Vaikean aivovamman saaneen asiakkaan interaktiivinen neuropsykologinen etäohjaus

Tutkimuksessa käsiteltävän Invalidiliiton avomuotoisen etäkuntoutus-projektin tarkoituksena oli kehittää aivovamman saaneiden asiakkaiden avomuotoista kuntoutusta etäterapiana ja etäkuntoutuksena. Interaktiivisen neuropsykologisen etäohjauksen tavoitteena oli hankkeen pilottivaiheesta saatujen havaintojen jälkeen simuloida neuropsykologinen face-fo-face-yksilökuntoutustilanne etäohjausjärjestelmää hyödyntäen ja toteuttaa asiakkaan neuropsykologiset yksilökäynnit etälaitteen kautta. Tässä tutkimuksessa käsitellään yhtä asiakastapausta. Kuntoutuksen menetelminä käytettiin neuropsykologisella kuntoutusohjelmalla tapahtunutta tietokoneavusteista kuntoutusta, supportiivista ohjausta ja aivovamman neuropsykologisia jälkioireita ja niiden ilmenemistä koskevaa psykoedukaatiota. Interaktiivinen neuropsykologinen etäohjaus osoittautui hyödylliseksi toimintatavaksi myös vaikea-asteisesta aivovammasta kärsivällä asiakkaalla, kun neuropsykologisen oirekuvan erityispiirteet huomioitiin ohjaustilanteissa ja kun asiakkaan kanssa samassa fyysisessä tilassa oli käytettävissä ohjaava avustaja. Asiakkaan neuropsykologisessa oirekuvassa todettiin edistymisestä huolimatta edelleen merkittävät häiriöt. Tämä tutkimus on tiettävästi ensimmäinen, jossa on simuloitu face-to-face-neuropsykologinen yksilöohjausjakso vaikeavammaisella asiakkaalla etäohjausjärjestelmän kautta ja saatu havaintoja tieteellisesti tutkittuun neuropsykologiseen tietoon perustuvan kognitiivisen, tietokoneavusteisen kuntoutusmenetelmän toimivuudesta interaktiivisessa neuropsykologisessa etäohjauksessa. Abstract Interactive neuropsychological telerehabilitation of a client with severe TBI The aim of a telerehabilitation project of Finnish Association of people with physical disabilities (FPD) was to develop telerehabilitation of traumatic brain injury (TBI) clients in the area of teletherapy and telerehabilitation. In the present study the objective was to simulate face-to-face neuropsychological rehabilitation sessions via an Internet-based videoconferencing telerehabilitation system on the ground of the experiences observed during the pilot phase of the project. The client was a 35-year-old male with severe TBI as a result of a high energy accident occurred in May 2012. He participated in 12 neuropsychological telerehabilitation sessions at a frequency of a 60 minute session weekly including 5 sessions during the pilot phase of the project and 7 sessions during the face-to-face simulation sessions. The procedures included computer-based rehabilitation of cognitive functions, supportive guidance and psychoeducation of neuropsychological consequences of TBI. Interactive neuropsychological telerehabilitation of the client with severe TBI proved to be a useful procedure when the specific features of the client`s neuropsychological outcome after TBI were taken into account and there was an assistant worker in the same physical environment of the client. Nevertheless, in spite of the progress the degree of neuropsychological disorders was still severe. This is presumably the first study to report the observations of simulated face-to-face neuropsychological sessions via an Internet-based videoconferencing telerehabilitation system with evidence-based computer-assisted training of cognitive functions for the client with severe TBI. Keywords: interactive neuropsychological telerehabilitation, traumatic brain injury, computer-based rehabilitation of cognitive functions, single-case stud

Elämänlaadun ja toimintakyvyn muutokset ikääntyneillä aivoverenkiertohäiriön sairastaneilla kävelyn ja käden tehostetun käytön kuntoutuksen aikana

65–85-vuotiaiden aivoverenkiertohäiriön (AVH:n) sairastaneiden (n = 270) kuntoutustutkimus toteutettiin osana Kelan kehittämishanketta. Kontrolloimattomassa seurantatutkimuksessa selvitettiin laitos- ja avomuotoisen kävely- ja käsikuntoutuksen aikana tapahtuneita muutoksia elämänlaadussa ja toimintakyvyssä. Kävelykuntoutus sisälsi painokevennettyä ja muuta kävelyharjoittelua. Käsikuntoutus sisälsi halvaantuneen käden tehostetun käytön harjoittelua. Kävelykuntoutuksen perusjakson kesto laitos- ja avokuntoutuksessa oli 20/18 vrk, käsikuntoutuksen 14/13 vrk. Seurantajaksot I (6 vrk) ja II (2 vrk, loppumittaukset) toteutettiin 6 ja 12 kuukauden kuluttua perusjakson päättymisestä. Alkutilanteessa kävelyn avokuntoutujissa itsenäisesti käveleviä (FAC) oli enemmän kuin laitoskuntoutujissa. Laitoskuntoutujilla itsenäisesti kävelevien määrä kasvoi 45 %:sta 63 %:iin. Molemmilla ryhmillä kävelymatka (6 min) piteni. Laitoskuntoutujilla motorinen ja kognitiivinen toiminta (FIM) paranivat. Avokuntoutujien motoriset ja prosessitaidot (AMPS) paranivat. Laitoskuntoutujien elämänlaatupisteet ympäristön osa-alueella (WHOQOL-BREF) nousivat. Alkutilanteessa yläraajan toimintakyky (WMFT) oli käden laitoskuntoutujilla parempi kuin avokuntoutujilla. Molemmissa ryhmissä halvaantuneen yläraajan toimintakyky koheni. Laitoskuntoutujien puristusvoima (dynamometri) ja avokuntoutujilla motoriset taidot (AMPS) paranivat. Tutkittavien iän, sukupuolen, sairastamisajan ja toimintakyvyn lähtötason yhteyttä tutkittiin toimintakykyä kuvaavien mittareiden muutoksiin. Vain alhainen lähtötaso ennakoi parempaa edistymistä mittaustuloksissa. Ikääntynyttä AVH:n sairastanutta kannattaa kuntouttaa kävelyn, halvaantuneen yläraajan käytön sekä päivittäisistä toiminnoista suoriutumisen parantamiseksi

Does the company's economic performance affect access to occupational health services?

<p>Abstract</p> <p>Background</p> <p>In Finland like in many other countries, employers are legally obliged to organize occupational health services (OHS) for their employees. Because employers bear the costs of OHS it could be that in spite of the legal requirement OHS expenditure is more determined by economic performance of the company than by law. Therefore, we explored whether economic performance was associated with the companies' expenditure on occupational health services.</p> <p>Methods</p> <p>We used a prospective design to predict expenditure on OHS in 2001 by a company's economic performance in 1999. Data were provided by Statistics Finland and expressed by key indicators for profitability, solidity and liquidity and by the Social Insurance Institution as employers' reimbursement applications for OHS costs. The data could be linked at the company level. Regression analysis was used to study associations adjusted for various confounders.</p> <p>Results</p> <p>Nineteen percent of the companies (N = 6 155) did not apply for reimbursement of OHS costs in 2001. The profitability of the company represented by operating margin in 1999 and adjusted for type of industry was not significantly related to the company's probability to apply for reimbursement of the costs in 2001 (OR = 1.00, 95%CI: 0.99 to 1.01). Profitability measured as operating profit in 1999 and adjusted for type of industry was not significantly related to costs for curative medical services (Beta -0.001, 95%CI: -0.00 to 0.11) nor to OHS cost of prevention in 2001 (Beta -0.001, 95%CI: -0.00 to 0.00).</p> <p>Conclusion</p> <p>We did not find a relation between the company's economic performance and expenditure on OHS in Finland. We suppose that this is due to legislation obliging employers to provide OHS and the reimbursement system both being strong incentives for employers.</p

The Effectiveness of Lower-Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: A Systematic Review

Background: With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Regaining ambulation is a top priority for an increasing number of stroke survivors. However, despite an increase in research exploring these devices for lower limb rehabilitation, little is known of the effectiveness. Objective: This review aims to assess the effectiveness of lower limb wearable technology for improving activity and participation in adult stroke survivors. Methods: Randomized controlled trials (RCTs) of lower limb wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs. Results: In the review, we included 11 RCTs with collectively 550 participants at baseline and 474 participants at final follow-up including control groups and participants post stroke. Participants' stroke type and severity varied. Only one study found significant between-group differences for systems functioning and activity. Across the included RCTs, the lowest number of participants was 12 and the highest was 151 with a mean of 49 participants. The lowest number of participants to drop out of an RCT was zero in two of the studies and 19 in one study. Significant between-group differences were found across three of the 11 included trials. Out of the activity and participation measures alone, P values ranged from P=.87 to P≤.001. Conclusions: This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes, appropriateness of the RCT methodology for complex interventions, a lack of appropriate analysis of outcome data, and participant stroke severity

MiR-34b is associated with clinical outcome in triple-negative breast cancer patients

<p>Abstract</p> <p>Background</p> <p>Breast cancer is the most common malignancy with the highest incidence rates among women worldwide. Triple-negative breast cancer (TNBC) represents the major phenotype of basal-like molecular subtype of breast cancer, characterized by higher incidence in young women and a very poor prognosis. MicroRNAs (miRNAs) are small non-coding RNAs playing significant role in the pathogenesis of many cancers including breast cancer. Therefore, miRNAs are also potential prognostic and/or predictive biomarkers in triple-negative breast cancer patients.</p> <p>Methods</p> <p>Thirty-nine TNBC patients with available formalin-fixed paraffin-embedded (FFPE) tissues were enrolled in the study. MiR-34a, miR-34b, and miR-34c were analyzed using qRT-PCR and correlated to clinico-pathological features of TNBC patients.</p> <p>Results</p> <p>Expression levels of miR-34b significantly correlate with disease free survival (DFS) (<it>p </it>= 0.0020, log-rank test) and overall survival (OS) (<it>p </it>= 0.0008, log-rank test) of TNBC patients. No other significant associations between miR-34a, miR-34b, and miR-34c with available clinical pathological data were observed.</p> <p>Conclusions</p> <p>MiR-34b expression negatively correlates with disease free survival and overall survival in TNBC patients. Thus, miR-34b may present a new promising prognostic biomarker in TNBC patients, but independent validations are necessary.</p

Suositus aivoverenkiertohäiriö (AVH)- ja MS-kuntoutujan liikkumisen ja osallistumisen arviointiin

TOIMIA-suositusTämän vanhan suosituksen korvaavat uudet suositukset osoitteissa: http://urn.fi/URN:NBN:fi-fe2019041011712 ja http://urn.fi/URN:NBN:fi-fe2017113055174</a

A narrative review on haptic devices: relating the physiology and psychophysical properties of the hand to devices for rehabilitation in central nervous system disorders

Purpose. This paper provides rehabilitation professionals and engineers with a theoretical and pragmatic rationale for the inclusion of haptic feedback in the rehabilitation of central nervous system disorders affecting the hand.Method. A narrative review of haptic devices used in sensorimotor hand rehabilitation was undertaken. Presented papers were selected to outline and clarify the underlying somatosensory mechanisms underpinning these technologies and provide exemplars of the evidence to date.Results. Haptic devices provide kinaesthetic and/or tactile stimulation. Kinaesthetic haptics are beginning to be incorporated in central nervous system rehabilitation, however, there has been limited development of tactile haptics. Clinical research in haptic rehabilitation of the hand is embryonic but initial findings indicate potential clinical benefit. Conclusions. Haptic rehabilitation offers the potential to advance sensorimotor hand rehabilitation but both scientific and pragmatic developments are needed to ensure that its potential is realised.<br/