Development of a home-based Computer Assisted Arm Rehabilitation (hCAAR) device for upper limb exercises in stroke patients

Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The aim of this research project was to develop and evaluate a robotic device hCAAR that can be used independently at home by stroke survivors with upper limb weakness. The project had two stages: Stage 1, hCAAR development using a user-centred design process; Stage 2, A feasibility clinical study in the home setting. Stage 1: Nine stroke survivors with upper limb weakness and six healthcare professionals were involved in the concept and design stages of device development. hCAAR consists of a powered joystick with a computer interface, which is used to direct the movement of the upper limb to perform therapeutic movements as directed by tasks on the screen. hCAAR also provides controlled assistance when the user’s voluntary upper limb movement is insufficient to complete the prescribed task. Stage 2: In the feasibility study, 19 participants (stroke survivors with upper limb weakness) were recruited and 17 participants used hCAAR in their homes for eight weeks. No serious adverse events were reported. All 17 participants were able to use the device independently. A statistically significant improvement was observed in the kinematic and clinical outcomes. Three participants showed clinically significant improvement in all clinical outcomes. Five participants reported improvement in functional ability in daily activities. Participants, family members and therapists were satisfied with the usability of hCAAR in the home setting. This research project also demonstrated that the International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for stroke provides a useful basis to structure interviews to gather feedback from end-users and healthcare professionals in different stages of the rehabilitation device development. In summary, hCAAR is a home-based rehabilitation robotic device that can be independently used by stroke survivors with upper limb weakness and has the potential to improve upper limb movement and function

Flexion reminder device to discourage recurrent posterior dislocation of a total hip replacement: a case report

<p>Abstract</p> <p>Introduction</p> <p>Recurrent dislocation of a total hip replacement prosthesis is a frustrating complication for both the surgeon and the patient. For positional dislocations with no indications for revision surgery, the current best treatment is physiotherapy, the use of abduction braces and avoidance of unsafe hip positions. Abduction braces can be cumbersome and have poor compliance. We report the successful use of a new lightweight flexion reminder device that can be used to treat people with this condition.</p> <p>Case presentation</p> <p>A 64-year-old British woman experienced recurrent positional posterior dislocation after primary hip replacement, particularly when involved in activities involving unsafe flexion of the operated hip. She disliked using an abduction brace and hence was given a simple 'flexion reminder device' that could be strapped to the thigh. Beyond the safe flexion limit, the padded top end of the device hitched against the groin crease and reminded her not to flex further, to avoid dislocation. She experienced no discomfort in wearing the device continuously throughout the day and was very satisfied. She has had no further dislocations in the 2 years since she began using it.</p> <p>Conclusion</p> <p>In cases of arthroplasty dislocation caused mainly by an unsafe hip position, and with no indication for revision surgery, this new lightweight and easily worn flexion reminder device may be a good option for avoiding such positional dislocations, particularly those caused by unsafe flexion.</p

Neurofeedback for Chronic Pain

Neurofeedback is a novel neuromodulatory therapy where individuals are given real-time feedback regarding their brain neurophysiological signals in order to increase volitional control over their brain activity. Such biofeedback platform can be used to increase an individual’s resilience to pain as chronic pain has been associated with abnormal central processing of ascending pain signals. Neurofeedback can be provided based on electroencephalogram (EEG) or functional magnetic resonance imaging (fMRI) recordings of an individual. Target brain rhythms commonly used in EEG neurofeedback for chronic pain include theta, alpha, beta and sensorimotor rhythms. Such training has not only been shown to improve pain in a variety of pain conditions such as central neuropathic pain, fibromyalgia, traumatic brain injury and chemotherapy induced peripheral neuropathy, but has also been shown to improve pain associated symptoms such as sleep, fatigue, depression and anxiety. Adverse events associated with neurofeedback training are often self-limited and resolve with decreased frequency of training. Provision of such training has also been explored in the home setting whereby individuals have been encouraged to practice this as and when required with promising results. Therefore, neurofeedback has the potential to provide low-cost yet holistic approach to the management of chronic pain

Potential link between compromised air quality and transmission of the novel corona virus (SARS-CoV-2) in affected areas

The emergence of a novel human corona virus disease (COVID-19) has been declared as a pandemic by the World Health Organization. One of the mechanisms of airborne transmission of the severe acute respiratory syndrome corona virus (SARS-CoV-2) amid humans is through direct ejection of droplets via sneezing, coughing and vocalizing. Nevertheless, there are ample evidences of the persistence of infectious viruses on inanimate surfaces for several hours to a few days. Through a critical review of the current literature and a preliminary analysis of the link between SARS-CoV-2 transmission and air pollution in the affected regions, we offer a perspective that polluted environment could enhance the transmission rate of such deadly viruses under moderate-to-high humidity conditions. The aqueous atmospheric aerosols offer a conducive surface for adsorption/absorption of organic molecules and viruses onto them, facilitating a pathway for higher rate of transmission under favourable environmental conditions. This mechanism partially explains the role of polluted air besides the exacerbation of chronic respiratory diseases in the rapid transmission of the virus amongst the public. Hence, it is stressed that more ambitious policies towards a cleaner environment are required globally to nip in the bud what could be the seeds of a fatal outbreak such as COVID-19

Influence of acute fasting on pain tolerance in healthy subjects: a randomised crossover study

BackgroundAlthough chronic pain and obesity are global health crises with substantial healthcare costs, little is known about the relationship between pain perception and eating behaviours. Food consumption has been reported to provide an analgesic effect by the release of neurotransmitters modulating the pain network. However, whether short-term (acute) fasting affects pain perception remains unclear.PurposeThis study aimed to investigate the effect of acute fasting on pain perception and whether attention and mood changes drove the observed changes.Patients and methodsThe cold pressor test (CPT) was used to investigate the pain tolerance of 25 healthy participants in both non-fasting and 12-h fasting sessions. They were randomised to either session with a crossover to the other after at least 24 h, with the experimenter blinded to the sessions. The pain tolerance was measured using a Stroop task in both attentive and distracted states. The Profile of Mood States (POMS) questionnaire was used to capture the mood, and a 10-point hunger scale was used to measure hunger. Mixed-effects models were used to investigate the influence of fasting and distraction on pain perception, accounting for the repeated measures.ResultsFasting reduced CPT pain tolerance, with fasting participants twice as likely to withdraw their hands early (hazard ratio = 2.4, 95% CI: 1.3–4.5). Though men tolerated CPT pain longer than women, there was no evidence that men responded to fasting differently than women (p = 0.9). In addition, no evidence supporting that fasting affected attention or mood was found. Nonetheless, it increased hunger scores by 2.7 points on a 10-point scale (95% CI: 1.2–4.2) and decreased blood glucose concentration levels by 0.51 mmol/L (95% CI: 0.19–0.84).ConclusionAcute fasting reduces pain tolerance in the healthy participants, and this effect is independent of gender and attention or mood changes

Impact of Long COVID on productivity and informal caregiving

BackgroundAround 2 million people in the UK suffer from Long COVID (LC). Of concern is the disease impact on productivity and informal care burden. This study aimed to quantify and value productivity losses and informal care receipt in a sample of LC patients in the UK.MethodsThe target population comprised LC patients referred to LC specialist clinics. The questionnaires included a health economics questionnaire (HEQ) measuring productivity impacts, informal care receipt and service utilisation, EQ-5D-5L, C19-YRS LC condition-specific measure, and sociodemographic and COVID-19 history variables. Outcomes were changes from the incident infection resulting in LC to the month preceding the survey in paid work status/h, work income, work performance and informal care receipt. The human capital approach valued productivity losses; the proxy goods method valued caregiving hours. The values were extrapolated nationally using published prevalence data. Multilevel regressions, nested by region, estimated associations between the outcomes and patient characteristics.Results366 patients responded to HEQ (mean LC duration 449.9 days). 51.7% reduced paid work hours relative to the pre-infection period. Mean monthly work income declined by 24.5%. The average aggregate value of productivity loss since incident infection was £10,929 (95% bootstrap confidence interval £8,844-£13,014) and £5.7 billion (£3.8-£7.6 billion) extrapolated nationally. The corresponding values for informal caregiving were £8,726 (£6,247-£11,204) and £4.8 billion (£2.6-£7.0 billion). Multivariate analyses found significant associations between each outcome and health utility and C19-YRS subscale scores.ConclusionLC significantly impacts productivity losses and provision of informal care, exacerbated by high national prevalence of LC

A feasibility study of pre-sleep audio and visual alpha brain entrainment for people with chronic pain and sleep disturbance

Introduction: Chronic pain and sleep disturbance are bi-directionally related. Cortical electrical activity in the alpha frequency band can be enhanced with sensory stimulation via the phenomenon of entrainment, and may reduce pain perception. A smartphone based programme which delivers 10Hz stimulation through flickering light or binaural beats was developed for use at night, pre-sleep, with the aim of improving night time pain and sleep and thereby subsequent pain and related daytime symptoms. The aim of this study was to assess the feasibility and give an indication of effect of this programme for individuals with chronic pain and sleep disturbance. Materials and methods: In a non-controlled feasibility study participants used audio or visual alpha entrainment for 30 minutes pre-sleep each night for 4 weeks, following a 1 week baseline period. The study was pre-registered at ClinicalTrials.gov with the ID NCT04176861. Results: 28 participants (79% female, mean age 45 years) completed the study with high levels of data completeness (86%) and intervention adherence (92%). Daily sleep diaries showed an increase compared to baseline in total sleep time of 29 minutes (p=0.0033), reduction in sleep onset latency of 13 minutes (p=0.0043), and increase in sleep efficiency of 4.7% (p=0.0009). Daily 0-10 numerical rating scale of average pain at night improved by 0.5 points compared to baseline (p=0.027). Standardised questionnaires showed significant within-participant improvements in sleep quality (change in median Global PSQI from 16 to 12.5), pain interference (change in median BPI Pain Interference from 7.5 to 6.8), fatigue (change in median MFI total score from 82.5 to 77), and depression and anxiety (change in median HADS depression score from 12 to 10.5 and anxiety from 13.5 to 11). Discussion: Pre-sleep use of a smartphone programme for alpha entrainment by audio or visual stimulation was feasible for individuals with chronic pain and sleep disturbance. The effect on symptoms requires further exploration in controlled studies

Psychometric analysis of the modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) in a prospective multicentre study

Background: Long COVID (LC) is a novel multisystem clinical syndrome affecting millions of individuals worldwide. The modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) is a condition-specific patient-reported outcome measure designed for assessment and monitoring of people with LC. Objectives: To evaluate the psychometric properties of the C19-YRSm in a prospective sample of people with LC. Methods: 1314 patients attending 10 UK specialist LC clinics completed C19-YRSm and EuroQol 5D-5L (EQ-5D-5L) longitudinally. Scale characteristics were derived for C19-YRSm subscales (Symptom Severity (SS), Functional Disability (FD) and Overall Health (OH)) and internal consistency (Cronbach’s alpha). Convergent validity was assessed using the Functional Assessment of Chronic Illness Therapy (FACIT)—Fatigue Scale. Known groups validity was assessed for the Other Symptoms subscale as tertiles, as well as by hospitalisation and intensive care admission. Responsiveness and test–retest reliability was evaluated for C19-YRSm subscales and EQ-5D-5L. The minimal important difference (MID) and minimal clinically important difference (MCID) were estimated. Confirmatory factor analysis was applied to determine the instrument’s two-factor structure. Results: C19-YRSm demonstrated good scale characteristic properties. Item-total correlations were between 0.37 and 0.65 (for SS and FD), with good internal reliability (Cronbach’s alphas&gt;0.8). Item correlations between subscales ranged between 0.46 and 0.72. Convergent validity with FACIT was good (−0.46 to −0.62). The three subscales discriminated between different levels of symptom burden (p&lt;0.001) and between patients admitted to hospital and intensive care. There was moderate responsiveness for the three subscales ranging from 0.22 (OH) to 0.50 (SS) which was greater than for the EQ-5D-5L. Test–retest reliability was good for both SS 0.86 and FD 0.78. MID was 2 for SS, 2 for FD and 1 for OH; MCID was 4 for both the SS and FD. The factor analysis supported the two-factor SS and FD structure. Conclusions: The C19-YRSm is a condition-specific, reliable, valid and responsive patient-reported outcome measure for LC

Long COVID clinical severity types based on symptoms and functional disability: A longitudinal evaluation

Background: Long COVID (LC) is a multisystem clinical syndrome with functional disability and compromised overall health. Information on LC clinical severity types is emerging in cross-sectional studies. This study explored the pattern and consistency of long COVID (LC) clinical severity types over time in a prospective sample. Methods: Participants with LC completed the condition-specific outcome measure C19-YRSm (Yorkshire Rehabilitation Scale modified version) at two assessment time points. A cluster analysis for clinical severity types was undertaken at both time points using the k-means partition method. Results: The study included cross-sectional data for 759 patients with a mean age of 46.8 years (SD = 12.7), 69.4% females, and a duration of symptoms of 360 days (IQR 217 to 703 days). The cluster analysis at first assessment revealed three distinct clinical severity type clusters: mild (n = 96), moderate (n = 422), and severe (n = 241). Longitudinal data on 356 patients revealed that the pattern of three clinical severity types remained consistent over time between the two assessments, with 51% of patients switching clinical severity types between the assessments. Conclusions: This study is the first of its kind to demonstrate that the pattern of three clinical severity types is consistent over time, with patients also switching between severity types, indicating the fluctuating nature of LC