Aplicación del aprendizaje automático para predecir la recuperación de pacientes con desórdenes prolongados de conciencia: reporte preliminar

Comprender el pronóstico a largo plazo y predecir la recuperación de pacientes con Desórdenes Prolongados de Conciencia (DPC) continúa siendo un desafío en la actualidad. Nos proponemos explorar la viabilidad del uso de la tecnología de Aprendizaje Automático (AA) para predecir la recuperación de la conciencia en pacientes con DPC que participaron de un programa de neurorehabilitación. Se incluyeron 90 pacientes de los cuales el 26% (23/90) recuperaron la conciencia. Con 63 pacientes se entrenaron 7 tipos de modelos de AA observándose mejores desempeños al incluir variables recolectadas en el seguimiento. En la validación con el conjunto de test (n=27) la red neuronal entrenada con 37 variables logró la mejor exactitud balanceada (EB): 0.95 (Área Bajo la Curva: 0.96, Sensibilidad: 100%, Especificidad: 90%). Con la tecnología del aprendizaje automático fue posible predecir con alta exactitud, sensibilidad y especificidad la recuperación de la conciencia de pacientes con DPC incluyendo variables recolectadas durante el primer mes de internación. A pesar de las limitaciones dadas por la pequeña cantidad de pacientes, el enfoque demostró resultados iniciales prometedores que ameritan mayor investigación.Sociedad Argentina de Informática e Investigación Operativ

Reliability of the Spanish version of the wheelchair skills test 4.2 for manual wheelchair users with spinal cord injury

<p><b>Study design:</b> Cross-sectional.</p> <p><b>Objectives:</b> The majority of people with a spinal cord injury (SCI) are dependent on wheelchair for their mobility. Approximately, 36% of wheelchair users reported that obstacles such as curbs, uneven terrain, flooring surfaces and thresholds were barriers to mobility. Several studies have shown that assessment and training of wheelchair skills leads to improvements in those skills. The purpose of our study was to translate the Wheelchair Skill Test (4.2) and its report form into Spanish and then determine the inter-rater reliability of the WST 4.2 for manual wheelchairs operated by their users.</p> <p><b>Setting:</b> Rehabilitation Unit, FLENI Institute, Buenos Aires, Argentina.</p> <p><b>Methods:</b> The translation was performed by a physical therapist with advanced English language skills and specialized in the treatment of SCI subjects. We administrated and video-recorded the WST 4.2 manual Spanish version in 11 SCI subjects. Two physical therapists received specific training for administering the test and scoring the record. The reliability of the total percentage WST score were statistically quantified by intraclass correlation coefficient (ICC).</p> <p><b>Results:</b> ICC values for Interrater were 0.998 (<i>p</i> < .0001). 17 out of the 32 skills had a 100 percentage of agreement. Percentage of agreement in the three skills that presented less rating agreement was 73%, 81 % and 82 %, respectively.</p> <p><b>Conclusion:</b> The results show that the Spanish version of WST 4.2 is a reliable assessment tool to evaluate the skills capacity of spinal cord manual wheelchair users.Implications for rehabilitation</p><p>Wheelchair users require a proficient management of various wheelchair skills to achieve maximum independence in daily life. Determining which wheelchair skills should be addressed during the rehabilitation process is of great importance for their correct training. The WST 4.2 is an appropriate assessment tool to determine the functional capacity of wheelchair users.</p><p>Making available the WST 4.2 in the Spanish language and demonstrating its reliability in this language allows its use in the Spanish-speaking world. A reliable wheelchair skills test is needed in the Spanish language.</p><p></p> <p>Wheelchair users require a proficient management of various wheelchair skills to achieve maximum independence in daily life. Determining which wheelchair skills should be addressed during the rehabilitation process is of great importance for their correct training. The WST 4.2 is an appropriate assessment tool to determine the functional capacity of wheelchair users.</p> <p>Making available the WST 4.2 in the Spanish language and demonstrating its reliability in this language allows its use in the Spanish-speaking world. A reliable wheelchair skills test is needed in the Spanish language.</p