumin compared to both C and O groups. CONCLUSION: Both Ola and SB improved ADL, cognitive and memory functions. Although SB saved testicular and renal functions, it worsened liver function compared to Ola.

Defining the appropriate setting for treating obese patients: do we have the right tools?

PURPOSE: To allocate obese patients to the correct therapeutic setting, the Italian Obesity Society (SIO) has suggested a new algorithm based on the Edmonton obesity staging system (EOSS). The aim of our study was to apply in two retrospective cohorts of obese patients both the EOSS and the activities of daily life (ADL) scale to identify also their rehabilitation needs. METHODS: 288 out-patients and 298 in-patients were recruited. All patients were evaluated with a multidisciplinary approach and the mental, mechanical, and metabolic comorbidities were scored. RESULTS: The 2 groups differed for gender (28.8% men in out-patients, p = 0.001), age (> 60 years in in-patients, p = 0.03), BMI (40.8 ± 6.3 kg/m2 in in-patients, p < 0.001), and ADL (44.0 ± 16.0 in in-patients, p < 0.001). EOSS distribution was significant different: stages 0 and 1 were more present in out-patients and stages 3 and 4 in in-patients. In both groups, BMI increased significantly in EOSS category [95% CI + 1.4 (+ 0.5; + 2.2) for out-patients and + 1.7 (+ 0.7; + 2.6) for in-patients] and ADL were positively correlated with EOSS [95% CI + 5.0 (+ 2.5; + 7.4) for out-patients and + 9.9 (+ 7.7; + 12.2) for in-patients]. Mean ADL difference between the two groups, adjusted for age (over/under 60 years), BMI category, and EOSS was 24.8 (p < 0.0001). CONCLUSIONS: SIO algorithm seems an effective tool for staging obesity in relation to the clinical impairment. To better define the correct rehabilitative allocation of obese patients, we suggest to integrate the SIO algorithm with the ADL score. LEVEL OF EVIDENCE: Level III, retrospective case-control analytic study.

Comparative Study on Activities of Daily Living of Elderly / 中国康复理论与实践

@#Objective To compare the activities of daily living(ADL) of the elderly in different styles of providing.Methods 662 subjects were in range of 60～100 years old living in the organization for the aged and 620 subjects were in the range of 60～98 years old living at home from Beijing urban. They were evaluated with the ADL rating scales and a self-designed health status questionnaire.Results The total scores of ADL were not significantly difference between the elderly living at home and living in the organization(t=-0.299, P＞0.05). But age (OR=3.05, 95%CI: 1.805～2.935), educational level (OR=2.01, 95%CI: 1.512～2.544), and physical health (OR=1.25, 95%CI: 1.524～2.012) were related to ADL. Conclusion Age is the important factor affecting ADL (OR=3.05, 95%CI: 1.805～2.935), but ADL of the elderly in different styles of providing is not significantly difference.

Effect of Early Rehabilitation Nursing on Secondary Disturbance in Hemiplegics after Stroke / 中国康复理论与实践

@#ObjectiveTo study the effect of early rehabilitation nursing on secondary disturbance in hemiplegics after stroke.Methods140 patients were randomly divided into two groups , rehabilitation nursing group (70 cases) and control group (70 cases). Patients in the rehabilitation nursing group were given clinical treatment and regularly convalescent nursing, while those in control group were given clinical treatment and unguided self-training. Evaluation was performed in pre-treatment and 12 weeks post-treatment respectively.ResultsSecondary disturbance rate in the rehabilitation nursing group was significant lower than that in the control group (P<0.01). The motor scores and ADL scores measured by Barthel Index in both groups raised after 12 weeks treatment, but the scores in the early rehabilitation nursing group were obviously superior to those in the control group (P<0.01).ConclusionEarly rehabilitation nursing for hemiplegics afte sroke may prevent or lessen the secondary disturbance, as well as obviously improve motor function of the limbs and ADL.