The Influence of State-Level Contextual Factors on State/Federal System Vocational Rehabilitation Employment Outcomes for Persons With Traumatic Brain Injury

The purpose of this exploratory study was to develop a preliminary understanding of the influence of state-level contextual factors predictive of employment outcomes for State/Federal Vocational Rehabilitation System (State VR) participants with traumatic brain injury (TBI). Participants were 5,213 individuals with TBI with Individualized Plans for Employment closed during Federal Fiscal Year 2016. A four-step hierarchical logistic regression model (5.6% explained variance) containing five demographic, three state-level economic, six state TBI service climate, and nine State VR service variable expenditures correctly classified 57.0% of cases as attaining or not attaining an employment outcome at closure. Significant predictors associated with an employment closure were (a) education, veteran status, and presence of a secondary area of disability impairment; (b) state-level per-capita income; (c) State VR specialized acquired brain injury (ABI)/TBI service and state TBI Implementation Partnership grant funding; and (d) State VR service expenditures on diagnosis and treatment, occupational or vocational training, on-the-job training, job readiness training, transportation, maintenance support, and benefits counseling. The practice, policy, and research implications of these findings are presented.

Stroke Telerehabilitation in Calabria: A Health Technology Assessment

Introduction: Telerehabilitation (TR) is defined as a model of home service for motor and cognitive rehabilitation, ensuring continuity of care over time. TR can replace the traditional face-to-face approach as an alternative method of delivering conventional rehabilitation and applies to situations where the patient is unable to reach rehabilitation facilities or for low-income countries where outcomes are particularly poor. For this reason, in this study, we sought to demonstrate the feasibility and utility of a well-known TR intervention on post-stroke patients living in one of the poorest indebted regions of Italy, where the delivery of rehabilitation services is inconsistent and not uniform.Materials and Methods: Nineteen patients (13 male/6 female; mean age: 61.1 ± 8.3 years) with a diagnosis of first-ever ischemic (n = 14) or hemorrhagic stroke (n = 5), who had been admitted to the intensive rehabilitation unit (IRU) of the Institute S. Anna (Crotone, Italy), were consecutively enrolled to participate in this study. After the discharge, they continued the motor treatment remotely by means of a home-rehabilitation system. The entire TR intervention was performed (online and offline) using the Virtual Reality Rehabilitation System (VRRS) (Khymeia, Italy). All patients received intensive TR five times a week for 12 consecutive weeks (60 sessions, each session lasting about 1h).Results: We found a significant motor recovery after TR protocol as measured by the Barthel Index (BI); Fugl-Meyer motor score (FM) and Motricity Index (MI) of the hemiplegic upper limbs.Conclusions: This was the first demonstration that a well-defined virtual reality TR tool promotes motor and functional recovery in post-stroke patients living in a low-income Italian region, such as Calabria, characterized by a paucity of specialist rehabilitation services.

Wearable Hand-Rehabilitation System with Soft Gloves for Patient with Face Paralysis and Disability

Artificially intelligent advances such as tech gloves allow handicapped wearers to handle daily matters as normal. A wearable hand-rehabilitation system, i.e., a robotic arm, is engineered with controlled programming to control a disabled hand with features such as movement of fingers and holding items. A life-threatening disease (stroke) is caused when brain cells start to die, causing around 50–70% of patients to face paralysis and disability. People may face after-effects such as reduced use of the hand and limb or a paralyzed hand. Many methods have been introduced to overcome these issues, including therapies, but they are not so reliable when overcoming disability issues. To overcome these issues, we proposed a smart robotic hand that encounters hand disability issues. The smart robotic hand will aid the hands of disabled people by replacing their disabled hand with the smart robotic hand and by controlling the movement of the robot with the movement of the other hand. This can also be helpful for environments where it is not feasible for humans to work, such as in nuclear reactors and in bomb disposal squads. Some people have disabilities of the hand, so this smart robotic hand can also be used in that scenario. The robotic hand is mainly controlled through a flex sensor. By using Arduino, flex sensor outputs are mapped accordingly to the servo motors. The robot is controlled by a wired arrangement.

Experiences of access to justice for persons deprived of liberty in Ecuador

The Ecuadorian prison system has conditions that denotes a questionable validity of rights for inmates. In this context, access to justice (ATJ) is one of the most important rights to guarantee the rehabilitation of persons deprived of liberty (PDL) since confinement and the reality of the prison generate unique barriers for the ATJ. Through the analysis of in-depth semi-structured interviews, the ATJ experiences of the PDL and of actors linked to the social rehabilitation system are identified to state critical points in relation to the validity of this key right.

ABOUT REHABILITATION OF PATIENTS WITH LONG-TERM CONSEQUENCES OF COVID-19

Новая коронавирусная инфекция и ее отдаленные последствия занимают особое место в научной медицине и практическом здравоохранении. Появление COVID-19, распространение его среди населения земного шара, появление все новых штаммов поставило перед специалистами здравоохранения задачи, связанные с быстрой диагностикой инфекции, вызванной новым коронавирусом, оказанием специализированной медицинской помощи, включая диагностику, лечение, первичную и вторичную профилактику, медицинскую реабилитацию. Реабилитация пациентов, перенесших COVID-19, имеет важнейшее значение для восстановления трудоспособности и сохранения здоровья этой категории граждан. Эффективная организация и полноценная реализация реабилитационных мероприятий, достижение целей и задач медицинской и социальной реабилитации определяют социальные последствия пандемии как для конкретного индивида, так и для общества и государства в целом. Статья посвящена изучению и анализу возможностей применения рефлексотерапии в комплексе реабилитационных мероприятий пациентов с отдаленными последствиями новой коронавирусной инфекции COVID - 19. Дальнейшее совершенствование системы реабилитации, включая расширение и оптимизацию применения средств и методов реабилитационных мероприятий, будет способствовать повышению качества и эффективности оказания медицинской помощи, преодолению негативных последствий перенесенной новой коронавирусной инфекции COVID-19 The new coronavirus infection and its long-term consequences occupy a special place in scientific medicine and practical healthcare. The emergence of COVID-19, its spread among the world's population, and the emergence of new strains have set health professionals tasks related to the rapid diagnosis of infection caused by the new coronavirus, the provision of specialized medical assistance, including diagnosis, treatment, primary and secondary prevention, and medical rehabilitation. Rehabilitation of patients who have undergone COVID-19 is of crucial importance for the restoration of working capacity and the preservation of the health of this category of citizens. Effective organization and full implementation of rehabilitation measures, achievement of goals and objectives of medical and social rehabilitation determines the social consequences of the pandemic both for a particular individual and for society and the state as a whole. The article is devoted to the study and analysis of the possibilities of using refloxotherapy in a complex of rehabilitation measures for patients with long-term consequences of a new coronavirus infection COVID - 19. Further improvement of the rehabilitation system, including the expansion and optimization of the use of means and methods of rehabilitation measures, will contribute to improving the quality and effectiveness of medical care, overcoming the negative consequences of the new coronavirus infection COVID-19

Upper limb rehabilitation system based on virtual reality for breast cancer patients: Development and usability study

Background Functional exercise is crucial for breast cancer patients after surgery, and the use of virtual reality technology to assist patients with postoperative upper limb functional rehabilitation has gradually attracted the attention of researchers. However, the usability of the developed rehabilitation system is still unknown to a large extent. The purpose of this study was to develop a virtual reality upper limb rehabilitation system for patients after breast cancer surgery and to explore its usability. Methods We built a multidisciplinary team based on virtual reality and human-computer interaction technology and designed and developed an upper limb function rehabilitation system for breast cancer patients after surgery. Breast cancer patients were recruited from a grade III-a general hospital in Changchun city for the experiment. We used the System Usability Scale to evaluate the system availability, the Presence Questionnaire scale to measure the immersive virtual reality scene, and the Simulator Sickness Questionnaire subjective measurement scale for simulator sickness symptoms. Results This upper limb rehabilitation system hardware consisted of Head-mounted Display, a control handle and notebook computers. The software consisted of rehabilitation exercises and game modules. A total of 15 patients were tested on this system, all of whom were female. The mean age was 54.73±7.78 years, and no patients were excluded from the experiment because of adverse reactions such as dizziness and vomiting. The System Usability Scale score was 90.50±5.69, the Presence Questionnaire score was 113.40±9.58, the Simulator Sickness Questionnaire-nausea score was 0.93±1.16, the Simulator Sickness Questionnaire-oculomotor score was 0.80±1.27, the Simulator Sickness Questionnaire-disorientation score was 0.80±1.27, and the Simulator Sickness Questionnaire total score was 2.53±3.40. Conclusions This study fills in the blanks regarding the upper limb rehabilitation of breast cancer patients based on virtual reality technology system usability research. As the starting point of research in the future, we will improve the system’s function and design strictly randomized controlled trials, using larger samples in the promotion, to evaluate its application in breast cancer patients with upper limbs and other physiological functions and the feasibility and effects of rehabilitation.

METHODS AND MEANS OF PROVIDING REHABILITATION PROCEDURES THROUGH A BIOTECHNICAL SYSTEM WITH BIOLOGICAL FEEDBACK AND A FUZZY CONTROL MODULE

В статье описана реабилитационная биотехническая система с виртуальной реальностью, позволяющая модулю нечеткого управления осуществлять биологическую обратную связь путем сопоставления стимулирующих сигналов виртуальной реальности, электроэнцефалографических сигналов и электромиосигналов. Предложена рекурсивная математическая модель планирования процедур реабилитации с использованием биологической обратной связи, основанная на понятии функций «обучения» и «забывания», позволяющая планировать сеансы тренинга и прогнозировать их результаты. Разработано аппаратное, алгоритмическое и программное обеспечение биотехничекой системы реабилитации постинсультных больных с модулем нечеткого управления экзоскелетом, позволяющее адаптировать программу реабилитации постинсультных больных с функциональным состоянием конкретного пациента. Сформирована экспериментальная группа для оценки эффективности БТС-тренинга постинсультных больных с паретичными нижними конечностями. Контрольная группа формировалась виртуально на основе статистического анализа ретроспективных стратифицированных результатов реабилитации постинсультных больных посредством биотехнической системы с робототехническим устройством без использования модуля нечеткого управления. Исследование показало, что можно изменить показатели клинического исхода у пациентов с подострым и хроническим течением инсульта после 12 сеансов БТС-тренинга. Биотехничесая система с нечетким управлением робототехническим устройством позволяет осуществлять индивидуальную стратегию реабилитации постинсультных больных (включая целенаправленную тренировку ходьбы) The article describes a biotechnical rehabilitation system with virtual reality, which allows the fuzzy control module to carry out biological feedback by comparing stimulating signals of virtual reality, electroencephalographic signals and electromyosignals. A recursive mathematical model for planning rehabilitation procedures using biofeedback is proposed, based on the concept of “learning” and “forgetting” functions, which allows planning training sessions and predicting their results. The hardware, algorithmic and software support of the biotechnical rehabilitation system for post-stroke patients with a fuzzy exoskeleton control module has been developed, which allows to adapt the rehabilitation program for post-stroke patients with the functional state of a particular patient. An experimental group was formed to assess the effectiveness of BPS training in post-stroke patients with paretic lower extremities. The control group was formed virtually on the basis of statistical analysis of retrospective stratified results of rehabilitation of post-stroke patients using a biotechnical system with a robotic device without using a fuzzy control module. The study showed that it is possible to change the indicators of clinical outcome in patients with subacute and chronic stroke after 12 sessions of BPS training. A biotechnical system with fuzzy control of a robotic device allows an individual strategy for the rehabilitation of post-stroke patients (including targeted walking training)

Effects of home-based virtual reality telerehabilitation system in people with multiple sclerosis: A randomized controlled trial

Background and objective Multiple sclerosis is an inflammatory and neurodegenerative disorder of the central nervous system that can lead to severe motor disability. The aim of this study was to verify the health care effects of an integrated telerehabilitation approach involving dual-domains (motor and cognitive) in people with multiple sclerosis using a virtual reality rehabilitation system compared to a home-based conventional rehabilitative intervention usual care for patient-relevant outcomes (motor, cognitive and participation). Methods This multicentre interventional, randomized controlled trial included 70 participants with multiple sclerosis, 35 in the telerehabilitation group (30 sessions of home-based virtual reality rehabilitation system training, five sessions for week each lasting 45 min) and 35 in the usual care group (30 sessions of conventional treatment, five sessions for week). Participants completed the assessment of motor, cognitive and participation outcomes at baseline and after 6 weeks of treatment. Results In total, 63.3% of the telerehabilitation group exhibited improvement in the physical domain of the quality of life ( p = 0.045). The telerehabilitation group showed greater improvement than the usual care group in Mini-BESTest domains of balance ( p = 0.014), postural control ( p = 0.024), and dynamic walking ( p = 0.020) at post-treatment. Higher adherence was registered for telerehabilitation compared with usual care (86.67% vs . 80.0%). Discussion This study provides evidence that people with multiple sclerosis can benefit from telerehabilitation treatment in the physical domain of the quality of life and motor symptoms. Moreover, considering the persistent COVID-19 emergency, telerehabilitation can represent an effective telemedicine solution for safely delivering effective rehabilitation care to people with multiple sclerosis. Trial registration number and trial register This trial was registered at ClinicalTrials.gov (NCT03444454).