Action for Rehabilitation from Neurological Injury (ARNI): A pragmatic study of functional training for stroke survivors

This article has been made available through the Brunel Open Access Publishing Fund. Copyright @ 2013 Cherry Kilbride et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This study evaluated the effectiveness of a twelve-week community-based functional training on measures of impairment, activity and participation in a group of stroke survivors. Isometric strength of the knee musculature, Centre-Of-Pressure (COP) based measures of balance, Berg Balance Scale (BBS), 10 m walk test, and the Subjective Index of Physical and Social Out come (SIPSO), were recorded at baseline, post-intervention, and after twelve weeks (follow-up). Exercise instructors delivered training once a week in a group format at a community centre. Significant improvement was noted in the BBS (p < 0.002), and 10 m walk speed (p = 0.03) post intervention which remained unchanged at follow-up. Total SIPSO score improved significantly post-intervention (p = 0.044). No other significant differences and no adverse effects were observed. It is possible that functional training provided more opportunity for the improvement of dynamic aspects of balance control that could be captured by the BBS but not with the traditional measures of balance using COP data. Results also suggest positive effects on the level of participation, and lack of association between measures of impairment and activity. Community based functional training could be effective and used to extend access to rehabilitation services beyond the acute and sub-acute stages after stroke.London Borough of Hillingdo

Stroke units: The implementation of a complex intervention

This article reports on selected findings from an action research study that looked at the lessons learnt from setting up a new in-patient stroke service in a London teaching hospital. Key participants in the design and evaluation of this 2-year study included members of the multi-professional stroke team and support staff within the unit, the hospital management team and representatives of patients and carers. Mixed methods (focus groups, indepth interviews, audits, documentary analysis, participant observation field notes) were used to generate data. Findings demonstrated positive change overtime with four main themes emerging from the process: building a team; developing practice-based knowledge and skills in stroke; valuing the central role of the nurse in stroke care; and creating an organisational climate for supporting change. The interplay of these non-linear, but interrelated factors is supported by complexity theory, which includes exploration of how the sum of a whole can be more than its constituent parts. Findings are likely to be of interest to practitioners, managers and policy makers interested in supporting change in a learning organisation

Development and preliminary evaluation of a novel low cost VR-based upper limb stroke rehabilitation platform using Wii technology.

Abstract Purpose: This paper proposes a novel system (using the Nintendo Wii remote) that offers customised, non-immersive, virtual reality-based, upper-limb stroke rehabilitation and reports on promising preliminary findings with stroke survivors. Method: The system novelty lies in the high accuracy of the full kinematic tracking of the upper limb movement in real-time, offering strong personal connection between the stroke survivor and a virtual character when executing therapist prescribed adjustable exercises/games. It allows the therapist to monitor patient performance and to individually calibrate the system in terms of range of movement, speed and duration. Results: The system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed, with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated. Conclusions: Given the preliminary findings, it would be beneficial to extend the case study in terms of duration and participants and to conduct an acceptability and feasibility study with community dwelling survivors. Implications for Rehabilitation Low-cost, off-the-shelf game sensors, such as the Nintendo Wii remote, are acceptable by stroke survivors as an add-on to upper limb stroke rehabilitation but have to be bespoked to provide high-fidelity and real-time kinematic tracking of the arm movement. Providing therapists with real-time and remote monitoring of the quality of the movement and not just the amount of practice, is imperative and most critical for getting a better understanding of each patient and administering the right amount and type of exercise. The ability to translate therapeutic arm movement into individually calibrated exercises and games, allows accommodation of the wide range of movement difficulties seen after stroke and the ability to adjust these activities (in terms of speed, range of movement and duration) will aid motivation and adherence - key issues in rehabilitation. With increasing pressures on resources and the move to more community-based rehabilitation, the proposed system has the potential for promoting the intensity of practice necessary for recovery in both community and acute settings.The National Health Service (NHS) London Regional Innovation Fund

Persistent growth of a young andesite lava cone: Bagana volcano, Papua New Guinea

Bagana, an andesite lava cone on Bougainville Island, Papua New Guinea, is thought to be a very young central volcano. We have tested this idea by estimating the volumes of lava extruded over different time intervals (1-, 2-, 3-, 9-, 15-, 70- years) using digital elevation models (DEMs), mainly created from satellite data. Our results show that the long-term extrusion rate at Bagana, measured over years to decades, has remained at about 1.0 m3s-1. We present models of the total edifice volume, and show that, if our measured extrusion rates are representative, the volcano could have been built in only ~300 years. It could also possibly have been built at a slower rate during a longer, earlier period of growth. Six kilometres NNW of Bagana, an andesite-dacite volcano, Billy Mitchell, had a large, caldera-forming plinian eruption 437 years ago. We consider the possibility that, as a result of this eruption, the magma supply was diverted from Billy Mitchell to Bagana. It seems that Bagana is a rare example of a very youthful, polygenetic, andesite volcano. The characteristics of such a volcano, based on the example of Bagana, are: a preponderance of lava products over pyroclastic products, a high rate of lava extrusion maintained for decades, a very high rate of SO2 emission, evidence of magma batch fractionation and location in a trans-tensional setting at the end of an arc segment above a very steeply dipping and rapidly converging subduction zone

Developing theory and practice: Creation of a Community of Practice through Action Research produced excellence in stroke care

Much emphasis is placed on expert knowledge such as evidence based stroke guidelines, but not enough attention is paid to the processes that are required to translate this into delivery of everyday good care. This paper highlights the worth of creating a Community of Practice (CoP) as a means to achieve this. Drawing on findings from a study conducted 2000 - 2002 of the processes involved in establishment of a nationally lauded high quality Stroke Unit, it demonstrates how successful development of a new service was linked to creation of a CoP. Recent literature suggests CoPs have a key role in the implementation of evidence-based practice; this study supports this claim whilst revealing for the first time the practical knowledge and skills required to develop this style of working. Findings also indicate that the participatory and democratic characteristics of Action Research are congruent with the collaborative approach required for the development of a CoP. The study is an exemplar of how practitioner researchers can capture learning from changing practice, thus contributing to evidence-based healthcare with theoretical as well as practical knowledge. Findings are relevant to those developing stroke services globally but also to those interested in evidence-based practice. (198

The Pre-Raphaelite School: Recent Approaches

This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1111/lic3.12258The assumption of easy translatability between the different idioms of poetry and the visual arts and a focus on an established canon of poets has short-circuited sustained investigation into “Pre-Raphaelite” poetic style. This article considers work published since 2008 by way of three connected challenges facing critics keen to test the term “Pre-Raphaelite”, which I explore under the headings of ‘ambidexterity’, ‘brotherhood’ and ‘style’.I am especially thankful to both the Delaware Art Museum and The University of Delaware Library for the granting of this fellowship

Multi-year satellite observations of sulfur dioxide gas emissions and lava extrusion at bagana volcano, papua new guinea

Bagana, arguably the most active volcano in Papua New Guinea, has been in a state of near-continuous eruption for over 150 years, with activity dominated by sluggish extrusion of thick blocky lava flows. If current extrusion rates are representative, the entire edifice may have been constructed in only 300–500 years. Bagana exhibits a remarkably high gas flux to the atmosphere, with persistent sulfur dioxide (SO2) emissions of several thousand tons per day. This combination of apparent youth and high outgassing fluxes is considered unusual among persistently active volcanoes worldwide. We have used satellite observations of SO2 emissions and thermal infrared radiant flux to explore the coupling of lava extrusion and gas emission at Bagana. The highest gas emissions (up to 10 kt/day) occur during co-extrusive intervals, suggesting a degree of coupling between lava and gas, but gas emissions remain relatively high (~2,500 t/d) during inter-eruptive pauses. These passive emissions, which clearly persist for decades if not centuries, require a large volume of degassing but non-erupting magma beneath the volcano with a substantial exsolved volatile phase to feed the remarkable SO2 outgassing: an additional ~1.7–2 km3 basaltic andesite would be required to supply the excess SO2 emissions we observe in our study interval (2005 to present). That this volatile phase can ascend freely to the surface under most conditions is likely to be key to Bagana's largely effusive style of activity, in contrast with other persistently active silicic volcanoes where explosive and effusive eruptive styles alternate

Glucose metabolism determines resistance of cancer cells to bioenergetic crisis after cytochrome-c release

How can cancer cells survive the consequences of cyt-c release? Huber et al provide a quantitative analysis of the protective role of enhanced glucose utilization in cancer cells and investigate the impact of cell-to-cell heterogeneity in mitochondrial bioenergetics