Home-based rehabilitation in patients over 60 with stabilized ankylosing spondylitis during the COVID-19 pandemic

BACKGROUND: COVID-19 has become a significant healthcare issue, particularly challenging for patients with ankylosing spondylitis (AS), because immune-related diseases and their treatments could adversely affect the susceptibility to or severity of a viral infection. OBJECTIVE: This study is conducted to present an exercise rehabilitation program that patients older than 60 years with AS can do at home during the COVID-19 pandemic. METHODS: Three Delphi surveys were conducted to reach a consensus on home-based rehabilitation programs. This study recruited ten experts and performed three Delphi rounds for a month. RESULTS: The expert panel suggested that home-based rehabilitation for the patients should be carried out with a clear rehabilitation goal. Their final recommendations are to institute a program aimed to ease symptoms, such as pain and stiffness; encourage patients to consult with experts regularly to ensure that they perform exercise rehabilitation properly at home; add fast walking and stretching to the rehabilitation program; and see if indoor cycling, Pilates, or yoga could be appropriate. CONCLUSIONS: This study suggests that patients with AS over 60 should repeat low-intensity exercises, such as stretching, for an hour a day, four to six times a week during the COVID-19 pandemic.

Setting meaningful goals in rehabilitation: A qualitative study on the experiences of clients and clinicians in working with a practical tool

Objective To evaluate the experience of clients and clinicians in working with a tool to help set goals that are personally meaningful to rehabilitation clients. Design We have applied the tool in the outpatient rehabilitation setting. Clients’ and clinicians’ experiences in working with the tool were evaluated in individual, semi-structured interviews and focus group interviews, respectively. Thematic analysis was used to analyze the data. Setting A university medical center and a rehabilitation center. Subjects Clients with a first-time stroke ( n = 8) or multiple sclerosis ( n = 10), and clinicians ( n = 38). Intervention The tool to help set meaningful goals consisted of a session (i) to explore the client's fundamental beliefs, goals and attitudes and (ii) to identify a meaningful overall rehabilitation goal. The results of that session were used by the multidisciplinary rehabilitation team (iii) to help the client to set specific rehabilitation goals that served to achieve the meaningful overall rehabilitation goal. Results Both clients and clinicians reported that the tool helped to set a meaningful overall rehabilitation goal and specific goals that became meaningful as they served to achieve the overall goal. This contributed to clients’ intrinsic rehabilitation motivation. In some clients, the meaningfulness of the rehabilitation goals facilitated the process of behavior change. Both clients and clinicians made suggestions on how the tool could be further improved. Conclusion In the opinion of both clients and clinicians, the tool does indeed result in goal setting that is personally meaningful. Further development, implementation and evaluation of the tool is warranted.

The Impact of COVID-19 on Speakers With Aphasia: What Is Currently Known and Missing?

Purpose Enhancing social participation and reducing emotional distress in persons with aphasia (PWA) are a critical rehabilitation goal. Social relationships and meaningful activities performed by PWA are also crucial to promote positive psychosocial well-being. As a precautionary measure specific to the COVID-19 pandemic, most PWA worldwide have generally followed the guidelines of going out less, restricting when and where to gather with friends and peers, reducing social activities, and maintaining appropriate social distance; these acts are contrary to the traditional principles of managing aphasia. This article aims to (a) highlight and add to our understanding of issues related to the impact of the currently evolving COVID-19 pandemic on PWA, (b) direct readers to relevant reports in the literature of telerehabilitation for aphasia to look for useful information regarding remote assessment and therapy to be considered during the pandemic, (c) summarize support initiatives developed and resources compiled thus far as well as provide links for caregivers and PWA to find more information about COVID-19 in their communities, and (d) offer recommendations to potentially move the field of aphasia research and clinical PWA services forward in a positive way to endure the pandemic and in the forthcoming post-COVID world. Conclusions At present, there are significant knowledge gaps regarding the short and long-term impacts of COVID-19 on PWA and their caregivers. It is crucial that different stakeholders be sensitive and flexible when addressing the psychosocial and rehabilitation needs of PWA to mitigate the negative effects during and after the COVID-19 era.

Research Development of End Traction Shoulder Rehabilitation Device

Background: With the rapid growth of the elderly population, the phenomenon of shoulder subluxation caused by stroke is increasing. For young people, frozen shoulders caused by works and shoulder fractures caused by accidents are also increasing. With the development and popularization of rehabilitation medicine, more and more people realize that rehabilitation and treatment are equally important. So, more and more shoulder rehabilitation devices are designed Objective: To provide an overview of the end traction shoulder rehabilitation device and introduce their classification, characteristics and development Methods: This paper reviewed various productions and patents related to the end traction shoulder rehabilitation device. The structural characteristics, differentiations, applications of the end traction rehabilitation device are also introduced Results: By analyzing the physiological structure and movement characteristics of the shoulder, the rehabilitation mechanism is understood. According to the usage and training track of the end traction shoulder rehabilitation device, it is classified and compared, and the typical characteristics are concluded. The main problems in its development are analyzed and studied. The current and future research of the productions and patents on it are discussed Conclusion: As a single joint rehabilitation device, the rehabilitation goal of the end traction shoulder rehabilitation device is clearer. Through analysis of existing patents, it is found that the safety, the rehabilitation effect and the rehabilitation program of device need to be further improved. In the future, in order to better serve patients, technologies such as human-machine interaction and rehabilitation process monitoring are also essential

Persons post-stroke restore step length symmetry by walking asymmetrically

Background: Restoration of step length symmetry is a common rehabilitation goal after stroke. Persons post-stroke often retain the ability to walk with symmetric step lengths (“symmetric steps”); however, the resulting walking pattern remains effortful. Two key questions with direct implications for rehabilitation have emerged: 1) how do persons post-stroke generate symmetric steps, and 2) why do symmetric steps remain so effortful? The objective of this study was to understand how persons post-stroke generate symmetric steps and how the resulting gait pattern relates to the metabolic cost of transport. Methods: We recorded kinematic, kinetic, and metabolic data as ten persons post-stroke walked on an instrumented treadmill under two conditions: preferred walking and symmetric stepping (using visual feedback).Results: Persons post-stroke restored step length symmetry using energetically costly, asymmetric patterns. Impaired paretic propulsion and abnormal vertical movement of the center of mass were evident during both preferred walking and symmetric stepping. These deficits contributed to diminished positive work performed by the paretic limb on the center of mass in both conditions. Decreased positive paretic work correlated with increased metabolic cost of transport, decreased self-selected walking speed, and increased asymmetry in limb kinematics.Conclusions: It is critical to consider the mechanics used to restore symmetric steps when designing interventions to improve walking after stroke. Facilitating symmetric steps via increased paretic propulsion or enabling paretic limb advancement without excessive vertical movement may enable persons post-stroke to walk with a less effortful gait pattern.

Mechanics of very slow human walking

Human walking speeds can be influenced by multiple factors, from energetic considerations to the time to reach a destination. Neurological deficits or lower-limb injuries can lead to slower walking speeds, and the recovery of able-bodied gait speed and behavior from impaired gait is considered an important rehabilitation goal. Because gait studies are typically performed at faster speeds, little normative data exists for very slow speeds (less than 0.6 ms$${}^{-1}$$−1). The purpose of our study was to investigate healthy gait mechanics at extremely slow walking speeds. We recorded kinematic and kinetic data from eight adult subjects walking at four slow speeds from 0.1 ms$${}^{-1}$$−1 to 0.6 ms$${}^{-1}$$−1 and at their self-selected speed. We found that known relations for spatiotemporal and work measures are still valid at very slow speeds. Trends derived from slow speeds largely provided reasonable estimates of gait measures at self-selected speeds. Our study helps enable valuable comparisons between able-bodied and impaired gait, including which pathological behaviors can be attributed to slow speeds and which to gait deficits. We also provide a slow walking dataset, which may serve as normative data for clinical evaluations and gait rehabilitative devices.

Persons post-stroke restore step length symmetry by walking asymmetrically

ABSTRACTBackgroundRestoration of step length symmetry is a common rehabilitation goal after stroke. Persons post-stroke often retain the capacity to walk with symmetric step lengths (“symmetric steps”); however, the resulting walking pattern remains effortful. Two key questions with direct implications for rehabilitation have emerged: 1) how do persons post-stroke generate symmetric steps, and 2) why do symmetric steps remain so effortful?ObjectiveTo understand how persons post-stroke generate symmetric steps and how the resulting gait pattern relates to the metabolic cost of transport.MethodsTen persons post-stroke walked on an instrumented treadmill under two conditions: preferred walking and symmetric stepping (using visual feedback). We recorded kinematic, kinetic, and metabolic data during both conditions.ResultsPersons post-stroke restored step length symmetry using energetically expensive, asymmetric patterns. Impaired paretic propulsion and abnormal vertical movement of the center of mass were evident during both preferred walking and symmetric stepping. These deficits contributed to diminished positive work performed by the paretic limb on the center of mass in both conditions. Decreased positive paretic work correlated with increased metabolic cost of transport, decreased self-selected walking speed, and increased asymmetry in limb kinematics.ConclusionsIt is important to consider the mechanics used to restore symmetric steps when designing interventions to improve walking after stroke. Facilitating symmetric steps via increased paretic propulsion or enabling paretic limb advancement without excessive vertical movement may enable persons post-stroke to walk with a less effortful, more symmetric gait pattern.

Setting meaningful goals in rehabilitation: rationale and practical tool

Context: Goal-setting is a key characteristic of modern rehabilitation. However, goals need to be meaningful and of importance to the client. Axioms: Both theories and empirical evidence support the importance of a hierarchy of goals: one or more overall goals that clients find personally meaningful and specific goals that are related to the overall goals. We posit that the client’s fundamental beliefs, goals and attitudes (“global meaning”) need to be explored before setting any rehabilitation goal. A chaplain or other person with similar skills can be involved in doing so in an open-ended way. The client’s fundamental beliefs, goals and attitudes serve as a point of departure for setting rehabilitation goals. Setting goals: We set out a three-stage process to set goals: (1) exploring the client’s global meaning (i.e. fundamental beliefs, goals and attitudes), (2) deriving a meaningful overall rehabilitation goal from the client’s global meaning and (3) setting specific rehabilitation goals that serve to achieve the meaningful overall rehabilitation goal. Conclusion: This is an extension of current practice in many rehabilitation teams, which may help counter the drive toward exclusively functional goals based around independence.