Valoración del PHQ-9 y GHQ-12 como herramientas de tamizaje de la depresión en el ámbito de atención primaria en el Ecuador experiencia del uso de versiones electrónicas y auto administradas en la Clínica Universitaria USFQ sede San Rafael

La depresión es una enfermedad tratable cuya prevalencia en el Ecuador se desconoce. El propósito principal de esta investigación es determinar la prevalencia y aplicabilidad del uso de instrumentos para detectar la depresión, validados para su uso, en el ámbito de la atención primaria en Estados Unidos y Europa. La detección de la depresión a nivel de atención primaria es aún más importante en este medio donde el acceso a recursos de salud es limitado

Transparent control in overground walking exoskeleton reveals interesting changing in subject's stepping frequency

ABSTRACT: Lower-limb gait training (GT) exoskeletons have been successfully used in rehabilitation programs to overcome the burden of locomotor impairment. However, providing suitable net interaction torques to assist patient movements is still a challenge. Previous transparent operation approaches have been tested in treadmill-based GT exoskeletons to improve user-robot interaction. However, it is not yet clear how a transparent lower-limb GT system affects user’s gait kinematics during overground walking, which unlike treadmill-based systems, requires active participation of the subjects to maintain stability. In this study, we implemented a transparent operation strategy on the ExoRoboWalker, an overground GT exoskeleton, to investigate its effect on the user’s gait. The approach employs a feedback zero-torque controller with feedforward compensation for the exoskeleton’s dynamics and actuators’ impedance. We analyzed the data of five healthy subjects walking overground with the exoskeleton in transparent mode (ExoTransp) and non-transparent mode (ExoOff) and walking without exoskeleton (NoExo). The transparent controller reduced the user-robot interaction torque and improved the user’s gait kinematics relative to ExoOff. No significant difference in stride length is observed between ExoTransp and NoExo (p = 0.129). However, the subjects showed a significant difference in cadence between ExoTransp (50.9± 1.1 steps/min) and NoExo (93.7 ± 8.7 steps/min) (p = 0.015), but not between ExoTransp and ExoOff (p = 0.644). Results suggest that subjects wearing the exoskeleton adjust their gait as in an attention-demanding task changing the spatiotemporal gait characteristics likely to improve gait balance

A novel approach to the analysis of muscle synergies based on the average threshold crossing technique

The work herein presented aimed to investigate the application of the Average Threshold Crossing (ATC) technique in the analysis of muscle synergies. The ability of the technique to approximate different modulations of the electromyographic (EMG) data was assessed via simulations. By selecting the proper threshold and window length, it was possible to obtain R2 similarity values above 0.8. This result improved by averaging the ATC envelopes over multiple epochs. The technique was also tested on real EMG data collected from 8 subjects during over ground walking. The synergies extracted using the ATC technique showed high similarity with the ones obtained with a standard approach using the EMG envelopes for both weights and temporal activations

Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies

Background: The application of rehabilitation robots has grown during the last decade. While meta-analyses have shown beneficial effects of robotic interventions for some patient groups, the evidence is less in others. We established the Advanced Robotic Therapy Integrated Centers (ARTIC) network with the goal of advancing the science and clinical practice of rehabilitation robotics. The investigators hope to exploit variations in practice to learn about current clinical application and outcomes. The aim of this paper is to introduce the ARTIC network to the clinical and research community, present the initial data set and its characteristics and compare the outcome data collected so far with data from prior studies. Methods: ARTIC is a pragmatic observational study of clinical care. The database includes patients with various neurological and gait deficits who used the driven gait orthosis Lokomat® as part of their treatment. Patient characteristics, diagnosis-specific information, and indicators of impairment severity are collected. Core clinical assessments include the 10-Meter Walk Test and the Goal Attainment Scaling. Data from each Lokomat® training session are automatically collected. Results: At time of analysis, the database contained data collected from 595 patients (cerebral palsy: n = 208; stroke: n = 129; spinal cord injury: n = 93; traumatic brain injury: n = 39; and various other diagnoses: n = 126). At onset, average walking speeds were slow. The training intensity increased from the first to the final therapy session and most patients achieved their goals. Conclusions: The characteristics of the patients matched epidemiological data for the target populations. When patient characteristics differed from epidemiological data, this was mainly due to the selection criteria used to assess eligibility for Lokomat® training. While patients included in randomized controlled interventional trials have to fulfill many inclusion and exclusion criteria, the only selection criteria applying to patients in the ARTIC database are those required for use of the Lokomat®. We suggest that the ARTIC network offers an opportunity to investigate the clinical application and effectiveness of rehabilitation technologies for various diagnoses. Due to the standardization of assessments and the use of a common technology, this network could serve as a basis for researchers interested in specific interventional studies expanding beyond the Lokomat®

Can mHealth Technology Help Mitigate the Effects of the COVID-19 Pandemic?

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Can kinematic parameters of 3D reach-to-target movements be used as a proxy for clinical outcome measures in chronic stroke rehabilitation? An exploratory study

Background: Despite numerous trials investigating robot-assisted therapy (RT) effects on upper-extremity (UE) function after stroke, few have explored the relationship between three-dimensional (3D) reach-to-target kinematics and clinical outcomes. The objectives of this study were to 1) investigate the correlation between kinematic parameters of 3D reach-to-target movements and UE clinical outcome measures, and 2) examine the degree to which differences in kinematic parameters across individuals can account for differences in clinical outcomes in response to RT. Methods: Ten chronic stroke survivors participated in a pilot RT intervention (eighteen 1-h sessions) integrating cognitive skills training and a home-action program. Clinical outcome measures and kinematic parameters of 3D reach-to-target movements were collected pre- and post-intervention. The correlation between clinical outcomes and kinematic parameters was investigated both cross-sectionally and longitudinally (i.e., changes in response to the intervention). Changes in clinical outcomes and kinematic parameters were tested for significance in both group and subject-by-subject analyses. Potential associations between individual differences in kinematic parameters and differences in clinical outcomes were examined. Results: Moderate-to-strong correlation was found between clinical measures and specific kinematic parameters when examined cross-sectionally. Weaker correlation coefficients were found longitudinally. Group analyses revealed significant changes in clinical outcome measures in response to the intervention; no significant group changes were observed in kinematic parameters. Subject-by-subject analyses revealed changes with moderate-to-large effect size in the kinematics of 3D reach-to-target movements pre- vs. post-intervention. Changes in clinical outcomes and kinematic parameters varied widely across participants. Conclusions: Large variability was observed across subjects in response to the intervention. The correlation between changes in kinematic parameters and clinical outcomes in response to the intervention was variable and not strong across parameters, suggesting no consistent change in UE motor strategies across participants. These results highlight the need to investigate the response to interventions at the individual level. This would enable the identification of clusters of individuals with common patterns of change in response to an intervention, providing an opportunity to use cluster-specific kinematic parameters as a proxy of clinical outcomes.Science Foundation IrelandInsight Research CentreMGH Institute of Health Professions and the Motion Analysis Laboratory at Spaulding Rehabilitation Hospital2021-02-24 JG: broken PDF replace

Tablet-Based Screening of Depressive Symptoms in Quito, Ecuador: Efficiency in Primary Care

Depression is a frequent yet overlooked occurrence in primary health care clinics worldwide. Depression and related health screening instruments are available but are rarely used consistently. The availability of technologically based instruments in the assessments offers novel approaches for gathering, storing, and assessing data that includes self-reported symptom severity from the patients themselves as well as clinician recorded information. In a suburban primary health care clinic in Quito, Ecuador, we tested the feasibility and utility of computer tablet-based assessments to evaluate clinic attendees for depression symptoms with the goal of developing effective screening and monitoring tools in the primary care clinics. We assessed individuals using the 9-item Patient Health Questionnaire, the Quick Inventory of Depressive Symptoms-Self-Report, the 12-item General Health Questionnaire, the Clinical Global Impression Severity, and a DSM-IV checklist of symptoms. We found that 20% of individuals had a PHQ9 of 8 or greater. There was good correlation between the symptom severity assessments. We conclude that the tablet-based PHQ9 is an excellent and efficient method of screening for depression in attendees at primary health care clinics and that one in five people should be assessed further for depressive illness and possible intervention

Evaluation of the Keeogo exoskeleton for assisting ambulatory activities in people with multiple sclerosis: an open-label, randomized, cross-over trial

Abstract Background Although physical activity and exercise is known to benefit people with multiple sclerosis (MS), the ability of these individuals to participate in such interventions is difficult due to the mobility impairments caused by the disease. Keeogo is a lower-extremity powered exoskeleton that may be a potential solution for enabling people with MS to benefit from physical activity and exercise. Methods An open-label, randomized, cross-over trial was used to examine the immediate performance effects when using the device, and the potential benefits of using the device in a home setting for 2 weeks. Clinical performance tests with and without the device included the 6 min walk test, timed up and go test and the 10-step stair test (up and down). An activity monitor was also used to measure physical activity at home, and a patient-reported questionnaire was used to determine the amount and extent of home use. Generalized linear models were used to test for trial effects, and correlation analysis used to examine relationships between trial effects and usage. Results Twenty-nine patients with MS participated. All measures showed small decrements in performance while wearing the device compared to not wearing the device. However, significant improvements in unassisted (Rehab effect) performance were found after using the device at home for 2 weeks, compared to 2 weeks at home without the device, and participants improved their ability to use the device over the trial period (Training effect). Rehab and Training effects were related to the self-reported extent that participants used Keeogo at home. Conclusions Keeogo appears to deliver an exercise-mediated benefit to individuals with MS that improved their unassisted gait endurance and stair climbing ability. Keeogo might be a useful tool for delivering physical activity interventions to individuals with mobility impairment due to MS. Trial registration ClinicalTrials.gov : NCT02904382 . Registered 19 September 2016 - Retrospectively registered