Discovering the Context of People With Disabilities : Semantic Categorization Test and Environmental Factors Mapping of Word Embeddings from Reddit

The World Health Organization's International Classification of Functioning Disability and Health (ICF) conceptualizes disability not solely as a problem that resides in the individual, but as a health experience that occurs in a context. Word embeddings build on the idea that words that occur in similar contexts tend to have similar meanings. In spite of both sharing "context" as a key component, word embeddings have been scarcely applied in disability. In this work, we propose social media (particularly, Reddit) to link them. The objective of our study is to train a model for generating word associations using a small dataset (a subreddit on disability) able to retrieve meaningful content. This content will be formally validated and applied to the discovery of related terms in the corpus of the disability subreddit that represent the physical, social, and attitudinal environment (as defined by a formal framework like the ICF) of people with disabilities. Reddit data were collected from pushshift.io with the pushshiftr R package as a wrapper. A word2vec model was trained with the wordVectors R package using the disability subreddit comments, and a preliminary validation was performed using a subset of Mikolov analogies. We used Van Overschelde's updated and expanded version of the Battig and Montague norms to perform a semantic categories test. Silhouette coefficients were calculated using cosine distance from the wordVectors R package. For each of the 5 ICF environmental factors (EF), we selected representative subcategories addressing different aspects of daily living (ADLs); then, for each subcategory, we identified specific terms extracted from their formal ICF definition and ran the word2vec model to generate their nearest semantic terms, validating the obtained nearest semantic terms using public evidence. Finally, we applied the model to a specific subcategory of an EF involved in a relevant use case in the field of rehabilitation. We analyzed 96,314 comments posted between February 2009 and December 2019, by 10,411 Redditors. We trained word2vec and identified more than 30 analogies (eg, breakfast - 8 am + 8 pm = dinner). The semantic categorization test showed promising results over 60 categories; for example, s(A relative)=0.562, s(A sport)=0.475 provided remarkable explanations for low s values. We mapped the representative subcategories of all EF chapters and obtained the closest terms for each, which we confirmed with publications. This allowed immediate access (≤ 2 seconds) to the terms related to ADLs, ranging from apps "to know accessibility before you go" to adapted sports (boccia). For example, for the support and relationships EF subcategory, the closest term discovered by our model was "resilience," recently regarded as a key feature of rehabilitation, not yet having one unified definition. Our model discovered 10 closest terms, which we validated with publications, contributing to the "resilience" definition. This study opens up interesting opportunities for the exploration and discovery of the use of a word2vec model that has been trained with a small disability dataset, leading to immediate, accurate, and often unknown (for authors, in many cases) terms related to ADLs within the ICF framework

Rehabilitation for Multiple Sclerosis in Adults (I); Impairment and Impact on Functioning and Quality of Life: An Overview

Multiple sclerosis (MS) is a chronic, central nervous system, disabling disease. International Classification of Functioning and relevant generic and specific outcome measures are reported. Problems perceived by people with MS (PwMS) affect mobility, sight, continence, feeding, or cognitive impairment, depending on whether acute, chronic, or long-term disability was involved. The most common body function and structure impairments leading to disability and reported by health care professionals are fatigue, weakness, decreased fitness, sensory disorders, pain, upper motor neuron syndromes, ataxia and tremor, balance and postural control problems, gait pattern disorders, visual problems, and neurogenic lower urinary tract and bowel dysfunction; sexual, autonomic, neuropsychological, and neuropsychiatric impairment; dysarthrophonia, dysphagia, and respiratory and sleep disorders. The most frequently affected activities and relationships include mobility, domestic life, community and social activities, remunerative employment, interpersonal relationships, self-care, learning and applying knowledge, and economic life. Limitations in activities of daily life because of fatigue, pain, visual problems, incontinence, sexual and cognitive impairment, depressive disorders, sleep disorders, economic pressure, employment status, and lack of information have an impact on quality of life (QoL). Increased caregiving tasks, psychological burden, limitation in activities and participation, and reduced QoL have a profound influence on caregivers. This paper summarizes the perception of problems and needs, the disease's impact on functioning and QoL of PwMS, and the impact on their significant others and caregivers, according to health and social research.Martinez-Assucena, A.; Marnetoft, S.; Roig Rovira, T.; Hernandez-San-Miguel, J.; Bernabeu, M.; Martinell-Gispert-Sauch, M. (2010). Rehabilitation for Multiple Sclerosis in Adults (I); Impairment and Impact on Functioning and Quality of Life: An Overview. Critical Reviews in Physical and Rehabilitation Medicine. 22(1-4):103-178. doi:10.1615/CritRevPhysRehabilMed.v22.i1-4.90103178221-

Rehabilitation for Multiple Sclerosis, in Adults (II); Management and Impact on Impairment, Functioning, and Quality of Life: An Overview

Multiple sclerosis (MS) often leads to different levels of severity and progression of impairment and disability and to dissimilar levels of limitation in activities and participation in different social domains, with varying impacts on quality of life (QoL) among people with MS (PwMS). Results have shown that, for PwMS, prioritizing goal setting may enhance adherence to treatment. Interdisciplinary rehabilitation may prolong the functional status level of PwMS, may result in transient improvement in the aspects of impairment features, may increase their participation in activities, and may improve their QoL, even when disease progression is not modified. Single rehabilitation packages of comprehensive care have proven beneficial, such as physiotherapy, which enhances aerobic capacity, strength, pain, mood, mobility, and QoL. Occupational therapy can help reduce the impact of impairment on QoL, especially fatigue. Neuropsychological interventions, such as learning and memory remediation, psychological intervention for depressive disorders, and acquistion of coping skills and self-management techniques help PwMS to adjust to disease and disability. Speech therapy can improve intelligibility of communication. Learning swallowing techniques can help prevent material from entering the airway. Clean intermittent self-catheterization can help prevent urinary tract infections. Power wheelchairs enhance occupational performance and energy conservation. Further vocational rehabilitation settings and research are required for more appropriate interventions due to high unemployment rates among PwMS. Comprehensive care for PwMS should include planning for future independent living and long-term care needs.Martinez-Assucena, A.; Marnetoft, S.; Roig Rovira, T.; Hernandez-San-Miguel, J.; Bernabeu, M.; Martinell-Gispert-Sauch, M. (2010). Rehabilitation for Multiple Sclerosis, in Adults (II); Management and Impact on Impairment, Functioning, and Quality of Life: An Overview. 22(1-4):179-239. doi:10.1615/CritRevPhysRehabilMed.v22.i1-4.100179239221-

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

An Observational Report of Intensive Robotic and Manual Gait Training in Sub-acute Stroke

Background: The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to provide a benchmark for expected change in gait function in early stroke patients, from an intensive inpatient rehabilitation program including both robotic and manual gait training. Methods: We followed 103 sub-acute stroke patients who met the clinical inclusion criteria for Body Weight Supported Robotic Gait Training (BWSRGT). Patients completed an intensive 8-week gait-training program comprising robotic gait training (weeks 0-4) followed by manual gait training (weeks 4-8). A change in clinical function was determined by the following assessments taken at 0, 4 and 8 weeks (baseline, mid-point and end-point respectively): Functional Ambulatory Categories (FAC), 10 m Walking Test (10 MWT), and Tinetti Gait and Balance Scales. Results: Over half of the patients made a clinically meaningful improvement on the Tinetti Gait Scale (>3 points) and Tinetti Balance Scale (>5 points), while over 80% of the patients increased at least 1 point on the FAC scale (0-5) and improved walking speed by more than 0.2 m/s. Patients responded positively in gait function regardless of variables gender, age, aetiology (hemorrhagic/ischemic), and affected hemisphere. The most robust and significant change was observed for patients in the FAC categories two and three. The therapy was well tolerated and no patients withdrew for factors related to the type or intensity of training. Conclusions: Eight-weeks of intensive rehabilitation including robotic and manual gait training was well tolerated by early stroke patients, and was associated with significant gains in function. Patients with mid-level gait dysfunction showed the most robust improvement following robotic training

Alteracions de l'excitabilitat cortico-espinal en pacients amb dany axonal difús d'origen traumàtic

Aquest treball ha estat dirigit a investigar les característiques de l'excitabilitat cortical del sistema motor en el dany axonal difús (DAD), conseqüència d'un Traumatisme Cranioencefàlic greu (TCE). Hem aplicat diversos paradigmes d'estimulació magnètica transcranial (TMS) de polsos simples, sobre l'escorça motora, per avaluar l'excitabilitat cortical i els mecanismes excitatoris i inhibitoris. Els paràmetres inclouen el llindar motor en repòs (MT), l'àrea sota la corba dels potencials motors evocats compostos (MEP), corbes d'estímul resposta, la variabilitat dels MEPs i la durada del període de silenci (SP). El grup de pacients en general va mostrar un MT més alt que els pacients, àrees dels MEPs més petites, i menor increment en les corbes en comparació amb els controls normals (p 0,05). Les alteracions en l'excitabilitat van ser significativament més pronunciades amb l'augment de la gravetat del DAD (p 0,005) i la presència de deteriorament motor (p 0,05), mentre que la coexistència de lesions focals no va afectar el grau dels canvis del MEPs. La variabilitat dels MEPs va ser significativament menor en el grup que presentava sols dèficit motor (P 0,05). La inhibició cortical, segons mostrava la durada del SP, no va mostrar diferències significatives en cap dels grups de pacients. En conclusió, les nostres troballes reforcen el concepte de que l'alteració dels fenòmens excitatoris i inhibitoris en l'escorça motora no son processos paral·lels, i aporten informació sobre els diferents patrons d'alteració en el DAD. A més, aquestes dades suggereixen que les alteracions en els mecanismes excitatoris corticoespinals es determinen principalment per la gravetat del DAD i mostren una relació significativa amb l'afectació clínica en relació a la funció motora després d'un TCE greu que afecta difusament les connexions corticals del sistema motor. Des d'un punt de vista clínic, aquest estudi indica que la neurofisiologia hauria de ser considerada com una exploració complementaria a l'exploració neurològica en el TCE greu

The Impact of Body Mass Index on Functional Rehabilitation Outcomes of Working-age Inpatients with Stroke

BACKGROUND: Stroke is the most relevant cause of acquired persistent disability in adulthood. The relationship between patient’s weight during rehabilitation and stroke functional outcome is controversial, previous research reported positive, negative and no effects, with scarce studies specifically addressing working-age patients.AIM: To evaluate the association between Body Mass Index (BMI) and the functional progress of adult (\u3c65 \u3eyears) patients with stroke admitted to a rehabilitation hospital.DESIGN: Retrospective observational cohort study.SETTING: Inpatient rehabilitation center.POPULATION: 178 stroke patients (ischemic or hemorrhagic).METHODS: Point-biserial and Spearman’s correlations, multivariate linear regressions and analysis of covariance were used to describe differences in functional outcomes after adjusting for age, sex, severity, dysphagia, depression and BMI category. Functional Independence Measure (FIM), FIM gain, efficiency and effectiveness were assessed.RESULTS: Participants were separated in 3 BMI categories: normal weight (47%), overweight (33%) and obese (20%). There were no significant differences between BMI categories in any functional outcome (total FIM (TFIM), cognitive (CFIM), motor (MFIM)) at discharge, admission, gain, efficiency or effectiveness. In regression models BMI (as continuous variable) was not significant predictor of TFIM at discharge after adjusting for age, sex, severity, dysphagia, depression and ataxia (R2=0.4813), significant predictors were TFIM at admission (β = 0.528) and NIHSS (β=-0.208). MFIM efficiency did not significantly differ by BMI subgroups, neither did CFIM efficiency. Length of stay (LOS) and TFIM effectiveness were associated for normal (r=0.33) and overweight (r=0.43), but not for obese. LOS and TFIM efficiency were strongly negatively associated only for obese (r=-0.50).CONCLUSIONS: FIM outcomes were not associated to BMI, nevertheless each BMI category when individually considered (normal weight, overweight or obese) was characterized by different associations involving FIM outcomes and clinical factors. CLINICAL REHABILITATION IMPACT: In sub-acute post-stroke working-age patients undergoing rehabilitation, BMI was not associated to FIM outcomes (no obesity paradox was reported in this sample). Distinctive significant associations emerged within each BMI category, (supporting their characterization) such as length of stay and TFIM effectiveness were associated for normal weight and overweight, but not for obese. Length of stay and TFIM efficiency were strongly negatively associated only for obese

The impact of COVID-19 on home, social, and productivity integration of people with chronic traumatic brain injury or stroke living in the community

Compare community integration of people with stroke or traumatic brain injury (TBI) living in the community before and during the coronavirus severe acute respiratory syndrome coronavirus 2 disease (COVID-19) when stratifying by injury: participants with stroke (G1) and with TBI (G2); by functional independence in activities of daily living: independent (G3) and dependent (G4); by age: participants younger than 54 (G5) and older than 54 (G6); and by gender: female (G7) and male (G8) participants. Prospective observational cohort study In-person follow-up visits (before COVID-19 outbreak) to a rehabilitation hospital in Spain and on-line during COVID-19. Community dwelling adults (≥18 years) with chronic stroke or TBI. Community integration questionnaire (CIQ) the total-CIQ as well as the subscale domains (ie, home-CIQ, social-CIQ, productivity CIQ) were compared before and during COVID-19 using the Wilcoxon ranked test or paired t test when appropriate reporting Cohen effect sizes (d). The functional independence measure was used to assess functional independence in activities of daily living. Two hundred four participants, 51.4% with stroke and 48.6% with TBI assessed on-line between June 2020 and April 2021 were compared to their own in-person assessments performed before COVID-19. When analyzing total-CIQ, G1 (d = −0.231), G2 (d = −0.240), G3 (d = −0.285), G5 (d = −0.276), G6 (d = −0.199), G7 (d = −0.245), and G8 (d = −0.210) significantly decreased their scores during COVID-19, meanwhile G4 was the only group with no significant differences before and during COVID-19. In productivity-CIQ, G1 (d = −0.197), G4 (d = −0.215), G6 (d = −0.300), and G8 (d = −0.210) significantly increased their scores, meanwhile no significant differences were observed in G2, G3, G5, and G7. In social-CIQ, all groups significantly decreased their scores: G1 (d = −0.348), G2 (d = −0.372), G3 (d = −0.437), G4 (d = −0.253), G5 (d = −0.394), G6 (d = −0.319), G7 (d = −0.355), and G8 (d = −0.365). In home-CIQ only G6 (d = −0.229) significantly decreased, no significant differences were observed in any of the other groups. The largest effect sizes were observed in total-CIQ for G3, in productivity-CIQ for G6, in social-CIQ for G3 and in home-CIQ for G6 (medium effect sizes). Stratifying participants by injury, functionality, age or gender allowed identifying specific CIQ subtotals where remote support may be provided addressing them

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

Risk Taking in Hospitalized Patients with Acute and Severe Traumatic Brain Injury

Altres ajuts: Fundació La Marató de TV3 (071931)Rehabilitation can improve cognitive deficits observed in patients with traumatic brain injury (TBI). However, despite rehabilitation, the ability of making a choice often remains impaired. Risk taking is a daily activity involving numerous cognitive processes subserved by a complex neural network. In this work we investigated risk taking using the Balloon Analogue Risk Task (BART) in patients with acute TBI and healthy controls. We hypothesized that individuals with TBI will take less risk at the BART as compared to healthy individuals. We also predicted that within the TBI group factors such as the number of days since the injury, severity of the injury, and sites of the lesion will play a role in risk taking as assessed with the BART. Main findings revealed that participants with TBI displayed abnormally cautious risk taking at the BART as compared to healthy subjects. Moreover, healthy individuals showed increased risk taking throughout the task which is in line with previous work. However, individuals with TBI did not show this increased risk taking during the task. We also investigated the influence of three patients' characteristics on their performance at the BART: Number of days post injury, Severity of the head injury, and Status of the frontal lobe. Results indicate that performance at the BART was influenced by the number of days post injury and the status of the frontal lobe, but not by the severity of the head injury. Reported findings are encouraging for risk taking seems to naturally improve with time postinjury. They support the need of conducting longitudinal prospective studies to ultimately identify impaired and intact cognitive skills that should be trained postinjury