Rehabilitation for improving automobile driving after stroke

Publisher version made available in accordance with the publisher's policy. This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy. 'This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2014, Issue 2. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.’Background Interventions to improve driving ability after stroke, incl uding driving simulation and retraining visual skills, hav e limited evaluation of their effectiveness to guide policy and practice. Objectives To determine whether any intervention, with the specific aim o f maximising driving skills, improves the driving performa nce of people after stroke. Search methods WesearchedtheCochrane Stroke GroupTrialsregister(August 2 013), theCochrane Central Registerof ControlledTrials( The Cochrane Library 2012, Issue 3), MEDLINE (1950 to October 2013), EMBASE (1980 to Octo ber 2013), and six additional databases. To identify further published, unpublished and ongoing trial s, we handsearched relevant journals and conference proceeding s, searched trials and research registers, checked reference lists and conta cted key researchers in the area. Selection criteria Randomised controlled trials (RCTs), quasi-randomised trials and cluster studies of rehabilitation interventions, with t he specific aim of maximising driving skills or with an outcome of assessing d riving skills in adults after stroke. The primary outcome of i nterest was the performance in an on-road assessment after training. Secon dary outcomes included assessments of vision, cognition and dr iving behaviour. Data collection and analysis Two review authors independently selected trials based on pr e-defined inclusion criteria, extracted the data and assessed ri sk of bias. A third review author moderated disagreements as required. T he review authors contacted all investigators to obtain missi ng information. Main results We included four trials involving 245 participants in the revi ew. Study sample sizes were generally small, and interventi ons, controls and outcome measures varied, and thus it was inappropriate to pool studies. Included studies were at a low risk of bias for th e majority of domains, with a high/unclear risk of bias identified in the a reas of: performance (participants not blinded to allocation), a nd attrition (incomplete outcome data due to withdrawal) bias. Interventio n approaches included the contextual approach of driving simula tion and underlying skill development approach, including the ret raining of speed of visual processing and visual motor skills . The studies were conducted with people who were relatively young and the ti ming after stroke was varied. Primary outcome: there was no cle ar evidence of improved on-road scores immediately after trainin g in any of the four studies, or at six months (mean difference 15 points on the Test Ride for Investigating Practical Fitness to Drive - Belgian version, 95% confidence intervals (CI) 4.56 to 34.56, P v alue = 0.15, one study, 83 participants). Secondary outcomes: road sig n recognition was better in people who underwent training comp ared with control (mean difference 1.69 points on the Road Sign Recogn ition Task of the Stroke Driver Screening Assessment, 95% CI 0 .51 to 2.87, P value = 0.007, one study, 73 participants). Significan t findings were in favour of a simulator-based driving rehabil itation programme (based on one study with 73 participants) but these r esults should be interpreted with caution as they were based o n a single study. Adverse effects were not reported. There was insufficie nt evidence to draw conclusions on the effects on vision, other me asures of cognition, motor and functional activities, and driving beh aviour with the intervention. Authors’ conclusions There was insufficient evidence to reach conclusions about the use of rehabilitation to improve on-road driving skills after st roke. We found limited evidence that the use of a driving simulator m ay be beneficial in improving visuocognitive abilities, such as road sign recognition that are related to driving. Moreover, we we re unable to find any RCTs that evaluated on-road driving lesso ns as an intervention. At present, it is unclear which impairments tha t influence driving ability after stroke are amenable to rehab ilitation, and whether the contextual or remedial approaches, or a combinatio n of both, are more efficacious

Virtual reality stroke rehabilitation – hype or hope?

Author version made in accordance with Publisher copyright policy

Measuring technology self efficacy: reliability and construct validity of a modified computer self efficacy scale in a clinical rehabilitation setting

Author version made available in accordance with the Publisher's policy.Purpose: To describe a modification of the Computer Self Efficacy Scale for use in clinical settings and to report on the modified scale’s reliability and construct validity. Methods: The Computer Self Efficacy Scale was modified to make it applicable for clinical settings (for use with older people or people with disabilities using everyday technologies). The modified scale was piloted, then tested with patients in an Australian inpatient rehabilitation setting (n=88) to determine the internal consistency using Cronbach’s alpha coefficient. Construct validity was assessed by correlation of the scale with age and technology use. Factor analysis using principal components analysis was undertaken to identify important constructs within the scale. Results: The modified Computer Self Efficacy scale demonstrated high internal consistency with a standardised alpha coefficient of 0.94. Two constructs within the scale were apparent; using the technology alone, and using the technology with the support of others. Scores on the scale were correlated with age and frequency of use of some technologies thereby supporting construct validity. Conclusions: The modified Computer Self Efficacy Scale has demonstrated reliability and construct validity for measuring the self efficacy of older people or people with disabilities when using everyday technologies. This tool has the potential to assist clinicians in identifying older patients who may be more open to using new technologies to maintain independence

Are Vision-Specific Quality of Life Questionnaires Important in Assessing Rehabilitation for Patients With Hemianopia Post Stroke?

This author accepted manuscript (post print) is made available following a 12 month embargo from the date of publication (2011) in accordance with the publisher copyright policy.Objective: To explore the relationship between disability and functional measures with vision-specific quality of life (QoL) measures for people with hemianopia and stroke. Method: The Behavioral Inattention Test (BIT) and the Mayo-Portland Adaptability Inventory (MPAI) were compared with scores on 2 vision-specific QoL measures, the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and Veteran Low Vision Visual Function Questionnaire (VA LV VFQ-48). Setting: Rehabilitation hospitals in Adelaide, South Australia. Participants: Stroke patients (n = 24) with homonymous hemianopia. Results: Most of the BIT and MPAI scores were significantly associated with the NEI VFQ-25 and VA LV VFQ-48 scores. Behavioral test scores of the BIT and the MPAI total score correlated with more aspects of the QoL measures than the other components of the BIT and the MPAI. Conclusion: BIT and MPAI measure constructs associated with QoL for people with hemianopia following stroke. Vision-specific QoL questionnaires can complement the functional instruments by identifying the domains of difficulty, based on the instrument’s subscale, that can guide rehabilitation therapists to address the person’s deficit

Virtual reality for stroke rehabilitation (review)

Published version made available following 12 month embargo from the date of publication [12 Feb 2015] according to publisher policy. Accessed 10/03/2015. Published version available from 13 February 2016

Completing the Census of AGN in GOODS-S/HUDF: New Ultra-Deep Radio Imaging and Predictions for JWST

A global understanding of Active Galactic Nuclei (AGN) and their host galaxies hinges on completing a census of AGN activity without selection biases down to the low-luminosity regime. Toward that goal, we identify AGN within faint radio populations at cosmic noon selected from new ultra-deep, high resolution imaging from the Karl G. Jansky Very Large Array at 6 and 3 GHz. These radio data are spatially coincident with the ultra-deep legacy surveys in the GOODS-S/HUDF region, particularly the unparalleled Chandra 7 Ms X-ray imaging. Combined, these datasets provide a unique basis for a thorough census of AGN, allowing simultaneous identification via (1) high X-ray luminosity; (2) hard X-ray spectra; (3) excess X-ray relative to 6 GHz; (4) mid-IR colors; (5) SED fitting; (6) radio excess via the radio-infrared relation; (7) flat radio spectra via multi-band radio; and (8) optical spectroscopy. We uncover AGN in fully half our faint radio sample, indicating a source density of one AGN arcmin$^{-2}$, with a similar number of radio-undetected AGN identified via X-ray over the same area. Our radio-detected AGN are majority radio-quiet, with radio emission consistent with being powered predominantly by star formation. Nevertheless, we find AGN radio signatures in our sample: $\sim12\%$ with radio excess indicating radio-loud activity and $\sim16\%$ of radio-quiet AGN candidates with flat or inverted radio spectra. The latter is a lower limit, pending our upcoming deeper 3 GHz survey. Finally, despite these extensive datasets, this work is likely still missing heavily obscured AGN. We discuss in detail this elusive population and the prospects for completing our AGN census with JWST/MIRI.Comment: Accepted for publication in ApJ. 30 pages, 13 figures, 2 tables, 2 appendices. Minor update to fix typos and better match published versio

Virtual reality for stroke rehabilitation (Review)

Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This review is made available in accordance with Cochrane Database of Systematic Review's repositories policyBackground Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. Objectives Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. Search methods We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists. Selection criteria Randomised and quasi‐randomised trials of virtual reality ("an advanced form of human‐computer interface that allows the user to 'interact' with and become 'immersed' in a computer‐generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function. Data collection and analysis Two review authors independently selected trials based on pre‐defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information. Main results We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard‐care approach. Primary outcome: results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) ‐0.05 to 0.20, 22 studies, 1038 participants, low‐quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low‐quality evidence). Secondary outcomes: when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate‐quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty‐three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild. Authors' conclusions We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant

Telerehabilitation services for stroke

Publisher version made available in accordance with the publisher's policy. This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy. 'This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2013, Issue 12. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.’Background Telerehabilitation is an alternative way of delivering rehabilitation services. Information and communication technologies are used to facilitate communication between the healthcare professional and the patient in a remote location. The use of telerehabilitation is becoming more viable as the speed and sophistication of communication technologies improve. However, it is currently unclear how effective this model of delivery is relative to rehabilitation delivered face-to-face. Objectives To determine whether the use of telerehabilitation leads to improved ability to perform activities of daily living amongst stroke survivors when compared with (1) in-person rehabilitation (when the clinician and the patient are at the same physical location and rehabilitation is provided face-to-face); or (2) no rehabilitation. Secondary objectives were to determine whether use of telerehabilitation leads to greater independence in self care and domestic life and improved mobility, health-related quality of life, upper limb function, cognitive function or functional communication when compared with in-person rehabilitation and no rehabilitation. Additionally, we aimed to report on the presence of adverse events, cost-effectiveness, feasibility and levels of user satisfaction associated with telerehabilitation interventions. Search methods We searched the Cochrane Stroke Group Trials Register (November 2012), the Cochrane Effective Practice and Organization of Care Group Trials Register (November 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 11, 2012), MEDLINE (1950 to November 2012), EMBASE (1980 to November 2012) and eight additional databases. We searched trial registries, conference proceedings and reference lists. Selection criteria Randomised controlled trials (RCTs) of telerehabilitation in stroke. We included studies that compared telerehabilitation with in-person rehabilitation or no rehabilitation. In addition, we synthesised and described the results of RCTs that compared two different methods of delivering telerehabilitation services without an alternative group. We included rehabilitation programmes that used a combination of telerehabilitation and in-person rehabilitation provided that the greater proportion of intervention was provided via telerehabilitation. Data collection and analysis Two review authors independently identified trials on the basis of prespecified inclusion criteria, extracted data and assessed risk of bias. A third review author moderated any disagreements. The review authors contacted investigators to ask for missing information. Main results We included in the review 10 trials involving a total of 933 participants. The studies were generally small, and reporting quality was often inadequate, particularly in relation to blinding of outcome assessors and concealment of allocation. Selective outcome reporting was apparent in several studies. Study interventions and comparisons varied, meaning that in most cases, it was inappropriate to pool studies. Intervention approaches included upper limb training, lower limb and mobility retraining, case management and caregiver support. Most studies were conducted with people in the chronic phase following stroke. Primary outcome: no statistically significant results for independence in activities of daily living (based on two studies with 661 participants) were noted when a case management intervention was evaluated. Secondary outcomes: no statistically significant results for upper limb function (based on two studies with 46 participants) were observed when a computer programme was used to remotely retrain upper limb function. Evidence was insufficient to draw conclusions on the effects of the intervention on mobility, health-related quality of life or participant satisfaction with the intervention. No studies evaluated the cost-effectiveness of telerehabilitation. No studies reported on the occurrence of adverse events within the studies. Authors' conclusions We found insufficient evidence to reach conclusions about the effectiveness of telerehabilitation after stroke. Moreover, we were unable to find any randomised trials that included an evaluation of cost-effectiveness. Which intervention approaches are most appropriately adapted to a telerehabilitation approach remain unclear, as does the best way to utilise this approach

Virtual Reality Grocery Shopping Simulator: Development and Usability in Neurological Rehabilitation

This author accepted manuscript (post print) is made available following a 3 month embargo from the date of publication in accordance with the publisher copyright policy.Few virtual reality programs have been designed to retrain performance of activities of daily living for people undergoing neurological rehabilitation. This is despite the advantages of using this type of approach, including task-specific practice of meaningful and relevant activities. This paper summarizes the development of a grocery shopping simulator which uses a novel approach to interaction between the user and the program. The shopping simulation program underwent usability testing with patients participating in neurological rehabilitation. The results indicated that patients found the program easy and enjoyable to use and felt it would be a useful part of a rehabilitation program