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Stroke is a major cause of lasting disability worldwide. Virtual reality (VR) training has been introduced as a means of increasing the effectiveness of rehabilitation by providing large doses of task-related training with many repetitions and different modes of feedback. As VR is increasingly used in neurorehabilitation, cost considerations are important.
A cost-analysis was conducted based on the Virtual Reality for Upper Extremity in Subacute stroke (VIRTUES) trial, a recent international randomized controlled observer-blind multicenter trial. Average therapist time required per therapy session may differ between VR and conventional training (CT), leading to potential cost savings due to a therapist being able to supervise more than one patient at a time. Exploratory cost analyses are presented to explore such assumptions.
Based on our calculations, VR incurs extra costs as compared with CT when the same amount of therapist contact is provided, as was the case in VIRTUES. However, the exploratory analyses demonstrated that these costs may be rapidly counterbalanced when time for therapist supervision can be reduced.
Extra costs for VR can be outweighed by reduced therapist time and decreasing VR system costs in the nearer future, and not least by increased patient motivation.
Increasingly, narrative and creative arts approaches are being used to enhance recovery after traumatic brain injury (TBI). Narrative and arts-based approaches congruent with Indigenous storytelling may therefore provide benefit during the transition from hospital to home for some Indigenous TBI patients. This qualitative study explored the use and impact of this approach as part of a larger, longitudinal study of TBI transition with Indigenous Australians.
A combined narrative and arts-based approach was used with one Indigenous Australian artist to describe his transition experiences following TBI. Together with the researchers and filmmaking team, the artist was involved in aspects of the process. The artist contributed two paintings, detailing the story of his life and TBI. Based on the artworks, a film was co-created. Following the viewing of the film, impacts of the narrative and arts-based process were examined through semi-structured interviews with the artist, a service provider and a family member. Multiple sources of data were used in the final thematic analysis including transcripts of the interviews and filming, paintings (including storylines) and researcher notes.
Positive impacts from the process for the artist included positive challenge; healing and identity; understanding TBI and raising awareness.
This approach may enable the individual to take ownership over their transition story and to make sense of their life following TBI at a critical point in their recovery. A combined narrative and arts-based approach has potential as a culturally responsive rehabilitation tool for use with Indigenous Australians during the transition period following TBI.
Sarcopenia (loss of muscle mass/strength) burdens many older adults – hospitalized older adults being particularly vulnerable. Treating the condition, protein-supplementation (PrS) and resistance-training (RT) may act synergistically. Therefore, this block-randomised, double-blind, multicentre intervention study, recruiting geriatric patients >70 years from three Medical Departments, investigated the effect of PrS combined with RT during hospitalization and 12 weeks after discharge. Participants were randomly allocated (1:1) to receive PrS (totally 27.5 g whey protein/day, ≈2000 kJ/day) or iso-energetic placebo-products (<1.5 g protein/day), divided into two servings/day to supplement habitual diet. Both groups were engaged in a standardized, progressive low intensity/volume RT-program for the lower-extremities (hospital: supervised daily/after discharge: self-training 4x/week). From April 2016 to September 2017, 2351 patients were screened, 462 were eligible, and 165 included. 14 were excluded and 10 dropped-out, leaving 141 participants in the ITT-analysis. The average total protein intake during hospitalization/after discharge was 1.0 (0.8-1.3)/1.1 (0.9–1.3) g/kg/d (protein-group) and 0.6 (0.5–0.8)/ 0.9 (0.6–1.0) g/kg/d (placebo-group). Both groups improved significantly for the primary and secondary endpoints of muscle mass/strength, functional measurements, and quality-of-life, but no additional effect of PrS was seen for the primary endpoint (30-s Chair-stand-test, repetitions, median (Q1,Q3) changes from baseline: (standard-test: 0 (0,5) (protein-group) vs. 2 (0,6) (placebo-group) & modified-test: 2 (0,5) (protein-group) vs. 2 (-1,5) (placebo-group)) or any secondary endpoints (Mann-Whitney-U tests, P>0.05). In conclusion, PrS increasing total protein intake by 0.4 and 0.2 g/kg/d during hospitalization and after discharge, respectively, does not seem to increase the adaptive response to low intensity/volume RT in geriatric medical patients.
The overarching cultural context of the brain injury survivor, particularly that related to minority peoples with a history of colonisation and discrimination, has rarely been referred to in the research literature, despite profoundly influencing a person’s recovery journey in significant ways, including access to services. This study highlights issues faced by Australian Aboriginal traumatic brain injury (TBI) survivors in terms of real-life consequences of the high incidence of TBI in this population, current treatment and long-term challenges.
A case study approach utilised qualitative interview and file review data related to five male Aboriginal TBI survivors diagnosed with acquired communication disorders. The five TBI survivors were from diverse areas of rural and remote Western Australia, aged between 19 and 48 years at the time of injury, with a range of severity.
Common themes included: significant long-term life changes; short-term and long-term dislocation from family and country as medical intervention and rehabilitation were undertaken away from the person’s rural/remote home; family adjustments to the TBI including permanent re-location to a metropolitan area to be with their family member in residential care; challenges related to lack of formal rehabilitation services in rural areas; poor communication channels; poor cultural security of services; and lack of consistent follow-up.
Discussion and Conclusion:
These case reports represent some of the first documented stories of Aboriginal Australian TBI survivors. They supplement available epidemiological data and highlight different contexts for Aboriginal people after TBI, contributing to an overall profile that is relevant for rehabilitation service planning.
Formally established in the fall of 1947, the Laboratory of Archaeology at the University of Georgia is an archaeological research and collection repository. It is considered one of the premier institutions for curation of archaeological collections from the American Southeast. For over 70 years, the Laboratory has served as a repository for objects and associated records generated from archaeological projects and research undertaken by faculty, students, CRM professionals, and state and federal agencies. The Laboratory curates over 20,000 cubic feet of artifacts as well as paper and digital archives. In addition, the Laboratory houses the Georgia Archaeological Site File and manages data from more than 59,000 archaeological sites, including over 11,500 archaeological reports. In this paper, we explore implementation procedures for bringing legacy collections up to modern curation standards. We also outline how we migrate the data on paper records into the digital realm, articulating them within a comprehensive framework.
of this study was to examine the Twitter experiences and networks of six adults with cognitive-communication disability after a traumatic brain injury (TBI).
Using mixed methods, the study integrated: (a) quantitative analysis of Twitter networks using computational and manual coding of tweets; and (b) narrative analysis of in-depth interviews.
Diverse experiences were evident, with two experienced and four novice users of the platform. However, all reported feeling connected and included, and identified both positive and negative experiences in their use of Twitter. Developing a supportive network facilitated higher frequency of tweets and increased feelings of enjoyment and connectedness. All expressed a desire to continue using or learning to use Twitter but novices lacked support from rehabilitation professionals or experienced Twitter users, and relied instead on a “trial and error” approach.
Proactive integration of Twitter use during rehabilitation after TBI is warranted to support safe, enjoyable, and meaningful use.
To explore whether the improvement in self-awareness induced by a structured intervention programme in patients suffering a brain injury is associated with an enhancement in their functional outcomes.
This study uses a pre- and post-test control group design with a sample of 56 patients with acquired brain injury randomly assigned to an experimental and a control group. Pre- and post-intervention measurements were self-awareness (using a previously developed scale) and functional outcome (using the Lawton Instrumental Activities of Daily Living Scale).
Patients who received the intervention programme showed a greater improvement in their self-awareness level and functional outcome than patients in the control group. Additionally, the correlation analyses between improvements at both measures showed a relation between improvement in self-awareness and improvement in functional outcome, especially when the pre-treatment self-awareness level was considered.
Implementing an intervention programme in self-awareness, in the context of a global rehabilitation process of patients with acquired brain injury, is useful for improving their self-awareness level and the functionality in their daily activities.
Despite an increasing awareness of the importance of spirituality in mental health contexts, a ‘religiosity gap’ exists in the difference in the value placed on spirituality and religion by professionals compared with service users. This may be due to a lack of understanding about the complex ways people connect with spirituality within contemporary society and mental health contexts, and can result in people's spiritual needs being neglected, dismissed or pathologised within clinical practice. The aim of this qualitative systematic review is to characterise the experiences of spirituality among adults with mental health difficulties in published qualitative research.
An electronic search of seven databases was conducted along with forward and backward citation searching, expert consultation and hand-searching of journals. Thirty-eight studies were included from 4944 reviewed papers. The review protocol was pre-registered (PROSPERO:CRD42017080566).
A thematic synthesis identified six key themes: Meaning-making (sub-themes: Multiple explanations; Developmental journey; Destiny v. autonomy), Identity, Service-provision, Talk about it, Interaction with symptoms (sub-themes: Interactive meaning-making; Spiritual disruption) and Coping (sub-themes: Spiritual practices; Spiritual relationship; Spiritual struggles; Preventing suicide), giving the acronym MISTIC.
This qualitative systematic review provides evidence of the significant role spirituality plays in the lives of many people who experience mental health difficulties. It indicates the importance of mental health professionals being aware of and prepared to support the spiritual dimension of people using services. The production of a theory-based framework can inform efforts by health providers to understand and address people's spiritual needs as part of an integrated holistic approach towards care.
There is growing evidence to support recovery and rehabilitation services and interventions for people with severe mental illness (SMI). However, those from ethnic minority communities face inequitable outcomes and access to mental health services and poorer functional outcomes. This article reviews the evidence and discusses facilitators and barriers in the recovery journey of people with SMI from ethnic minority groups. Although there is limited evidence for specific interventions for ethnic minority patients, areas for future study and action are discussed.
After reading this article you will be able to:
•understand the scope of rehabilitation practices and interventions and evidence for use with ethnic minority patients with severe mental illness
•describe differences and similarities in the conceptualisation of recovery by majority and minority ethnic communities
•appreciate facilitators and barriers to rehabilitation and recovery for ethnic minority patients with SMI.
To better understand and improve the rehabilitation process of older adults with sensory losses in both hearing and vision or dual sensory impairment (DSI), this study explored the perspectives of health care professionals who work with this population. Thirteen individuals, with varied professional backgrounds, were interviewed about their experiences in working with older adults with DSI. We transcribed and coded the interviews, then conducted content analysis. Regardless of their professional backgrounds, the participants reported additional roles that they perceived they fulfilled: (a) counsellor, (b) navigator, and (c) trainer and re-trainer. These roles involved helping individuals with DSI, and their family, with depression, acceptance, repeat consultations, and way-finding through the health system. From the professionals’ perspective, these additional roles increase workload and place them in situations they were not trained for. They suggest education for all professionals and for family members working with people with DSI; moreover, they suggest a multidisciplinary team rehabilitation approach.
Objectives: To investigate whether the relationship between arm use and motor impairment post-stroke is influenced by the hemisphere of damage. Methods: Right-handed patients with unilateral left hemisphere damage (LHD) or right (RHD) (n=58; 28 LHD, 30 RHD) were recruited for this study. The Arm Motor Ability Test and Functional Impact Assessment were used to derive arm use patterns. The Fugl-Meyer motor assessment scale was used to quantify the level of motor impairment. Results: A significant interaction between patient group and impairment level was observed for contralesional, but not ipsilesional arm use. For lower impairment levels, contralesional (right arm for LHD and left arm for RHD) arm use was greater in LHD than RHD patients. In contrast, for greater levels of impairment, there were no arm use differences between the two patient groups. Conclusions: When motor impairment is significant, it overrides potential effects of stroke laterality on the patterns of arm use. However, a robust influence of hemisphere of damage on the patterns of arm use is evident at lower impairment levels. This may be attributed to previously described arm preference effects. These findings suggest adoption of distinct strategies for rehabilitation following left versus right hemisphere damage in right-handers, at least when the impairment is moderate to low. (JINS, 2019, 25, 470–478)
Post-World War II reconstruction in Europe and Asia is a topic of growing interest, but relatively little attention has been paid to the relief and rehabilitation effort in China in the immediate post-1945 period. This article reassesses the postwar program implemented by the Chinese Nationalist (Guomindang) government and the UNRRA (the United Nations Relief and Rehabilitation Administration), not just in terms of humanitarian relief, but also as part of a process that led to new thinking about the nature of the postwar state in Asia. It focuses on the ideas and actions of Jiang Tingfu (T. F. Tsiang), head of the Chinese National Relief and Rehabilitation Administration that worked with UNRRA. Chinese ideas for reconstruction in China were simultaneously statist, international, and transnational, and were shaped by high modern ideas drawn from Soviet and American examples. They were also influenced by China's poverty and wartime vulnerability, which made locally directed solutions more relevant in areas such as public hygiene. Success was unlikely because of the incipient Chinese Civil War and the huge demands of reconstruction on a state that was near-destitute, with a destroyed infrastructure. Nonetheless, its characteristics still bear examination as a first, tentative chapter in a longer story of post-imperialist and Cold War state-building that would shape countries in Asia and beyond.
Working in neurological rehabilitation brings with it numerous opportunities to gain an understanding of the factors that contribute to shaping meaningful living and wellbeing for those tackling the major life changes encountered following acquired brain injury (ABI). These opportunities come in many forms: challenging and brave clients, wise and worrying families, questioning and inspiring colleagues, empowering and limiting work environments and rigid and advancing policy and legislative contexts.
Our personal and collective understanding of the things that help and the things that get in the way of effective rehabilitation continuously emerges from the convergence of the experience and knowledge afforded by these opportunities. The aim of this paper is to consider the things that help and the things that get in the way as they have been identified by people with ABI, their families and those who work with them and have been further evidenced through research targeted towards improving short, medium and long-term outcomes for those living with the consequences of ABI. These things as discussed in this paper capture the essential role of the self, the importance of rights and access to rehabilitation, the impact of the family and the contribution of social connection.
Morphophysiological dormancy (MPD) is predominantly found in seeds of temperate regions and is uncommon in arid biomes. MPD has been reported in a number of Hibbertia (Dilleniaceae) species of temperate Australia, and in a single species of the arid zone, H. glaberrima. This study aimed to examine the dormancy and germination ecology of seeds of H. glaberrima. Seeds were subjected to temperature stratification treatments designed to mimic summer and autumn conditions in the Pilbara region of Western Australia. Seed germination and embryo growth were measured. We also tested the interaction between temperature stratification and cycles of drying and wetting designed to mimic sporadic rainfall events. All temperature and moisture treatments were tested in combination (+/–) with the smoke-derived chemical karrikinolide (KAR1). Exposing dormant seeds to temperatures suitable for warm stratification (35°C) for ≥ 8 weeks, followed by incubation at 25°C, resulted in significantly higher germination compared with non-stratified seeds. Exposing seeds to dry/wet cycling in conjunction with temperature stratification did not significantly increase germination. Exposure to KAR1 increased germination under most conditions. Once seeds are shed during October to December, they are exposed to hot and sporadically wet conditions over summer, allowing MPD to be overcome in a proportion of the seed population. Seeds may germinate in autumn (March to April), in conjunction with cooler temperatures. More deeply dormant individuals may require more than one summer to overcome dormancy. Similar to other species occurring in fire-prone ecosystems, fire also plays a crucial role in the germination ecology of H. glaberrima.
This paper reports on a funded summit, which convened a multidisciplinary group of experts to provide consensus on the research priorities necessary for improving long-term community integration of individuals with traumatic brain injury (TBI) and their caregivers.
The 2-day summit was directed using the World Café Methodology, to engage stakeholders and collaboratively arrive at a consensus on the problems to be targeted in research. Participants (n=54), drawn from two Canadian provinces, included an interdisciplinary group of researchers, clinicians, representatives from brain injury associations, individuals with TBI, and caregivers. In small groups, participants discussed challenges to long-term community integration and potential initiatives that would address these barriers. Field notes from the discussions were analyzed using qualitative content analysis.
The consensus on prioritized research directions included developing interventions to optimize the functioning and participation of individuals with TBI, reducing caregiver burden, and evaluating how emerging technology can facilitate delivery of care.
The World Café Methodology was an effective method for developing research priorities. The breadth of expertise of participants and the collegial environment allowed for the identification of a broad perspective on important future research directions with potential to enhance the long-term community integration of individuals with brain injury.
Background and Objective: As cognitive impairments represent the greatest impediment to participation following moderate–severe traumatic brain injury (TBI), cognitive rehabilitation is vital. Several sets of guidelines for cognitive rehabilitation have been published, including INCOG in 2014. However, little is known about current practice by therapists working with individuals with TBI. This study aimed to characterise current cognitive rehabilitation practices via an online survey of therapists engaged in rehabilitation in individuals with TBI.
Method: The survey documented demographic information, current cognitive rehabilitation practice, resources used to inform cognitive rehabilitation, and reflections on cognitive rehabilitation provided.
Results: The 221 Australian respondents were predominantly occupational therapists, neuropsychologists, and speech pathologists with an average 9 years of clinical experience in cognitive rehabilitation and TBI. Cognitive retraining and compensatory strategies were the most commonly identified approaches used in cognitive rehabilitation. Executive functioning was mostly targeted for retraining, whereas memory was targeted with compensatory strategies. Attentional problems were less frequently addressed. Client self-awareness, family involvement, team collaboration, and goal-setting were seen as important ingredients for success.
Conclusion: Clinical practice of cognitive rehabilitation in Australia is broadly consistent with guidelines. However, addressing the impediments to its delivery is important to enhance the quality of life for individuals with TBI.
This article attempts to highlight the challenges and possibilities for hearing healthcare through technology and aural rehabilitation in a resource-constrained setting, using South Africa as an example.
Results and conclusion
The authors argue that it is possible to enhance service delivery by using free resources and maximising the limited existing resources. In order to provide a sustainable hearing healthcare service in developing countries, it is pertinent to understand the context where the services are needed, and not just adopt an approach developed for a different context. Audiologists in such settings need to employ strategies to develop context-specific tools, and adapt existing tools to serve the needs of the local population. Some examples, although not exhaustive, are provided in the article.