Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research

<b>Background</b> Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed ‘treatment burden’ and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.<p></p> <b>Methods and findings</b> The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.<p></p> <b>Conclusions</b> Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems

Occupational therapy for stroke patients - A systematic review

Ergotherapie helpt patiënten die een beroerte gehad hebben bij het revalideren. Ook mensen met reumatoïde artritis (RA) hebben baat bij ergotherapie, onder andere door instructie over gewrichtsbeschermende maatregelen. Dit blijkt uit NIVEL onderzoek in opdracht van het Reumafonds en het College voor Zorgverzekeringen (CvZ). NIVEL onderzoeker Esther Steultjens vergeleek, schiftte en analyseerde de resultaten van al het onderzoek naar de effectiviteit van ergotherapie bij Reumatoïde Artritis (37 wetenschappelijke studies) en beroertes (32 wetenschappelijke studies) van de afgelopen 40 jaar. De resultaten zijn gebaseerd op een klein aantal, omdat de meeste gevonden studies van beperkte kwaliteit zijn. Beroerte Steultjens concludeert dat bij mensen die een beroerte gehad hebben ergotherapie de sociale participatie en de zelfredzaamheid bevordert. Vaardigheidstraining leidt ook tot enige verbetering van de zelfredzaamheid. Ze vond onvoldoende bewijs voor het nut van spalken om de spierspanning te verminderen. Per jaar krijgen ongeveer 32.000 mensen in Nederland een beroerte. Na een jaar heeft 66% van de overlevenden problemen met zelfstandig functioneren, driekwart van de overlevenden heeft problemen met een zinvolle tijdsbesteding. Steultjens: "Uit dit onderzoek blijkt dat ergotherapie een belangrijke rol heeft in de multidisciplinaire aanpak van de revalidatie van mensen met een beroerte." Reumatoïde artritis (RA) Steultjens concludeert dat er bewijs is dat ergotherapie bij mensen met RA een positief effect heeft op het kunnen verrichten van dagelijkse activiteiten en op het verlichten van pijn. Vooral instructies over het nemen van gewrichtsbeschermende maatregelen hebben invloed op het functioneren. Het spalken van aangedane ledematen lijkt de pijn te verminderen, ook al kan het de patiënt hinderen bij het bewegen. RA is een chronische ontsteking van de gewrichten die het dagelijks functioneren van ongeveer 145.000 Nederlanders beperkt. Ergotherapie is een vorm van paramedisch handelen die zich richt op het verbeteren van het dagelijks functioneren. De ergotherapeutische behandeling streeft ernaar het uitvoeren van taken te vergemakkelijken door met de patiënten sommige dagelijkse activiteiten te trainen en ze voor andere compensatiestrategieën aan te leren. Andere onderdelen van de ergotherapeutische behandeling zijn het geven van leefstijladviezen (zoals gewrichtsbeschermende of energiebesparende maatregelen) en advies/instructie over hulpmiddelen en spalktherapie. Het onderzoek is opgezet en uitgevoerd volgens de richtlijnen van de Cochrane Collaboration. Dit is een internationale organisatie die het maken, actualiseren en verspreiden van de resultaten van systematisch literatuuronderzoek naar de effecten van gezondheidszorg tot doel heeft. Arthritis Care & Research, Volume 47, Issue 6, 2002 Occupational therapy for rheumatoid arthritis: A systematic review Esther M. J. Steultjens , Joost Dekker, Lex M. Bouter, Dirkjan van Schaardenburg, Marie-Antoinette H. van Kuyk, Cornelia H. M. van den Ende Arthritis Care & Research is het Official Journal of the Association of Rheumatology Health Professionals

Healthcare Robotics

Robots have the potential to be a game changer in healthcare: improving health and well-being, filling care gaps, supporting care givers, and aiding health care workers. However, before robots are able to be widely deployed, it is crucial that both the research and industrial communities work together to establish a strong evidence-base for healthcare robotics, and surmount likely adoption barriers. This article presents a broad contextualization of robots in healthcare by identifying key stakeholders, care settings, and tasks; reviewing recent advances in healthcare robotics; and outlining major challenges and opportunities to their adoption.Comment: 8 pages, Communications of the ACM, 201

Neurorehabilitation for an Individual with Bilateral Thalamic Stroke and Preexisting Visual Impairment Presenting with Impaired Use of Sensory Cues: A Case Report

Introduction: Impaired balance is one of the primary causes of functional limitations. Related to sensory deficits specifically, balance disorder in stroke may be caused by decreased central integration of sensory cues, including somatosensory, visual and vestibular input. Case Presentation: This case describes a 23-year-old male with bilateral thalamic stroke following surgical resection of a recurring optic nerve meningioma. He had a complex medical history and is legally blind. He presented to outpatient neurorehabilitation 5 months following his stroke. He demonstrated absent light touch sensation and absent proprioception and kinesthetic awareness in his upper extremities, lower extremities, and trunk. Secondary to absent proprioception and vision and significant impairments related to shunt malfunction, he required total assistance for all mobility at initial examination. Discussion: After 8 months of intensive rehabilitation, he demonstrated substantial improvements in all functional mobility and recovery of sensation. Rehabilitation included interventions such as electrical stimulation, fluidotherapy, repetitive task training, and most significantly, external augmented feedback. This feedback included sensory cues, auditory and tactile cues, and maximizing the use of vestibular input. This case demonstrates that neurorehabilitation can benefit patients with impaired use of sensory cues and central integration

Biomechanics

Biomechanics is a vast discipline within the field of Biomedical Engineering. It explores the underlying mechanics of how biological and physiological systems move. It encompasses important clinical applications to address questions related to medicine using engineering mechanics principles. Biomechanics includes interdisciplinary concepts from engineers, physicians, therapists, biologists, physicists, and mathematicians. Through their collaborative efforts, biomechanics research is ever changing and expanding, explaining new mechanisms and principles for dynamic human systems. Biomechanics is used to describe how the human body moves, walks, and breathes, in addition to how it responds to injury and rehabilitation. Advanced biomechanical modeling methods, such as inverse dynamics, finite element analysis, and musculoskeletal modeling are used to simulate and investigate human situations in regard to movement and injury. Biomechanical technologies are progressing to answer contemporary medical questions. The future of biomechanics is dependent on interdisciplinary research efforts and the education of tomorrow’s scientists

Overcoming barriers and increasing independence: service robots for elderly and disabled people

This paper discusses the potential for service robots to overcome barriers and increase independence of elderly and disabled people. It includes a brief overview of the existing uses of service robots by disabled and elderly people and advances in technology which will make new uses possible and provides suggestions for some of these new applications. The paper also considers the design and other conditions to be met for user acceptance. It also discusses the complementarity of assistive service robots and personal assistance and considers the types of applications and users for which service robots are and are not suitable

A Profile of Canadians Over the Age of 65 Years Living with Coexisting Vision and Mobility Impairments: A Sequential Mixed Method Analysis

The purpose of this dissertation was (i) to investigate the prevalence of older Canadian adults living with coexisting vision and mobility impairments, and (ii) to describe how disability associated with both impairments relate to health status, activities of daily living, physical activity participation, assistive technology use, and health care services. These goals were achieved by using mixed methodology approach. The first manuscript was based on secondary analyses of the 2006/2007 National Population Health Survey (NPHS). The results of the secondary analysis of the NPHS revealed that approximately 3% of the Canadian population over the age of 65 was living with coexisting vision and mobility impairments. Also, older adults with both conditions required more assistance with activities of daily living and they reported the lowest levels of physical activity participation compared to those living with one or no impairment. The second part of the core component was based on secondary analyses of the 2006 Participation and Activity Limitations Survey (PALS). The PALS was specifically designed for individuals who reported they were living with a disability. As a result, a greater proportion of respondents indicated the presence of both target conditions – approximately 15% of older Canadians who reported having a disability were living with coexisting vision and mobility impairments. The analysis of the PALS data revealed that older adults with both impairments required more assistance with activities of daily living and they reported a higher use of assistive technology; however, there was a higher level of unmet needs for vision related assistive technology. The final manuscript consisted of in-depth interviews conducted to add the personal perspective of older adults with both impairments, and to expand and clarify the quantitative findings. The analyses of the transcripts revealed four main themes among participants: (i) the meaning behind vision, mobility, and coexisting impairments; (ii) adaptation of desired activities; (iii) external support for engaging in activity; and (iv) internal support for engaging in activity. The results of this dissertation contribute knowledge about living with coexisting vision and mobility impairments and offer a starting point to guide rehabilitation services for clients with multiple impairments

Plasticity and awareness of bodily distortion

Knowledge of the body is filtered by perceptual information, recalibrated through predominantly innate stored information, and neurally mediated by direct sensory motor information. Despite multiple sources, the immediate prediction, construction, and evaluation of one’s body are distorted. The origins of such distortions are unclear. In this review, we consider three possible sources of awareness that inform body distortion. First, the precision in the body metric may be based on the sight and positioning sense of a particular body segment. This view provides information on the dual nature of body representation, the reliability of a conscious body image, and implicit alterations in the metrics and positional correspondence of body parts. Second, body awareness may reflect an innate organizational experience of unity and continuity in the brain, with no strong isomorphism to body morphology. Third, body awareness may be based on efferent/afferent neural signals, suggesting that major body distortions may result from changes in neural sensorimotor experiences. All these views can be supported empirically, suggesting that body awareness is synthesized from multimodal integration and the temporal constancy of multiple body representations. For each of these views, we briefly discuss abnormalities and therapeutic strategies for correcting the bodily distortions in various clinical disorder