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

Developing Core Sets for Persons With Traumatic Brain Injury Based on the International Classification of Functioning, Disability, and Health

The authors outline the process for developing the International Classification of Functioning, Disability, and Health (ICF) Core Sets for traumatic brain injury (TBI). ICF Core Sets are selections of categories of the ICF that identify relevant categories of patients affected by specific diseases. Comprehensive and brief ICF Core Sets for TBI should become useful for clinical practice and for research. The final definition of the ICF Core Sets for TBI will be determined at an ICF Core Sets Consensus Conference, which will integrate evidence from preliminary studies. The development of ICF Core Sets is an inclusive and open process and rehabilitation professionals are invited to participate

Descripción del funcionamiento en pacientes que han sufrido un Traumatismo Craneoencefálico: un abordaje integral basado en la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud

El traumatismo craneoencefálico (TCE) es la primera causa de discapacidad en gente joven y constituye un grave problema de salud no sólo en los países desarrollados sino también en los subdesarrollados. Las secuelas que ocasiona el TCE son variadas y los déficits que produce tienen un impacto no sólo sobre la función y estructura de los órganos corporales sino también sobre las actividades cotidianas como vestirse o comer pero también la participación en la sociedad como es ir al trabajo o acudir a una cena con unos amigos. Estos déficits y limitaciones son las que impactan en definitiva la percepción subjetiva de calidad de vida y marcan la pérdida de funcionamiento tras un TCE. Todo esto y el hecho de su habitual cambio a largo plazo, han hecho que la Organización Mundial de la Salud (OMS) haya definido al TCE como una enfermedad crónica. El objetivo de esta tesis doctoral es describir el espectro de funcionamiento de pacientes con secuelas por un TCE fundamentado en el modelo biopsicosocial de la enfermedad y empleando una taxonomía etiológicamente neutral y con un lenguaje universal como es la Clasificación Internacional de la Funcionamiento, la Discapacidad y la Salud (CIF). Con ello se pretende crear un conjunto mínimo de datos (ICF Core Sets) del número total que constituye la CIF (1453 ítems). Esta tesis resulta del compendio de cuatro publicaciones. El primer estudio consistió en una revisión de la literatura y un análisis conceptual basado en la CIF que tenía por objetivo definir qué es lo que miden los instrumentos de medida más frecuentemente empleados en la investigación y rehabilitación del TCE. La segunda publicación trata de describir el espectro funcional de un grupo de pacientes con secuelas con TCE, definiendo cuáles son los problemas en sus “funciones corporales”, en sus “estructuras”, en las “actividades y participación” así como los facilitadores y barreras que se encuentran en relación a los “factores medioambientales”. La tercera publicación recoge la visión sobre el TCE que tienen los diferentes profesionales de la salud. Para garantizar una mayor universalidad, se realizó una encuesta que alcanzase a profesionales de todas las regiones de la OMS y que fuesen de diferentes grupos profesionales incluyendo a aquellos que típicamente constituyen el equipo interdisciplinar de rehabilitación. El último artículo recoge el conjunto de categorías que mejor describe el espectro funcional tras un TCE, lo que se conoce en el mundo anglosajón como los ICF Core Sets. Para ello, se realizó un ejercicio Delphi de toma de decisiones en el que participaron expertos de TCE de todo el mundo y se tomó como punto de partida la información recogida en los estudios previos. Esta tesis transmite varios mensajes de interés en la rehabilitación tras un TCE: 1) Los instrumentos de medida existentes no capturan de forma integral la pérdida de funcionalidad global tras un TCE. 2) Los principales problemas se centran en los capítulos de funciones mentales y musculo esqueléticas con un impacto negativo en todos los capítulos constituyentes del dominio de actividades y participación. Los factores medioambientales pueden actuar como barreras o facilitadores influenciando la funcionalidad. 3) Los profesionales de la salud tienen presente el paradigma médico de la discapacidad y tienden a centrar sus actuaciones sobre el dominio de funciones corporales cuando las intervenciones en actividad y participación suelen tener un impacto más favorable sobre la independencia. 4) El uso de los ICF Core Sets para el TCE puede ayudar a mejorar la práctica asistencial, promoviendo una visión integradora de la funcionalidad teniendo en cuenta la perspectiva del paciente y la del profesional.Traumatic Brain Injury (TBI) is the leading cause of disability in young people. It is a severe public health problem not only in developed but also in developing countries. The consequences of TBI are heterogeneous and lead to impairments in body functions and structures, causes restriction in activities such as dressing or eating and limits participation in society as in going to work or to have dinner with friends. These impairments and limitations are responsible for the impact in the subjective perception of quality of life and the loss of functioning after TBI. The World Health Organization has therefore considered TBI as a chronic disease. The objective of this thesis is to describe based on the bio psychosocial model the functioning profile of patients that have suffered from TBI using an etiological neutral taxonomy and a universal language such as the International Classification of Functioning, Disability and Health (ICF). A further aim is to select the items from the ICF that best describe the functioning after TBI and create the ICF Core Sets for TBI. This thesis is constituted by four publications. The first study comprised a literature review and a content analysis based on the ICF. The aim was to define what was being measured by the mostly used measurement instruments used in TBI rehabilitation. The second publication aims to describe the functioning profile of patients with TBI focusing on the problems in “body functions”, “body structures”, “activities and participation” and “environmental factors”. The third publication reports the perspective of the professionals over the problems in functioning after TBI. In order to provide a better universality, the survey included professionals from the different regions from WHO and from the different professions that typically constitute the interdisciplinary rehabilitation team. The last publication identified the ICF Core Sets for TBI. Worldwide experts in TBI participated in a decision making process and consensus process that integrated the evidence gathered in the previous studies. This thesis provides with interesting messages in rehabilitation after TBI: 1) there is no measurement instrument that universally describes functioning after TBI. 2) problems after TBI focus in mental functions and musculoskeletal functions with a negative impact in all the chapters that constitute the domain in activities and participation. Environmental factors can act as barriers or facilitators. 3) when interviewed health professionals tend to center their acts in the domain of body functions followed by interventions in activities and participation which have a more positive impact in independence. 4) The use of ICF provides a comprehensive assessment of functioning integrating both, the patient and the professional perspective and can therefore improve medical treatment

Descripción del funcionamiento en pacientes que han sufrido un Traumatismo Craneoencefálico: un abordaje integral basado en la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud

El traumatismo craneoencefálico (TCE) es la primera causa de discapacidad en gente joven y constituye un grave problema de salud no sólo en los países desarrollados sino también en los subdesarrollados. Las secuelas que ocasiona el TCE son variadas y los déficits que produce tienen un impacto no sólo sobre la función y estructura de los órganos corporales sino también sobre las actividades cotidianas como vestirse o comer pero también la participación en la sociedad como es ir al trabajo o acudir a una cena con unos amigos. Estos déficits y limitaciones son las que impactan en definitiva la percepción subjetiva de calidad de vida y marcan la pérdida de funcionamiento tras un TCE. Todo esto y el hecho de su habitual cambio a largo plazo, han hecho que la Organización Mundial de la Salud (OMS) haya definido al TCE como una enfermedad crónica. El objetivo de esta tesis doctoral es describir el espectro de funcionamiento de pacientes con secuelas por un TCE fundamentado en el modelo biopsicosocial de la enfermedad y empleando una taxonomía etiológicamente neutral y con un lenguaje universal como es la Clasificación Internacional de la Funcionamiento, la Discapacidad y la Salud (CIF). Con ello se pretende crear un conjunto mínimo de datos (ICF Core Sets) del número total que constituye la CIF (1453 ítems). Esta tesis resulta del compendio de cuatro publicaciones. El primer estudio consistió en una revisión de la literatura y un análisis conceptual basado en la CIF que tenía por objetivo definir qué es lo que miden los instrumentos de medida más frecuentemente empleados en la investigación y rehabilitación del TCE. La segunda publicación trata de describir el espectro funcional de un grupo de pacientes con secuelas con TCE, definiendo cuáles son los problemas en sus "funciones corporales", en sus "estructuras", en las "actividades y participación" así como los facilitadores y barreras que se encuentran en relación a los "factores medioambientales". La tercera publicación recoge la visión sobre el TCE que tienen los diferentes profesionales de la salud. Para garantizar una mayor universalidad, se realizó una encuesta que alcanzase a profesionales de todas las regiones de la OMS y que fuesen de diferentes grupos profesionales incluyendo a aquellos que típicamente constituyen el equipo interdisciplinar de rehabilitación. El último artículo recoge el conjunto de categorías que mejor describe el espectro funcional tras un TCE, lo que se conoce en el mundo anglosajón como los ICF Core Sets. Para ello, se realizó un ejercicio Delphi de toma de decisiones en el que participaron expertos de TCE de todo el mundo y se tomó como punto de partida la información recogida en los estudios previos. Esta tesis transmite varios mensajes de interés en la rehabilitación tras un TCE: 1) Los instrumentos de medida existentes no capturan de forma integral la pérdida de funcionalidad global tras un TCE. 2) Los principales problemas se centran en los capítulos de funciones mentales y musculo esqueléticas con un impacto negativo en todos los capítulos constituyentes del dominio de actividades y participación. Los factores medioambientales pueden actuar como barreras o facilitadores influenciando la funcionalidad. 3) Los profesionales de la salud tienen presente el paradigma médico de la discapacidad y tienden a centrar sus actuaciones sobre el dominio de funciones corporales cuando las intervenciones en actividad y participación suelen tener un impacto más favorable sobre la independencia. 4) El uso de los ICF Core Sets para el TCE puede ayudar a mejorar la práctica asistencial, promoviendo una visión integradora de la funcionalidad teniendo en cuenta la perspectiva del paciente y la del profesional.Traumatic Brain Injury (TBI) is the leading cause of disability in young people. It is a severe public health problem not only in developed but also in developing countries. The consequences of TBI are heterogeneous and lead to impairments in body functions and structures, causes restriction in activities such as dressing or eating and limits participation in society as in going to work or to have dinner with friends. These impairments and limitations are responsible for the impact in the subjective perception of quality of life and the loss of functioning after TBI. The World Health Organization has therefore considered TBI as a chronic disease. The objective of this thesis is to describe based on the bio psychosocial model the functioning profile of patients that have suffered from TBI using an etiological neutral taxonomy and a universal language such as the International Classification of Functioning, Disability and Health (ICF). A further aim is to select the items from the ICF that best describe the functioning after TBI and create the ICF Core Sets for TBI. This thesis is constituted by four publications. The first study comprised a literature review and a content analysis based on the ICF. The aim was to define what was being measured by the mostly used measurement instruments used in TBI rehabilitation. The second publication aims to describe the functioning profile of patients with TBI focusing on the problems in "body functions", "body structures", "activities and participation" and "environmental factors". The third publication reports the perspective of the professionals over the problems in functioning after TBI. In order to provide a better universality, the survey included professionals from the different regions from WHO and from the different professions that typically constitute the interdisciplinary rehabilitation team. The last publication identified the ICF Core Sets for TBI. Worldwide experts in TBI participated in a decision making process and consensus process that integrated the evidence gathered in the previous studies. This thesis provides with interesting messages in rehabilitation after TBI: 1) there is no measurement instrument that universally describes functioning after TBI. 2) problems after TBI focus in mental functions and musculoskeletal functions with a negative impact in all the chapters that constitute the domain in activities and participation. Environmental factors can act as barriers or facilitators. 3) when interviewed health professionals tend to center their acts in the domain of body functions followed by interventions in activities and participation which have a more positive impact in independence. 4) The use of ICF provides a comprehensive assessment of functioning integrating both, the patient and the professional perspective and can therefore improve medical treatment

Using community detection techniques to discover non-explicit relationships in neurorehabilitation treatments

The interaction between patients and professionals in complex clinical domains, as in the case of Neurorehabilitation, is always a complex process where crucial decision making in a short period of time is required, and where every decision has a serious impact on the patient. In this situation, deciding which are the most appropriate interventions is not an easy task because these patients simultaneously present several impairments, multiple diagnoses, and required complex interdisciplinary approaches. In this context, a methodology and a tool based on ICF have been developed to explore the relationships between patient impairments and therapeutic goals. The proposed approach, based on graph analysis, was used to analyze a set of 1960 patients that suffered an Acquired Brain Injury. Results achieved show that the proposed methodology is able to find non-explicit relationships. This study constitute a first step to the goal of designing a clinical decision support tool for neurorehabilitation.Peer reviewe

ICF profiling of patients with traumatic brain injury: an international professional survey

Purpose: A worldwide internet survey was conducted (1) to identify problems of individuals with traumatic brain injury (TBI) addressed by health professionals and (2) to summarize these problems using the International Classification of Functioning, Disability and Health (ICF). Method: A pool of professionals involved in the TBI rehabilitation process that included physicians, nurses, physical therapists, occupational therapists, social workers and psychologists were surveyed to identify problems in functioning and contextual factors of individuals with TBI using open-ended questions. All answers were translated ("linked") to the ICF based on established rules. The frequencies of the linked ICF categories were reported stratified based on context. Results: One-hundred thirty seven professionals from the six World Health Organization regions identified 5656 concepts. 92.66% could be linked to the ICF; 33.03% were related to the domain of body functions, 27.28% to activities and participation, 10.98% to structures and 21.38% to environmental factors. Conclusions: The complexity of TBI was described through the identification of a wide variety of ICF categories. ICF language proved to be a neutral framework allowing the comparison of answers between different professionals in different world regions. Implications for rehabilitation: People that suffered a traumatic brain injury (TBI) may have a variety of sequelae that impair functioning. The International Classification of Functioning, Disability and Health (ICF) can help in providing information regarding the identification of patients problems and needs as well as planning, implementing and coordinating the rehabilitation process. The ICF provides a frame of reference process illustrated as the rehabilitation cycle that can help during the rehabilitation process in goal setting bringing together the clinicians' and patient's perspectives in a patient oriented biopsychosocial approach. In the field of TBI rehabilitation, activity limitations and participation restrictions are broadly affected as reported by the professionals interviewed and highly influenced by cognitive and moreover behavioral problems.Medicin

TDCS does not enhance the effects of robot-assisted gait training in patients with subacute stroke

Background: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique, which can modulate cortical excitability and combined with rehabilitation therapies may improve motor recovery after stroke. Objective: Our aim was to study the feasibility of a 4-week robotic gait training protocol combined with tDCS, and to study tDCS to the leg versus hand motor cortex or sham to improve walking ability in patients after a subacute stroke. Methods: Forty-nine subacute stroke patients underwent 20 daily sessions (5 days a week for 4 weeks) of robotic gait training combined with tDCS. Patients were assigned either to the tDCSleg group (n = 9), receiving 2mA anodal tDCS over the motor cortex leg representation (vertex), or an active control group (n = 17) receiving anodal tDCS over the hand motor cortex area (tDCShand). In addition, we studied 23 matched patients in a control group receiving gait training without tDCS (notDCS). Study outcomes included gait speed (10-meter walking test), and quality of gait, using the Functional Ambulatory Category (FAC) before and after the 4-week training period. Results: Only one patient did not complete the treatment because he presented a minor side-effect. Patients in all three groups showed a significantly improvement in gait speed and FAC. The tDCSleg group did not perform better than the tDCShand or notDCS group. Conclusion: Combined tDCS and robotic training is a safe and feasible procedure in subacute stroke patients. However, adding tDCS to robot-assisted gait training shows no benefit over robotic gait training alone