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Despite improving survival rates, people with advanced cancer face several physical and psychosocial concerns. Leisure-time physical activity (LPA) has been found to be beneficial after cancer diagnosis, but little is known about the current state of research exploring LPA in advanced cancer. Our objectives were to (a) map the literature examining LPA in people with advanced cancer, (b) report on the terms used to describe the advanced cancer population within the literature, and (c) examine how the concept of LPA is operationalized within the literature.
Our scoping review followed Arksey and O'Malley's methodological framework. We performed a search of 11 electronic databases and supplementary sources (February 2018; database search updated January 2020). Two reviewers independently reviewed and selected articles according to the inclusion criteria: English-language journal articles on original primary research studies exploring LPA in adults diagnosed with advanced cancer. Descriptive and thematic analyses were performed.
Ninety-two articles met our criteria. Most included studies were published in the last decade (80%) and used quantitative methods (77%). Many study populations included mixed (40%), breast (21%), or lung (17%) cancers. Stages 3–4 or metastatic disease were frequently indicated to describe study populations (77%). Several studies (68%) described LPA programs or interventions. Of these, 78% involved structured aerobic/resistance exercise, while 16% explored other LPA types.
Significance of results
This review demonstrates a recent surge in research exploring LPA in advanced cancer, particularly studies examining exercise interventions with traditional quantitative methods. There remains insufficient knowledge about patient experiences and perceptions toward LPA. Moreover, little is known about other leisure activities (e.g., Tai Chi, dance, and sports) for this population. To optimize the benefits of LPA in people with advanced cancer, research is needed to address the gaps in the current literature and to develop personalized, evidence-based supportive care strategies in cancer care.
Most patients with suspected stroke should be transported without delay to a hospital, which has access to the required diagnostic tests and appropriate hyperacute treatments 24 h/day and 7 days/week. Once admitted, patients should be managed in a stroke unit rather than a general medical ward. There appears to be no systematic increase in length of hospital stay associated with organized (stroke unit) care. The recent development of hyperacute stroke units is not based on evaluation within RCTs but appears to improve processes of care in the acute phase. Processes of care on a stroke unit should mirror those found to be effective in RCTs. Stroke care should be specialized, organized, and multidisciplinary (i.e. provided by medical, nursing, physiotherapy, occupational therapy, speech therapy, and social work staff who are interested and trained in stroke care). The other beneficial components of organized stroke care are likely to be many, but it remains uncertain which are the most effective. Early discharge from the stroke unit with support from a domiciliary rehabilitation team (coordinated by the stroke unit) promises to reduce hospital length of stay and improve rehabilitation in the home and patient outcome.
Non-invasive brain stimulation to stimulate neuroplasticity, enhance recovery, and improve mood after stroke has made substantial technical advances in the past two decades. The most common neuromodulatory techniques are transcranial direct current stimulation (tDCS), applying a weak electrical current across the brain, and transcranial magnetic stimulation (TMS), inducing an electrical field within the brain. Currently, the only non-invasive brain stimulation technique and indication for which there is a sufficiently strong evidence base to support routine use in clinical practice is transcranial magnetic stimulation to improve mood in post-stroke depression. TMS applied to dorsolateral prefrontal cortices can substantially reduce depressive symptoms, though not increase complete remission. TMS is a reasonable second-line intervention in patients with post-stroke depressed mood who have been resistant to pharmacotherapy. For several additional indications in post-stroke patients, both TMS and tDCS have shown signals of potential benefit in randomized trials. The strongest evidence is for enhancement of recovery of upper extremity motor function and hand dexterity with TMS. In addition, there is suggestive evidence for possible benefit in improving recovery of function after stroke in walking (TMS), activities of daily living (tDCS), aphasia (both), hemispatial neglect (both), and swallowing (both). However, for these and potentially other recovery-enhancing applications, substantial additional larger trials are needed.
Pre-clinical studies provide clear and consistent evidence that a variety of centrally acting drugs affecting specific neurotransmitters can either facilitate or interfere with functional recovery after brain injury. Although at least some clinical trials suggest similar effects in humans, results have been inconsistent. The impact of important factors such as drug dose, duration, and intensity of physiotherapy, and timing between injury and treatment are difficult to translate from preclinical studies. Issues related to variability in stroke severity, location of injury, and comorbid conditions further complicate trial design and could obscure a true treatment effect. Because of these and other issues, the design of efficacy trials assessing putative neuro-restorative interventions is not trivial. Although a proven pharmacological approach resulting in a clinically meaningful improvement in post-stroke recovery remains elusive, it is reasonable to avoid medications that may have harmful effects in patients who have had a stroke. It is also important to control for these possible harmful effects in future clinical trials assessing the outcomes of stroke patients after the acute period.
This study aimed to evaluate the benefits of betahistine or vestibular rehabilitation (Tetrax biofeedback) on the quality of life and fall risk in patients with Ménière's disease.
Sixty-six patients with Ménière's disease were randomly divided into three groups: betahistine, Tetrax and control groups. Patients’ Dizziness Handicap Index and Tetrax fall index scores were obtained before and after treatment.
Patients in the betahistine and Tetrax groups showed significant improvements in Dizziness Handicap Index and fall index scores after treatment versus before treatment (p < 0.05). The improvements in the Tetrax group were significantly greater than those in the betahistine group (p < 0.05).
Betahistine and vestibular rehabilitation (Tetrax biofeedback) improve the quality of life and reduce the risk of falling in patients with Ménière's disease. Vestibular rehabilitation (Tetrax biofeedback) is an effective management method for Ménière's disease.
This study aimed to investigate the association between long-term survival and different management of major aortopulmonary collateral arteries in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries.
From November, 2009 to October, 2018, a total of 98 consecutive patients with pulmonary atresia, ventricular septal defect, major aortopulmonary collateral arteries, and hypoplastic pulmonary arteries treated with modified Blalock–Taussig shunt or right ventricle–pulmonary artery connection were included. Fifty-five patients who received occlusion or ligation of major aortopulmonary collateral arteries during or after palliative procedure were occlusion group, and the other 43 patients were no occlusion group. The early and late outcomes were compared.
The mean duration of follow-up was 30.9 months in no occlusion group and 49.8 months in the occlusion group (p < 0.001). Multivariate analysis showed that only no occlusion of major aortopulmonary collateral arteries was predictive of total mortality (Hazard Ratio: 4.42, 95% CI: 1.27 to 15.42, p = 0.02). The Kaplan–Meier survival curves confirmed that patients without occlusion of major aortopulmonary collateral arteries demonstrated worse survival as compared with the occlusion group (p = 0.013). The Kaplan–Meier survival curves of patients who underwent different palliative procedures showed no differences.
For patients with pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries when a primary repair is not feasible, those without occlusion of major aortopulmonary collateral arteries have a higher risk of death following an initial palliative procedure compared with patients who underwent occlusion of major aortopulmonary collateral arteries. The occlusion of major aortopulmonary collateral arteries is not associated with a higher rate of complete repair or better improvement of pulmonary artery growth.
In 2010, we proposed a personal factor classification which was published in this journal. Since then, the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization (WHO) and the biopsychosocial model were increasingly incorporated into the German Social Law Code for participation and rehabilitation, implying that personal factors are indispensable for individual assessments. For the present study, we aimed to come up with an updated version of the personal factors classification based on current research. To achieve this goal, we employed a qualitative approach to re-examine the basic structure, consistency, and selection of categories in the classification from our 2010 study, to amend and supplement the categories to reflect best practice personal factor classifications. Our findings indicate that the basic structure remained largely unchanged, with relatively minor changes, including the deletion of 5 categories from our 2010 classification, 10 categories revised in format or content, and 13 new categories. We believe our revised classification to be useful for supporting users in systematically, comprehensively, and transparently reporting influences on specific aspects of individuals’ life and living background on their functioning and participation, thus facilitating an equitable allocation of disability benefits.
As the pathophysiology of Covid-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.
During the first wave of the Covid-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status.
Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with Covid-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.
The intention of this paper is to develop the personal concept of appropriate access. We report on the service access experiences and opportunities of adults with an acquired brain injury after leaving inpatient rehabilitation. The benefits of appropriate access underpin standards in early and long-term recovery, though users’ access needs are highly personal.
The study used a qualitative design involving 16 semi-structured interviews with Australian adults with an acquired brain injury after discharge from inpatient brain rehabilitation. Data were thematically analysed.
Three main themes were derived from the analysis. Theme 1 shows that participants valued being steered to services that providers thought appropriate for them early after discharge from inpatient rehabilitation. Theme 2 highlights the tensions between timing and personal recovery and perceived needs. Theme 3 captures participants’ insights into the challenges of gaining access vis-a-vis what the system offers and the enablers of actualising appropriate access.
The positive experiences of being directed to specialist services early after discharge suggest that continuity of care constitutes appropriateness of access for participants in this study. However, it is also clear that continuity should not displace flexibility in the timing of services, to accord with individuals’ perceived needs. This, in addition to enablement of access opportunities, through funding and transport, are important in maintaining a personalised approach.
To evaluate an abbreviated NIH Toolbox Cognition Battery (NIHTB-CB) protocol that can be administered remotely without any in-person assessments, and explore the agreement between prorated scores from the abbreviated protocol and standard scores from the full protocol.
Participant-level age-corrected NIHTB-CB data were extracted from six studies in individuals with a history of stroke, mild traumatic brain injury (mTBI), treatment-resistant psychosis, and healthy controls, with testing administered under standard conditions. Prorated fluid and total cognition scores were estimated using regression equations that excluded the three fluid cognition NIHTB-CB instruments which cannot be administered remotely. Paired t tests and intraclass correlations (ICCs) were used to compare the standard and prorated scores.
Data were available for 245 participants. For fluid cognition, overall prorated scores were higher than standard scores (mean difference = +4.5, SD = 14.3; p < 0.001; ICC = 0.86). For total cognition, overall prorated scores were higher than standard scores (mean difference = +2.7, SD = 8.3; p < 0.001; ICC = 0.88). These differences were significant in the stroke and mTBI groups, but not in the healthy control or psychosis groups.
Prorated scores from an abbreviated NIHTB-CB protocol are not a valid replacement for the scores from the standard protocol. Alternative approaches to administering the full protocol, or corrections to scoring of the abbreviated protocol, require further study and validation.
Chapter 5 focuses on women’s release from prison using petitions that convicted women or interested parties wrote to lords lieutenant for release from prison or a reduction in sentence, as well as letters that ex-convicts wrote to prison officials in an effort to secure the balance of their gratuities. Women and men directly connected with the prison took an interest in a convict’s plans on departure to maximise her chances of successful rehabilitation and to prevent habitual criminality. The first section outlines the groups and individuals who influenced decisions about a woman’s release. The second and third sections examine how the domestic and employment situations to which an inmate would return could inform her discharge. These two sections document the fates of women after release and the realities of life in nineteenth-century Ireland. The fourth section offers an insight into legislation and practices that developed around convicts and habitual criminals, and the lived experiences for some repeat offenders. The final part of this chapter examines experiences for those women who sought to emigrate. This chapter argues that women’s intentions not to again offend could be thwarted at home or abroad by the challenging circumstances to which they returned.
This chapter argues that the institutional dynamics of the autonomous system – centralization and ethnicization – have intensified in the reform era, fueling key sources of ethnic tensions in contemporary China. The driving force has been the decline of class universalism and the rise of identity politics. The chapter shows how these two developments were spurred by early post-Mao policies to redress the leftist excesses of the Mao era, including the “declassing” of minority policy, rehabilitation of former ethnic elites, exit of Han personnel, revival of religion, and accommodation of ethnic customs in law enforcement. These policies have affected the TAR and Xinjiang in particular because of the central government’s greater urgency and efforts to implement them in the two politically sensitive and centrifugal regions. Yet the very end of class universalism and the advent of identity politics have also made it harder for the central state to achieve its goal of better integration. Whereas class universalism was divisive intraethnically, pitting ethnic masses against small groups of ethnic aristocrats, identity politics is divisive interethnically, creating cleavages along ethnic lines.
The dynamical stability of the cable-driven lower-limb rehabilitation training robot (CLLRTR) is a crucial question. Based on the established dynamics model of CLLRTR, the solution to the wrench closure of the under-constrained system is presented. Secondly, the stability index of CLLRTR is proposed by the Krasovski method. Finally, in order to analyze the stability distribution of CLLRTR in the workspace, the stability evaluation index in the workspace is calculated using the eigenvalue decomposition method. The stability distribution laws of CLLRTR are further verified by the experimental study. The results provide references for studying trajectory planning and anti-pendulum control of CLLRTR.
It has been noted that as high as 20.3% of patients hospitalized for coronavirus disease 2019 (COVID-19) require intensive care unit (ICU) admission. This has most commonly been attributed to the development of acute respiratory distress syndrome. These patients require prolonged periods of ICU stay, averaging approximately 20 days. As people recover and are discharged, there will be a new pandemic of critical illness survivors. These patients would present with impairments and disabilities arising because of prolonged ICU stay as well as consequences of severe respiratory illness. The longer the duration of ICU stay, the higher is the risk for long-term physical, cognitive, and emotional impairments needing comprehensive and early rehabilitation. This article focuses on the indispensable role of early and interdisciplinary rehabilitation in effective disaster management, restoring functions, and improving quality of life in COVID survivors. It outlines how to practically expand rehabilitation services in a resource-limited country, such as India, and lists the limitations being faced that prevent the uniform application of rehabilitation services in India. This would help to deal with the rapid increase in demand of postacute care facilities, be it in hospital services, in the form of inpatient or outpatient rehabilitation or home care facilities, including telemedicine.
Chapter 1 provides an overview of different theories of justice and how they can inform the development of a civil dimension of international criminal law. This chapter also traces the evolution of different dichotomies of the legal duty to provide reparations and the right to reparation: from perspectives of state versus state, to state versus individual, to individual versus individual. It also outlines the development of a duty to repair for individual perpetrators alongside states’ duty to repair. This introductory chapter thus provides the theoretical foundation that supports the analysis in the following chapters and it sets out the main themes that are discussed throughout the book. This chapter also lays out and discusses some challenges and counterarguments to the inclusion of a reparative dimension to international criminal justice from a theoretical perspective. Finally, this chapter draws on the enlightening jurisprudence of the Inter-American Court of Human Rights.
The rehabilitation of essential services infrastructure following hostilities, whether during a conflict or post-conflict, is a complex undertaking. This is made more complicated in protracted conflicts due to the continuing cycle of damage and expedient repair amid changing demands. The rehabilitation paradigm that was developed for the successful post-World War II rehabilitation of Germany and Japan has been less successful since. There are a myriad of conflicting interests that impede its application, yet the issue consistently comes down to a lack of systems-level understanding of the current situation on the ground and a lack of alignment between what is delivered and the actual local need. This article proposes a novel conceptual framework to address this, affording a greater “system of systems” understanding of the local essential services and how they can be restored to reflect the changed needs of the local population that has itself been changed by the conflict. The recommendations draw on heuristic practice and commercially available tools to provide a practicable approach to restoring infrastructure function in order to enable essential services that are resilient to temporary returns to violence and support the overall rehabilitation of the affected community.
In a program we developed called “Let's keep wiping to draw pictures!”, projected graphic images change according to rehabilitation movements for upper limbs, and the levels of exercise amount and quality of movement achieved by patients are reflected in the outcome of the artwork as feedback. At a rehabilitation hospital, inpatients who used the program to perform rehabilitation exercises showed higher levels of satisfaction and expectation in the exercises, and performed simple and repetitive movements more willingly. The program can expect to maintain motivation towards rehabilitation.
Specialised rehabilitation units offer inpatient multi-disciplinary rehabilitation for individuals with severe and enduring mental illness. A cornerstone of therapy is the work in the community through further education and community organisations. However, coronavirus restrictions have meant that such external supports are no longer available for the duration of the crisis. This has led to opportunities for developing new ways of offering rehabilitation within hospital environments. This article describes some of the new initiatives developed. The benefits of the lockdown for service users are also discussed. Many found the cessation of visits from family members with whom they had an ambivalent relationship helpful. The lockdown improved relationships between patients on the unit and encouraged a greater feeling of community. The lockdown has also emphasised the importance of team self-awareness and an awareness of the nature of the treatments offered.
Faith communities are important to the psychiatric care of people with mental illness. I distinguish the effects of two principles of becoming welcoming communities: compassion, in which the community accommodates members with mental illnesses so they are fully included, and dignity, which rests on the essential worth of everyone.