Effectiveness of intensive physiotherapy for gait improvement in stroke: systematic review

Introduction: Stroke is one of the leading causes of functional disability worldwide. Approximately 80% of post-stroke subjects have motor changes. Improvement of gait pattern is one of the main objectives of physiotherapists intervention in these cases. The real challenge in the recovery of gait after stroke is to understand how the remaining neural networks can be modified, to be able to provide response strategies that compensate for the function of the affected structures. There is evidence that intensive training, including physiotherapy, positively influences neuroplasticity, improving mobility, pattern and gait velocity in post-stroke recovery. Objectives: Review and analyze in a systematic way the experimental studies (RCT) that evaluate the effects of Intensive Physiotherapy on gait improvement in poststroke subjects. Methodology: Were only included all RCT performed in humans, without any specific age, that had a clinical diagnosis of stroke at any stage of evolution, with sensorimotor deficits and functional gait changes. The databases used were: Pubmed, PEDro (Physiotherapy Evidence Database) and CENTRAL (Cochrane Center Register of Controlled Trials). Results: After the application of the criteria, there were 4 final studies that were included in the systematic review. 3 of the studies obtained a score of 8 on the PEDro scale and 1 obtained a score of 4. The fact that there is clinical and methodological heterogeneity in the studies evaluated, supports the realization of the current systematic narrative review, without meta-analysis. Discussion: Although the results obtained in the 4 studies are promising, it is important to note that the significant improvements that have been found, should be carefully considered since pilot studies with small samples, such as these, are not designed to test differences between groups, in terms of the effectiveness of the intervention applied. Conclusion: Intensive Physiotherapy seems to be safe and applicable in post-stroke subjects and there are indications that it is effective in improving gait, namely speed, travelled distance and spatiotemporal parameters. However, there is a need to develop more RCTs with larger samples and that evaluate the longterm resultsN/

Acute care in occupational therapy a package of care and the essential therapeutic equipment needed.

Master’s Degree. University of KwaZulu-Natal, Durban.ABSTRACT Introduction: Occupational therapy, together other clinical services are required by government to describe and outline their services so that minimum standards can be set, to ensure that quality care is delivered to all who use the public health service in South Africa. In KZN, where this study is focused, the vast majority of health institutions deliver acute care services at either a district, regional or tertiary level. Aligning therapeutic services to appropriate clinical service at each level will have an impact on optimal health care. Aim: This study focused on developing a package of services for occupational therapy in acute care and outlining an essential therapeutic equipment list. Methodology: A mixed methods explorative sequential study with three phases was implemented. The first phase focused on a documentation audit to determine the context, background and any relevant information on the topic. Approximately 13 documents were selected to conduct a thematic analysis and extract pertinent information to answer the research question. The second phase consisted of implementing a survey in KZN with all eligible occupational therapists to determine their opinions on existing information and generate new ideas. This survey was constructed utilizing information from the document analysis. The final phase ensured that consensus was drawn on a package of occupational therapy services and equipment list by conducting a focus group utilizing the nominal group technique. Senior experienced occupational therapists that worked in acute care constituted the expert group. Results: The documentation audit yielded a rich description of information which set the background on the survey questionnaire. A 78 % response from the survey ensured that the senior experts on the nominal focus group were well informed xii when drawing consensus on a final package of occupational therapy in acute care and the essential therapeutic equipment and assessments needed. Conclusion: This study will provide therapists with a baseline standard of care for acute care hospitals and assist them with motivating for appropriate cost effective resources to deliver effective services in KZN.Abstract available in the PDF

MAMI Tech Toolkit Utilising Action Research to Develop a Technological Toolkit to Facilitate Access to Music-Making

Music is essential to most of us, it can light up all areas of the brain, help develop skills with communication, help to establish identity, and allow a unique path for expression. However, barriers to access or gaps in provision can restrict access to music-making and sound exploration for some people. Research has shown that technology can provide unique tools to access music-making but that technology is underused by practitioners. This action research project details the development and design of a technological toolkit called MAMI – the Modular Accessible Musical Instrument technology toolkit - in conjunction with stakeholders from four research sites. Stakeholders included music therapists, teachers, community musicians, and children and young people. The overarching aims of the research were: to explore how technology was incorporated into practices of music creation and sound exploration; to explore the issues that stakeholders had with current music technology; to create novel musical tools and tools that match criteria as specified by stakeholders, and address issues as found in a literature review; to assess the effectiveness of these novel tools with a view to improving practices; and to navigate propagation of the practices, technologies, and methods used to allow for transferability into the wider ecology. Outcomes of the research include: a set of design considerations that contribute to knowledge around the design and practical use of technological tools for music-making in special educational needs settings; a series of methodological considerations to help future researchers and developers navigate the process of using action research to create new technological tools with stakeholders; and the MAMI Tech Toolkit – a suite of four bespoke hardware tools and accompanying software - as an embodiment of the themes that emerged from: the cycles of action research; the design considerations; and a philosophical understanding of music creation that foregrounds it as an situated activity within a social context

MAMI tech toolkit: utilising action research to develop a technological toolkit to facilitate access to music-making.

Music is essential to most of us, it can light up all areas of the brain, help develop skills with communication, help to establish identity, and allow a unique path for expression. However, barriers to access or gaps in provision can restrict access to music-making and sound exploration for some people. Research has shown that technology can provide unique tools to access music-making but that technology is underused by practitioners. This action research project details the development and design of a technological toolkit called MAMI – the Modular Accessible Musical Instrument technology toolkit - in conjunction with stakeholders from four research sites. Stakeholders included music therapists, teachers, community musicians, and children and young people. The overarching aims of the research were: to explore how technology was incorporated into practices of music creation and sound exploration; to explore the issues that stakeholders had with current music technology; to create novel musical tools and tools that match criteria as specified by stakeholders, and address issues as found in a literature review; to assess the effectiveness of these novel tools with a view to improving practices; and to navigate propagation of the practices, technologies, and methods used to allow for transferability into the wider ecology. Outcomes of the research include: a set of design considerations that contribute to knowledge around the design and practical use of technological tools for music-making in special educational needs settings; a series of methodological considerations to help future researchers and developers navigate the process of using action research to create new technological tools with stakeholders; and the MAMI Tech Toolkit – a suite of four bespoke hardware tools and accompanying software - as an embodiment of the themes that emerged from: the cycles of action research; the design considerations; and a philosophical understanding of music creation that foregrounds it as an situated activity within a social context

A Comparative Analysis of the Mechanisms of Social Inclusion for Hard of Hearing People in Germany and in the Russian Federation

Inklusion von Menschen mit Behinderungen ist zu einem der vordringlichen Ziele der Sozialpolitik der Europäischen Union und in der Russischen Föderation geworden, u. a. aufgrund der zunehmenden Zahl von Ländern, die die UN-BRK1 ratifizierten, sowie Herausforderungen wegen, die eine "alternde" Gesellschaft verursacht. Jedoch werden Menschen mit Hörbehinderung und deren spezielle Bedürfnisse im Vergleich zu anderen, eher sichtbaren Behinderungen, oft übersehen. Das zentrale Anliegen der vorliegenden Untersuchung ist es, die Mechanismen und Ergebnisse der sozialen Inklusion schwerhöriger Menschen in Russland und Deutschland näher zu betrachten und zu vergleichen, sowie mit empirisch belegten Befunden zur Forschung über schwerhörige Personen beizutragen. Der Forschungstand hierzu ist in den Disability Studies noch sehr lückenhaft. Eine Analyse der Sozial- und Behindertenpolitik in beiden Ländern sowie ein Vergleich der rechtlichen und institutionellen Maßnahmen als auch der Chancen bildet den Rahmen für eine empirische Analyse (Fragebogen, Interviews mit schwerhörigen Personen, NGOs und Experten). Die Einschätzung der politischen Maßnahmen und der Infrastrukturen folgt den konzeptionellen und normativen Bewertungsmaßstäben der Disability Studies. Die vergleichende Analyse konzentriert sich auf den Zugang schwerhöriger Menschen zu Bildung und Arbeitsmarkt, zu Wiedereingliederung, Information und Kommunikation – Bereiche welche für Inklusion und Teilhabe entscheidend sind. Die empirischen Erhebungen enthalten explorative, nicht-repräsentative Fragebögen-Untersuchungen unter a) 190 jungen Befragten, 18-35 Jahre alt (davon 136 aus Deutschland; 150 aus Russland) b) 110 älteren Befragten, 65 bzw. 60 Jahre alt — abhängig vom betreffenden Land — und älter (43 aus Deutschland; 67 aus Russland) und Experten-Interviews mit Schlüsselpersonen zum Thema (Forscher, politische Entscheidungsträger, medizinische und pädagogische Experten, schwerhörige NGO-Aktivisten); darüber hinaus Leitfaden-Interviews mit schwerhörigen Personen (11 in Deutschland, 16 in Russland). Übereinstimmungen und Abweichungen in den nationalen politischen Richtlinien werden diskutiert, Beispiele von positiven Praktiken in medizinischer, ausbildungsbezogener und beruflicher Rehabilitation und potentielle politische Maßnahmen werden vorgeschlagen.Inclusion of people with disabilities has become one of the priorities of the social policy in the European Union and in the Russian Federation, in part, in connection with the increasing ratification of the UN CRPD worldwide and problems induced by the “ageing” society. However, people with hearing loss and their specific needs are often overlooked in comparison with more visible disabilities. The main purpose of this study is to look into and compare the mechanisms and results of social inclusion of hard of hearing people (HoH) in Russia and Germany and to contribute with empirically grounded findings to the research on hard of hearing people of which there is a lack in the disability research field. An analysis of the social and disability related policies in both countries and a comparison of the legal and institutional arrangements and opportunities provides the framework for the empirical analysis (questionnaire, interviews with HoH persons, NGOs and with experts). The appraisal of the policies and infrastructures is following the conceptual and normative benchmarks of the Disability studies. The comparative analysis is focused on access of HoH people to education and employment, to rehabilitation, information and communication – the fields critical to inclusion and participation. The empirical research comprises an explorative non-representative questionnaire survey with a) 190 young respondents aged 18-35 years (136 from Germany, 150 from Russia) b) 110 elderly respondents (65 or 60 years old and older; 43 from Germany, 67 from Russia), and expert interviews with the key persons in the field (researchers, political decision-makers, medical and educational professionals, hard of hearing NGO activists); furthermore, guided interviews with HoH people (N=11 in Germany, N=16 in Russia) were conducted. Commonalities and discrepancies in the national policy directions are discussed, examples of positive practices in medical, educational and professional rehabilitation and potential policy measures are suggested

Proceedings of the 9th international conference on disability, virtual reality and associated technologies (ICDVRAT 2012)

The proceedings of the conferenc

Embodied Imagination: An Exploration of Participatory Performance and Interactive Technology to Support Stroke Recovery

Life after a stroke leads to the challenge of adjusting to new possibilities and fosters an increased risk of social isolation and depression. Re-building personal narratives and creating new community networks are key to conceiving an identity beyond the stroke. In this context, participatory performance provides methods for exploring physical and social identities, imagining new ways of being. Meanwhile, digital technology offers tools to help envision these possibilities. A participatory performance workshop supported by real-time motion capture technology has been redesigned in collaboration with the performance company Split Britches. The Green Screening workshop’s objective is to help stroke survivors imagine new physical and social possibilities by enacting fantasies of things they have always wanted to do. Participants construct storylines supported by a custom-built interactive scenography. Movement data is collected and transformed into real-time visualisations to progressively build fantasy narratives enacted with and for other participants. Three research studies conducted with stroke support groups around England analysed progressive iterations of the Green Screening workshop. The first study focused on the project's feasibility in aiding social support. The second study explored embodied imagination and social collaboration in enacted storylines. Finally, the third study analysed communication as a means of recovery and further potential to foster social collaboration. Findings are based on qualitative analysis of the participants' experience. Results reveal that the narrative process and visualisations encouraged a rich repertoire of improvised movements, and the communal aspect of the process was found especially important in achieving these results. This work argues that this framework can simultaneously bring a rich, prospective and political understanding of people’s lived experience to the design space in HCI and provide community stroke support