ORCID Profile
0000-0002-6071-6137
Current Organisations
University of South Australia
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Private Practice
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Publisher: Springer Science and Business Media LLC
Date: 08-08-2019
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.APMR.2019.01.011
Abstract: To systematically search the literature and construct a meta-synthesis of how choice and control are perceived by people with spinal cord injury (SCI). Medline, Academic Search Premier, CINAHL, Cochrane, EMBASE, HealthSource, ProQuest, PsychInfo, SAGE, and SCOPUS were searched from 1980 until September 2018 including all languages. Reference lists of selected studies were also reviewed. Eligible qualitative studies included perspectives about choice of control as reported by people with an SCI. Studies were excluded if they included perspectives from other stakeholder groups. A total of 6706 studies were screened for title and abstract and full text of 127 studies were reviewed resulting in a final selection of 29. Characteristics of the studies were extracted along with any data (author interpretations and quotes) relating to perspectives on choice and control. First-order analysis involved coding the data in each study and second-order analysis involved translating each segment of coded data into broader categories with third-order analysis condensing categories to 2 broad overarching themes. These themes were experiencing vulnerability or security and adapting to bounded abilities. Perspectives of choice and control are influenced by interrelated environmental, interpersonal, and personal contexts. From a personal perspective, participants reported a readiness for adaptation that included turning points where emotional and cognitive capacity to make choices and take control changed. Health professionals need to be responsive to this readiness, promote empowerment and foster, rather than remove, hope.
Publisher: Informa UK Limited
Date: 04-2010
DOI: 10.2147/CA.S9435
Publisher: Copernicus GmbH
Date: 09-03-2022
DOI: 10.5194/ACP-2022-104
Abstract: Abstract. Despite considerable efforts during the last decade, real-time characterization of the marine boundary layer and aerosol optical properties over the Southern Ocean remains scarce. We conducted simultaneous measurements of the marine boundary layer utilizing a synergy of remote sensing technology at the Baseline Air Pollution Station at Cape Grim in northwestern Tasmania, Australia, from 14 May to 16 July 2019. Aerosol optical properties were monitored by lidar (miniMPL) and a ceilometer to identify the boundary layer height, and sodar provided wind profiles to investigate their influences on the layer evolution. Boundary layer heights simulated using the Weather Research and Forecasting (WRF) model were also employed for comparison purposes. Through complementary analyses of three cases representing different source influences (marine, sea breeze and continental), this paper evaluates two algorithms (Image Edge Detection Algorithm (IEDA) and gradient method) for boundary layer height detection and examines the vertical aerosol distribution within the boundary layer at Cape Grim with an emphasis on the contributions of regional and local meteorology. We found IEDA generally performed better than the gradient method, especially during the marine-flow-influenced period with a convective layer structure. Different features of boundary layer structures in three episodes, including differential boundary layer growth and interaction with wind evolutionary processes were investigated. One was characterized by a diurnal variation with a boundary layer height of approximately 0.2–0.5 km, associated with the veering of the wind vector within the marine boundary layer during the development of a sea breeze. The other showed a thermally stable layer below 0.3 km with an enhanced extinction coefficient and linear depolarization ratio under the influence of continental sources, which was also validated by the observation from Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) satellite. The increasing extinction coefficient and depolarization ratio with wind speeds may be attributed to the increased wet sea salt production and regional transportation from mainland Australia.
Publisher: Springer Science and Business Media LLC
Date: 05-01-2017
Publisher: SAGE Publications
Date: 19-01-2015
DOI: 10.1111/IJS.12410
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.JPAIN.2016.12.020
Abstract: Prognostic screening in patients with low back pain (LBP) offers a practical approach to guiding clinical decisions. Whether screening is helpful in secondary care is unclear. This prospective cohort study in adults with LBP placed on outpatient clinic waiting lists, compared the performance of the short-form Orebro Musculoskeletal Pain Screening Questionnaire, the Predicting the Inception of Chronic Pain Tool, and the STarT Back Tool. We assessed predictive validity for outcome at 4-month follow-up, by calculating estimates of discrimination, calibration, and overall performance. We applied a decision curve analysis approach to describe the clinical value of screening in this setting via comparison with a 'treat-all' strategy. Complete data were available for 89% of enrolled participants (n = 195). Eighty-four percent reported 'poor outcome' at follow-up. The area under the receiver operating characteristic curve (95% confidence interval) was .66 (.54-.78) for the Orebro Musculoskeletal Pain Screening Questionnaire, .61 (.49-.73) for the Predicting the Inception of Chronic Pain Tool, and .69 (.51-.80) for the STarT Back Tool. All instruments were miscalibrated and underestimated risk. The decision curve analysis indicated that, in this setting, prognostic screening does not add value over and above a treat-all approach. The potential for LBP patients to be misclassified using screening and the high incidence of nonrecovery indicate that care decisions should be made with the assumption that all patients are 'at risk.' This article presents a head-to-head comparison of 3 LBP screening instruments in a secondary care setting. Early patient screening is likely to hold little clinical value in this setting and care pathways that consider all patients at risk of a poor outcome are suggested to be most appropriate.
Publisher: SAGE Publications
Date: 19-06-2009
Abstract: This article introduces two new datasets produced by the Institutions and Elections Project.Those datasets contain nuanced information describing the political institutions, the constitutional and practical arrangements in governments, and every national election for every country in the international system between 1972 and 2005.We believe the 127 variables in these data represent a significant contribution to research programs in comparative and world politics interested in the nuances of domestic politics.
Publisher: PeerJ
Date: 02-2018
DOI: 10.7717/PEERJ.4301
Abstract: Although it is broadly accepted that clinicians should endeavour to reassure patients with low back pain, to do so can present a significant clinical challenge. Guidance for how to provide effective reassurance is scarce and there may be a need to counter patient concerns arising from misinterpretation of spinal imaging findings. ‘GLITtER’ (Green Light Imaging Intervention to Enhance Recovery) was developed as a standardised method of communicating imaging findings in a manner that is reassuring and promotes engagement in an active recovery. This feasibility study is an important step towards definitive testing of its effect. This feasibility study was a prospective, quasi-randomised, parallel trial with longitudinal follow-up, involving s ling of patients attending a spinal outpatient clinic at a metropolitan hospital. English speaking adults (18–75 years) presenting to the clinic with low back pain and prior spinal imaging were considered for inclusion. Eligible patients were allocated to receive a GLITtER consultation or a standard consultation (as determined by appointment scheduling and clinician availability), and were blinded to their allocation. Full details of the GLITtER intervention are described in accordance with the Tidier template. Follow-up data were collected after 1 and 3 months. The primary outcome of this study was the fulfillment of specific feasibility criteria which were established a priori . Determination of a s le size for a definitive randomised controlled trial was a secondary objective. Two hundred seventy-six patients underwent preliminary screening and 31 patients met the final eligibility criteria for study inclusion. Seventeen participants were allocated to the intervention group and 14 were allocated to the control group. Three month follow-up data were available from 42% of the 31 enrolled participants ( N = 13, six intervention, seven control). Feasibility indicators for consent, resource burden and acceptability of the GLITtER intervention were met, however participant recruitment was slower than anticipated and an acceptable follow-up rate was not achieved. Failure to achieve pre-specified recruitment and follow-up rates were important outcomes of this feasibility study. We attribute failure to issues that are likely to be relevant for other clinical trials with this population. It is realistic to consider that these challenges can be overcome through careful strategy, le funding and continued partnership with health care providers. The trial was registered on the Australian and New Zealand Clinical Trials Registry on 28/2/2017 (ACTRN12617000317392).
Publisher: American Physiological Society
Date: 08-2007
DOI: 10.1152/AJPREGU.00612.2006
Abstract: Calcineurin signaling is essential for successful muscle regeneration. Although calcineurin inhibition compromises muscle repair, it is not known whether calcineurin activation can enhance muscle repair after injury. Tibialis anterior (TA) muscles from adult wild-type (WT) and transgenic mice overexpressing the constitutively active calcineurin-Aα transgene under the control of the mitochondrial creatine kinase promoter (MCK-CnAα*) were injected with the myotoxic snake venom Notexin to destroy all muscle fibers. The TA muscle of the contralateral limb served as the uninjured control. Muscle structure was assessed at 5 and 9 days postinjury, and muscle function was tested in situ at 9 days postinjury. Calcineurin stimulation enhanced muscle regeneration and altered levels of myoregulatory factors (MRFs). Recovery of myofiber size and force-producing capacity was hastened in injured muscles of MCK-CnAα* mice compared with control. Myogenin levels were greater 5 days postinjury and myocyte enhancer factor 2a (MEF2a) expression was greater 9 days postinjury in muscles of MCK-CnAα* mice compared with WT mice. Higher MEF2a expression in regenerating muscles of MCK-CnAα* mice 9 days postinjury may be related to an increase of slow fiber genes. Calcineurin activation in uninjured and injured TA muscles slowed muscle contractile properties, reduced fatigability, and enhanced force recovery after 4 min of intermittent maximal stimulation. Therefore, calcineurin activation can confer structural and functional benefits to regenerating skeletal muscles, which may be mediated in part by differential expression of MRFs.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Wiley
Date: 24-08-2006
Publisher: Copernicus GmbH
Date: 26-11-2020
Publisher: Informa UK Limited
Date: 2010
Publisher: BMJ
Date: 09-03-2011
Abstract: To determine whether high-intensity, progressive gym-based exercise performed once a week is as effective as twice weekly for maintaining both subjective and objective outcomes in older adults post discharge from a metropolitan day rehabilitation centre (DRC). Randomised controlled trial. Community-based exercise centre for older adults, located in Metropolitan Adelaide, South Australia. 21 men and 85 women who completed the DRC programme were assessed and randomly allocated to a study group. The two experimental interventions were gym-based exercise programmes (including resistance, aerobic, flexibility and balance training) varying only in frequency of delivery: either once or twice a week, directly compared with usual care (control). Lower limb strength (one-repetition maximum), balance (Berg Balance Scale), physical function (gait speed, 30-s chair stand test, timed up and go test (primary outcome) and 6-min walk test), self-reported pain (Glasgow Pain Questionnaire), activities of daily living (Barthel Index and Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire), perceived benefits of and barriers to exercise (Exercise Benefits Barriers Scale), quality of life (Assessment of Quality of Life Questionnaire) and exercise frequency preference. Most of the outcomes (69%, 11/16) were maintained over the intervention period with no significant group effects detected between the two intervention groups or compared to the control group. Physical activity levels recorded in the control group showed a significant proportion of participants were actively exercising once weekly. A per-protocol analysis was undertaken to take this potential contamination effect into account. This showed that the control group participants, who did not exercise, did not maintain outcomes to the extent of the intervention groups, with significant group-by-time effects detected between the two intervention groups and the control group. Most of all participants (66%, 62/94) nominated once a week as their preferred exercise frequency. The overall finding of no significant differences between the two intervention groups for all outcomes measured gives support to the effectiveness of once-a-week exercise in maintaining outcomes at 3 months post rehabilitation. Further research is warranted given the once-a-week exercise intervention should cost less, had higher compliance and was nominated as the preferred exercise frequency by most of the participants.
Publisher: Mark Allen Group
Date: 02-2005
DOI: 10.12968/IJTR.2005.12.2.17458
Abstract: This pilot study investigated the potential effects of inversion-control ankle taping on the timing and distribution of plantar pressures in the hemiplegic foot during the stance phase of gait. Five subjects with residual left hemiplegia after stroke and equinovarus foot posture participated in the single-case design study. The Emed-AT-2 force plate system was used to measure and analyse specific plantar pressure variables, including time to heel strike, contact area and maximum mean pressure under the total surface of the foot. Subjective reports of functional gait were also recorded. Descriptive statistics were calculated for the analysis of results. All subjects achieved earlier heel-strike under the taped condition. Changes in other gait parameters appeared to depend on the in idual subject characteristics. This study has identified beneficial effects and further research is warranted to confirm the use of ankle taping as a quick and affordable gait re-education tool after stroke.
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.JSTROKECEREBROVASDIS.2022.106557
Abstract: To investigate whether cognitive reserve modifies the relationship between functional connectivity, lesion volume, stroke severity and upper-limb motor impairment and recovery in stroke survivors. Ten patients with first-ever ischemic middle cerebral artery stroke completed the Cognitive Reserve Index Questionnaire at baseline. Upper-limb motor impairment and functional connectivity were assessed using the Fugl-Meyer Assessment and electroencephalography respectively at baseline and 3-months post-stroke. A debiased weighted phase lag index was computed to estimate functional connectivity between electrodes. Partial least squares (PLS) regression identified a connectivity model that maximally predicted variance in the degree of upper-limb impairment. Regression models were generated to determine whether cognitive reserve modified the relationship between neural function (functional connectivity), neural injury (lesion volume), stroke severity (National Institutes of Health Stroke Scale) and upper-limb motor impairment at baseline and recovery at 3-months (Fugl-Meyer Assessment). The addition of cognitive reserve to a regression model with a dependent variable of upper-limb motor recovery and independent variables of functional connectivity between the ipsilesional motor cortex and parietal cortex, stroke severity and lesion volume improved model efficiency (∆BIC=-7.07) despite not reaching statistical significance (R Preliminary observations suggest cognitive reserve might modify the relationship between neural function, neural injury, stroke severity and upper-limb motor recovery. Further investigation of cognitive reserve in motor recovery post-stroke appears warranted.
Publisher: AOSIS
Date: 29-03-2018
Abstract: Background: Approximately two out of three people with stroke experience gait problems. Trunk movement control and symmetry is an important prerequisite for functional walking gait. Movement control, measured objectively as kinematics during walking gait, is rarely investigated.Objective: To describe the three-dimensional (3D) kinematics of the trunk during gait in people with stroke, including key spatiotemporal characteristics.Methodology: A total of 17 adults with stroke who met the inclusion criteria were selected to participate in this cross-sectional pilot study. An eight-camera T-10 Vicon system with Nexus 1.8 software (Vicon Motion System Limited, Oxford, UK) was used to analyse the 3D kinematics of the trunk during self-selected walking speed. Trunk kinematics throughout the gait cycle and spatiotemporal parameters were extracted using custom-built scripts in MATLAB used at the Stellenbosch University Movement Analysis Laboratory. Stata Version 12.1 software was used to assess differences in trunk kinematics between the affected and unaffected sides during gait using the Sign test (statistical significance level p 0.05).Results: Participants achieved functional gait speeds although they presented with asymmetrical trunk kinematics. During the full gait cycle, there were statistically significant differences of trunk motion between the affected and unaffected sides in the coronal plane (p 0.001). There were statistically significant differences in the trunk kinematics between the affected side and unaffected sides at initial contact (p 0.001) and foot off (p 0.049) in the coronal plane as well as at initial contact (p 0.000) and foot off (p 0.013) in the transverse plane.Conclusion: This pilot study found significant asymmetry in trunk motion between the affected and unaffected sides that varied across the gait cycle. This suggests the trunk may need to be targeted in clinical gait retraining post-stroke.
Publisher: Elsevier BV
Date: 2008
DOI: 10.1016/S0004-9514(08)70065-5
Abstract: Does circuit class therapy result in a greater incidence or severity of shoulder pain compared with in idual therapy? Is the incidence influenced by the degree of active shoulder control? Controlled trial with intention-to-treat analysis. Sixty-eight people (6 drop-outs) undergoing inpatient rehabilitation after stroke. Participants received either in idual therapy or group circuit class therapy. Incidence of shoulder pain over the previous 24 hours was measured as a yes/no response while severity of shoulder pain was measured using a visual analogue scale at admission, Week 4, and discharge. There was no greater chance of participants receiving circuit class therapy having shoulder pain at Week 4 (OR 0.95, 95% CI 0.32 to 2.80) or discharge (OR 0.38, 95% CI 0.11 to 1.45) than participants receiving in idual therapy. Of those participants who reported pain, there was no difference between groups in the severity of pain at Week 4 (mean difference -0.2 cm, 95% CI -3.2 to 2.7) or discharge (mean difference -2.1 cm, 95% CI -4.8 to 0.6). There was a greater chance of participants who had no active shoulder control having shoulder pain at Week 4 (OR 5.8, 95% CI 1.6 to 20.4) and at discharge (OR 3.8, 95% CI 1.0 to 13.9) than participants who had active shoulder control. The incidence and severity of shoulder pain was influenced by degree of active shoulder control but not by type of physiotherapy service delivery. Concerns regarding shoulder pain should not be a barrier to the implementation of circuit class therapy during inpatient stroke rehabilitation.
Publisher: Copernicus GmbH
Date: 03-03-2021
DOI: 10.5194/EGUSPHERE-EGU21-196
Abstract: & & An overlapping need exists between the climate science, air quality and radiological protection communities for a robust, portable and direct monitor of atmospheric & sup& & /sup& Rn concentrations typical of the ambient outdoor atmosphere. To reliably characterise afternoon radon concentrations, or resolve daytime vertical radon gradients in the atmospheric boundary layer (requirements for radon measurements to be used to evaluate the performance of chemical transport models), detection limits of & #8804 .2 Bq m& sup& -3& /sup& at an hourly temporal resolution are required. Commercial portable radon detectors are mainly designed for indoor use, and the best of these has a detection limit of & #8805 Bq m& sup& -3& /sup& for hourly s ling, with an approximate uncertainty of 60% at typical outdoor daytime radon concentrations.& Here we introduce a portable (200 L) version of the two-filter dual-flow-loop radon detector, designed and built by ANSTO in collaboration with the EMPIR 19ENV01 traceRadon project. While not as compact as commercial monitors (standing 1.6 m tall, and 0.48 m wide), its longest component is 1.2 m, enabling transportation in a standard utility vehicle or 4x4 (and can fit inside a 19& #8221 instrument rack). Constructed of marine grade stainless steel, it is weather resistant, robust, and suitable for long-term, continuous, autonomous deployment in fact it is fully remotely controllable if a networked computer is available. The estimated lower limit of detection is 0.17 Bq m& sup& -3& /sup& for hourly observations, and the counting uncertainty at typical ambient outdoor radon concentrations is around 7%. Additional uncertainty associated with current calibration techniques, which inject calibration gas on top of ambient s led air, varies from 2-6%. Some objectives of the traceRadon project include establishing direct calibration traceability to the SI and developing an improved closed-loop calibration technique, using a new, low activity Radium-226 source. If successful, the absolute accuracy of the 200 L radon detector at typical ambient outdoor concentrations could be kept well below 15% for hourly observations. This project has received funding from the EMPIR programme co-financed by the Participating States and from the European Union's Horizon 2020 research and innovation programme. 19ENV01 traceRadon denotes the EMPIR project reference.& &
Publisher: Elsevier BV
Date: 10-2021
Publisher: Informa UK Limited
Date: 2011
DOI: 10.3109/09638288.2011.573058
Abstract: To investigate the personal experiences and perceived outcomes of a yoga programme for stroke survivors. This article reports on a preliminary study using qualitative methods to investigate the personal experiences and perceived outcomes of a yoga programme. Nine in iduals who had experienced stroke were interviewed following a 10-week yoga programme involving movement, breathing and meditation practices. An interpretative phenomenological approach was used to determine meanings attached to yoga participation as well as perceptions of outcomes. Interpretative themes evolving from the data were organised around a bio-psychosocial model of health benefits from yoga. Emergent themes from the analysis included: greater sensation feeling calmer and becoming connected. These themes respectively revealed perceived physical improvements in terms of strength, range of movement or walking ability, an improved sense of calmness and the possibility for reconnecting and accepting a different body. The study has generated original findings that suggest that from the perspective of people who have had a stroke yoga participation can provide a number of meaningful physical, psychological and social benefits and support the rationale for incorporating yoga and meditation-based practices into rehabilitation programmes.
Publisher: Springer Science and Business Media LLC
Date: 28-02-2011
Publisher: John Wiley & Sons, Ltd
Date: 17-10-2007
Publisher: Frontiers Media SA
Date: 26-02-2021
DOI: 10.3389/FNEUR.2021.621495
Abstract: We present information on acute stroke care for the first wave of the COVID-19 pandemic in Australia using data from the Australian Stroke Clinical Registry (AuSCR). The first case of COVID-19 in Australia was recorded in late January 2020 and national restrictions to control the virus commenced in March. To account for seasonal effects of stroke admissions, patient-level data from the registry from January to June 2020 were compared to the same period in 2019 (historical-control) from 61 public hospitals. We compared periods using descriptive statistics and performed interrupted time series analyses. Perceptions of stroke clinicians were obtained from 53/72 (74%) hospitals participating in the AuSCR (80% nurses) via a voluntary, electronic feedback survey. Survey data were summarized to provide contextual information for the registry-based analysis. Data from the registry covered locations that had 91% of Australian COVID-19 cases to the end of June 2020. For the historical-control period, 9,308 episodes of care were compared with the pandemic period (8,992 episodes). Patient characteristics were similar for each cohort (median age: 75 years 56% male ischemic stroke 69%). Treatment in stroke units decreased progressively during the pandemic period (control: 76% pandemic: 70%, p & 0.001). Clinical staff reported fewer resources available for stroke including 10% reporting reduced stroke unit beds. Several time-based metrics were unchanged whereas door-to-needle times were longer during the peak pandemic period (March-April, 2020 82 min, control: 74 min, p = 0.012). Our data emphasize the need to maintain appropriate acute stroke care during times of national emergency such as pandemic management.
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/PY08054
Abstract: Pre and post testing were conducted on community-dwelling older adults referred to a geriatric day rehabilitation centre (DRC). Consecutive DRC clients were screened for inclusion over a 16-month period and were eligible if: aged 60+ years cognitively intact and reason for referral involved spinal or lower limb musculoskeletal impairment, disability or surgery, and/or reduced functional mobility or falls. Clients were excluded if they had a neurological disorder, or did not complete the program. Outcome measures included: lower limb strength balance mobility self-reported pain activities of daily living and quality of life. Data were summarised using descriptive statistics and analysed using paired t-tests. Of the 137 participants recruited, 110 were female and the mean age was 79.5 ± 7.3 years. In total, 106 participants completed the DRC program and were assessed at baseline and re-assessed at discharge. The mean length of stay was 12.4 ± 2.9 weeks, with 21.4 ± 5.4 attendances. From baseline to discharge, statistically significant differences were found for all objective measures of physical functioning, balance, and for all lower limb strength tests (P 0.0001). Glasgow Pain Questionnaire scores demonstrated statistically significant improvements in all five domains of the scale (P 0.0001). The Barthel Index and Multi-dimensional Functional Assessment Questionnaire both showed a statistically significant improvement in the level of independence in activities of daily living (ADL) (P 0.05). The Assessment of Quality of Life Questionnaire showed a statistically significant improvement (P = 0.027). The Exercise Benefits/Barriers Scale also showed a statistically significant improvement over DRC attendance (P = 0.005). The Falls Efficacy Scale showed a positive change, but the improvement was not statistically significant (P = 0.80). The study’s results indicate that community-dwelling older adults with physical disabilities and multiple comorbidities who attended the interdisciplinary geriatric DRC, significantly improved their lower limb strength, balance and physical function, and also showed significant decreases in self-reported pain, and improvements in independence in ADL and quality of life. Given the limitations of the current study, further research, in the form of high quality studies with larger s le sizes that involve direct comparisons with other forms of care or against a control group, is needed to determine whether day rehabilitation centre programs provide the optimum mode of rehabilitation for this population in the most cost effective manner.
Publisher: Wiley
Date: 13-01-2015
Publisher: John Wiley & Sons, Ltd
Date: 16-02-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2010
Publisher: American Physiological Society
Date: 03-2008
DOI: 10.1152/AJPREGU.00375.2007
Abstract: Calcineurin activation ameliorates the dystrophic pathology of hindlimb muscles in mdx mice and decreases their susceptibility to contraction damage. In mdx mice, the diaphragm is more severely affected than hindlimb muscles and more representative of Duchenne muscular dystrophy. The constitutively active calcineurin Aα transgene (CnAα) was overexpressed in skeletal muscles of mdx ( mdx CnAα*) mice to test whether muscle morphology and function would be improved. Contractile function of diaphragm strips and extensor digitorum longus and soleus muscles from adult mdx CnAα* and mdx mice was examined in vitro. Hindlimb muscles from mdx CnAα* mice had a prolonged twitch time course and were more resistant to fatigue. Because of a slower phenotype and a decrease in fiber cross-sectional area, normalized force was lower in fast- and slow-twitch muscles of mdx CnAα* than mdx mice. In the diaphragm, despite a slower phenotype and a ∼35% reduction in fiber size, normalized force was preserved. This was likely mediated by the reduction in the area of the diaphragm undergoing degeneration (i.e., mononuclear cell and connective and adipose tissue infiltration). The proportion of centrally nucleated fibers was reduced in mdx CnAα* compared with mdx mice, indicative of improved myofiber viability. In hindlimb muscles of mdx mice, calcineurin activation increased expression of markers of regeneration, particularly developmental myosin heavy chain isoform and myocyte enhancer factor 2A. Thus activation of the calcineurin signal transduction pathway has potential to ameliorate the mdx pathophysiology, especially in the diaphragm, through its effects on muscle degeneration and regeneration and endurance capacity.
Publisher: MDPI AG
Date: 24-08-2023
Abstract: Radon (Rn) is a radioactive, colourless, odourless, noble gas that decays rapidly. It’s most stable isotope, 222Rn, has a half-life of around 3.8 days. Atmospheric radon measurements play an important role in understanding our atmospheric environments. Naturally occurring radon can be used as an atmospheric tracer for airmass tracking, to assist in modelling boundary layer development, and is important for understanding background radiation levels and personal exposure to natural radiation. The daughter products from radon decay also play an important role when measuring fine particle pollution using beta-attenuation monitors (BAM). Beta radiation from the 222Rn decay chain interferes with BAM measurements of fine particles thus, some BAMs incorporate radon measurements into their s ling systems. BAMs are ubiquitous in air quality monitoring networks globally and present a hitherto unexplored source of dense, continuous radon measurements. In this paper, we compare in situ real world 222Rn measurements from a high quality ANSTO dual flow loop, dual filter radon detector, and the radon measurements made by a commercial BAM instrument (Thermo 5014i). We find strong correlations between systems for hourly measurements (R2 = 0.91), daily means (R2 = 0.95), hour of day (R2 = 0.72–0.94), and by month (R2 = 0.83–0.94). The BAM underestimates radon by 22–39% however, the linear response of the BAM measurements implies that they could be corrected to reflect the ANSTO standard measurements. Regardless, the radon measurements from BAMs could be used with correction to estimate local mixed layer development. Though only a 12-month study at a single location, our results suggest that radon measurements from BAMs can complement more robust measurements from standard monitors, augment radon measurements across broad regions of the world, and provide useful information for studies using radon as a tracer, particularly for boundary layer development and airmass identification.
Publisher: Frontiers Media SA
Date: 25-01-2021
Publisher: Medical Journals Sweden AB
Date: 2011
Abstract: To examine the effectiveness of group circuit class therapy for improving the mobility of adults after stroke. Cochrane systematic review. A comprehensive search strategy was used to find randomized and quasi-randomized controlled trials of adults post-stroke receiving circuit class therapy. Two authors independently selected trials for inclusion, assessed the methodological rigor and extracted data. Six trials were included, involving 292 participants most were community-dwelling survivors who were able to walk independently. Circuit class therapy was effective in improving walking ability (6-minute walk test mean difference, 76.6 m, 95% confidence interval 38.4-114.7, walking speed mean difference 0.12 m/s, 95% confidence interval 0-0.24) and balance (step test mean difference 3.0 steps, 95% confidence interval 0.08-5.9, activities specific balance confidence mean difference 7.76 points, 95% confidence interval 0.66-14.9). Other balance measures did not show a difference in effect. Results from two studies suggest that circuit class therapy can reduce length of hospital stay (mean difference -19.7 days, 95% confidence interval -35.4 to -4.0). Two studies measured adverse events (falls) all were minor. Circuit class therapy is safe and effective in improving mobility in people after stroke and, when provided as part of hospital-based rehabilitation, may reduce length of stay.
Publisher: Copernicus GmbH
Date: 23-06-2021
Abstract: Abstract. Aerosol measurements over the Southern Ocean have been identified as critical to an improved understanding of aerosol–radiation and aerosol–cloud interactions, as there currently exists significant discrepancies between model results and measurements in this region. The atmosphere above the Southern Ocean provides crucial insight into an aerosol regime relatively free from anthropogenic influence, yet its remoteness ensures atmospheric measurements are relatively rare. Here we present observations from the Polar Cell Aerosol Nucleation (PCAN) c aign, hosted aboard the RV Investigator during a summer (January–March) 2017 voyage from Hobart, Australia, to the East Antarctic seasonal sea ice zone. A median particle number concentration (condensation nuclei 3 nm CN3) of 354 (95 % CI 345–363) cm−3 was observed from the voyage. Median cloud condensation nuclei (CCN) concentrations were 167 (95 % CI 158–176) cm−3. Measured particle size distributions suggested that aerosol populations had undergone significant cloud processing. To understand the variability in aerosol observations, measurements were classified by meteorological variables. Wind direction and absolute humidity were used to identify different air masses, and aerosol measurements were compared based on these identifications. CN3 concentrations measured during SE wind directions (median 594 cm−3) were higher than those measured during wind directions from the NW (median 265 cm−3). Increased frequency of measurements from these wind directions suggests the influence of large-scale atmospheric transport mechanisms on the local aerosol population in the boundary layer of the East Antarctic seasonal ice zone. Modelled back trajectories imply different air mass histories for each measurement group, supporting this suggestion. CN3 and CCN concentrations were higher during periods where the absolute humidity was less than 4.3 gH2O/m3, indicative of free tropospheric or Antarctic continental air masses, compared to other periods of the voyage. Increased aerosol concentration in air masses originating close to the Antarctic coastline have been observed in numerous other studies. However, the smaller changes observed in the present analyses suggest seasonal differences in atmospheric circulation, including lesser impact of synoptic low-pressure systems in summer. Further measurements in the region are required before a more comprehensive picture of atmospheric circulation in this region can be captured and its influence on local aerosol populations understood.
Publisher: SAGE Publications
Date: 24-02-2020
Abstract: Stroke is a leading cause of death and disability. It is a complex and largely heterogeneous condition. Prognosis for variations in impairment and recovery following stroke continues to be challenging and inaccurate, highlighting the need to examine the influence of other currently unknown variables to better predict and understand interin idual differences in stroke impairment and recovery. The concept of “cognitive reserve,” a feature of brain function said to moderate the relationship between brain pathology and clinical outcomes, might provide a partial explanation. This review discusses the potential significance of cognitive reserve in the context of stroke, with reference to reduced burden of disability poststroke, health promotion, intervention and secondary prevention of cognitive impairment, ease and challenges of translation into clinical practice, prognosis and prediction of recovery, and clinical decisions and trial stratification. Discussions from the review aim to encourage stroke clinicians and researchers to better consider the role of premorbid, lifestyle-related variables, such as cognitive reserve, in facilitating successful neurological outcomes and recovery following stroke.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2019
Publisher: AMPCo
Date: 05-2017
DOI: 10.5694/MJA16.01075
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2017
Publisher: Copernicus GmbH
Date: 27-11-2019
Publisher: Frontiers Media SA
Date: 29-04-2015
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.APMR.2007.04.010
Abstract: To compare the effectiveness of circuit class therapy and in idual physiotherapy (PT) sessions in improving walking ability and functional balance for people recovering from stroke. Nonrandomized, single-blind controlled trial. Medical rehabilitation ward of a rehabilitation hospital. Sixty-eight persons receiving inpatient rehabilitation after a stroke. Subjects received group circuit class therapy or in idual treatment sessions as the sole method of PT service delivery for the duration of their inpatient stay. Five-meter walk test (5MWT), two-minute walk test (2MWT), and the Berg Balance Scale (BBS) measured 4 weeks after admission. Secondary outcome measures included the Iowa Level of Assistance Scale, Motor Assessment Scale upper-limb items, and patient satisfaction. Measures were taken on admission and 4 weeks later. Subjects in both groups showed significant improvements between admission and week 4 in all primary outcome measures. There were no significant between group differences in the primary outcome measures at week 4 (5MWT mean difference, .07m/s 2MWT mean difference, 1.8m BBS mean difference, 3.9 points). A significantly higher proportion of subjects in the circuit class therapy group were able to walk independently at discharge (P=.01) and were satisfied with the amount of therapy received (P=.007). Circuit class therapy appeared as effective as in idual PT sessions for this s le of subjects receiving inpatient rehabilitation poststroke. Favorable results for circuit classes in terms of increased walking independence and patient satisfaction suggest this model of service delivery warrants further investigation.
Publisher: Frontiers Media SA
Date: 11-01-2023
Publisher: Frontiers Media SA
Date: 29-11-2021
DOI: 10.3389/FNEUR.2021.745964
Abstract: Background: Body awareness (BA) is a process that involves sensory awareness originating from the body's physiological states, processes and actions, and is shaped by one's attitudes, perceptions, beliefs and experience of social and cultural context. Impairments in body awareness after stroke are believed to be common and may be an important influence on recovery outcomes. However, recovery of body awareness is poorly understood and receives little consideration in rehabilitation. Aims: To investigate if body awareness changes over time following stroke and identify if body awareness after stroke is associated with sensation, motor impairment, self-efficacy and quality of life. Methods: An exploratory longitudinal observational study was performed. Participants with a stroke diagnosis and associated motor impairment were recruited from an acute stroke unit. An assessment battery consisting of sensory and motor impairment and function, body awareness, self-efficacy and quality of life measures were used at baseline, 1, 3 and 6 months. Results: A total of 105 people with stroke were recruited. Most recovery in sensation and body awareness occurred within the first month after stroke (all p & 0.01). Sensation and body awareness were correlated with other clinical outcomes (motor impairment, self-efficacy and quality of life), demographics, and stroke specific clinical characteristics (all p & 0.01). Conclusions: This is the first study to track recovery of body awareness after stroke and investigate the relationship it may have in recovery of sensation, motor impairment and function, self-efficacy and quality of life. Further research is now warranted to continue investigation of body awareness and to develop effective stroke-specific assessment and intervention strategies.
Publisher: Springer Science and Business Media LLC
Date: 20-11-2020
Publisher: SAGE Publications
Date: 23-02-2015
Abstract: Proprioception is a vital aspect of motor control and when degraded or lost can have a profound impact on function in erse clinical populations. This systematic review aimed to identify clinically related tools to measure proprioceptive acuity, to classify the construct(s) underpinning the tools, and to report on the clinimetric properties of the tools. We searched key databases with the pertinent search terms, and from an initial list of 935 articles, we identified 57 of relevance. These articles described 32 different tools or methods to quantify proprioception. There was wide variation in methods, the joints able to be tested, and the populations s led. The predominant construct was active or passive joint position detection, followed by passive motion detection and motion direction discrimination. The clinimetric properties were mostly poorly evaluated or reported. The Rivermead Assessment of Somatosensory Perception was generally considered to be a valid and reliable tool but with low precision other tools with higher precision are potentially not clinically feasible. Clinicians and clinical researchers can use the summary tables to make more informed decisions about which tool to use to match their predominant requirements. Further discussion and research is needed to produce measures of proprioception that have improved validity and utility.
Publisher: MDPI AG
Date: 12-01-2023
DOI: 10.3390/RS15020461
Abstract: A comparative study and evaluation of boundary layer height (BLH) estimation was conducted during an experimental c aign conducted at the Cape Grim Air Pollution station, Australia, from 1 June to 13 July 2019. The temporal and spatial distributions of BLH were studied using data from a ceilometer, sodar, in situ meteorological measurements, and back-trajectory analyses. Generally, the BLH under continental sources is lower than that under marine sources. The BLH is featured with a shallow depth of 515 ± 340 m under the Melbourne/East Victoria continental source. Especially the mixed continental sources (Melbourne/East Victoria and Tasmania direction) lead to a rise in radon concentration and lower BLH. In comparison, the boundary layer reaches a higher averaged BLH value of 730 ± 305 m when marine air is prevalent. The BLH derived from ERA5 is positively biased compared to the ceilometer observations, except when the boundary layer is stable. The height at which wind profiles experience rapid changes corresponds to the BLH value. The wind flow within the boundary layer increased up to ∼200 m, where it then meandered up to ∼300 m. Furthermore, the statistic shows that BLH is positively associated with near-surface wind speed. This study firstly provides information on boundary layer structure in Cape Grim and the interaction with wind, which may aid in further evaluating their associated impacts on the climate and ecosystem.
Publisher: Mark Allen Group
Date: 02-2009
DOI: 10.12968/IJTR.2009.16.2.38893
Abstract: This study investigated the amount of time people recovering from stroke spend engaged in physical activity during physiotherapy sessions, and the types of activities included in physiotherapy sessions. An observational study was conducted with 15 people receiving inpatient stroke rehabilitation. Participants were video-taped in one circuit class therapy session and one in idual physiotherapy session. The proportion of session time participants spent engaged in physical activity within circuit class therapy and in idual physiotherapy sessions and the proportion of session time participants spent engaged in specific activities during therapy sessions was measured. There was little difference in the percentage of the total session time that participants spent engaged in physical activity (mean difference=1.7 (standard deviation 13.9% 95% confidence interval −6.0 to 9.4) between the two modes of therapy delivery. The most prevalent activity engaged in during in idual therapy sessions was walking (44%). The most prevalent activity engaged in during circuit class therapy sessions was activities in standing (25%). A large percentage of therapy session time was spent resting in sitting in both circuit class therapy (30%) and in idual physiotherapy sessions (21%). Participants spent a similar percentage of the total therapy time in circuit class therapy and in idual therapy sessions engaged in physical activity. As circuit class therapy sessions ran for longer each day, and involved a lower staff to patient ratio they may be a more resource efficient means of providing therapy. This requires further investigation. In both types of physiotherapy sessions, participants spent a large amount of time inactive. Physiotherapists should consider strategies to maximize the time patients spend engaged in physical activity, regardless of the form of therapy delivery.
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1016/J.APMR.2007.06.010
Abstract: To determine the effects of a sensory retraining protocol on sensation, postural control, and gait in acute stroke subjects. Randomized controlled pilot trial. Inpatient rehabilitation hospital. Twenty-one subjects with sensory deficits in the feet, undergoing rehabilitation for stroke. Sensory retraining of the more affected lower limb versus relaxation (sham intervention). Light touch at the sole of the foot (Semmes-Weinstein monofilaments), proprioception (Distal Proprioception Test), postural control (Berg Balance Scale), and gait (timed, Iowa Level of Assistance Scale). Significant improvements (P<.05) over time were found in light touch at 3 points of the feet and in postural control, timed gait, and walking aid. No significant time effects were observed in proprioception or amount of assistance required to walk. No significant differences were detected between groups in any of the outcome variables, apart from light touch at the first metatarsal. The study had poor power (13%) to detect group effects due to the small s le size. Results of this pilot study are unable to support or refute the routine use of sensory retraining of the lower limb for people during inpatient rehabilitation after stroke. Further research with a larger s le size is required.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-01-2014
Publisher: OMICS Publishing Group
Date: 11-2013
DOI: 10.2217/CPR.13.64
Publisher: CSIRO Publishing
Date: 08-04-2022
DOI: 10.1071/PY21219
Abstract: In promoting positive cardiovascular health for Aboriginal and Torres Strait Islander peoples, there is a need to ensure provision of high-quality risk assessment and management in primary healthcare settings. There is some evidence of gender gaps for Australian women in the provision of cardiovascular risk assessment and management however, there is little understanding of whether these gaps are also present for Aboriginal and Torres Strait Islander women. A mixed-method systematic review was utilised to synthesise existing evidence on the provision of assessment and management against guideline-recommended care for Aboriginal and Torres Strait Islander women, and determine whether gender disparities in provision of care exist for this population. Sixteen studies that report gender-specific data indicate there are significant gaps in the provision of assessment and management for Aboriginal and Torres Strait Islander women and men alike. There is no evidence of incorporation of social and emotional wellbeing into cardiovascular care and limited studies outlining the assessment and management of behaviours and factors that may be protective of cardiovascular health. Furthermore, little is known about the provision of care in mainstream primary health services for Aboriginal and Torres Strait Islander peoples.
Publisher: Informa UK Limited
Date: 2010
DOI: 10.3109/09638280903171519
Abstract: Outcome measurement is an integral part of delivering rehabilitation services in community settings. However, measurement is of little value if instruments are chosen ad hoc and are not administered consistently. The purpose of this study was to develop and test a participatory process of outcome measure selection which would engender consistent use of robust and appropriate instruments. The ICF provided the conceptual framework for a systematic review of the literature for relevant outcome measures. A summary of the critical appraisal of the clinimetric properties of the identified instruments was created. The summaries were reviewed and vetted by stakeholders including clinicians, researchers, and managers olicy makers. From the 300 identified and appraised measures, 28 were chosen and made available in a Compendium of Clinical Measures for Community Rehabilitation. The Compendium contains three core measures to be used routinely with all rehabilitation clients and a further 25 that cover particular discipline and client needs. This resource is now available to all clinicians working in the participating rehabilitation services. A participatory process combining rigorous review of the literature, expert opinion, and clinician feedback is recommended in the selection and implementation of outcome measures in rehabilitation settings in the community.
Publisher: Copernicus GmbH
Date: 26-11-2020
Abstract: Abstract. Aerosol measurements over the Southern Ocean have been identified as critical to an improved understanding of aerosol-radiation and aerosol-cloud interactions, as there currently exists significant discrepancies between model results and measurements in this region. Previous springtime measurements from the East Antarctic seasonal ice zone revealed a significant increase in aerosol number concentrations when crossing the atmospheric polar front into the Polar cell. A return voyage in summer 2017 made a more extensive range of aerosols measurements, including in particular aerosol number concentrations and submicron size distributions. Again, significantly greater aerosol number concentrations were observed in the Polar cell than in the Ferrel cell. Unlike the previous spring voyage however, the polar front was unable to be identified by a step change in aerosol concentration. A possible explanation is that atmospheric mixing across the polar front occurs to a greater degree in summer, therefore weakening the atmospheric boundary at the front. This atmospheric mixing in summer complicates the determination of the polar front location. These changes, together with the increased source of precursors from phytoplankton emissions, are likely to explain the seasonal differences observed in the magnitude of aerosol populations between the Ferrel and Polar cell. In the present analysis, meteorological variables were used to identify different air-masses and then aerosol measurements were compared based on these identifications. CN3 concentrations measured during wind directions indicative of Polar cell airmasses (median 594 cm−3) were larger than those measured during wind directions indicative of Ferrel cell air (median 265 cm−3). CN3 and CCN concentrations were larger during periods where the absolute humidity was less than 4.3 gH2O/m3, indicative of free tropospheric or Antarctic continental airmasses, compared to other periods of the voyage. These results indicate that a persistently more concentrated aerosol population is present in the Polar cell over the East Antarctic seasonal ice zone, although the observed difference between the two cells may vary seasonally.
Publisher: Elsevier BV
Date: 03-2013
Publisher: Springer Science and Business Media LLC
Date: 05-2013
Publisher: Hindawi Limited
Date: 2012
DOI: 10.1155/2012/820673
Abstract: Background . Targeted physical activity drives functional recovery after stroke. This review aimed to determine the amount of time stroke survivors spend physically active during physiotherapy sessions. Summary of Review . A systematic search was conducted to identify published studies that investigated the use of time by people with stroke during physiotherapy sessions. Seven studies were included six observational and one randomised controlled trial. People with stroke were found to be physically active for an average of 60 percent of their physiotherapy session duration. The most common activities practiced in a physiotherapy session were walking, sitting, and standing with a mean (SD) practice time of 8.7 (4.3), 4.5 (4.0), and 8.3 (2.6) minutes, respectively. Conclusion . People with stroke were found to spend less than two-thirds of their physiotherapy sessions duration engaged in physical activity. In light of dosage studies, practice time may be insufficient to drive optimal motor recovery.
Publisher: SAGE Publications
Date: 15-07-2017
Abstract: To explore the factors perceived to affect rehabilitation assessment and referral practices for patients with stroke. Qualitative study using data from focus groups analysed thematically and then mapped to the Theoretical Domains Framework. Eight acute stroke units in two states of Australia. Health professionals working in acute stroke units. Health professionals at all sites had participated in interventions to improve rehabilitation assessment and referral practices, which included provision of copies of an evidence-based decision-making rehabilitation Assessment Tool and pathway. Eight focus groups were conducted (32 total participants). Reported rehabilitation assessment and referral practices varied markedly between units. Continence and mood were not routinely assessed (4 units), and people with stroke symptoms were not consistently referred to rehabilitation (4 units). Key factors influencing practice were identified and included whether health professionals perceived that use of the Assessment Tool would improve rehabilitation assessment practices (theoretical domain ‘social and professional role’) beliefs about outcomes from changing practice such as increased equity for patients or conversely that changing rehabilitation referral patterns would not affect access to rehabilitation (‘belief about consequences’) the influence of the unit’s relationships with other groups including rehabilitation teams (‘social influences’ domain) and understanding within the acute stroke unit team of the purpose of changing assessment practices (‘knowledge’ domain). This study has identified that health professionals’ perceived roles, beliefs about consequences from changing practice and relationships with rehabilitation service providers were perceived to influence rehabilitation assessment and referral practices on Australian acute stroke units.
Publisher: Springer Science and Business Media LLC
Date: 05-01-2017
Publisher: Oxford University Press (OUP)
Date: 10-2016
DOI: 10.2522/PTJ.20150668
Abstract: Exercise interventions are often incompletely described in reports of clinical trials, h ering evaluation of results and replication and implementation into practice. The aim of this study was to develop a standardized method for reporting exercise programs in clinical trials: the Consensus on Exercise Reporting Template (CERT). Using the EQUATOR Network's methodological framework, 137 exercise experts were invited to participate in a Delphi consensus study. A list of 41 items was identified from a meta-epidemiologic study of 73 systematic reviews of exercise. For each item, participants indicated agreement on an 11-point rating scale. Consensus for item inclusion was defined a priori as greater than 70% agreement of respondents rating an item 7 or above. Three sequential rounds of anonymous online questionnaires and a Delphi workshop were used. There were 57 (response rate=42%), 54 (response rate=95%), and 49 (response rate=91%) respondents to rounds 1 through 3, respectively, from 11 countries and a range of disciplines. In round 1, 2 items were excluded 24 items reached consensus for inclusion (8 items accepted in original format), and 16 items were revised in response to participant suggestions. Of 14 items in round 2, 3 were excluded, 11 reached consensus for inclusion (4 items accepted in original format), and 7 were reworded. Sixteen items were included in round 3, and all items reached greater than 70% consensus for inclusion. The views of included Delphi panelists may differ from those of experts who declined participation and may not fully represent the views of all exercise experts. The CERT, a 16-item checklist developed by an international panel of exercise experts, is designed to improve the reporting of exercise programs in all evaluative study designs and contains 7 categories: materials, provider, delivery, location, dosage, tailoring, and compliance. The CERT will encourage transparency, improve trial interpretation and replication, and facilitate implementation of effective exercise interventions into practice.
Publisher: Informa UK Limited
Date: 28-06-2022
DOI: 10.1080/10749357.2021.1911771
Abstract: Aboriginal and Torres Strait Islander (hereinafter respectfully termed Aboriginal) people have a greater incidence of stroke at a younger age than non-Indigenous people in Australia. The needs and preferences of Aboriginal people for rehabilitation and longer-term support remain largely unknown. To identify the long-term rehabilitation needs of Aboriginal people who have a stroke, from the perspectives of Aboriginal persons with stroke and health care providers. Aboriginal people who had experienced stroke in the previous three years were interviewed to obtain their experiences of rehabilitation care. Health professionals who provided care in each of six designated hospitals and nearby community health sites were involved in focus groups and in idual interviews. Information obtained was thematically analyzed separately for Aboriginal people with stroke and health professionals, and compared using Nvivo. Among six Aboriginal people with stroke and 78 healthcare providers, four main themes emerged: the importance of family variable access to services the impact of stroke on Aboriginal peoples' lives and making positive choices. Communication and involvement of family was highlighted as essential for a shared understanding, particularly when making decisions about participating in short and long-term rehabilitation. Co-morbidities, conflicting priorities, and inadequate or inflexible services and transport compounded issues with changing life roles. Stories of resilience were also shared. Aboriginal people report making positive lifestyle changes, but experience significant unmet rehabilitation needs. Addressing issues of communication, advocacy and flexible delivery should improve some of the shortfalls in service provision, particularly in regional and remote areas.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2017
DOI: 10.1097/PEP.0000000000000423
Abstract: To investigate whether the environment and personnel providing intervention to children with developmental coordination disorder make a difference in motor outcomes and perceived competency. Ninety-three children (66 males), aged 5 years 1 month to 8 years 11 months, with developmental coordination disorder were randomized to receive a 13-week group-based task-oriented intervention, either at school by a school assistant or physical therapist, or in a health clinic by a physical therapist. The Movement Assessment Battery for Children (MABC) assessed motor skills pre- and postintervention. Self-perception and cost-effectiveness were also assessed. Participants demonstrated a significant improvement in motor skills following intervention for all modes of delivery up to 6 months postintervention, MABC mean difference 7.20 (95% confidence interval, 5.89-8.81), effect size = 0.98. Group intervention programs for developmental coordination disorder can be run by either a health professional or a school assistant (supported by physical therapist) in either the school or clinic environment and provide successful outcomes.
Publisher: JMIR Publications Inc.
Date: 18-10-2018
DOI: 10.2196/10848
Publisher: Elsevier BV
Date: 2003
Publisher: Wiley
Date: 21-05-2010
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.GAITPOST.2017.04.020
Abstract: Understanding the biomechanics of the foot is essential for many areas of research and clinical practice such as orthotic interventions and footwear development. Despite the widespread attention paid to the biomechanics of the foot during gait, what largely remains unknown is how the foot moves inside the shoe. This study investigated the reliability of the Adelaide In-Shoe Foot Model, which was designed to quantify in-shoe foot kinematics and kinetics during walking. Intra-rater reliability was assessed in 30 participants over five walking trials whilst wearing shoes during two data collection sessions, separated by one week. Sufficient reliability for use was interpreted as a coefficient of multiple correlation and intra-class correlation coefficient of >0.61. Inter-rater reliability was investigated separately in a second s le of 10 adults by two researchers with experience in applying markers for the purpose of motion analysis. The results indicated good consistency in waveform estimation for most kinematic and kinetic data, as well as good inter-and intra-rater reliability. The exception is the peak medial ground reaction force, the minimum abduction angle and the peak abduction/adduction external hindfoot joint moments which resulted in less than acceptable repeatability. Based on our results, the Adelaide in-shoe foot model can be used with confidence for 24 commonly measured biomechanical variables during shod walking.
Publisher: MDPI AG
Date: 31-12-2020
Abstract: Volatile organic compounds (VOCs) play a key role in the formation of ozone and secondary organic aerosol, the two most important air pollutants in Sydney, Australia. Despite their importance, there are few available VOC measurements in the area. In this paper, we discuss continuous GC-MS measurements of 10 selected VOCs between February (summer in the southern hemisphere) and June (winter in the southern hemisphere) of 2019 in a semi-urban area between natural eucalypt forest and the Sydney metropolitan fringe. Combined, isoprene, methacrolein, methyl-vinyl-ketone, α-pinene, p-cymene, eucalyptol, benzene, toluene xylene and tri-methylbenzene provide a reasonable representation of variability in the total biogenic VOC (BVOC) and anthropogenic VOC (AVOC) loading in the area. Seasonal changes in environmental conditions were reflected in observed BVOC concentrations, with a summer peak of 8 ppb, dropping to approximately 0.1 ppb in winter. Isoprene, and its immediate oxidation products methacrolein (MACR) and methyl-vinyl-ketone (MVK), dominated BVOC concentrations during summer and early autumn, while monoterpenes comprised the larger fraction during winter. Temperature and solar radiation drive most of the seasonal variation observed in BVOCs. Observed levels of isoprene, MACR and MVK in the atmosphere are closely related with variations in temperature and photosynthetically active radiation (PAR), but chemistry and meteorology may play a more important role for the monoterpenes. Using a nonlinear model, temperature explains 51% and PAR 38% of the isoprene, MACR and MVK variation. Eucalyptol dominated the observed monoterpene fraction (contributing ~75%), with p-cymene (20%) and α-pinene (5%) also present. AVOCs maintain an average concentration of ~0.4 ppb, with a slight decrease during autumn–winter. The low AVOC concentrations observed indicate a relatively small anthropogenic influence, generally occurring when (rare) northerly winds transport Sydney emissions to the measurement site. The site is influenced by domestic, commercial and vehicle AVOC emissions. Our observed AVOC concentrations can be explained by the seasonal changes in meteorology and the emissions in the area as listed in the NSW emissions inventory and thereby act as an independent validation of this inventory. We conclude that the variations in atmospheric composition observed during the seasons are an important variable to consider when formulating air pollution control policies over Sydney given the influence of biogenic sources during summer, autumn and winter.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2008
Publisher: Copernicus GmbH
Date: 10-07-2020
Abstract: Abstract. Cloud–radiation interactions over the Southern Ocean are not well constrained in climate models, in part due to uncertainties in the sources, concentrations, and cloud-forming potential of aerosol in this region. To date, most studies in this region have reported measurements from fixed terrestrial stations or a limited set of instrumentation and often present findings as broad seasonal or latitudinal trends. Here, we present an extensive set of aerosol and meteorological observations obtained during an austral summer cruise across the full width of the Southern Ocean south of Australia. Three episodes of continental-influenced air masses were identified, including an apparent transition between the Ferrel atmospheric cell and the polar cell at approximately 64∘ S, and accompanied by the highest median cloud condensation nuclei (CCN) concentrations, at 252 cm−3. During the other two episodes, synoptic-scale weather patterns erted air masses across distances greater than 1000 km from the Australian and Antarctic coastlines, respectively, indicating that a large proportion of the Southern Ocean may be periodically influenced by continental air masses. In all three cases, a highly cloud-active accumulation mode dominated the size distribution, with up to 93 % of the total number concentration activating as CCN. Frequent cyclonic weather conditions were observed at high latitudes and the associated strong wind speeds led to predictions of high concentrations of sea spray aerosol. However, these modelled concentrations were not achieved due to increased aerosol scavenging rates from precipitation and convective transport into the free troposphere, which decoupled the air mass from the sea spray flux at the ocean surface. CCN concentrations were more strongly impacted by high concentrations of large-diameter Aitken mode aerosol in air masses which passed over regions of elevated marine biological productivity, potentially contributing up to 56 % of the cloud condensation nuclei concentration. Weather systems were vital for aerosol growth in biologically influenced air masses and in their absence ultrafine aerosol diameters were less than 30 nm. These results demonstrate that air mass meteorological history must be considered when modelling sea spray concentrations and highlight the potential importance of sub-grid-scale variability when modelling atmospheric conditions in the remote Southern Ocean.
Publisher: Elsevier BV
Date: 06-2019
Publisher: Springer Science and Business Media LLC
Date: 05-2013
Publisher: Elsevier BV
Date: 12-2016
Publisher: Informa UK Limited
Date: 05-10-2016
Publisher: Informa UK Limited
Date: 22-12-2023
Publisher: Informa UK Limited
Date: 03-10-2022
DOI: 10.1080/09638288.2022.2123053
Abstract: To summarise body awareness assessment tools and interventions relevant for stroke rehabilitation using a framework that categorises key body awareness constructs, disorders and impairments. Online electronic databases and trial registries were searched from inception until July 2021, in addition to hand searching reference lists of included studies and reviews. Study selection included any study design where the investigation involved assessing and/or intervening in body awareness following stroke. Data were extracted based on predefined criteria by two independent reviewers and mapped to the emergent framework. The final analysis included 144 papers that reported 43 assessment tools and 8 types of interventions for body awareness. Consensus was reached on a synthesised body awareness framework. This comprised specific impairments and disorders, constructs, sub-categories and main categories leading to the overarching term of body awareness. Clinical and psychometric properties of the assessment tools were not reported or poorly evaluated, and the interventions lacked robust study designs and rigorous methods. The framework produced will enable future research and clinical practice to be based on consistent concepts and definitions. Clinicians can also use this information to cautiously select assessment tools and/or interventions but are reminded of the limitations identified in this review.Implications for rehabilitationThere is limited understanding, compounded by inconsistent terminology and definitions regarding body awareness after stroke.A synthesized framework to define key constructs and definitions of body awareness is proposed.Assessment tools and interventions reported in the literature are mapped to the proposed framework.Psychometric properties of available tools are reported.Significant work remains to refine concepts of body awareness, develop and evaluate assessment tools and interventions.
Publisher: Springer Science and Business Media LLC
Date: 28-06-2019
Publisher: Frontiers Media SA
Date: 24-11-2021
DOI: 10.3389/FNEUR.2021.742365
Abstract: Objective: The objective of this scoping review was to capture the reported definitions for the subtypes of neglect post stroke and map the range of assessment tools employed for each neglect subtype. Methods: EMBASE, Emcare, Medline, and psychINFO were searched from database inception. Searching included all allied terms and mesh headings for stroke, spatial neglect, measurement, screening tools, psychometric properties. Two reviewers independently screened studies for inclusion. Primary studies with documented protocols of a spatial neglect tool for adults post stroke, with some aspect of validity or reliability were included. Two reviewers independently reviewed the documented protocols of each tool to determine the underlying subtypes and disagreements were resolved through discussion. Results: There were 371 articles included with 292 tools used for the screening or diagnosis of neglect. The majority of studies (67%) included a tool that did not specify the neglect subtype being assessed, therefore an analysis of the underlying subtypes for each tool is presented. Conclusions: There is no consistency with the terms used to refer to the syndrome of spatial neglect with over 200 different terms used within the included studies to refer to the syndrome as a whole or one of its subtypes. It is essential to unify the terminology and definition for each neglect subtype. There are hundreds of neglect tools available, however many are not able to differentiate presenting subtypes. It is important for clinicians and researchers to critically evaluate the neglect tools being used for the screening and diagnosis of neglect.
Publisher: Springer Science and Business Media LLC
Date: 26-10-2011
DOI: 10.1038/SC.2010.148
Abstract: Retrospective, observational study, with consecutive s ling. To document the frequency and time frames for the achievement of independence in mobility skills for people undergoing rehabilitation following spinal cord injury (SCI). The South Australian Spinal Cord Injury Service, H stead Rehabilitation Centre, Adelaide, Australia. Retrospective data collection from a purpose-designed form. The achievement of independence in nine functional mobility skills, and time lines for this, were documented for people with a new SCI undergoing rehabilitation. Data from 152 participants were analyzed. Of the nine mobility-based goals evaluated, the one most likely to be achieved was sitting on the edge of the bed and the least likely was gait. Time taken to achieve the skills varied from 4 to 10 weeks on average and reflected the degree of difficulty. The frequency and time frames to achieve independence in mobility skills documented in this study will be useful when goal setting in a post-acute SCI rehabilitation setting.
Publisher: SAGE Publications
Date: 2006
DOI: 10.1191/0269215506CR877OA
Abstract: Objective: To investigate the sensitivity of three commonly used functional outcome measures to detect change over time in subjects receiving inpatient rehabilitation post stroke. Design: Subjects were assessed within one week of admission and one week of discharge from an inpatient rehabilitation facility. Several parameters of sensitivity were calculated, including floor and ceiling effects, the percentage of subjects showing no change and the effect size of the change between admission and discharge. Setting: The medical rehabilitation ward of an inpatient rehabilitation facility. Subjects: Seventy-eight subjects receiving inpatient rehabilitation following a first or recurrent stroke. Measures: Five-metre walk, comfortable pace (gait speed), the Berg Balance Scale and the Motor Assessment Scale. Results: Sixty-one subjects had complete admission and discharge data. Gait speed and the Berg Balance Scale were both sensitive to change and demonstrated large effect sizes. The Motor Assessment Scale item five also showed a large effect size and was able to detect change amongst lower functioning subjects. The other items of the Motor Assessment Scale were less useful, in particular, the effect sizes for upper extremity change scores were small ( d=0.36–0.5) and the majority of subjects (44.3–63.9%) showed no change over time on these measures. Conclusion: Gait speed, the Berg Balance Scale and the Motor Assessment Scale item five were sensitive to change over time in this s le.
Publisher: SAGE Publications
Date: 21-05-2020
Abstract: Background. Resting state functional connectivity (RSFC) is a developmental priority for stroke recovery. Objective. To determine whether (1) RSFC differs between stroke survivors based on integrity of descending motor pathways (2) RSFC is associated with upper-limb behavior in chronic stroke and (3) the relationship between interhemispheric RSFC and upper-limb behavior differs based on descending motor pathway integrity. Methods. A total of 36 people with stroke (aged 64.4 ± 11.1 years, time since stroke 4.0 ± 2.8 years) and 25 healthy adults (aged 67.3 ± 6.7 years) participated in this study. RSFC was estimated from electroencephalography (EEG) recordings. Integrity of descending motor pathways was ascertained using transcranial magnetic stimulation to determine motor-evoked potential (MEP) status and magnetic resonance imaging to determine lesion overlap and fractional anisotropy of the corticospinal tract (CST). For stroke participants, upper-limb motor behavior was assessed using the Fugl-Meyer test, Action Research Arm Test and grip strength. Results. β-Frequency interhemispheric sensorimotor RSFC was greater for MEP+ stroke participants compared with MEP− ( P = .020). There was a significant positive correlation between β RSFC and upper-limb behavior ( P = .004) that appeared to be primarily driven by the MEP+ group. A hierarchical regression identified that the addition of β RSFC to measures of CST integrity explained greater variance in upper-limb behavior ( R 2 change = 0.13 P = .01). Conclusions. This study provides insight to understand the role of EEG-based measures of interhemispheric network activity in chronic stroke. Resting state interhemispheric connectivity was positively associated with upper-limb behavior for stroke survivors where residual integrity of descending motor pathways was maintained.
Publisher: Informa UK Limited
Date: 08-06-2016
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.JPHYS.2013.12.006
Abstract: Do people with stroke spend more time in active task practice during circuit class therapy sessions versus in idual physiotherapy sessions? Do people with stroke practise different tasks during circuit class therapy sessions versus in idual physiotherapy sessions? Prospective, observational study. Twenty-nine people with stroke in inpatient rehabilitation settings. In idual therapy sessions and circuit class therapy sessions provided within a larger randomised controlled trial. Seventy-nine therapy sessions were video-recorded and the footage was analysed for time spent engaged in various categories of activity. In a subs le of 28 videos, the number of steps taken by people with stroke per therapy session was counted. Circuit class therapy sessions were of a longer duration (mean difference 38.0minutes, 95% CI 29.9 to 46.1), and participants spent more time engaged in active task practice (mean difference 23.8minutes, 95% CI 16.1 to 31.4) compared with in idual sessions. A greater percentage of time in circuit class therapy sessions was spent practising tasks in sitting (mean difference 5.3%, 95% CI 2.4 to 8.2) and in sit-to-stand practice (mean difference 2.7%, 95% CI 1.4 to 4.1), and a lower percentage of time in walking practice (mean difference 19.1%, 95% CI 10.0 to 28.1) compared with in idual sessions. PARTICIPANTS took an average of 371 steps (SD 418) during therapy sessions and this did not differ significantly between group and in idual sessions. People with stroke spent more time in active task practice, but a similar amount of time in walking practice when physiotherapy was offered in circuit class therapy sessions versus in idual therapy sessions. There is a need for effective strategies to increase the amount of walking practice during physiotherapy sessions for people after stroke.
Publisher: Wiley
Date: 31-10-2022
DOI: 10.1111/HEX.13636
Abstract: Acquired brain injury (ABI) can result in considerable life changes. Having choice and control over daily life is valued by people following ABI. This meta‐synthesis will analyse and integrate international research exploring perspectives of choice and control in daily life following ABI. Databases were searched from 1980 to 13 January 2022 for eligible qualitative studies. After duplicates were removed, 22,768 studies were screened by title and abstract, and 241 studies received full‐text assessment with 56 studies included after pearling. Study characteristics and findings were extracted that related to personal perspectives on choice and control by people with an ABI (including author interpretation and quotes). Data from each study were coded and then segments of coded data across the studies were compared to create multiple broad categories. Findings were then reduced from categories into 3 overarching themes with 12 subthemes. These themes were: (1) feeling like a second‐class citizen (2) reordering life and (3) choosing a path. Participants with an ABI tussled between their feelings of loss following brain injury and their thinking about how they start to regain control and become agents of their own choices. The themes describe their sense of self, their changed self and their empowered self in relation to ‘choice and control’. Re‐engaging with choice and control after ABI is dynamic and can be challenging. Health professionals and supporters need to facilitate a gradual and negotiated return to agency for people following ABI. A sensitive and person‐centred approach is needed that considers the readiness of the person with ABI to reclaim choice and control at each stage of their recovery. Clear service or process indicators that are built on lived experience research are needed to facilitate changes in service delivery that are collaborative and inclusive. This review included the voices of 765 people living with ABI and was conducted by a erse team of allied health professionals with practice knowledge and research experience with people following ABI. Twenty‐nine of the 56 included studies had participants contributing to their design or analysis.
Publisher: John Wiley & Sons, Ltd
Date: 08-10-2008
Publisher: American Geophysical Union (AGU)
Date: 05-11-2018
DOI: 10.1029/2018GL079981
Publisher: Informa UK Limited
Date: 18-06-2015
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.JENVRAD.2018.03.012
Abstract: Ambient gamma dose, radon, and rainfall have been monitored in southern Bucharest, Romania, from 2010 to 2016. The seasonal cycle of background ambient gamma dose peaked between July and October (100-105 nSv h
Publisher: Wiley
Date: 06-2011
Publisher: SAGE Publications
Date: 24-11-2011
DOI: 10.1111/J.1747-4949.2011.00686.X
Abstract: There is strong evidence for a dose–response relationship between physical therapy early after stroke and recovery of function. The optimal method of maximizing physical therapy within finite health care resources is unknown. To determine the effectiveness and cost-effectiveness of two alternative models of physical therapy service delivery (seven-days per week therapy services or group circuit class therapy over five-days a week) to usual care for people receiving inpatient rehabilitation after stroke. Multicenter, three-armed randomized controlled trial with blinded assessment of outcomes. A total of 282 people admitted to inpatient rehabilitation facilities after stroke with an admission functional independence measure (FIM) score within the moderate range (total 40–80 points or motor 38–62 points) will be randomized to receive one of three interventions: • usual care therapy over five-days a week • standard care therapy over seven-days a week, or • group circuit class therapy over five-days a week. Participants will receive the allocated intervention for the length of their hospital stay. Analysis will be by intention-to-treat. The primary outcome measure is walking ability (six-minute walk test) at four-week postintervention with three- and six-month follow-up. Economic analysis will include a costing analysis based on length of hospital stay and staffing/resource costs and a cost-utility analysis (incremental quality of life per incremental cost, relative to usual care). Secondary outcomes include walking speed and independence, ability to perform activities of daily living, arm function, quality of life and participant satisfaction.
Publisher: Springer Science and Business Media LLC
Date: 02-08-2018
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH12034
Abstract: Objective. To estimate the risk of functional decline after discharge for older people presenting to, and discharged from, a large emergency department (ED) of a tertiary hospital. Methods. The cohort was generated by consecutive s ling of non-Indigenous males and females aged 65 years or over or Aboriginal and Torres Strait Islander males and females aged 45 years or more, without diagnosed dementia, who were living independently in the community before presenting at ED and who were not admitted to hospital as an inpatient after presenting to ED. The hospital assessment risk profile (HARP) was administered to all eligible participants. Sociodemographic information was collected. Results. Approximately 40 patients per day over two 14-week data collection periods were potentially eligible for inclusion in the study. In total, 597 (17.6% of in iduals who presented to ED) were eligible, agreed to participate and continued to be eligible on discharge from ED. Their HARP scores suggested that ~52% were at-risk of functional decline (14.1% high risk, 38.5% intermediate risk). Conclusions. Elderly patients present to and are discharged from ED every day. The routinely administered HARP instrument scores suggested that approximately half these in iduals were at-risk of functional decline in one large hospital ED. Given this instrument’s moderate diagnostic accuracy, the true figure may be higher. We suggest that all over-65 year olds presenting at ED without being admitted as an inpatient should be considered for routine screening for potential downstream functional decline, and for intervention if indicated. What is known about the topic? Older in iduals often present to ED in lieu of consulting a general medical practitioner, and are not admitted to a hospital bed. Patient demographics, functional and mental capacity and reasons for presentation may be flags for functional decline in the coming months. These could be used by ED staff to implement targeted assessment and intervention. What does this paper add? This paper highlights the high percentage of older in iduals who, at time of ED presentation, are at-risk of downstream functional decline. What are the implications for practitioners? Older people who are discharged from ED without a hospital admission may ‘slip through the net’, as an ED presentation presents a limited window of opportunity for ED staff to undertake targeted assessment, and intervention, to address the potential for downstream functional decline. The busy nature of ED, resource implications and the range of presenting conditions of older people may preclude this. This research suggests a reality that a large percentage of older people who present at ED but do not require a subsequent hospital admission have the potential for functional decline after discharge. Addressing this, in terms of specific screening processes and interventions, requires a rethink of hospital and community resources, and relationships.
Publisher: John Wiley & Sons, Ltd
Date: 21-01-2009
Publisher: American Geophysical Union (AGU)
Date: 26-12-2017
DOI: 10.1002/2017JD026833
Publisher: Springer Science and Business Media LLC
Date: 02-05-2017
Publisher: JMIR Publications Inc.
Date: 11-12-2020
DOI: 10.2196/23369
Abstract: Behavior change apps can develop iteratively, where the app evolves into a complex, dynamic, or personalized intervention through cycles of research, development, and implementation. Understanding how existing users engage with an app (eg, frequency, amount, depth, and duration of use) can help guide further incremental improvements. We aim to explore how simple visualizations can provide a good understanding of temporal patterns of engagement, as usage data are often longitudinal and rich. This study aims to visualize behavioral engagement with Drink Less, a behavior change app to help reduce hazardous and harmful alcohol consumption in the general adult population of the United Kingdom. We explored behavioral engagement among 19,233 existing users of Drink Less. Users were included in the s le if they were from the United Kingdom were 18 years or older were interested in reducing their alcohol consumption had a baseline Alcohol Use Disorders Identification Test score of 8 or above, indicative of excessive drinking and had downloaded the app between May 17, 2017, and January 22, 2019 (615 days). Measures of when sessions begin, length of sessions, time to disengagement, and patterns of use were visualized with heat maps, timeline plots, k-modes clustering analyses, and Kaplan-Meier plots. The daily 11 AM notification is strongly associated with a change in engagement in the following hour reduction in behavioral engagement over time, with 50.00% (9617/19,233) of users disengaging (defined as no use for 7 or more consecutive days) 22 days after download identification of 3 distinct trajectories of use, namely engagers (4651/19,233, 24.18% of users), slow disengagers (3679/19,233, 19.13% of users), and fast disengagers (10,903/19,233, 56.68% of users) and limited depth of engagement with 85.076% (7,095,348/8,340,005) of screen views occurring within the Self-monitoring and Feedback module. In addition, a peak of both frequency and amount of time spent per session was observed in the evenings. Visualizations play an important role in understanding engagement with behavior change apps. Here, we discuss how simple visualizations helped identify important patterns of engagement with Drink Less. Our visualizations of behavioral engagement suggest that the daily notification substantially impacts engagement. Furthermore, the visualizations suggest that a fixed notification policy can be effective for maintaining engagement for some users but ineffective for others. We conclude that optimizing the notification policy to target both effectiveness and engagement is a worthwhile investment. Our future goal is to both understand the causal effect of the notification on engagement and further optimize the notification policy within Drink Less by tailoring to contextual circumstances of in iduals over time. Such tailoring will be informed from the findings of our micro-randomized trial (MRT), and these visualizations were useful in both gaining a better understanding of engagement and designing the MRT.
Publisher: Oxford University Press (OUP)
Date: 05-2016
DOI: 10.2522/PTJ.20150210
Abstract: Proprioceptive imprecision is believed to contribute to persistent pain. Detecting imprecision in order to study or treat it remains challenging given the limitations of current tests. The aim of this study was to determine whether proprioceptive imprecision could be detected in people with neck pain by testing their ability to identify incongruence between true head motion and a false visual reference using the Proprioception Incongruence Detection (PID) Test. A cross-sectional study was conducted. Twenty-four people with neck pain and 24 matched controls repeatedly rotated to specific markers within a virtual world and indicated if their true head rotation was more or less than the rotation suggested by the visual feedback. Visual feedback was manipulated at 6 corrections, ranging from 60% of true movement to 140% of true movement. A standard repositioning error (RPE) test as undertaken for comparison. Healthy controls were better able to detect incongruence between vision and true head rotation (X̅=75.6%, SD=8.5%) than people with neck pain were (X̅=69.6%, SD=12.7%). The RPE test scores were not different between groups. The PID Test score related to self-reported pain intensity but did not relate to RPE test score. Causality cannot be established from this cross-sectional study, and further work refining the PID Test is needed for it to offer clinical utility. Proprioceptive precision for neck movement appears worse in people with neck pain than in those without neck pain, and the extent of the deficit appears to be related to usual pain severity. The PID Test appears to be a more sensitive test than the RPE test and is likely to be useful for assessment of proprioceptive function in research and clinical settings.
Publisher: Springer Science and Business Media LLC
Date: 10-06-2015
Publisher: SAGE Publications
Date: 06-2010
DOI: 10.1111/J.1747-4949.2010.00427.X
Abstract: Stroke rehabilitation for people living in the community is commonly delivered either in a centre, outpatient or day hospital setting. More recently, services may be offered in the actual home of the person as home-based or domiciliary rehabilitation. There are differing reports of the benefits and barriers of home-based vs. centre-based community rehabilitation. This systematic review sought to pool data from all retrieved studies that compared the functional benefits of home-based vs. centre for community-dwelling people with stroke. A comprehensive search strategy was implemented in all major databases (Cochrane library, Medline, AMED, Embase, Ageline, Cinahl, PEDro) for randomised controlled trials investigating this question in relation to functional benefits as a primary outcome and carer, cost or other benefits as secondary outcomes. There were no language or date limits. Eleven trials were found and results pooled for the Barthel Index, the measure of functional independence used consistently across the majority of retrieved studies. There was a significant effect in favour of home-based rehabilitation at 6 weeks ( P = 0·03) and 3–6 months ( P = 0·01). The effects were less clear at 6 months, although this was using the less sensitive version of the Barthel Index ( P = 0·27 or adjusted P = 0·04). In idual studies reported cost benefits and increased carer satisfaction in favour of home-based rehabilitation. The provision of rehabilitation for people living in the community should trend towards home-based. Further research is required into adverse events and the experiences of all stakeholders.
Publisher: Elsevier BV
Date: 06-2016
Publisher: PeerJ
Date: 06-12-2017
DOI: 10.7717/PEERJ.4151
Abstract: Low back pain clinical practice guidelines consistently recommend against the routine ordering of spinal imaging however, imaging is frequently requested in primary care, without evidence of benefit. Imaging reports frequently identify degenerative features which are likely to be interpreted as ‘abnormal’, despite their high prevalence in symptom-free in iduals. The aim of this study was to investigate whether post-imaging back-related perceptions are influenced by providing prior information about normal findings, and to compare the effect of receiving imaging results with best practice care (without imaging). The impact of introducing novel, ‘enhanced’ reporting strategies was also explored. This study was a simulated-patient, randomised, multiple-arm experiment. Patient scenarios were presented to volunteer healthy adult participants via an online survey. In the scenarios, ‘virtual’ patients with low back pain were randomised to one of three groups. Group 1 received imaging and was pre-informed about normal findings. Group 2 received imaging (without pre-information). Group 3 received best practice care: quality information without imaging. Group 1 was further ided to receive either a standard report, or an ‘enhanced’ report (containing altered terminology and epidemiological information). The primary outcome was back-related perceptions (BRP), a composite score derived from three numeric rating scale scores exploring perceptions of spinal condition, recovery concerns and planned activity. The secondary outcomes were satisfaction and kinesiophobia. Full data were available from 660 participants (68% female). Analysis of covariance revealed a significant effect of group after controlling for baseline BRP scores $(F(2,74)=10.4,p\\lt 0.001,{\\eta }_{p}^{2}=.04)$. Pairwise comparisons indicated that receiving best practice care resulted in more positive BRPs than receiving imaging results, and receiving prior information about normal findings had no impact. Enhanced reporting strategies also positively impacted BRPs $(F(1,275)=13.06,p\\lt 0.001,{\\eta }_{p}^{2}=.05)$. Significant relationships between group allocation and both satisfaction $(F(2,553)=7.5,p=0.001,{\\eta }_{p}^{2}=.03)$ and kinaesiophobia $(F(2,553)=3.0,p=0.050,{\\eta }_{p}^{2}=.01)$ were found, with statistically significant pairwise comparisions again in favour of best-practice care. Intervention strategies such as enhanced reporting methods and the provision of quality information (without imaging) have the potential to improve the outcome of patients with recent-onset LBP and should be further considered by primary care providers.
Publisher: Informa UK Limited
Date: 24-11-2016
DOI: 10.3109/09638288.2015.1103788
Abstract: To explore stroke survivors' perspectives of two novel models of inpatient physiotherapy, which provide an increased amount of therapy: five days a week circuit class therapy and seven days a week in idual therapy. This is a qualitative descriptive study using semi-structured interviews and thematic analysis. The participants were 10 purposively s led stroke survivors in the post-acute phase of recovery, who had experienced seven days a week in idual therapy or five days a week circuit group therapy during inpatient rehabilitation. Three main themes emerged from the data: Too much, too little or just right My experience - alone and together and Meeting my needs. Findings revealed considerable variety in participants' beliefs, priorities and preferences regarding how intensely they could work their experience of success and challenge in idually and collectively and their need to have their own unique in idual needs met. Lack of choice seemed to be a linking concept between the themes. In order to provide patient-centred services, novel methods of increased therapy must take into consideration the in idual needs and preferences of the people accessing them. One model may not meet all these needs, hence a "menu" of options for therapy sessions (different timing, frequency, duration, content, rest and supervision) may be required to accommodate the ersity of patient needs, preferences and capacities. Implications for Rehabilitation People with stroke have erse needs and preferences regarding the modes of delivering more therapy during rehabilitation. These erse needs may not be met by one rigid service model. Therapists and service providers could engage their clients in a dialogue about the need for more therapy and how it can be delivered. This dialogue could include options of the various ways to increase their therapy. Therapists need to provide clear reasons and education around therapy components, including rest time and practice schedules.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-10-2003
DOI: 10.1212/01.WNL.0000078809.33581.1F
Abstract: Combined peripheral nerve and brain stimulation ("dual stimulation") induces changes in the excitability of normal motor cortex. The authors sought to establish whether dual stimulation would also induce motor cortex plasticity and associated functional improvements in nine stroke patients with chronic stable hemiparesis. Following 4 weeks of daily dual stimulation, improvements were seen in some neurophysiological and functional measures. This technique may offer therapeutic opportunities in some stroke patients.
Publisher: Future Medicine Ltd
Date: 11-2018
Abstract: Following an initial stroke, approximately two in five people will experience another stroke within 10 years. Recurrent strokes are often more severe and fatal. Mindfulness-based interventions (MBIs) that use movement to focus attention, such as yoga and tai chi, may offer a lifestyle strategy in addition to standard rehabilitation options, for moderating risk factors for stroke. We conducted a scoping review to explore the potential for yoga or tai chi to moderate modifiable risk factors for stroke. 26 papers between 1985 and 2017 were identified using online and gray literature databases. Overall, yoga or tai chi may reduce hypertension (up to 16/9 mmHg), and to a lesser extent some lipid and blood sugar levels. Study designs were heterogeneous. Further research on mediating pathways of MBIs, such as yoga or tai chi, on modifiable risk factors for stroke is warranted.
Publisher: Springer Science and Business Media LLC
Date: 17-02-2017
Publisher: SAGE Publications
Date: 06-2014
DOI: 10.2466/25.27.PMS.118K27W2
Abstract: Evaluation of psychomotor skills is undertaken in a number of broad contexts. This includes testing of health professional populations as a measure of innate ability, to evaluate skill acquisition, or to compare professions. However, the use of psychomotor tests is frequently confounded by a lack of understanding of a particular tool's psychometric properties, strengths, and weaknesses. To identify and appraise the most commonly used tests on health professional populations, 86 articles were reviewed and the top nine tests identified. Few tests have had sufficient validity or reliability testing on health professionals. Based on the evidence available, use of the Grooved Pegboard Test, the Purdue Pegboard Test, or the Finger Tapping Test is recommended for the evaluation of dexterity in a health professional population however, this choice may be dependent on the task(s) to which findings are generalised. More rigorous evaluation of validity and other psychometric properties is required.
Publisher: American Podiatric Medical Association
Date: 03-2018
DOI: 10.7547/15-223
Abstract: In the podiatric medicine profession, there are a variety of manual tasks that require precision and skill beyond what would be usually expected in everyday living. It is the expectation of employers, regulatory bodies, and the public that graduating podiatric physicians sufficiently meet certain minimum competencies for that profession, including those for manual skills. However, teaching and evaluation methods seem to be inconsistent between countries, institutions, and programs. This may be the consequence of uncertainty regarding the safest and most effective methods to do so. A review of available international literature pertaining to psychomotor learning across a range of health professions was undertaken. As a result of this broad review, we present herein the available evidence and make recommendations for the teaching of psychomotor skills in the podiatric medicine profession. Specific aspects considered important include methods of teaching, practice, and feedback.
Publisher: Copernicus GmbH
Date: 21-02-2019
Abstract: Abstract. The Southern Ocean (south of 30∘ S) is a key global-scale sink of carbon dioxide (CO2). However, the isolated and inhospitable nature of this environment has restricted the number of oceanic and atmospheric CO2 measurements in this region. This has limited the scientific community's ability to investigate trends and seasonal variability of the sink. Compared to regions further north, the near-absence of terrestrial CO2 exchange and strong large-scale zonal mixing demands unusual inter-site measurement precision to help distinguish the presence of midlatitude to high latitude ocean exchange from large CO2 fluxes transported southwards in the atmosphere. Here we describe a continuous, in situ, ultra-high-precision Southern Ocean region CO2 record, which ran at Macquarie Island (54∘37′ S, 158∘52′ E) from 2005 to 2016 using a LoFlo2 instrument, along with its calibration strategy, uncertainty analysis and baseline filtering procedures. Uncertainty estimates calculated for minute and hourly frequency data range from 0.01 to 0.05 µmol mol−1 depending on the averaging period and application. Higher precisions are applicable when comparing Macquarie Island LoFlo measurements to those of similar instruments on the same internal laboratory calibration scale and more uncertain values are applicable when comparing to other networks. Baseline selection is designed to remove measurements that are influenced by local Macquarie Island CO2 sources, with effective removal achieved using a within-minute CO2 standard deviation metric. Additionally, measurements that are influenced by CO2 fluxes from Australia or other Southern Hemisphere land masses are effectively removed using model-simulated radon concentration. A comparison with flask records of atmospheric CO2 at Macquarie Island highlights the limitation of the flask record (due to corrections for storage time and limited temporal coverage) when compared to the new high-precision, continuous record: the new record shows much less noisy seasonal variations than the flask record. As such, this new record is ideal for improving our understanding of the spatial and temporal variability of the Southern Ocean CO2 flux, particularly when combined with data from similar instruments at other Southern Hemispheric locations.
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.ENVPOL.2018.08.043
Abstract: We discuss 15 years (2000-2015) of daily-integrated PM
Publisher: PeerJ
Date: 27-03-2014
DOI: 10.7717/PEERJ.331
Publisher: Informa UK Limited
Date: 05-2009
DOI: 10.1310/TSR1603-189
Abstract: Reliable and clinically relevant measures of change in the postural control of people post stroke are important for evaluating clinical interventions. This study investigated the reliability and usefulness of the F-Scan insole plantar pressure system in measuring possible postural control variables in a s le of 15 people post stroke. A test-retest design was employed to measure contact pressure (CP), contact area (CA), center of force (COF) and its motion characteristics in four different stance positions. The data collection was repeated 30 minutes later to replicate the timing of a standard therapy period. Good to excellent intertrial reliability was demonstrated (r = 0.704-0.986). The CP and CA data demonstrated relatively equal values between the hemi- and non-hemiparetic foot for the easier tasks (mean 3.6 to 3.7 KPa), and the asymmetry increased towards the non-hemiparetic foot as the tasks became harder (4 KPa vs. 3.3KPa on the hemiparetic). There were unexpected areas of high peak contact pressure on the more affected foot for several participants, whilst CA data quantified the expected redistribution of contact/weight toward the lateral border of the more affected foot in most, but not all, subjects. COF motion was markedly reduced on the more affected lower limb with a mean of 0.3 cm versus 0.5-3.8 cm for the other lower limb. The main findings were that the F-Scan generates reliable data and produces variables that are clinically useful for measuring asymmetry parameters of postural control post stroke.
Publisher: JMIR Publications Inc.
Date: 23-04-2018
Abstract: troke can have devastating consequences for an in idual’s quality of life. Interventions capable of enhancing response to therapy would be highly valuable to the field of neurological rehabilitation. One approach is to use noninvasive brain stimulation techniques, such as transcranial direct current stimulation, to induce a neuroplastic response. When delivered in combination with rehabilitation exercises, there is some evidence that transcranial direct current stimulation is beneficial. However, responses to stimulation are highly variable. Therefore biomarkers predictive of response to stimulation would be valuable to help select appropriate people for this potentially beneficial treatment. he objective of this study is to investigate connectivity of the stimulation target, the ipsilesional motor cortex, as a biomarker predictive of response to anodal transcranial direct current stimulation in people with stroke. his study is a double blind, randomized controlled trial (RCT), with two parallel groups. A total of 68 participants with first ever ischemic stroke with motor impairment will undertake a two week (14 session) treatment for upper limb function (Graded Repetitive Arm Supplementary Program GRASP). Participants will be randomized 2:1 to active:sham treatment groups. Those in the active treatment group will receive anodal transcranial direct current stimulation to the ipsilesional motor cortex at the start of each GRASP session. Those allocated to the sham treatment group will receive sham transcranial direct current stimulation. Behavioural assessments of upper limb function will be performed at baseline, post treatment, 1 month follow-up and 3 months follow-up. Neurophysiological assessments will include magnetic resonance imaging (MRI), electroencephalography (EEG) and transcranial magnetic stimulation (TMS) and will be performed at baseline, post treatment, 1 month follow-up (EEG and TMS only) and 3 months follow-up (EEG and TMS only). articipants will be recruited between March 2018 and December 2018, with experimental testing concluding in March 2019. dentifying a biomarker predictive of response to transcranial direct current stimulation would greatly assist clinical utility of this novel treatment approach. ustralia New Zealand Clinical Trials Registry ACTRN12618000443291 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000443291 (Archived by WebCite at 37QOXXxt) R1-10.2196/10848
Publisher: Informa UK Limited
Date: 25-11-2015
DOI: 10.3109/09638288.2015.1103791
Abstract: Less than half of the patients with stroke in Australian hospitals are assessed by rehabilitation specialists. We sought to explore how clinicians working in acute stroke units (ASUs) determine which patients to refer to rehabilitation services. Qualitative descriptive study. Team meetings were observed and medical records were reviewed over four weeks at two ASUs. Focus groups were conducted with staff from eight ASUs in two states of Australia. Rehabilitation was mentioned in team meetings for 50/64 patients (78%) during the observation period. Rehabilitation referrals were organised for 47 patients (94%) for whom rehabilitation was discussed (74% of the s le) and for no patients when rehabilitation was not discussed. Factors identified that influenced whether referrals were organised included the anticipated discharge destination severity of stroke staff expectations of the patient's recovery and if there was advocacy by families about rehabilitation. Clinicians tended to refer the patients they considered would be accepted by the rehabilitation service. Staff at two ASUs expressed concern that referring all patients with stroke-related deficits to rehabilitation would be unfavourable with rehabilitation providers. Decisions made by ASU staff regarding who to refer to stroke rehabilitation are often not solely based on patients' rehabilitation requirements. Implications for Rehabilitation Not all patients on acute stroke units (ASUs) who may have benefited from rehabilitation were offered rehabilitation referrals. Criteria for rehabilitation referrals need to be made explicit and discussed openly with consumers, ASU clinicians and rehabilitation specialists. A change in rehabilitation assessment practices is required to provide data regarding the unmet rehabilitation needs of patients with stroke. New models of rehabilitation service delivery or increased rehabilitation services may be required to meet the rehabilitation needs of all patients with stroke.
Publisher: Informa UK Limited
Date: 1997
Abstract: Reviews of statewide hospital separations' summaries and medical record data from a major teaching hospital, were conducted to describe the epidemiology of traumatic brain injury (TBI) in South Australia (SA), and to document the demographics of the population affected and the nature of their injuries. The groups most at risk were defined for targeting preventive programmes, and predictions were made regarding their ongoing service needs, for more appropriate provision of care. The results indicate that SA experiences a high incidence of TBI. At 322 per 100,000 head of population annually, it exceeds studies (with comparable methodologies) in communities in the United States and Europe. The causes nature and severity of the injuries were similar to those found in the international literature, as were the profiles of the population most at risk. Specifically, young males living in the country and working in manual trades showed the highest incidence, and were most likely to have sustained their TBI whilst driving a motor vehicle. When a formula to predict service needs was adapted using the SA data, it was apparent that hospitals in this state care for more than 4000 new cases of TBI each year and that, on discharge, over 1000 of these will have some degree of residual impairment and will therefore require some form of post-injury services.
Publisher: MDPI AG
Date: 21-12-2021
DOI: 10.3390/NEUROLINT14010001
Abstract: Movement-based mindfulness interventions (MBI) are complex, multi-component interventions for which the design process is rarely reported. For people with stroke, emerging evidence suggests benefits, but mainstream programs are generally unsuitable. We aimed to describe the processes involved and to conduct a formative evaluation of the development of a novel yoga-based MBI designed for survivors of stroke. We used the Medical Research Council complex interventions framework and principles of co-design. We purposefully approached health professionals and consumers to establish an advisory committee for developing the intervention. Members collaborated and iteratively reviewed the design and content of the program, formatted into a training manual. Four external yoga teachers independently reviewed the program. Formative evaluation included review of multiple data sources and documentation (e.g., formal meeting minutes, focus group discussions, researcher observations). The data were synthesized using inductive thematic analysis. Three broad themes emerged: (a) MBI content and terminology (b) manual design and readability and (c) barriers and enablers to deliver the intervention. Various perspectives and feedback on essential components guided finalizing the program. The design phase of a novel yoga-based MBI was strengthened by interdisciplinary, consumer contributions and peer review. The 12-week intervention is ready for testing among survivors of stroke.
Publisher: AOSIS
Date: 19-02-2016
Abstract: Background: Consideration of the patient’s perspective in healthcare is important because it may inform holistic and contextually relevant management strategies.Objectives: The purpose of this study was to explore patients’ experiences and perspectives about their chronic musculoskeletal (CMSK) pain and its management in the private healthcare sector in South Africa. This work was done as a pilot study to test, adapt and finalize an interview schedule.Methods: A descriptive, qualitative study was conducted. The s ling was purposive. Three patients with CMSK pain were recruited to participate in in-depth in idual interviews. The interviews were recorded and transcribed ensuring confidentiality. Inductive, thematic content analyses of the transcripts were undertaken. Initial codes were assigned and a code book developed, which was applied to the transcripts to develop categories and themes.Results: Four themes emerged from the data: (1) the participants sought understanding about the pain’s origin and the reason for pain persistence (2) pain impacted their lives in multiple ways (3) the participants depended on healthcare providers (HCP) for guidance and support and (4) they had the option of acceptance of chronic pain.Conclusion: The participants’ knowledge about their health condition had important implications as it influenced their perspectives on pain and its management. The pain presented the participants with several challenges, which included developing an understanding about pain and coping with the impact of pain in their lives. HCPs were perceived to play an important role in empowering or disempowering the participants.
Publisher: SAGE Publications
Date: 18-03-2014
DOI: 10.1111/IJS.12262
Abstract: Knowing when to commence physical rehabilitation after stroke is important to ensure optimal benefit for stroke survivors and efficient health care. The aims of this review were to: determine the effects on mortality, function and complications when physical rehabilitation commences ‘early’ (within seven days of stroke) and describe the effects of early transfer to rehabilitation wards/hospitals when sustained rehabilitation is unavailable in acute stroke units. From 3751 potential articles we included 5 randomized controlled trials and 38 cohort studies. Meta-analysis was performed with 3 randomized controlled trials involving 159 people to investigate the effects of commencing physical rehabilitation within 24 h of stroke compared to 48 h. Commencing physical rehabilitation within 24 h trended towards greater mortality (Mantel-Haenszel odds ratio 2·58 95% confidence interval 0·98 to 6·79, P = 0·06), with no differences in complications or health outcomes. The cohort studies provided evidence of benefits when physical rehabilitation was commenced on the day of admission ( n = 1), within 3 days of stroke ( n = 3), or ‘sooner rather than later’ (3 of 4 studies). The effect of earlier transfer to rehabilitation was reported in 32 cohort studies. In 23/26 (88%) cohort studies that accounted for age and stroke severity, results favored earlier transfer for improving post-stroke function, with no consensus on timeframes. In summary, the benefits of commencing physical rehabilitation within 24 h of stroke remain unclear from the current literature. Commencing physical rehabilitation or transferring to rehabilitation services ‘early’ may provide better functional outcomes.
Publisher: Springer Science and Business Media LLC
Date: 18-07-2018
Publisher: Taiwan Association for Aerosol Research
Date: 2017
Publisher: Walter de Gruyter GmbH
Date: 04-2016
DOI: 10.1016/J.SJPAIN.2015.09.007
Abstract: Non-nociceptive somatosensory input, such as tactile or proprioceptive information, alway precedes nociceptive input during a painful event. This relationship provides clear opportunities fo predictive associative learning, which may shape future painful experiences. In this differential classica conditioning study we tested whether pain-associated tactile cues (conditioned stimuli CS) could altei the perceived intensity of painful stimulation, and whether this depends on duration of the CS—seeing that CS duration might allow or prevent conscious expectation. Subjects underwent a classical differential conditioning task in which a tactile cue at locatior A (CS+) preceded painful electrical stimulation at location B (UShigh), whereas a tactile cue at location C (CS–) preceded non-painful electrical stimulation at location B (USlow). At test, we compared the pain evoked by a moderately painful stimulus (USmed) when preceded by either the CS+ or CS–. CS duration was manipulated between subjects. Participants were assigned to one of three groups: Long CS (4s, allowing conscious expectation), Short CS (110 ms) and CS-US indistinguishable (20 ms), preventing conscious expectation). We hypothesised that more pain would be evoked by the US when preceded by the CS+ relative to the CS-, and that the effect would be independent of CS duration. Fifty-four healthy participants (31 females, age = 26, SD = 9) were included in the analysis. The hypotheses were supported in that more intense pain was evoked by the USmed when paired with the tactile CS+, than when paired with the tactile CS- mean difference 3 mm on a 150 mm VAS (C 0.4-4.8 mm). CS duration did not moderate the effect. The effect was greater in those participants where calibration was optimal, as indicated by a relatively more painful UShigh. We conclude that pain-associated tactile cues can influence pain, and that this effect i: not dependent on stimulus duration. This suggests that explicit expectation is not a requirement for predictive cues to modulate pain. That the presence of the CS+ resulted in only a 5.3% higher intensity rating compared with the CS- may reflect a limitation of laboratory studies, where a limited number o trials, an artificial context and the use of experimental pain are likely to reveal only glimpses of what i: clinically possible. Pain-associated visual and auditory cues have been shown to enhance pain in laboratory and clinical scenarios, supposedly by influencing expectation of impending harm. We show that pain-associated somatosensory cues can also modulate pain and that this can occur independently of expectation. This points to a larger potential role for associative learning in the development and treatment of pain than has previously been considered. We suggest that research into associative mechanisms underpinning pain, as distinct from those that link pain to pain-related fear and avoidance, is worthwhile.
Publisher: CSIRO Publishing
Date: 19-08-2022
DOI: 10.1071/PY22064
Abstract: Background For Aboriginal and Torres Strait Islander women, the premature burden of cardiovascular disease is affecting their capacity to fulfil roles in society, and promote the health and wellbeing of future generations. In Australia, there is limited understanding of the difference in primary preventive cardiovascular care experienced by women, despite knowledge of sex and gender differentials in health profile and receipt of guideline-based acute care. This paper sought to explore the health profile and receipt of assessment and management of cardiovascular risk for Aboriginal and Torres Strait Islander women accessing preventive primary health care, and investigate gender differentials. Method Records of 1200 current clients, 50% women, aged 18–74 years from three Aboriginal Health Services in central and South Australia for the period 7/2018–6/2020 were reviewed. Results Twelve percent had documented cardiovascular disease. Compared with men, women with no recorded cardiovascular disease had a greater likelihood of being overweight or obese, a waist circumference indicative of risk, diabetes, and depression. Women were less likely to report being physically active. Conclusions The research concluded that gaps exist in the provision and recording of guideline-recommended primary preventive care regardless of sex. These are stark, given the evident burden.
Publisher: Wiley
Date: 23-06-2023
DOI: 10.1111/AJR.13012
Abstract: Stroke in Regional Australia may have worse outcomes due to difficulties accessing optimal care. The South Australian Regional Telestroke service aimed to improve telestroke neurologist access, supported by improved ambulance triage. To assess stroke care quality and patient mortality pre‐ and postimplementation of a vascular neurologist‐led Telestroke service. Historically controlled mixed methods cohort study comparing key quality indicators and patient mortality (6 months pre‐ vs. 18 months postimplementation date [4 June 2018]) at the three major South Australian regional stroke centres. The primary outcome was 13 care quality indicators as a combined composite risk‐adjusted score, and the secondary outcome was risk‐adjusted mortality at 12‐month postadmission. On an annualised basis, of 189 patients with stroke, more were admitted postintervention to the regional stroke centres than in the control period (158 [annualised rate 105.3, 95% CI 86.2–127.4] vs. 31 [annualised rate 62.0, 95% CI 47.5–79.5]) Baseline patient characteristics were similar in both periods. Post‐implementation, median last‐known‐well time to presentation (3.5 h [IQR 1.6–17] vs. 2.0 [IQR 1–14] p = 0.46) and door to needle times (121 min [IQR 97–144] vs. 90 [IQR 75–138] p = 0.65) were not significantly lower but an improvement in the combined composite quality score was observed (0.069 [95% CI 0.004–0.134 p = 0.04]), reflecting in idual improvements in some quality indicators. Mortality at 12‐month postimplementation was substantially lower postimplementation (prechange 23% vs. postchange 13% [hazard ratio 0.58 (95% CI 0.44–0.76 p 0.001)]). Implementation of a South Australian Regional Telestroke service was associated with improved care metrics and lower mortality.
Publisher: Wiley
Date: 02-06-2017
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.GAITPOST.2017.06.020
Abstract: Somatosensory impairments are common in multiple sclerosis. However, little data are available to characterize the nature and frequency of these problems in people with multiple sclerosis. To investigate the frequency of somatosensory impairments and identify any association with balance limitations in people with multiple sclerosis. The design was a prospective cross-sectional study, involving 82 people with multiple sclerosis and 30 healthy controls. Tactile and proprioceptive sensory acuity were measured using the Rivermead Assessment of Somatosensory Performance. Vibration duration was assessed using a tuning fork. Duration for the Timed Up and Go Test and reaching distance of the Functional Reach Test were measured to assess balance limitations. The normative range of sensory modalities was defined using cut-off points in the healthy participants. The multivariate linear regression was used to identify the significant predictors of balance in people with multiple sclerosis. Proprioceptive impairments (66.7%) were more common than tactile (60.8%) and vibration impairments (44.9%). Somatosensory impairments were more frequent in the lower limb (78.2%) than the upper limb (64.1%). All sensory modalities were significantly associated with the Timed Up and Go and Functional Reach tests (p<0.05). The Timed Up and Go test was independently predicted by the severity of the neurological lesion, Body Mass Index, ataxia, and tactile sensation (R2=0.58), whereas the Functional Reach test was predicted by the severity of the neurological lesion, lower limb strength, and vibration sense (R2=0.49). Somatosensory impairments are very common in people with multiple sclerosis. These impairments are independent predictors of balance limitation.
Publisher: Springer Science and Business Media LLC
Date: 17-11-2017
DOI: 10.1007/S00586-017-5389-8
Abstract: To develop and test a standardised method of interpreting spinal imaging findings in a manner designed to reassure patients with low back pain and promote engagement in an active recovery. A five-phase development and testing process involved collaborative working party contributions, informal and formal appraisal of the intervention content by clinicians and consumers, a two-stage online evaluation of the take-home patient resource, and onsite testing. A total of 12 health professionals and 77 consumers were included in formal evaluative processes at various stages of the development and testing process. Consumers assessed the revised iteration of the take-home resource to be clearer and easier to understand than the original version. We integrated all feedback and evaluation outcomes to develop the final intervention content, which was approved by experienced clinicians and considered safe. We devised a framework to guide delivery of the low-cost clinical intervention and a 10-15-min timeframe was demonstrated to be realistic. We have developed, modified, and tested a pragmatic framework for a brief, psychoeducational intervention. We have established face validity and acceptability from key stakeholders and engaged clinicians and are ready to proceed with a pilot feasibility trial.
Publisher: Informa UK Limited
Date: 1997
Abstract: The assessment of recovery and outcomes post-traumatic brain injury (TBI) has often been poorly researched and reported in past literature. Indeed, an accurate documentation of outcomes in this population had never been performed in the state of South Australia. To redress this situation this study collected data on people who had sustained a TBI 5 years previously, using medical records, personal interview/questionnaire and neurophysical assessment in order to investigate broad outcomes as well as the specific nature and prevalence of any residual physical impairment and disability. The results (n = 67) indicate that the subjects' living arrangements had not altered significantly, and nearly half had returned to some form of paid work, though over 50% were reliant on the welfare system. The majority (57%) felt they had improved in all areas, 19% partially improved and 8% felt they had actually deteriorated. Considering the physical data, the most frequent areas of residual impairment were headaches, followed by balance difficulties and fatigue/weakness. Functionally, 30% had some degree of deficit in upper limb activity and 9% required assistance for particular transfer tasks. Overall balance was impaired in 34% and gait was altered in 24% with 9% reliant on wheelchairs for mobility. Such data may be used in the education of people with TBI and those who live and/or work with them, as well as in future studies assessing the impact of various factors on recovery and outcomes. Evidence was also provided that residual physical issues should be considered along with the more researched areas of cognition and psychosocial issues.
Publisher: Springer Science and Business Media LLC
Date: 30-08-2017
Publisher: AMPCo
Date: 23-11-2019
DOI: 10.5694/MJA2.12034
Abstract: To identify factors associated with receiving acute goal-directed treatment, being assessed for ongoing rehabilitation, and receiving post-acute rehabilitation after having a stroke. Retrospective analysis of National Stroke Audit data for patients with acute stroke treated at Australian hospitals during 1 September 2014 - 28 February 2015. 112 Australian hospitals that admit adults with acute stroke. Associations between patient-related and organisational factors and the provision of rehabilitation interventions. Data for 3462 patients were eligible for analysis their median age was 74 years, 1962 (57%) were men, and 2470 (71%) had received care in a stroke unit. 2505 patients (72%) received goal-directed treatment during their acute admission it was not provided to 364 patients (10.5%) who were responsive, had not fully recovered, and did not refuse treatment. Factors associated with higher odds of receiving goal-directed treatment included goal-setting with the patient and their family (odds ratio [OR], 6.75 95% CI, 5.07-8.90) and receiving care in a stroke unit (OR, 2.08 95% CI, 1.61-2.70). 1358 patients (39%) underwent further rehabilitation after discharge from acute care factors associated with receiving post-acute rehabilitation included care in a stroke unit (OR, 1.73 95% CI, 1.34-2.22) and having an arm or speech deficit. Dementia was associated with lower odds of receiving acute goal-directed treatment (OR, 0.49 95%, 0.33-0.73) and post-acute rehabilitation (OR, 0.43 95%, 0.30-0.61). Access to stroke units and to early and ongoing rehabilitation for patients after stroke can be improved in Australia, both to optimise outcomes and to reduce the burden of care on underresourced community and primary care providers.
Publisher: Informa UK Limited
Date: 09-2013
DOI: 10.1310/TSR2005-432
Abstract: To describe the development of a clinical algorithm to enable standardized intervention prescription and progression for upper limb rehabilitation post stroke. We developed a standardized clinical algorithm that involved assessment of 18 critical impairments of upper limb function and application of task-specific exercises appropriate to the level of impairment. These tasks were consistent with recent evidence-based guidelines. We tested the feasibility of the algorithm with 20 participants recently discharged from inpatient rehabilitation following stroke who received outpatient therapy according to the clinical algorithm. Participants' abilities were regularly re-evaluated and task difficulty progressed. Outcomes were assessed at the level of impairment (Action Research Arm Test, Fugl-Meyer Assessment) and activity (Motor Activity Log). All participants attended the 9 sessions of training over the 3-week intervention period (100% compliance). No adverse events were reported. There were significant improvements in all outcome measures (P < .01). This evidence-based upper limb clinical algorithm provides a framework for standardizing task-specific training following stroke based on the assessment of functioning of the in idual following stroke in day-to-day life. This approach is appropriate for patients with different functional levels and may be used to standardize in idual or group self-directed practice sessions or to standardize the intervention and progressions in experimental studies.
Publisher: Springer Science and Business Media LLC
Date: 19-01-2017
Publisher: SAGE Publications
Date: 04-03-2022
DOI: 10.1177/02692155221083492
Abstract: Impairments in body awareness are common after stroke and are associated with decreased participation and performance in everyday activities. To explore the feasibility and safety of a body awareness program after stroke, and identify the preliminary efficacy of class-based lessons compared to home-based lessons on sensation, body awareness, motor impairment and quality of life. A two-armed pilot randomized controlled trial with a nested qualitative descriptive study was conducted. In iduals with a diagnosis of stroke (at least three months post injury) were randomized to either class-based face-to-face body awareness lessons or home-based in idually performed body awareness lessons. Outcome measures were safety, feasibility, sensation, body awareness, motor impairment, self-efficacy and quality of life. Semi-structured interviews were used to allow greater exploration and understanding of participants’ experience of the program. Twenty participants were randomized, 16 participants completed the program. Feasibility was greater in the class-based group. No adverse events were detected. The class-based group led to improvement in body awareness (p = 0.002), quality of life (p = 0.002), and the arm (p = 0.025) and leg (p = 0.005) motor impairment scores. Qualitative data similarly indicated that the class-based group experienced a stronger sense of awareness, achievement and connection than the home-based group. Body awareness training was safe, feasible and acceptable in people with stroke. In iduals in the class-based group showed greater benefit compared to those receiving home-based therapy.
Publisher: Copernicus GmbH
Date: 27-11-2019
Abstract: Abstract. Cloud-radiation interactions over the Southern Ocean are not well constrained in climate models, in part due to uncertainties in the sources, concentrations and cloud-forming potential of aerosol in this region. To date, most studies in this region have reported measurements from fixed terrestrial stations or a limited set of instrumentation, and often present findings as broad seasonal or latitudinal trends. Here, we present an extensive set of aerosol and meteorological observations obtained during an austral summer cruise across the full width of the Southern Ocean south of Australia. Three episodes of continental-influenced air masses were identified, including an apparent transition between the Ferrel atmospheric cell and the polar cell at approximately 64° S. During the other two episodes, synoptic-scale weather patterns erted air masses across distances greater than 1000 km from the Australian and Antarctic coastlines, respectively, indicating that a large proportion of the Southern Ocean may be periodically influenced by continental air masses. In all three cases, a highly cloud-active accumulation mode dominated the size distribution, with up to 93 % of the total number concentration activating as cloud condensation nuclei. In contrast, s ling periods influenced by marine air masses frequently demonstrated a correlation between air mass trajectories over regions of high biological productivity and subsequent enhancement of an Aitken mode centred at approximately 30 nm and contributing an average of 71 % of the total aerosol number concentration. Although these small diameters limited their contribution to cloud condensation nuclei concentrations, Aitken number concentrations and diameters were highly variable. A detailed investigation of the marine air masses revealed that this variability may be attributed to the availability of biogenic precursors, the competing influence of condensation sinks (such as sea spray aerosol) and vertical transport between the marine boundary layer and the free troposphere. This variability of the marine Aitken mode as well as the instances of long-range transport were governed by synoptic-scale weather systems, through their influence on air mass trajectories and both generation and depletion of condensation sinks. These results demonstrate the highly dynamic nature of Southern Ocean aerosol and their complex dependence on both biological productivity and synoptic-scale weather systems.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.APMR.2014.12.009
Abstract: To examine the frequency and factors associated with patients with stroke in Australian hospitals receiving documented rehabilitation assessments to examine the criteria used when rehabilitation was not recommended and to examine whether being assessed for rehabilitation affected access to rehabilitation. Retrospective medical record audit of patients with a diagnosis of stroke who were discharged consecutively between 2013 and 2014. Acute care public hospitals. Adults with stroke (N=333) receiving care in participating hospitals. Not applicable. Documented assessment regarding patient suitability for rehabilitation during acute hospitalization. Data from 292 patients were included for analysis (60% men mean age, 72y). Of the patients, 42% were assessed for rehabilitation by a health professional providing care in the hospital, 43% were assessed for rehabilitation by a representative from a rehabilitation service, and 37% did not receive any documented rehabilitation assessment. In multivariable analysis, patients were significantly more likely to be assessed for rehabilitation if they lived in the community before their stroke, had moderate severity strokes, or received occupational therapy during hospital admission. Rehabilitation was not recommended in 9% of assessments despite the presence of stroke-related symptoms. Patients not assessed for rehabilitation were significantly less likely to access rehabilitation than patients who were assessed. More than one third of patients were not assessed for rehabilitation. When assessed, rehabilitation was not consistently recommended for patients with stroke-related symptoms. This study highlights factors that increase the likelihood of being assessed for rehabilitation.
Publisher: Springer Science and Business Media LLC
Date: 24-07-2014
DOI: 10.1007/S00167-013-2616-7
Abstract: Preoperative function has been shown to persist posttotal knee arthroplasty. However, it remains unclear whether asymmetries are task specific. Therefore, we investigated postoperative asymmetries in loading during quiet stance and walking gait. Ten patients with end-stage knee osteoarthritis scheduled for total knee arthroplasty were studied at baseline (preoperative), 6-week, 3- and 6-month postoperative. Load distribution and balance were quantified during quiet stance. Furthermore, dynamic loading was quantified during walking gait. Patient satisfaction was assessed using the Knee Osteoarthritis and injury Outcome Score. Preoperatively, load distribution was significantly different between limbs, with approximately 70% of the load through the contralateral or 'good' side. Asymmetries persisted and up to 6-month postoperative during quiet stance. No significant change was found in balance. During walking, preoperative loading asymmetry was present however, no significant postoperative loading asymmetries were identified. Total knee arthroplasty does not appear to significantly change load distribution or balance 6-month postoperative during quiet stance however, during walking gait, symmetry appears to be restored. This could be potentially improved through enhanced rehabilitation. Therapeutic study, Level IV.
Publisher: Medical Journals Sweden AB
Date: 2011
Abstract: To evaluate the activity and participation levels of adults with spastic diplegia 17-26 years after selective dorsal rhizotomy to investigate relationships between subjects' functioning and age, socio-economic-status, level of satisfaction and their perceptions of the post-operative outcomes. Observational follow-up study. Thirty-one subjects with spastic diplegia, age range 21-44 years, who underwent selective dorsal rhizotomy between 1981 and 1991. A semi-structured interview was used to gather data on patients' characteristics and long-term experiences after the operation. The Functional Mobility Scale and Life-Habit questionnaire were completed. Based on the Functional Mobility Scale 84% of subjects were reported as independent for a distance of 5 m, and 61% for 50 and 500 m. Eighty percent were independent in accomplishing all life habits, with most problems found for Mobility and Recreation. This was in agreement with the subjects' perception, with strong correlations between Life-Habit questionnaire accomplishment and satisfaction levels. No significant associations were found between functioning and age at selective dorsal rhizotomy, current age and socio-economic status. More than 15 years after selective dorsal rhizotomy, adults with spastic diplegia showed high levels of functioning, and similar levels of satisfaction with life habits. The majority had positive feelings about the neurosurgical procedure, although there is a need for better follow-up after subjects leave school.
Publisher: Springer Singapore
Date: 2016
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/752160
Abstract: The Feldenkrais Method (FM) has broad application in populations interested in improving awareness, health, and ease of function. This review aimed to update the evidence for the benefits of FM, and for which populations. A best practice systematic review protocol was devised. Included studies were appraised using the Cochrane risk of bias approach and trial findings analysed in idually and collectively where possible. Twenty RCTs were included (an additional 14 to an earlier systematic review). The population, outcome, and findings were highly heterogeneous. However, meta-analyses were able to be performed with 7 studies, finding in favour of the FM for improving balance in ageing populations (e.g., timed up and go test MD −1.14 sec, 95% CI −1.78, −0.49 and functional reach test MD 6.08 cm, 95% CI 3.41, 8.74). Single studies reported significant positive effects for reduced perceived effort and increased comfort, body image perception, and dexterity. Risk of bias was high, thus tempering some results. Considered as a body of evidence, effects seem to be generic, supporting the proposal that FM works on a learning paradigm rather than disease-based mechanisms. Further research is required however, in the meantime, clinicians and professionals may promote the use of FM in populations interested in efficient physical performance and self-efficacy.
Publisher: Springer Science and Business Media LLC
Date: 13-08-2012
Abstract: Prolonged sitting has been associated with musculoskeletal dysfunction. For desk workers, workstation modifications frequently address the work surface and chair. Chairs which can prevent abnormal strain of the neuromuscular system may aid in preventing musculo-skeletal pain and discomfort. Anecdotally, adjustability of the seat height and the seat pan depth to match the anthropometrics of the user is the most commonly recommended intervention. Within the constraints of the current economic climate, employers demand evidence for the benefits attributed to an investment in altering workstations, however this evidence-base is currently unclear both in terms of the strength of the evidence and the nature of the chair features . The purpose of this study was to evaluate the evidence for the effectiveness of chair interventions in reducing workplace musculoskeletal symptoms. Pubmed, Cinahl, Pedro, ProQuest, SCOPUS and PhysioFocus were searched. ‘Ergonomic intervention’, ‘chair’, ‘musculoskeletal symptoms’, ‘ergonomics’, ‘seated work’ were used in all the databases. Articles were included if they investigated the influence of chair modifications as an intervention participants were in predominantly seated occupations employed a pre ost design (with or without control or randomising) and if the outcome measure included neuro-musculoskeletal comfort and/or postural alignment. The risk of bias was assessed using a tool based on The Cochrane Handbook . Five studies were included in the review. The number of participants varied from 4 to 293 participants. Three of the five studies were Randomised Controlled Trials, one pre and post-test study was conducted and one single case, multiple baselines (ABAB) study was done. Three studies were conducted in a garment factory, one in an office environment and one with university students. All five studies found a reduction in self-reported musculoskeletal pain immediately after the intervention. Bias was introduced due to poor randomization procedures and lack of concealed allocation. Meta-analysis was not possible due to the heterogeneity of the data (differing population, intervention and outcomes across studies). The findings of this review indicate a consistent trend that supports the role of a chair intervention to reduce musculoskeletal symptoms among workers who are required to sit for prolonged periods. However the amount, level and quality of the evidence are only moderate therefore we cannot make strong recommendations until further trials are conducted. The review also highlights gaps: for ex le in showing whether the effectiveness of a chair intervention has long-term impact, particularly with respect to musculoskeletal symptoms, as well as the recurrence of symptoms and the consequent cost of care.
Publisher: Copernicus GmbH
Date: 30-06-2016
Abstract: Abstract. The stable isotopic composition of water vapour provides information about moisture sources and processes that is difficult to obtain with traditional measurement techniques. Recently, it has been proposed that the D-excess (dv = δ2H − 8 × δ18O) of water vapour can provide a diagnostic tracer of continental moisture recycling. However, D-excess exhibits a diurnal cycle that has been observed across a variety of ecosystems and may be influenced by a range of processes beyond regional scale moisture recycling, including local evaporation (ET) fluxes. There is a lack of measurements of D-excess in evaporation (ET) fluxes, which has made it difficult to assess how ET fluxes modify the D-excess in water vapour (dv). With this in mind, we employed a chamber based approach to directly measure D-excess in ET (dET) fluxes. We show that ET fluxes imposed a negative forcing on the ambient vapour and could not explain the higher daytime dv values. The low dET observed here was sourced from a soil water pool that had undergone an extended drying period, leading to low D-excess of the soil moisture. A strong correlation between daytime dv and locally measured relative humidity was consistent with an oceanic moisture source, suggesting that remote hydrological processes were the major contributor to daytime dv variability. During the early evening, ET fluxes into a shallow nocturnal inversion layer caused a lowering of the dv values near the surface. In addition, transient mixing of vapour with a higher D-excess from above the nocturnal inversion modified these values, causing large within night variability. These results indicate dET can generally be expected to show large spatial and temporal variability and to depend on the soil moisture state. For long periods between rain events, common in semi-arid environments, ET would be expected to impose negative forcing on the surface dv. The variability of D-excess in ET fluxes therefore needs to be considered when using dv to study moisture recycling and during extended dry periods may act as a tracer of the relative humidity of the oceanic moisture source.
Publisher: Elsevier BV
Date: 02-2023
Publisher: Informa UK Limited
Date: 09-2013
DOI: 10.1310/TSR2005-441
Abstract: To obtain more generalizable information on the frequency and factors influencing sensory impairment after stroke and their relationship to mobility and function. A pooled analysis of in idual data of stroke survivors (N = 459) mean (SD) age = 67.2 (14.8) years, 54% male, mean (SD) time since stroke = 22.33 (63.1) days, 50% left-sided weakness. Where different measurement tools were used, data were recorded. Descriptive statistics described frequency of sensory impairments, kappa coefficients investigated relationships between sensory modalities, binary logistic regression explored the factors influencing sensory impairments, and linear regression assessed the impact of sensory impairments on activity limitations. Most patients' sensation was intact (55%), and in idual sensory modalities were highly associated (κ = 0.60, P < .001). Weakness and neglect influenced sensory impairment (P < .001), but demographics, stroke pathology, and spasticity did not. Sensation influenced independence in activities of daily living, mobility, and balance but less strongly than weakness. Pooled in idual data analysis showed sensation of the lower limb is grossly preserved in most stroke survivors but, when present, it affects function. Sensory modalities are highly interrelated interventions that treat the motor system during functional tasks may be as effective at treating the sensory system as sensory retraining alone.
Publisher: Elsevier BV
Date: 2021
Publisher: Wiley
Date: 16-12-2022
DOI: 10.1111/JEP.13644
Abstract: The prevalence of chronic musculoskeletal pain (CMSP) is high and rising. The multidimensional impact of CMSP on in iduals necessitates multidisciplinary evidence-based strategies to prevent and manage chronic pain. Primary health care (PHC) is the first point of care in many healthcare systems and evidence implementation at this point is important. We aim to describe the process of development of a comprehensive list of evidence-based recommendations derived from different high-quality clinical practice guidelines (CPGs) to inform the PHC healthcare of adults with CMSP. A systematic review was conducted of CPGs that focussed on PHC management of CMSP in adults. CPGs were identified by searching 13 guideline clearinghouses and five online databases. Eligible CPGs were critically appraised using Appraisal of Guidelines Research and Evaluation, Version II (AGREE II). A stepwise systematic process was followed to identify a core set of recommendations. This process comprised the following: extract recommendations analyze recommendations synthesize recommendations by assimilating similar recommendations determine the strength of the body of evidence underpinning the recommendations and produce a list of synthesized recommendations. Six high-quality CPGs were identified, providing 156 recommendations. These were condensed to 42 statements covering topics about the approach to care, assessment, advice and education, referral, pharmacological management, physical therapy, electrotherapy, psychological therapy, complementary therapy and self-management. The set of recommendations encompasses a person-centered approach, collaborative decision making, a biopsychosocial approach, patient education and empowerment towards self-management. The process of developing composite recommendations from multiple CPGs enables end-users to access comprehensive information on managing CMSP in PHC settings that is not available from one singular CPG. The content and evidence base for recommendations varied between CPGs. A similar stepwise process may be used to develop a core set of recommendations for other health conditions, where multiple, erse CPGs exist.
Publisher: Elsevier BV
Date: 07-2006
DOI: 10.1016/J.CLINPH.2006.02.027
Abstract: Analysis of a precision grip-lift task provides measures to assess functional disability of the hand, but the correlation between these measures and accepted tests of motor function in stroke patients has not been established. Seventeen subacute stroke patients were studied to compare parameters of a precision grip-lift task between the affected and unaffected side, and to correlate them with function. Functional impairment was assessed with the Action Research Arm Test and the Fugl-Meyer assessment, as well as grip strength and maximal finger-tapping speed. The grip force (GF) and load force (LF) were recorded as patients lifted a custom-built manipulandum. All measures were recorded on two separate occasions, at least 1 week apart. There was good reproducibility between testing sessions for the grip-lift and functional measures. The affected hand gripped the manipulandum for longer prior to lift-off than the unaffected hand, and the normal close temporal coupling between the rate of change of GF and LF during the lift was disrupted. These two measures correlated more highly with the ARAT than the FMA and, when combined with measures of grip strength and tapping speed, explained 71% of the variance of the ARAT. The grip-lift task is a sensitive measure of impaired dexterity following stroke and provides measures which correlate well with a commonly applied functional assessment scale. This task may be used clinically to detect changes in the hemiplegic upper limb during rehabilitation and recovery.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.JPAIN.2017.02.430
Abstract: Prominent clinical models of chronic pain propose a fundamental role of classical conditioning in the development of pain-related disability. If classical conditioning is key to this process, then people with chronic pain may show a different response to pain-related conditioned stimuli than healthy control subjects. We set out to determine whether this is the case by undertaking a comprehensive and systematic review of the literature. To identify studies comparing classical conditioning between people with chronic pain and healthy control subjects, the databases MEDLINE, PsychINFO, PsychARTICLES, Scopus, and CINAHL were searched using key words and medical subject headings consistent with 'classical conditioning' and 'pain.' Articles were included when: 1) pain-free control and chronic pain groups were included, and 2) a differential classical conditioning design was used. The systematic search revealed 7 studies investigating differences in classical conditioning between people with chronic pain and healthy control participants. The included studies involved a total of 129 people with chronic pain (fibromyalgia syndrome, spinal pain, hand pain, irritable bowel syndrome), and 104 healthy control participants. Outcomes included indices of pain-related conditioning such as unconditioned stimulus (US) expectancy and contingency awareness, self-report and physiological measures of pain-related fear, evaluative judgements of conditioned stimulus pleasantness, and muscular and cortical responses. Because of variability in outcomes, meta-analyses included a maximum of 4 studies. People with chronic pain tended to show reduced differential learning and flatter generalization gradients with respect to US expectancy and fear-potentiated eyeblink startle responses. Some studies showed a propensity for greater muscular responses and perceptions of unpleasantness in response to pain-associated cues, relative to control cues. The review revealed preliminary evidence that people with chronic pain may exhibit less differential US expectancy and fear learning. This characteristic may contribute to widespread fear-avoidance behavior. The assumption that altered classical conditioning may be a predisposing or maintaining factor for chronic pain remains to be verified.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.NEUROPSYCHOLOGIA.2015.06.006
Abstract: In idual experimental data suggest that visual input during tactile stimulation enhances tactile appreciation - whether this finding is replicated across studies and across body sites is unknown. To determine the available evidence as to whether non-informative vision of the body has an effect on tactile acuity. Studies that assessed tactile acuity with vision of the body, compared to vision of a neutral object or vision occluded, were systematically identified and reviewed. Seven relevant electronic databases were searched from their inception to April 2014. Risk of bias was assessed using adapted criteria from the Cochrane Handbook. Effect sizes were calculated using mean differences in a random effects model. Ten studies were included. All were randomized, within subject, controlled trials published in English (total n=232 participants), with low to moderate risk of bias. Despite the ersity of protocols and outcome measures used, eight of the studies reported improvements in tactile acuity when vision of the relevant body part (predominantly the hand) was available. Meta-analysis revealed statistically significant findings from grating orientation tests (p=0.002, SMD 3.31, 95% CI 1.24-5.39), demonstrating a positive effect of vision of the body. No significant effect was found for other sensory tests or for other body parts, such as the back, and statistical heterogeneity was high. This review provides confirmatory evidence for a visual enhancement effect for tactile acuity for body parts where vision has a plausible functional linkage - further studies are required to elaborate on the mechanisms for multi-modal processing of sensory stimuli.
Publisher: Copernicus GmbH
Date: 25-10-2018
DOI: 10.5194/AMT-2018-300
Abstract: Abstract. The Southern Ocean (south of 30° S) is a key global scale sink of carbon dioxide (CO2). However, the isolated and inhospitable nature of this environment has restricted the number of oceanic and atmospheric CO2 measurements in this region. This has limited the scientific community’s ability to investigate trends and seasonal variability of the sink. Compared to regions further north, the near-absence of terrestrial CO2 exchange and strong large-scale zonal mixing demands unusual inter-site measurement precision to help distinguish the presence of mid-to-high latitude ocean exchange from large CO2 fluxes transported southwards in the atmosphere. Here we describe a continuous, in-situ, ultra-high-precision, Southern Ocean region CO2 record, which ran at Macquarie Island (54°37’ S, 158°52’ E) from 2005–2016 using a LoFlo2 instrument, along with its calibration strategy, uncertainty analysis and baseline filtering procedures. Uncertainty estimates calculated for minute and hourly frequency data range from 0.01 to 0.05 μmol mol−1 depending on averaging period and application. Higher precisions are applicable when comparing MQA LoFlo measurements to those of similar instruments on the same internal laboratory calibration scale and more uncertain values are applicable when comparing to other networks. Baseline selection is designed to remove measurements that are influenced by local, Macquarie Island, CO2 sources, with effective removal achieved using a within-minute CO2 standard deviation metric. Additionally, measurements that are influenced by CO2 fluxes from Australia or other southern hemisphere land masses are effectively removed using model-simulated radon concentration. A comparison with flask records of atmospheric CO2 at Macquarie Island highlights the limitation of the flask record (due to corrections for storage time and limited temporal coverage) when compared to the new high-precision, continuous record the new record shows much less noisy seasonal variations than the flask record. As such this new record is ideal for improving our understanding of the spatial and temporal variability of the Southern Ocean CO2 flux particularly when combined with data from similar instruments at other Southern Hemispheric locations.
Publisher: Informa UK Limited
Date: 06-2011
DOI: 10.2147/JMDH.S20265
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.MSKSP.2019.01.010
Abstract: Left/right judgement (LRJ) of body parts is commonly used to assess the ability to perform implicit motor imagery and the integrity of brain-grounded maps of the body. Clinically, LRJ are often undertaken using a mobile tablet, but the concurrent validity and reliability of this approach has not yet been established. To evaluate the concurrent validity and test-retest reliability of a mobile tablet for assessing LRJ. Participants completed LRJ for 50 hand images (Experiment 1), and 40 back, foot, or neck images (Experiment 2) using a mobile tablet and desktop computer in random order. Participants in Experiment 2 performed a repeat test the following day to assess test-retest reliability. Accuracy and response time (RT) were recorded. Twenty participants aged 55.3 (±6.7) years in Experiment 1, and 37 participants aged 38.2 (±12.3) years in Experiment 2, were recruited. Concurrent validity of the mobile tablet was good to excellent for hand judgements (ICC The mobile tablet demonstrated good to excellent concurrent validity with the desktop computer in two separate s les. The mobile tablet also demonstrated good to excellent test-retest reliability. The mobile tablet for LRJ is a valid alternative to the original desktop version.
Publisher: Informa UK Limited
Date: 05-2014
DOI: 10.1310/TSR2103-256
Abstract: To assess the efficacy of yoga for motor function, mental health, and quality of life outcomes in persons with chronic poststroke hemiparesis. Twenty-two in iduals participated in a randomized controlled trial involving assessment of task-orientated function, balance, mobility, depression, anxiety, and quality of life domains before and after either a 10-week yoga intervention (n = 11) or no treatment (n = 11). The yoga intervention did not result in any significant improvements in objective motor function measures, however there was a significant improvement in quality of life associated with perceived motor function (P = .0001) and improvements in perceived recovery approached significance (P = .072). Memory-related quality of life scores significantly improved after yoga intervention (P = .022), and those participating in the intervention exhibited clinically relevant decreases in state and trait anxiety. Preliminary results offer promise for yoga as an intervention to address mental health and quality of life in persons with stroke-related activity limitations. There is a need to more rigorously evaluate these yoga benefits with a larger randomized controlled trial, which, based on this preliminary trial, is feasible.
Publisher: Copernicus GmbH
Date: 30-06-2016
Publisher: Bentham Science Publishers Ltd.
Date: 15-04-2010
Publisher: Elsevier BV
Date: 11-2016
Publisher: Elsevier BV
Date: 09-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
DOI: 10.1161/STROKEAHA.114.006038
Abstract: The optimum model of physiotherapy service delivery for maximizing active task practice during rehabilitation after stroke is unknown. The purpose of the study was to examine the relative effectiveness of 2 alternative models of physiotherapy service delivery against a usual care control with regard to increasing patient activity. Substudy within a large 3-armed randomized controlled trial, which compared 3 different models of physiotherapy service delivery, was provided for 4 weeks during subacute, inpatient rehabilitation (n=283). The duration of all physiotherapy sessions was recorded. In addition, 32 participants were observed at 10-minute intervals for 1 weekday and 1 weekend day between 8:00 am and 4:30 pm . At each observation, we recorded physical activity, location, and people present. Participants receiving 7-day-week and circuit class therapy received an additional 3 hours and 22 hours of physiotherapy time, respectively, when compared with usual care. Participants were standing or walking for a median of 8.2% of observations. On weekdays, circuit class therapy participants spent more time in therapy-related activity (10.2% of observations) when compared with usual care participants (6.1% of observations). On weekends, 7-day therapy participants spent more time in therapy-related activity (4.2% of observations) when compared with both usual care and circuit class therapy participants (0% of observations for both groups). Activity levels outside of therapy sessions did not differ between groups. A greater dosage of physiotherapy time did not translate into meaningful increases in physical activity across the day. URL: www.anzctr.org.au/ . Unique identifier: ACTRN12610000096055.
Publisher: Negah Scientific Publisher
Date: 06-2021
Abstract: Objectives: Ankle-Foot orthoses are used to minimize the impact of weakness in ankle dorsiflexion muscles. The study on different orthotic types defines the optimal design, which effectively improves the users’ mobility. This study investigated the potential benefits and risks of a Dictus-band (flexible orthotic), compared with a thermoplastic (fixed) ankle-foot orthosis on the mobility of in iduals with Multiple Sclerosis (MS). Methods: Fifteen subjects with MS and dorsiflexion ankle weakness volunteered in this randomized crossover study. The study participants received either a Dictus-band or a thermoplastic ankle-foot orthosis worn on the weaker leg, compared to barefoot as the control condition. Postural stability during standing, forward reach test, timed up and go test, and walking speed in the 10-meter walking test were compared between the study conditions. Results: There were no significant differences in the postural stability and forward reach tests between study conditions (P .5). When the research participants used a Dictus-band, compared to the fixed ankle-foot orthosis, the time required to complete the timed up and go was significantly reduced [P .01 Mean±SD difference: 6.4±1.4 95% Confidence Interval (CI): 2.7-10.2], and walking speed was increased in the 10-meter walking test (P .01 Mean±SD difference: 0.46±0.8 95%CI: 0.23-0.69). There was no difference in the timed up and go and 10-meter walking test data between the barefoot and Dictus-band conditions (P .5). No adverse or safety events were sustained in this research. Discussion: The present study data provided initial evidence for the lack of detrimental effects of using the Dictus-band in subjects with MS and ankle dorsiflexion deficiencies.
Publisher: Wiley
Date: 22-08-2016
Publisher: American Geophysical Union (AGU)
Date: 27-01-2019
DOI: 10.1029/2018JD029507
Publisher: Elsevier BV
Date: 06-2021
Publisher: Informa UK Limited
Date: 08-08-2017
DOI: 10.1080/09593985.2017.1357152
Abstract: Attitudes are recognized as influencing research implementation. However, little is known about the process by which physiotherapists' attitudes and beliefs shape their use of 7-day per week therapy and circuit class therapy research findings. Understanding beliefs may assist in addressing barriers to research uptake. Fifteen physiotherapists from six rehabilitation centers who ranged in seniority, experience, and education levels consented to be interviewed. The transcribed interviews were analyzed using a qualitative content analysis drawing on the Theory of Planned Behavior. Participants felt that they had autonomy in adopting new approaches when the evidence was supported by social norms. Participants believed that 7-day per week therapy delivers a seamless service that increases physiotherapy time, which helps maintain patient improvement, but needs to accommodate patient choice and expectations. Circuit class therapy was viewed positively as it provides more physiotherapy time, increases patient social interaction, and motivation. However, this was qualified by a belief that patients would not receive in idualized, quality of movement focused therapy, particularly for patients with limited capacities. Implementation of a new approach depends on the past experience, coherence with in idual beliefs regarding important elements of therapy content, and opportunities to control barriers to implementation.
Publisher: Informa UK Limited
Date: 19-01-2017
DOI: 10.1080/10749357.2016.1277481
Abstract: Survivors of stroke have long-term physical and psychological consequences that impact their quality of life. Few interventions are available in the community to address these problems. Yoga, a type of mindfulness-based intervention, is shown to be effective in people with other chronic illnesses and may have the potential to address many of the problems reported by survivors of stroke. To date only narrative reviews have been published. We sought to perform, the first systematic review with meta-analyses of randomized controlled trials (RCTs) that investigated yoga for its potential benefit for chronic survivors of stroke. Ovid Medline, CINHAL plus, AMED, PubMed, PsychINFO, PeDro, Cochrane database, Sport Discuss, and Google Scholar were searched for papers published between January 1950 and August 2016. Reference lists of included papers, review articles and OpenGrey for Grey literature were also searched. We used a modified Cochrane tool to evaluate risk of bias. The methodological quality of RCTs was assessed using the GRADE approach, results were collated, and random effects meta-analyses performed where appropriate. The search yielded five eligible papers from four RCTs with small s le sizes (n = 17-47). Quality of RCTs was rated as low to moderate. Yoga is beneficial in reducing state anxiety symptoms and depression in the intervention group compared to the control group (mean differences for state anxiety 6.05, 95% CI:-0.02 to 12.12 p = 0.05 and standardized mean differences for depression: 0.50, 95% CI:-0.01 to 1.02 p = 0.05). Consistent but nonsignificant improvements were demonstrated for balance, trait anxiety, and overall quality of life. Yoga may be effective for ameliorating some of the long-term consequences of stroke. Large well-designed RCTs are needed to confirm these findings.
Publisher: Elsevier BV
Date: 11-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2013
DOI: 10.1161/STROKEAHA.113.001538
Abstract: Regular physical activity (PA) is an important recommendation for stroke prevention. We compared the associations of self-reported PA with incident stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. REGARDS recruited 30 239 US blacks (42%) and whites, aged ≥45 years with follow-up every 6 months for stroke events. Excluding those with prior stroke, analysis involved 27 348 participants who reported their frequency of moderate to vigorous intensity PA at baseline according to 3 categories: none (physical inactivity), 1 to 3×, and ≥4× per week. Stroke and transient ischemic attack cases were identified during an average of 5.7 years of follow-up. Cox proportional hazards models were constructed to examine whether self-reported PA was associated with risk of incident stroke. Physical inactivity was reported by 33% of participants and was associated with a hazard ratio of 1.20 (95% confidence intervals, 1.02–1.42 P =0.035). Adjustment for demographic and socioeconomic factors did not affect hazard ratio, but further adjustment for traditional stroke risk factors (diabetes mellitus, hypertension, body mass index, alcohol use, and smoking) partially attenuated this risk (hazard ratio, 1.14 [0.95–1.37] P =0.17). There was no significant association between PA frequency and risk of stroke by sex groups, although there was a trend toward increased risk for men reporting PA 0 to 3× a week compared with ≥4× a week. Self-reported low PA frequency is associated with increased risk of incident stroke. Any effect of PA is likely to be mediated through reducing traditional risk factors.
Publisher: Informa UK Limited
Date: 29-11-2023
DOI: 10.1080/10749357.2021.2006982
Abstract: Appropriate sleep and physical activity are known to be important for positive neuroplastic changes in the brain and therefore may affect stroke recovery. To investigate the relationship between sleep and participation in different intensity levels of physical activity to investigate the convergent validity of a commercially available device (Fitbit Flex) in measuring sleep and physical activity in people with stroke. A cross-sectional observational study in people with stroke undergoing rehabilitation. Participants wore two accelerometers on their unaffected wrist for seven consecutive days and recorded a sleep log, the Pittsburgh Sleep Quality Index and Fatigue Assessment Scale. Any relationships between sleep and activity were assessed with linear regression. Pearson and intra-class correlation coefficients were used to assess the validity of the two accelerometers (Fitbit Flex against the validated GENEActiv). Twenty-three patients with stroke were recruited. Twenty complete data sets were analyzed. Participants had approximately 9 hours of sleep and 13 hours of sedentary behavior per day, with 99 minutes spent on physical activity (16 min spent on moderate to vigorous activity). Time spent on sleep was significantly related to sedentary, light and moderate physical activity time (r = -.67, .22, .20). The ICC of the Fitbit Flex in measuring light physical activity was .884 More sleep was related to less sedentary behavior and more time spent on physical activity. Fitbit Flex was only valid for measuring light physical activity.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2006
Publisher: Frontiers Media SA
Date: 14-07-2022
DOI: 10.3389/FNEUR.2022.869248
Abstract: Approximately one-third of stroke survivors experience post-stroke depression. Repetitive transcranial magnetic stimulation (rTMS) of the prefrontal cortex has shown promise as a treatment for depression with few side effects and high tolerability. However, previous post-stroke depression trials have not considered the effect of lesion location, the persistence of clinical improvements, nor the value of ongoing maintenance treatments. These questions are important to determine the therapeutic value of rTMS as a treatment for post-stroke depression. We report a unique case study of a 71-year-old male who had experienced a left hemispheric ischemic stroke 4 years prior. The patient was screened with the Beck Depression Inventory and Patient Health Questionnaire and found to be experiencing moderate levels of depression. Ten daily sessions of left dorsolateral pre-frontal cortex rTMS were applied over a two-week period. A clinically meaningful reduction in depression was achieved. Approximately 10 weeks following rTMS treatment, improvements in depression were attenuating. Weekly maintenance rTMS was delivered to the left dorsolateral pre-frontal cortex for 10 sessions. At the conclusion of maintenance rTMS, clinical assessments indicated depressive symptoms had reduced to a minimal to nil level. Clinically meaningful improvements in depression were maintained at 3 months after rTMS treatment had ceased. These findings provide novel insight to suggest rTMS may reduce depressive symptoms in stroke survivors with a lesion at the site of stimulation. Ongoing maintenance treatments might prove beneficial to enhance persistence of clinical improvements.
Publisher: Elsevier BV
Date: 2021
Publisher: Elsevier BV
Date: 2003
Publisher: Human Kinetics
Date: 08-2020
DOI: 10.1123/KR.2020-0022
Abstract: The Feldenkrais method (FM) is a process that uses verbally and manually guided exploration of novel movements to improve in iduals’ self-awareness and coordination. This paper reviews recent literature evaluating the therapeutic value of the FM for improving balance, mobility, and coordination and its effectiveness for management of chronic pain. The authors also explore and discuss studies that have investigated some of the other bodily effects and possible mechanisms of action, such as (a) the process of learning itself, (b) focus of attention during motor learning, (c) autonomic regulation, and (d) body image. They found that research clearly supports the effectiveness of the FM for improvement of balance and chronic pain management. The exploration into mechanisms of action raises interesting questions and possibilities for further investigation.
Publisher: Wiley
Date: 20-01-2010
Publisher: Informa UK Limited
Date: 04-2010
DOI: 10.3109/01942630903543575
Abstract: Aquatic therapy is an intervention for children with Developmental Coordination Disorder (DCD) that has not been investigated formally. This was a pilot randomized controlled trial to investigate the feasibility and preliminary effectiveness of an aquatic therapy program to improve motor skills of children with DCD. Thirteen children (mean age 7 years 1 month 10 males) with DCD were randomly allocated to receive either six sessions of aquatic therapy (once weekly session of 30 min for 6-8 weeks) or to a wait-list (control group). The intervention and measures were demonstrated to be feasible, but barriers, such as limited appointment times and accessibility, were encountered. Analysis of covariance indicated that at posttest, mean scores on the Movement Assessment Battery were higher for children who received aquatic therapy compared to those on the wait-list (p = .057). Similar trends were noted on the physical competence portion of the Pictorial Scale of Perceived Competence and Social Acceptance (p = .058). Participation levels, as measured by a parent questionnaire, showed improvement for both groups. Potential facilitators and barriers to implementation of an aquatic therapy for children with DCD are discussed.
Publisher: John Wiley & Sons, Ltd
Date: 07-07-2010
Publisher: Informa UK Limited
Date: 02-2009
DOI: 10.1080/00140130802304861
Abstract: The trunk is frequently modelled as one fixed segment ignoring possible multi-segmental contributions during manual handling. This study compared segmental trunk motion in a young and older population during a lifting task. Twelve elderly and 19 young subjects repeatedly lifted a 5 kg box from bench to shelf under two stance conditions. Displacement and angular trunk segment kinematics were recorded with an electromagnetic tracker system and then analysed. The elderly subjects displayed significantly increased pelvic and trunk displacement and significantly reduced pelvic and lower thorax (T10-L1) range of motion in both stance conditions. Upper thorax (C7-T10) motion was at times greater than lumbar motion and opposite to the lower segments and was related to the task while the lower segments contributed to both equilibrium and task requirements. Decreased segmental trunk angular kinematics may contribute to increased displacement kinematics and place the elderly at increased risk of injury and falling. The pelvis, lumbar spine, low thorax (T10-L1), upper thorax (C7-10) contributed uniquely and synchronously to trunk (C7-S2) mechanics during a lifting task. Reduced angular kinematics of the pelvis and low thorax contributed to increased displacement kinematics and hence increased the risk of falling in the elderly compared to the young. Investigations of trunk mechanics should include multi-segment analysis.
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Publisher: Human Kinetics
Date: 07-2020
Abstract: The aim of this study was to describe and undertake an initial evaluation of a student-led assessment service for children with possible motor-skill difficulties. A secondary analysis of cross-sectional descriptive clinical data collected from 2015 to 2016 was undertaken. Children ( N = 102) were assessed in preschools by physiotherapy students (supervised by qualified physiotherapists). Key outcomes included the following: Children’s Activities Scale, Movement Assessment Battery for Children-2, and demographic/service-usage/onward referral statistics. The results highlighted that for every five children referred/assessed, two were at risk of motor-skill difficulties (∼43%). About 66% of children were subsequently referred on or monitored (40% requiring multidisciplinary follow-up). Conversely 34% of children did not require further services. In conclusion, a student-led assessment service may be a sustainable and feasible option to assist children at risk of motor-skill difficulties, enabling onward referral. Additional evaluation is required to garner stakeholder feedback.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.HUMOV.2016.06.002
Abstract: The purpose of this study was to manipulate psychological stress and anxiety to investigate effects on ensuing perceptual-motor learning. Thirty-six participants attended two experimental sessions separated by 24h. In the first session, participants were randomized to either a mental arithmetic task known to increase stress and anxiety levels or a control condition and subsequently completed training on a speeded precision pinch task. Learning of the pinch task was assessed at the second session. Those exposed to the high stress-anxiety mental arithmetic task prior to training reported elevated levels of both stress and anxiety and demonstrated shorter movement times and improved retention of movement accuracy and movement variability. Response execution processes appear to benefit from elevated states of stress and anxiety immediately prior to training even when elicited by an unrelated task.
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.JPHYS.2016.05.015
Abstract: Among people receiving inpatient rehabilitation after stroke, does additional weekend physiotherapy and/or occupational therapy reduce the length of rehabilitation hospital stay compared to those who receive a weekday-only service, and does this change after controlling for in idual factors? Does additional weekend therapy improve the ability to walk and perform activities of daily living, measured at discharge? Does additional weekend therapy improve health-related quality of life, measured 6 months after discharge from rehabilitation? Which in idual, clinical and hospital characteristics are associated with shorter length of rehabilitation hospital stay? This study pooled in idual data from two randomised, controlled trials (n=350) using an in idual patient data meta-analysis and multivariate regression. People with stroke admitted to inpatient rehabilitation facilities. Additional weekend therapy (physiotherapy and/or occupational therapy) compared to usual care (5 days/week therapy). Length of rehabilitation hospital stay, independence in activities of daily living measured with the Functional Independence Measure, walking speed and health-related quality of life. Participants who received weekend therapy had a shorter length of rehabilitation hospital stay. In the un-adjusted analysis, this was not statistically significant (MD -5.7 days, 95% CI -13.0 to 1.5). Controlling for hospital site, age, walking speed and Functional Independence Measure score on admission, receiving weekend therapy was significantly associated with a shorter length of rehabilitation hospital stay (β=7.5, 95% CI 1.7 to 13.4, p=0.001). There were no significant between-group differences in Functional Independence Measure scores (MD 1.9 points, 95% CI -2.8 to 6.6), walking speed (MD 0.06 m/second, 95% CI -0.15 to 0.04) or health-related quality of life (SMD -0.04, 95% CI -0.26 to 0.19) at discharge. Modest evidence indicates that additional weekend therapy might reduce rehabilitation hospital length of stay. ACTRN12610000096055, ACTRN12609000973213. [English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, et al. (2016) Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of in idual patient data.Journal of Physiotherapy62: 124-129].
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.APMR.2017.06.014
Abstract: To investigate the therapeutic interventions reported in the research literature and synthesize their effectiveness in improving upper limb (UL) function in the first 4 weeks poststroke. Electronic databases and trial registries were searched from inception until June 2016, in addition to searching systematic reviews by hand. Randomized controlled trials (RCTs), controlled trials, and interventional studies with pre osttest design were included for adults within 4 weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared with usual care, sham, or another technique. Two reviewers independently assessed eligibility of full texts, and methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool. A total of 104 trials (83 RCTs, 21 nonrandomized studies) were included (N=5225 participants). Meta-analyses of RCTs only (20 comparisons) and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardized mean difference [SMD]=1.09 95% confidence interval [CI], .21-1.97) and task-specific training (SMD=.37 95% CI, .05-.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported. Use of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase poststroke. Further high-quality studies into the initial 4 weeks poststroke are needed to determine therapies for targeted functional UL outcomes.
Publisher: Elsevier BV
Date: 2003
Publisher: SAGE Publications
Date: 19-03-2015
DOI: 10.1111/IJS.12470
Abstract: Increased therapy has been linked to improvements in functional ability of people with stroke. To determine the effectiveness of two alternative models of increased physiotherapy service delivery (seven-day week therapy or group circuit class therapy five days a week) to usual care. Three-armed randomized controlled trial with blinded assessment of outcome. People admitted with a diagnosis of stroke, previously independently ambulant and with a moderate level of disability were recruited. ‘Usual care’ was in idual physiotherapy provided five-days a week. Seven-day week therapy was usual care physiotherapy provided seven-days a week. Participants in the circuit class therapy arm of the trial received physiotherapy in group circuit classes in two 90-min sessions, five-days a week. Primary outcome was distance walked on the six-minute walk test at four-weeks post-randomization. Two hundred eighty-three participants were randomized primary outcome data were available for 259 (92%). In the seven-day arm participants received an additional three hours of physiotherapy and thosein the circuit class armanadditional 22 h. There were no significant between-group differences at four-weeks in walking distance ( P = 0·72). Length of stay was shorter for seven-day (mean difference −2·9 days, 95% confidence interval −17·9 to 12·0) and circuit class participants (mean difference −9·2 days, 95% confidence interval −24·2 to 5·8) compared to usual care, but this was not significant. Both seven-day therapy and group circuit class therapy increased physiotherapy time, but walking outcomes were equivalent to usual care.
Publisher: SAGE Publications
Date: 30-03-2016
Abstract: Stroke represents a significant global disease burden. As of 2015, there is no chemical or biological therapy proven to actively enhance neurological recovery during the chronic phase post-stroke. Globally, cell-based therapy in stroke is at the stage of clinical translation and may improve neurological function through various mechanisms such as neural replacement, neuroprotection, angiogenesis, immuno-modulation, and neuroplasticity. Preclinical evidence in a rodent model of middle cerebral artery ischemic stroke as reported in four independent studies indicates improvement in neurobehavioral function with adult human dental pulp stem cell therapy. Human adult dental pulp stem cells present an exciting potential therapeutic option for improving post-stroke disability. TOOTH (The Open study Of dental pulp stem cell Therapy in Humans) will investigate the use of autologous stem cell therapy for stroke survivors with chronic disability, with the following objectives: (a) determine the maximum tolerable dose of autologous dental pulp stem cell therapy (b) define that dental pulp stem cell therapy at the maximum tolerable dose is safe and feasible in chronic stroke and (c) estimate the parameters of efficacy required to design a future Phase 2/3 clinical trial. TOOTH is a Phase 1, open-label, single-blinded clinical trial with a pragmatic design that comprises three stages: Stage 1 will involve the selection of 27 participants with middle cerebral artery ischemic stroke and the commencement of autologous dental pulp stem cell isolation, growth, and testing in sequential cohorts (n = 3). Stage 2 will involve the transplantation of dental pulp stem cell in each cohort of participants with an ascending dose and subsequent observation for a 6-month period for any dental pulp stem cell-related adverse events. Stage 3 will investigate the neurosurgical intervention of the maximum tolerable dose of autologous dental pulp stem cell followed by 9 weeks of intensive task-specific rehabilitation. Advanced magnetic resonance and positron emission tomography neuro-imaging, and clinical assessment will be employed to probe any change afforded by stem cell therapy in combination with rehabilitation. Nine participants will step-wise progress in Stage 2 to a dose of up to 10 million dental pulp stem cell, employing a cumulative 3 + 3 statistical design with low starting stem cell dose and subsequent dose escalation, assuming that an acceptable probability of dose-limiting complications is between 1 in 6 (17%) and 1 in 3 (33%) of patients. In Stage 3, another 18 participants will receive an intracranial injection with the maximum tolerable dose of dental pulp stem cell. The primary outcomes to be measured are safety and feasibility of intracranial administration of autologous human adult DPSC in patients with chronic stroke and determination of the maximum tolerable dose in human subjects. Secondary outcomes include estimation of the measures of effectiveness required to design a future Phase 2/3 clinical trial.
Publisher: SAGE Publications
Date: 16-03-2007
Abstract: Background. Reorganization of the human motor cortex can be induced by specific patterns of peripheral afferent stimulation. The potential for afferent stimulation to facilitate the functional recovery associated with conventional rehabilitative techniques has not previously been investigated. Objective. The authors sought to determine whether combining appropriate afferent stimulation with task-specific training resulted in greater improvements than training alone in patients with impaired upper limb function in the subacute phase following stroke. Method. Twenty patients with hemiparesis due to stroke were allocated randomly to either a stimulation or control group. All received 9 sessions of task-specific physiotherapy training over 3 weeks. Prior to each training session, associative electrical stimulation of the motor point of 2 hand muscles was given in the stimulation group, whereas the control group received sham stimulation. Changes in dexterity were assessed using a grip-lift task, and standard measures of upper-limb function were made before and following the intervention. Corticospinal excitability was examined using transcranial magnetic stimulation. Results. Both groups showed comparable improvements in functional measures of upper-limb function. Of the 20 patients, only 14 could perform the grip-lift task, which is an objective measure of dexterity. Patients in the stimulation group From the Research Centre for Human Movement Control, School of exhibited significantly greater improvements in this task than the control group. There was no significant change in corticospinal excitability in either group. Conclusion. This pilot study provides preliminary data suggesting that targeted afferent stimulation may facilitate the response to conventional rehabilitation in patients with hemiparesis due to stroke, but these results need to be confirmed in a larger scale study.
Publisher: Copernicus GmbH
Date: 10-02-2021
Abstract: Abstract. Radon-222 (222Rn) is a short-lived radioactive gas naturally emitted from land surfaces and has long been used to assess convective transport in atmospheric models. In this study, we simulate 222Rn using the GEOS-Chem chemical transport model to improve our understanding of 222Rn emissions and surface concentration seasonality and characterize convective transport associated with two Goddard Earth Observing System (GEOS) meteorological products, the Modern-Era Retrospective analysis for Research and Applications (MERRA) and GEOS Forward Processing (GEOS-FP). We evaluate four global 222Rn emission scenarios by comparing model results with observations at 51 surface sites. The default emission scenario in GEOS-Chem yields a moderate agreement with surface observations globally (68.9 % of data within a factor of 2) and a large underestimate of winter surface 222Rn concentrations at Northern Hemisphere midlatitudes and high latitudes due to an oversimplified formulation of 222Rn emission fluxes (1 atom cm−2 s−1 over land with a reduction by a factor of 3 under freezing conditions). We compose a new global 222Rn emission scenario based on Zhang et al. (2011) and demonstrate its potential to improve simulated surface 222Rn concentrations and seasonality. The regional components of this scenario include spatially and temporally varying emission fluxes derived from previous measurements of soil radium content and soil exhalation models, which are key factors in determining 222Rn emission flux rates. However, large model underestimates of surface 222Rn concentrations still exist in Asia, suggesting unusually high regional 222Rn emissions. We therefore propose a conservative upscaling factor of 1.2 for 222Rn emission fluxes in China, which was also constrained by observed deposition fluxes of 210Pb (a progeny of 222Rn). With this modification, the model shows better agreement with observations in Europe and North America ( 80 % of data within a factor of 2) and reasonable agreement in Asia (close to 70 %). Further constraints on 222Rn emissions would require additional concentration and emission flux observations in the central United States, Canada, Africa, and Asia. We also compare and assess convective transport in model simulations driven by MERRA and GEOS-FP using observed 222Rn vertical profiles in northern midlatitude summer and from three short-term airborne c aigns. While simulations with both GEOS products are able to capture the observed vertical gradient of 222Rn concentrations in the lower troposphere (0–4 km), neither correctly represents the level of convective detrainment, resulting in biases in the middle and upper troposphere. Compared with GEOS-FP, MERRA leads to stronger convective transport of 222Rn, which is partially compensated for by its weaker large-scale vertical advection, resulting in similar global vertical distributions of 222Rn concentrations between the two simulations. This has important implications for using chemical transport models to interpret the transport of other trace species when these GEOS products are used as driving meteorology.
Publisher: Public Library of Science (PLoS)
Date: 27-01-2022
DOI: 10.1371/JOURNAL.PONE.0261808
Abstract: To assess the effects of consumer engagement in health care policy, research and services. We updated a review published in 2006 and 2009 and revised the previous search strategies for key databases (The Cochrane Central Register of Controlled Trials MEDLINE EMBASE PsycINFO CINAHL Web of Science) up to February 2020. Selection criteria included randomised controlled trials assessing consumer engagement in developing health care policy, research, or health services. The International Association for Public Participation, Spectrum of Public Participation was used to identify, describe, compare and analyse consumer engagement. Outcome measures were effects on people effects on the policy/research/health care services or process outcomes. We included 23 randomised controlled trials with a moderate or high risk of bias, involving 136,265 participants. Most consumer engagement strategies adopted a consultative approach during the development phase of interventions, targeted to health services . Based on four large cluster-randomised controlled trials, there is evidence that consumer engagement in the development and delivery of health services to enhance the care of pregnant women results in a reduction in neonatal, but not maternal, mortality. From other trials, there is evidence that involving consumers in developing patient information material results in material that is more relevant, readable and understandable for patients, and can improve knowledge. Mixed effects are reported of consumer-engagement on the development and/or implementation of health professional training. There is some evidence that using consumer interviewers instead of staff in satisfaction surveys can have a small influence on the results. There is some evidence that consumers may have a role in identifying a broader range of health care priorities that are complementary to those from professionals. There is some evidence that consumer engagement in monitoring and evaluating health services may impact perceptions of patient safety or quality of life. There is growing evidence from randomised controlled trials of the effects of consumer engagement on the relevance and positive outcomes of health policy, research and services. Health care consumers, providers, researchers and funders should continue to employ evidence-informed consumer engagement in their jurisdictions, with embedded evaluation. Systematic review registration: PROSPERO CRD42018102595 .
Publisher: Frontiers Media SA
Date: 30-04-2019
Publisher: Elsevier BV
Date: 02-2006
DOI: 10.1016/J.MATH.2005.10.002
Abstract: In this paper, we present findings from literature which suggests an intrinsic relationship in patients with chronic pain between the development of rigid and limited perspectives based on the interpretation of experience and the development of decreased repertoires of movement patterns. We present a research-based clinical reasoning model for conceptualising the teaching of movement for patients with chronic pain and contend that therapists can intentionally teach movement using fundamentally different reasoning and learning processes. We propose that these different kinds of learning will assist clinicians to translate the findings of erse and complex pain research to clinical practice and, in particular, the teaching of these patients both new perspectives and movement patterns.
Publisher: Wiley
Date: 31-07-2017
Publisher: Elsevier BV
Date: 12-2009
Publisher: Copernicus GmbH
Date: 24-08-2020
DOI: 10.5194/ACP-2020-804
Abstract: Abstract. Radon-222 (222Rn) is a short-lived radioactive gas naturally emitted from land surfaces, and has long been used to assess convective transport in atmospheric models. In this study, we simulate 222Rn using the GEOS-Chem chemical transport model to improve our understanding of 222Rn emissions and surface concentration seasonality, and characterize convective transport associated with two Goddard Earth Observing System (GEOS) meteorological products, MERRA and GEOS-FP. We evaluate four global 222Rn emission scenarios by comparing model results with observations at 51 surface sites. The default emission scenario in GEOS-Chem yields a moderate agreement with surface observations globally ( 80 % data within a factor of 2), and reasonable agreement in Asia (close to 70 %). Further constraints on 222Rn emissions would require additional concentration and emission flux observations in the central U.S., Canada, Africa, and Asia. We also compare and assess convective transport in model simulations driven by MERRA and GEOS-FP using observed 222Rn vertical profiles in northern mid-latitude summer, and from three short-term airborne c aigns. While simulations with both GEOS products are able to capture the observed vertical gradient of 222Rn concentrations in the lower troposphere (0–4 km), neither correctly represents the level of convective detrainment, resulting in biases in the middle and upper troposphere. Compared with GEOS-FP, MERRA leads to stronger convective transport of 222Rn, which is partially compensated by its weaker large-scale vertical advection, resulting in similar global vertical distributions of 222Rn concentrations between the two simulations. This has important implications for using chemical transport models to interpret the transport of other trace species when these GEOS products are used as driving meteorology.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-09-2020
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.ENVRES.2022.113998
Abstract: We examined the seasonal cycle of radon concentration observed at King Sejong Station (KSG, 62°S), Antarctic Peninsula, during the period 2013-2016. The distribution of monthly radon concentration was found to be highly positively skewed from March through October (austral autumn to spring) due to large numbers of short-lived periods of high radon concentration. The global atmospheric chemistry model (CAM-Chem), which includes all global terrestrial sources of radon except for those in Antarctica, well reproduces the observed seasonal cycle of monthly-mean radon concentration at KSG. Further offline experiments suggest that uncertainties in radon emissions over South America and the Southern Ocean should be improved for the simulations of radon in Antarctica. The results demonstrate that seasonally varying transport of radon in the boundary layer from South America substantially affects the seasonality of monthly mean radon concentration at KSG. The composite analyses further reveal that high radon events at KSG are the result of a distinct east-west dipole-like structure associated with surface cyclonic circulation over the Bellingshausen Sea and anticyclonic circulation in the Weddell Sea. This atmospheric pattern provides favorable conditions for radon transport into KSG from the northwest. The relationship between radon concentration at KSG and climate variability is also discussed in this study.
Publisher: Copernicus GmbH
Date: 24-08-2020
Publisher: Informa UK Limited
Date: 23-08-2017
DOI: 10.1080/10749357.2017.1366010
Abstract: Background Inequities in accessing inpatient rehabilitation after stroke have been reported in many countries and impact on patient outcomes. Objective To explore variation in international recommendations regarding which patients should receive inpatient rehabilitation after stroke and to describe reported access to rehabilitation. Methods A scoping review was conducted to identify clinical guidelines with recommendations regarding which patients should access inpatient rehabilitation after stroke, and data regarding the proportion of patients accessing stroke rehabilitation. Four bibliographic databases and grey literature were searched. Results Twenty-eight documents were included. Selection criteria for post-acute inpatient rehabilitation were identified for 14 countries or regions and summary data on the proportion of patients receiving inpatient rehabilitation were identified for 14 countries. In Australia, New Zealand, and the United Kingdom, it is recommended that all patients with stroke symptoms should access rehabilitation, whereas guidelines from the United States, Canada, and Europe did not consistently recommend rehabilitation for people with severe stroke. Access to inpatient rehabilitation ranged from 13% in Sweden to 57% in Israel. Differences in availability of early supported discharge/home rehabilitation programs and variations in reporting methods may influence the ability to reliably compare access to rehabilitation between regions. Conclusion Recommendations regarding which patients with moderate and severe strokes should access ongoing rehabilitation are inconsistent. Clinical practice guidelines from different countries regarding post-stroke rehabilitation do not always reflect the evidence regarding the likely benefits to people with stroke. Inequity in access to rehabilitation after stroke is an international issue.
Publisher: Springer Science and Business Media LLC
Date: 12-12-2018
DOI: 10.1007/S00702-017-1822-8
Abstract: Upper limb function was investigated in children with ADHD using objective methods. We hypothesised that children with ADHD exhibit abnormal dexterity, force application during manipulation of a novel object, and movement rhythmicity. Two groups of age- and gender-matched children were investigated: 35 typically developing children (controls, 10.5 ± 0.4 years, 32M-3F) and 29 children (11.5 ± 0.5 years, 27M-2F) with formally diagnosed ADHD according to DSM-IV-TR criteria. Participants underwent a series of screening tests and tests of upper limb function while "off" medication. Objective quantification of upper limb function involved measurement of force during a grip and lift task, maximal finger tapping task, and maximal pinch grip. Acceleration at the index finger was also measured during rest, flexion and extension, and a postural task to quantify tremor. The Movement Assessment Battery for Children-2 (MABC-2) was also administered. Significant between-group differences were observed in movement rhythmicity, manipulation of a novel object, and performance of the MABC-2 dexterity and aiming and catching components. Children with ADHD lifted a novel object using a lower grip force (P = 0.036), and held the object with a more variable grip force (P = 0.003), than controls. Rhythmicity of finger tapping (P = 0.008) and performance on the dexterity (P = 0.007) and aiming and catching (P = 0.042) components of the MABC-2 were also significantly poorer in the ADHD group than controls. Movement speed, maximum pinch grip strength, and tremor were unaffected. The results of the study show for the first time that ADHD is associated with deficits in multiple, but not all domains of upper limb function.
Publisher: SAGE Publications
Date: 2009
Abstract: Objective: Retraining of sensory function following stroke is frequently overlooked in rehabilitation protocols despite more than 60% of patients presenting with sensory deficits. Methods to train sensory function include both passive and active training protocols. Here we examined the volume and quality of the evidence available for both passive and active sensory training following stroke. In addition, we aimed to quantify the effect of sensory training on impairment and function. Data sources: Databases searched included MEDLINE, AMED, CINAHL, Academic search elite, Scopus and the Cochrane library. Unpublished articles were identified using a search engine. Review methods: Studies utilizing passive or active sensory training paradigms post stroke were identified. Methodological quality was examined using the National Health and Medical Research Council hierarchy of evidence and the McMaster University critical appraisal tool. Results: Fourteen studies met the inclusion criteria 8 examined passive and 6 active sensory training. Methodological quality scores ranged from 11 to 18.5 (maximum 20). Meta-analysis was performed using three studies examining hand function, demonstrating a moderate effect in favour of passive sensory training. Other studies were unable to be pooled due to heterogeneity of measures or insufficient data. Conclusion: Meta-analyses and single studies offer some support for the effectiveness of passive sensory training in relation to sensory impairment and motor function. However, empirical evidence for active sensory training is limited. Further high-quality studies with greater statistical power and meaningful clinical measures are required in order to accurately determine the effectiveness of sensory retraining following stroke.
Publisher: Wiley
Date: 23-07-2019
DOI: 10.1111/HEX.12932
Publisher: Springer Science and Business Media LLC
Date: 30-06-2017
Publisher: SAGE Publications
Date: 06-2011
DOI: 10.2466/15.22.PMS.112.3.783-798
Abstract: The role of sensory awareness in movement control is receiving increasing interest in sports and clinical literature as a feed-forward and feedback mechanism. The aim of the study was to assess the feasibility and effect of training in sensory awareness on dexterity in healthy adults. 29 healthy students were randomly allocated to a single-group, sensory awareness lesson with the dominant hand, the same lesson with the nondominant hand, or to a sham control group. Dexterity measures included the Purdue Pegboard Test, a grip-lift manipulandum, and perceived changes using a questionnaire. The sensory awareness lesson with the dominant hand produced a statistically significant improvement in mean dexterity compared to the control group, but not between the other two pairs of groups. The sensory awareness training paradigm is feasible and a single session improved dexterity in healthy adults.
No related grants have been discovered for Susan Hillier.