Stroke Rehabilitation Treatment Line Performance: Discrete-Event Simulation Lessons from Queen Elizabeth I Hospital

The application of Discrete-Event Simulation (DES) modelling in Malaysia is gradually increasing with the aim of decreasing inpatient treatment lines’ at public funded hospitals. Major premise behind this application is that such simulation models may be exploited in monitoring stroke treatment flows. The objective of this research-in-progress paper is to demonstrate the feasibility of applying DES modelling in understanding treatment line performance of stroke patients in a general inpatient rehabilitation ward at a major tertiary hospital in Kota Kinabalu, Sabah

Rehabilitating individuals with spinocerebellar ataxia: Experiences from impairment-based rehabilitation through multidisciplinary care approach

Spinocerebellar ataxia (SCA) is a rare neurodegenerative disease with progressive course and poor expected outcomes. Therefore, rehabilitation remains the principal form of management especially in advanced disease. Impairment-based rehabilitation through multidisciplinary care approach has proven benefits for functional improvement in individuals with advancing SCA. This concept is based on comprehensive assessments of individualised impairments and functional limitations while exploring contributing environmental and personal factors affecting the person as a whole. From this assessment, individualised rehabilitation goals can be formulated through a multidisciplinary care approach. Neurologists, rehabilitation physicians, physiotherapists, occupational therapists and speech and language pathologists are key individuals involved in the multidisciplinary care for individuals with SCA rehabilitation. Two cases of individuals at different stages of SCA are presented to highlight the rehabilitation approach in providing focused interventions based on individualised impairments through multidisciplinary care. These cases emphasise the importance of understanding the needs of each individuals with SCA so that the rehabilitative therapies prescribed can be tailored to the functional achievements desired

Post-traumatic brain injury olfactory dysfunction: factors influencing quality of life

Purpose To evaluate if and how post-traumatic brain injury (TBI) olfactory dysfunction affects the quality of life (QoL). Methods In this case–control observational study, 32 adults with post-TBI olfactory dysfunction (cases) were matched with 32 TBI patients with intact olfactory function (controls). All subjects self-rated their olfactory function using the Visual Analogue Scale (VAS). Cases also underwent objective olfactory function assessment with the Sniffin’ Sticks test, which generated a Threshold, Discrimination, and Identification (TDI) score. QoL was assessed with the Questionnaire for Olfactory Disorders (QOD). Factors evaluated included age, gender, smoking, TBI severity and duration, lesion localisation, and Disability Rating Scale (DRS) score. Results Cases had a higher mean QOD score than controls at 26.31 ± 14.37 and 9.44 ± 8.30, respectively (F = 16.426, p < 0.001, η2 = 0.224). The effect size was large (d = 1.07) with an odds ratio of 7.02. The features of QoL most affected were perception of smell changes, adapting to smell changes, and fear of hazardous substance exposure. DRS score and severity of olfactory dysfunction significantly affected QoL (p < 0.05). Conclusion Post-TBI olfactory dysfunction significantly lowered QoL and increased the likelihood of having a low QoL relative to TBI alone

Developing Virtual Data Warehouse for Rehabilitation Registry in Sabah, Borneo: Towards Big Data Analytics and Geomapping

Clinical registry, defined as an organised system for the collection, storage, retrieval, analysis, and dissemination of information on individuals with a condition that predisposes to the occurrence of a health-related event, are designed through data repository or data warehouse. Data repository is described as a real-time database that consolidates data from a variety of clinical sources that offers a comprehensive source for storage and retrieval of relevant clinical information needed. However, data warehouse is a data repository that concentrates on data queries and data analytics. Rehabilitation registry in Malaysia is still at its infancy with lack of data sharing and integration. As rehabilitation is a subspecialty concerned with the prevention, diagnosis, and rehabilitation of disabling conditions, a registry would allow identification of patients’ demographics, clinical and functional outcomes improvement, benchmarking the delivery of rehabilitation services, and research purposes. The application of virtual data warehouse, cloud computing, big data analytics and geomapping for clinical registries have been implemented well in countries like China and United Kingdom. The main objectives of this research-in-progress paper are to demonstrate the feasibility of developing and designing virtual data warehouse framework based on cloud computing technology, in an attempt towards big data analytics and geomapping implementation for inpatient rehabilitation registry in Sabah, Malaysia

Local Descriptor for Retinal Fundus Image Registration

A feature-based retinal image registration (RIR) technique aligns multiple fundus images and composed of pre-processing, feature point extraction, feature descriptor, matching and geometrical transformation. Challenges in RIR include difference in scaling, intensity and rotation between images. The scale and intensity differences can be minimised with consistent imaging setup and image enhancement during the pre-processing, respectively. The rotation can be addressed with feature descriptor method that robust to varying rotation. Therefore, a feature descriptor method is proposed based on statistical properties (FiSP) to describe the circular region surrounding the feature point. From the experiments on public Fundus Image Registration dataset, FiSP established 99.227% average correct matches for rotations between 0° and 180°. Then, FiSP is paired with Harris corner, scale-invariant feature transform (SIFT), speeded-up robust feature (SURF), Ghassabi's and D-Saddle feature point extraction methods to assess its registration performance and compare with the existing feature-based RIR techniques, namely generalised dual-bootstrap iterative closet point (GDB-ICP), Harris-partial intensity invariant feature descriptor (PIIFD), Ghassabi's-SIFT, H-M 16, H-M 17 and D-Saddle-histogram of oriented gradients (HOG). The combination of SIFT-FiSP registered 64.179% of the image pairs and significantly outperformed other techniques with mean difference between 25.373 and 60.448% (p = <;0.001*)

A survey on gamification for health rehabilitation care: applications, opportunities, and open challenges

Research trends in gamification have shown a significant diversity in various areas of e-health, particularly in addressing the issues of rehabilitation and physical activity. Rehabilitation requires better engaging tools that help to increase the patient’s motivation and engagement in particular forms of rehabilitation training. Adopting gamification in rehabilitation offers different treatment and care environments when implementing rehabilitation training. As gamification is increasingly being explored in rehabilitation, one might not realize that using various techniques in gamified applications yields a different effect on gameplay. To date, varied gamification techniques have been utilized to provide useful experiences from the perspective of health applications. However, a limited number of surveys have investigated the gamification of rehabilitation and the use of suitable game techniques for rehabilitation in the literature. The objective of this paper is to examine and analyze the existing gamification techniques for rehabilitation applications. A classification of rehabilitation gamification is developed based on the rehabilitation gamifying requirements and the gamification characteristics that are commonly applied in rehabilitation applications. This classification is the main contribution of this paper. It provides insight for researchers and practitioners into suitable techniques to design and apply gamification with increased motivation and sustainable engagement for rehabilitation treatment and care. In addition, different game elements, selection blocks, and gamification techniques are identified for application in rehabilitation. In conclusion, several challenges and research opportunities are discussed to improve gamification deployment in rehabilitation in the futur

Functional Outcomes in Spinal Tuberculosis: A Review of the Literature

Spinal tuberculosis often leads to neurological deficit and subsequent deterioration in functional outcomes. This review assesses the recent evidence on functional outcomes in spinal tuberculosis, highlighting functional recovery, assessment tools for functional measures, and associative factors for functional recovery. Using PubMed, a literature search was done using the terms “spinal tuberculosis,” “tuberculous spondylitis,” “tuberculous spondylodiscitis,” and “functional outcome” for original articles published between January 2010 and December 2019. A total of 191 search results were found. Detailed screening showed that 19 articles met the eligibility criteria: 13 of these focused on surgical methods, four on conservative management, and two on rehabilitation approaches. The outcome measures used for functional assessment were the Oswestry Disability Index (11 articles), Japanese Orthopaedic Association score (n=3), modified Barthel Index (n=2), Functional Independence Measure (n=2), and 36-item Short-Form Health Survey (n=1). Functional outcome was mainly affected by pain, spinal cord compression, and inpatient rehabilitation. No significant difference in functional outcome was found between conservative management and surgery for cases with uncomplicated spinal tuberculosis. Most studies focused on surgery as the mode of treatment and used pain-related functional measures; however, these assessed functional limitations secondary to pain, and not neurological deficits. Further studies may consider examining functional outcomes in spinal tuberculosis by utilizing spinal cord-specific functional outcome measures, to evaluate outcome measures as a prognostic tool, and to measure functional outcomes from specific rehabilitation interventions

Impacts of bladder managements and urinary complications on quality of life: Cross-sectional perspectives of persons with spinal cord injury living in Malaysia, Indonesia, and Thailand

The impact of bladder care and urinary complications on quality of life (QoL) in persons with spinal cord injury (SCI) who have neurogenic lower urinary tract dysfunction has not been elucidated, especially in those living in low-resource countries. This multinational cross-sectional survey was conducted in rehabilitation facilities in Malaysia, Indonesia, and Thailand. Community-dwelling adults with traumatic or non-traumatic SCI participating in the International Spinal Cord Injury Community Survey (InSCI) from 2017 to 2018 were enrolled. Data regarding bladder management/care, presence of bladder dysfunction, urinary tract infection (UTI), and QoL score were extracted from the InSCI questionnaire. The impact of bladder care and urinary complications on QoL was determined using univariable and multivariable regression analysis. Questionnaires from 770 adults were recruited for analysis. After adjusting for all demographic and SCI-related data, secondary conditions, as well as activity and participation factors, UTI was an independent negative predictive factor of QoL score (p = 0.007, unstandardized coefficients = -4.563, multivariable linear regression analysis, enter method). Among bladder care and urinary complication factors, UTI is the only factor negatively impacting QoL. These results address the importance of proper bladder management and UTI prevention in persons with SCI to improve their QoL

Oxidative stress and antioxidant enzymes activity after cycling at different intensity and duration

This study aimed to compare the effects of intensity (I) and duration (D) on the oxidative stress marker (malondialdehyde, MDA) and the responses of the antioxidant enzymes (catalase, CAT; glutathione peroxidase, GPx; superoxide dismutase, SOD) among sedentary adults. In a crossover design, 25 sedentary adults performed nine cycling exercise sessions with a constant load of 50%, 60%, and 70% VO2peak for 10-, 20-, and 30-min each. Plasma MDA, CAT, GPx, and SOD activity were measured before and immediately after each exercise session. Results show that MDA concentration and SOD activity increased significantly immediately after exercise at all intensities and durations, except SOD decreased significantly at 70% .V O2pk for 30 min. CAT activities also increased significantly after exercise at 50% .V O2pk for 10 and 20 min but decreased at 60% .V O2pk for 30 min and at 70% .V O2pk for all durations. GPx activity decreased significantly after 20 and 30 min at all intensity levels. In conclusion, our results show that cycling at 50%, 60%, and 70% .V O2pk for 10, 20, and 30 min increased oxidative stress and antioxidant activities, but with different responses. These findings suggest that the starting exercise intensity for sedentary adults should not exceed 70% . VO2pk

Comparing neuroplasticity changes between high and low frequency gait training in subacute stroke: Protocol for a randomized, single-blinded, controlled study

Walking recovery post stroke can be slow and incomplete. Determining effective stroke rehabilitation frequency requires the assessment of neuroplasticity changes. Neurobiological signals from electroencephalogram (EEG) can measure neuroplasticity through incremental changes of these signals after rehabilitation. However, changes seen with a different frequency of rehabilitation require further investigation. It is hypothesized that the association between the incremental changes from EEG signals and the improved functional outcome measure scores are greater in higher rehabilitation frequency, implying enhanced neuroplasticity changes. The purpose of this study is to identify the changes in the neurobiological signals from EEG, to associate these with functional outcome measures scores, and to compare their associations in different therapy frequency for gait rehabilitation among subacute stroke individuals. A randomized, single-blinded, controlled study among patients with subacute stroke will be conducted with two groups: an intervention group (IG) and a control group (CG). Each participant in the IG and CG will receive therapy sessions three times a week (high frequency) and once a week (low frequency), respectively, for a total of 12 consecutive weeks. Each session will last for an hour with strengthening, balance, and gait training. The main variables to be assessed are the 6-Minute Walk Test (6MWT), Motor Assessment Scale (MAS), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and quantitative EEG indices in the form of delta to alpha ratio (DAR) and delta-plus-theta to alpha-plus-beta ratio (DTABR). These will be measured at preintervention (R0) and postintervention (R1). Key analyses are to determine the changes in the 6MWT, MAS, BBS, MBI, DAR, and DTABR at R0 and R1 for the CG and IG. The changes in the DAR and DTABR will be analyzed for association with the changes in the 6MWT, MAS, BBS, and MBI to measure neuroplasticity changes for both the CG and IG. We have recruited 18 participants so far. We expect to publish our results in early 2023. Conclusions: These associations are expected to be positive in both groups, with a higher correlation in the IG compared to the CG, reflecting enhanced neuroplasticity changes and objective evaluation on the dose-response relationship