Discovering the Context of People With Disabilities : Semantic Categorization Test and Environmental Factors Mapping of Word Embeddings from Reddit

The World Health Organization's International Classification of Functioning Disability and Health (ICF) conceptualizes disability not solely as a problem that resides in the individual, but as a health experience that occurs in a context. Word embeddings build on the idea that words that occur in similar contexts tend to have similar meanings. In spite of both sharing "context" as a key component, word embeddings have been scarcely applied in disability. In this work, we propose social media (particularly, Reddit) to link them. The objective of our study is to train a model for generating word associations using a small dataset (a subreddit on disability) able to retrieve meaningful content. This content will be formally validated and applied to the discovery of related terms in the corpus of the disability subreddit that represent the physical, social, and attitudinal environment (as defined by a formal framework like the ICF) of people with disabilities. Reddit data were collected from pushshift.io with the pushshiftr R package as a wrapper. A word2vec model was trained with the wordVectors R package using the disability subreddit comments, and a preliminary validation was performed using a subset of Mikolov analogies. We used Van Overschelde's updated and expanded version of the Battig and Montague norms to perform a semantic categories test. Silhouette coefficients were calculated using cosine distance from the wordVectors R package. For each of the 5 ICF environmental factors (EF), we selected representative subcategories addressing different aspects of daily living (ADLs); then, for each subcategory, we identified specific terms extracted from their formal ICF definition and ran the word2vec model to generate their nearest semantic terms, validating the obtained nearest semantic terms using public evidence. Finally, we applied the model to a specific subcategory of an EF involved in a relevant use case in the field of rehabilitation. We analyzed 96,314 comments posted between February 2009 and December 2019, by 10,411 Redditors. We trained word2vec and identified more than 30 analogies (eg, breakfast - 8 am + 8 pm = dinner). The semantic categorization test showed promising results over 60 categories; for example, s(A relative)=0.562, s(A sport)=0.475 provided remarkable explanations for low s values. We mapped the representative subcategories of all EF chapters and obtained the closest terms for each, which we confirmed with publications. This allowed immediate access (≤ 2 seconds) to the terms related to ADLs, ranging from apps "to know accessibility before you go" to adapted sports (boccia). For example, for the support and relationships EF subcategory, the closest term discovered by our model was "resilience," recently regarded as a key feature of rehabilitation, not yet having one unified definition. Our model discovered 10 closest terms, which we validated with publications, contributing to the "resilience" definition. This study opens up interesting opportunities for the exploration and discovery of the use of a word2vec model that has been trained with a small disability dataset, leading to immediate, accurate, and often unknown (for authors, in many cases) terms related to ADLs within the ICF framework

Stroke Survivors on Twitter : Sentiment and Topic Analysis From a Gender Perspective

BACKGROUND: Stroke is the worldwide leading cause of long-term disabilities. Women experience more activity limitations, worse health-related quality of life, and more poststroke depression than men. Twitter is increasingly used by individuals to broadcast their day-to-day happenings, providing unobtrusive access to samples of spontaneously expressed opinions on all types of topics and emotions. OBJECTIVE: This study aimed to consider the raw frequencies of words in the collection of tweets posted by a sample of stroke survivors and to compare the posts by gender of the survivor for 8 basic emotions (anger, fear, anticipation, surprise, joy, sadness, trust and disgust); determine the proportion of each emotion in the collection of tweets and statistically compare each of them by gender of the survivor; extract the main topics (represented as sets of words) that occur in the collection of tweets, relative to each gender; and assign happiness scores to tweets and topics (using a well-established tool) and compare them by gender of the survivor. METHODS: We performed sentiment analysis based on a state-of-the-art lexicon (National Research Council) with syuzhet R package. The emotion scores for men and women were first subjected to an F-test and then to a Wilcoxon rank sum test. We extended the emotional analysis, assigning happiness scores with the hedonometer (a tool specifically designed considering Twitter inputs). We calculated daily happiness average scores for all tweets. We created a term map for an exploratory clustering analysis using VosViewer software. We performed structural topic modelling with stm R package, allowing us to identify main topics by gender. We assigned happiness scores to all the words defining the main identified topics and compared them by gender. RESULTS: We analyzed 800,424 tweets posted from August 1, 2007 to December 1, 2018, by 479 stroke survivors: Women (n=244) posted 396,898 tweets, and men (n=235) posted 403,526 tweets. The stroke survivor condition and gender as well as membership in at least 3 stroke-specific Twitter lists of active users were manually verified for all 479 participants. Their total number of tweets since 2007 was 5,257,433; therefore, we analyzed the most recent 15.2% of all their tweets. Positive emotions (anticipation, trust, and joy) were significantly higher (P<.001) in women, while negative emotions (disgust, fear, and sadness) were significantly higher (P<.001) in men in the analysis of raw frequencies and proportion of emotions. Happiness mean scores throughout the considered period show higher levels of happiness in women. We calculated the top 20 topics (with percentages and CIs) more likely addressed by gender and found that women's topics show higher levels of happiness scores. CONCLUSIONS: We applied two different approaches-the Plutchik model and hedonometer tool-to a sample of stroke survivors' tweets. We conclude that women express positive emotions and happiness much more than men

Alteracions de l'excitabilitat cortico-espinal en pacients amb dany axonal difús d'origen traumàtic

Aquest treball ha estat dirigit a investigar les característiques de l'excitabilitat cortical del sistema motor en el dany axonal difús (DAD), conseqüència d'un Traumatisme Cranioencefàlic greu (TCE). Hem aplicat diversos paradigmes d'estimulació magnètica transcranial (TMS) de polsos simples, sobre l'escorça motora, per avaluar l'excitabilitat cortical i els mecanismes excitatoris i inhibitoris. Els paràmetres inclouen el llindar motor en repòs (MT), l'àrea sota la corba dels potencials motors evocats compostos (MEP), corbes d'estímul resposta, la variabilitat dels MEPs i la durada del període de silenci (SP). El grup de pacients en general va mostrar un MT més alt que els pacients, àrees dels MEPs més petites, i menor increment en les corbes en comparació amb els controls normals (p 0,05). Les alteracions en l'excitabilitat van ser significativament més pronunciades amb l'augment de la gravetat del DAD (p 0,005) i la presència de deteriorament motor (p 0,05), mentre que la coexistència de lesions focals no va afectar el grau dels canvis del MEPs. La variabilitat dels MEPs va ser significativament menor en el grup que presentava sols dèficit motor (P 0,05). La inhibició cortical, segons mostrava la durada del SP, no va mostrar diferències significatives en cap dels grups de pacients. En conclusió, les nostres troballes reforcen el concepte de que l'alteració dels fenòmens excitatoris i inhibitoris en l'escorça motora no son processos paral·lels, i aporten informació sobre els diferents patrons d'alteració en el DAD. A més, aquestes dades suggereixen que les alteracions en els mecanismes excitatoris corticoespinals es determinen principalment per la gravetat del DAD i mostren una relació significativa amb l'afectació clínica en relació a la funció motora després d'un TCE greu que afecta difusament les connexions corticals del sistema motor. Des d'un punt de vista clínic, aquest estudi indica que la neurofisiologia hauria de ser considerada com una exploració complementaria a l'exploració neurològica en el TCE greu

The impact of COVID-19 on home, social, and productivity integration of people with chronic traumatic brain injury or stroke living in the community

Compare community integration of people with stroke or traumatic brain injury (TBI) living in the community before and during the coronavirus severe acute respiratory syndrome coronavirus 2 disease (COVID-19) when stratifying by injury: participants with stroke (G1) and with TBI (G2); by functional independence in activities of daily living: independent (G3) and dependent (G4); by age: participants younger than 54 (G5) and older than 54 (G6); and by gender: female (G7) and male (G8) participants. Prospective observational cohort study In-person follow-up visits (before COVID-19 outbreak) to a rehabilitation hospital in Spain and on-line during COVID-19. Community dwelling adults (≥18 years) with chronic stroke or TBI. Community integration questionnaire (CIQ) the total-CIQ as well as the subscale domains (ie, home-CIQ, social-CIQ, productivity CIQ) were compared before and during COVID-19 using the Wilcoxon ranked test or paired t test when appropriate reporting Cohen effect sizes (d). The functional independence measure was used to assess functional independence in activities of daily living. Two hundred four participants, 51.4% with stroke and 48.6% with TBI assessed on-line between June 2020 and April 2021 were compared to their own in-person assessments performed before COVID-19. When analyzing total-CIQ, G1 (d = −0.231), G2 (d = −0.240), G3 (d = −0.285), G5 (d = −0.276), G6 (d = −0.199), G7 (d = −0.245), and G8 (d = −0.210) significantly decreased their scores during COVID-19, meanwhile G4 was the only group with no significant differences before and during COVID-19. In productivity-CIQ, G1 (d = −0.197), G4 (d = −0.215), G6 (d = −0.300), and G8 (d = −0.210) significantly increased their scores, meanwhile no significant differences were observed in G2, G3, G5, and G7. In social-CIQ, all groups significantly decreased their scores: G1 (d = −0.348), G2 (d = −0.372), G3 (d = −0.437), G4 (d = −0.253), G5 (d = −0.394), G6 (d = −0.319), G7 (d = −0.355), and G8 (d = −0.365). In home-CIQ only G6 (d = −0.229) significantly decreased, no significant differences were observed in any of the other groups. The largest effect sizes were observed in total-CIQ for G3, in productivity-CIQ for G6, in social-CIQ for G3 and in home-CIQ for G6 (medium effect sizes). Stratifying participants by injury, functionality, age or gender allowed identifying specific CIQ subtotals where remote support may be provided addressing them

Risk Taking in Hospitalized Patients with Acute and Severe Traumatic Brain Injury

Altres ajuts: Fundació La Marató de TV3 (071931)Rehabilitation can improve cognitive deficits observed in patients with traumatic brain injury (TBI). However, despite rehabilitation, the ability of making a choice often remains impaired. Risk taking is a daily activity involving numerous cognitive processes subserved by a complex neural network. In this work we investigated risk taking using the Balloon Analogue Risk Task (BART) in patients with acute TBI and healthy controls. We hypothesized that individuals with TBI will take less risk at the BART as compared to healthy individuals. We also predicted that within the TBI group factors such as the number of days since the injury, severity of the injury, and sites of the lesion will play a role in risk taking as assessed with the BART. Main findings revealed that participants with TBI displayed abnormally cautious risk taking at the BART as compared to healthy subjects. Moreover, healthy individuals showed increased risk taking throughout the task which is in line with previous work. However, individuals with TBI did not show this increased risk taking during the task. We also investigated the influence of three patients' characteristics on their performance at the BART: Number of days post injury, Severity of the head injury, and Status of the frontal lobe. Results indicate that performance at the BART was influenced by the number of days post injury and the status of the frontal lobe, but not by the severity of the head injury. Reported findings are encouraging for risk taking seems to naturally improve with time postinjury. They support the need of conducting longitudinal prospective studies to ultimately identify impaired and intact cognitive skills that should be trained postinjury

Alteracions de l’excitabilitat cortico-espinal en pacients amb dany axonal difús d’origen traumàtic

Aquest treball ha estat dirigit a investigar les característiques de l’excitabilitat cortical del sistema motor en el dany axonal difús (DAD), conseqüència d’un Traumatisme Cranioencefàlic greu (TCE). Hem aplicat diversos paradigmes d'estimulació magnètica transcranial (TMS) de polsos simples, sobre l'escorça motora, per avaluar l'excitabilitat cortical i els mecanismes excitatoris i inhibitoris. Els paràmetres inclouen el llindar motor en repòs (MT), l’àrea sota la corba dels potencials motors evocats compostos (MEP), corbes d’estímul resposta, la variabilitat dels MEPs i la durada del període de silenci (SP). El grup de pacients en general va mostrar un MT més alt que els pacients, àrees dels MEPs més petites, i menor increment en les corbes en comparació amb els controls normals (p <0,05). Les alteracions en l'excitabilitat van ser significativament més pronunciades amb l'augment de la gravetat del DAD (p <0,005) i la presència de deteriorament motor (p <0,05), mentre que la coexistència de lesions focals no va afectar el grau dels canvis del MEPs. La variabilitat dels MEPs va ser significativament menor en el grup que presentava sols dèficit motor (P<0,05). La inhibició cortical, segons mostrava la durada del SP, no va mostrar diferències significatives en cap dels grups de pacients. En conclusió, les nostres troballes reforcen el concepte de que l’alteració dels fenòmens excitatoris i inhibitoris en l'escorça motora no son processos paral•lels, i aporten informació sobre els diferents patrons d’alteració en el DAD. A més, aquestes dades suggereixen que les alteracions en els mecanismes excitatoris corticoespinals es determinen principalment per la gravetat del DAD i mostren una relació significativa amb l’afectació clínica en relació a la funció motora després d'un TCE greu que afecta difusament les connexions corticals del sistema motor. Des d'un punt de vista clínic, aquest estudi indica que la neurofisiologia hauria de ser considerada com una exploració complementaria a l’exploració neurològica en el TCE greu

Occupational performance and multisensory stimulation during post-traumatic amnesia: An observational and randomized controlled trial protocol

Background. Occupational performance (OP) and interventions during post-traumatic amnesia (PTA) following traumatic brain injury are poorly understood. Purpose. This study aims to describe a study protocol to (a) track person factors of OP throughout PTA and (b) assess the feasibility of a randomized controlled trial (RCT) protocol comparing an occupation-based multisensory stimulation and environmental enrichment intervention with usual care during PTA. Method. A prospective observational study will be conducted with an embedded Phase II RCT with 30 participants in PTA. Participants will be randomly assigned to group and regularly assessed on PTA and OP measures. Feasibility aspects will be recorded in a logbook. All measures will be repeated at PTA resolution and 1 month later, with a follow-up questionnaire completed at 6 months postinjury. Findings. Observational data will be analyzed using correlations. Feasibility will be examined descriptively, and group comparisons will be conducted to determine effect size

Alteracions de l'excitabilitat cortico-espinal en pacients amb dany axonal difús d'origen traumàtic

Aquest treball ha estat dirigit a investigar les característiques de l'excitabilitat cortical del sistema motor en el dany axonal difús (DAD), conseqüència d'un Traumatisme Cranioencefàlic greu (TCE). Hem aplicat diversos paradigmes d'estimulació magnètica transcranial (TMS) de polsos simples, sobre l'escorça motora, per avaluar l'excitabilitat cortical i els mecanismes excitatoris i inhibitoris. Els paràmetres inclouen el llindar motor en repòs (MT), l'àrea sota la corba dels potencials motors evocats compostos (MEP), corbes d'estímul resposta, la variabilitat dels MEPs i la durada del període de silenci (SP). El grup de pacients en general va mostrar un MT més alt que els pacients, àrees dels MEPs més petites, i menor increment en les corbes en comparació amb els controls normals (p 0,05). Les alteracions en l'excitabilitat van ser significativament més pronunciades amb l'augment de la gravetat del DAD (p 0,005) i la presència de deteriorament motor (p 0,05), mentre que la coexistència de lesions focals no va afectar el grau dels canvis del MEPs. La variabilitat dels MEPs va ser significativament menor en el grup que presentava sols dèficit motor (P 0,05). La inhibició cortical, segons mostrava la durada del SP, no va mostrar diferències significatives en cap dels grups de pacients. En conclusió, les nostres troballes reforcen el concepte de que l'alteració dels fenòmens excitatoris i inhibitoris en l'escorça motora no son processos paral·lels, i aporten informació sobre els diferents patrons d'alteració en el DAD. A més, aquestes dades suggereixen que les alteracions en els mecanismes excitatoris corticoespinals es determinen principalment per la gravetat del DAD i mostren una relació significativa amb l'afectació clínica en relació a la funció motora després d'un TCE greu que afecta difusament les connexions corticals del sistema motor. Des d'un punt de vista clínic, aquest estudi indica que la neurofisiologia hauria de ser considerada com una exploració complementaria a l'exploració neurològica en el TCE greu

Feasibility of aerobic exercise in the subacute phase of recovery from traumatic brain injury : A case series

Background and purpose: Injuries associated with traumatic brain injury (TBI) are common and can complicate rehabilitation. The objective of this study is to examine the feasibility of introducing aerobic physical exercise programs into the subacute phase of multidisciplinary rehabilitation from moderate-to-severe TBI, which includes computerized cognitive training. Case description: Five individuals undergoing inpatient rehabilitation with moderate or severe TBIs who also have concomitant physical injuries. All of these individuals are in the subacute phase of recovery from their TBIs. Intervention: An 8-week progressive aerobic physical exercise program. Participants were monitored to ensure that they could both adhere to and tolerate the exercise program. In addition to the physical exercise, individuals were undergoing their standard rehabilitation procedures which included cognitive training. Neuropsychological testing was performed to gain an understanding of each individuals' cognitive function. Outcomes: Two minor adverse events were reported. Participants adhered to both aerobic exercise and cognitive training. Poor correlations were noted between heart rate reserve and ratings of perceived effort. Discussion: Despite concomitant injuries and cognitive impairments, progressive aerobic exercise programs seem feasible and well tolerated in subacute rehabilitation from moderate-to-severe TBI. Some findings highlight the difficulty in measuring exercise intensity in this population

Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke : Elo Rating Approach

Stroke is a worldwide cause of disability; 40% of stroke survivors sustain cognitive impairments, most of them following inpatient rehabilitation at specialized clinical centers. Web-based cognitive rehabilitation tasks are extensively used in clinical settings. The impact of task execution depends on the ratio between the skills of the treated patient and the challenges imposed by the task itself. Thus, treatment personalization requires a trade-off between patients' skills and task difficulties, which is still an open issue. In this study, we propose Elo ratings to support clinicians in tasks assignations and representing patients' skills to optimize rehabilitation outcomes. This study aims to stratify patients with ischemic stroke at an early stage of rehabilitation into three levels according to their Elo rating; to show the relationships between the Elo rating levels, task difficulty levels, and rehabilitation outcomes; and to determine if the Elo rating obtained at early stages of rehabilitation is a significant predictor of rehabilitation outcomes. The PlayerRatings R library was used to obtain the Elo rating for each patient. Working memory was assessed using the DIGITS subtest of the Barcelona test, and the Rey Auditory Verbal Memory Test (RAVLT) was used to assess verbal memory. Three subtests of RAVLT were used: RAVLT learning (RAVLT075), free-recall memory (RAVLT015), and recognition (RAVLT015R). Memory predictors were identified using forward stepwise selection to add covariates to the models, which were evaluated by assessing discrimination using the area under the receiver operating characteristic curve (AUC) for logistic regressions and adjusted R 2 for linear regressions. Three Elo levels (low, middle, and high) with the same number of patients (n=96) in each Elo group were obtained using the 50 initial task executions (from a total of 38,177) for N=288 adult patients consecutively admitted for inpatient rehabilitation in a clinical setting. The mid-Elo level showed the highest proportions of patients that improved in all four memory items: 56% (54/96) of them improved in DIGITS, 67% (64/96) in RAVLT075, 58% (56/96) in RAVLT015, and 53% (51/96) in RAVLT015R (P <.001). The proportions of patients from the mid-Elo level that performed tasks at difficulty levels 1, 2, and 3 were 32.1% (3997/12,449), 31.% (3997/12,449), and 36.9% (4595/12,449), respectively (P <.001), showing the highest match between skills (represented by Elo level) and task difficulties, considering the set of 38,177 task executions. Elo ratings were significant predictors in three of the four models and quasi-significant in the fourth. When predicting RAVLT075 and DIGITS at discharge, we obtained R 2 =0.54 and 0.43, respectively; meanwhile, we obtained AUC=0.73 (95% CI 0.64-0.82) and AUC=0.81 (95% CI 0.72-0.89) in RAVLT075 and DIGITS improvement predictions, respectively. Elo ratings can support clinicians in early rehabilitation stages in identifying cognitive profiles to be used for assigning task difficulty levels