Rehabilitation interventions for foot drop in neuromuscular disease

"Foot drop" or "Floppy foot drop" is the term commonly used to describe weakness or contracture of the muscles around the ankle joint. It may arise from many neuromuscular diseases

Lead in painted surfaces and dusts from rented urban properties (Plymouth, UK).

X-ray fluorescence (XRF) spectrometry has been used to measure lead (Pb) in painted surfaces and indoor dusts from 14 rented properties in the city of Plymouth, UK. Lead was detected in 78 out of 164 surfaces measured (and in 69 out of 150 interior surfaces) with an overall median concentration of 7100 mg kg-1 (range from 157 to 139,000 mg kg-1), and was detected in all but two properties that included one building constructed within the last 25 years. Selected measurements on an area basis (n = 48) returned Pb concentrations ranging from below 0.01 to 16.1 mg cm-2 that were significantly correlated with concentrations on a mass basis but with scatter that was attributed to the degree to which leaded paint had been overpainted. As potential measures of Pb exposure, mean concentrations in samples of lint (n = 8) were <15 mg kg-1 while mean concentrations in hoovered dusts (n = 14) were more variable; specifically, mean Pb dust concentrations ranged from ∼20 to 140 mg kg-1 in 13 samples but was ∼4500 mg kg-1 in a property that had recently undergone extensive renovation. Although mean concentrations of Pb in lint or dust were not related to median Pb concentrations in paint, a strong correlation between barium (Ba) and Pb in dusts suggests that paint is the main source of dust Pb. This study indicates that, in most cases, leaded paints historically applied to interior surfaces have been over-coated and pose little risk, provided that surface coatings are in good condition. However, inappropriate practices during renovation can result in significant contamination of dusts. Our findings are likely to be more broadly applicable to the urban rented sector in the UK and landlords and tenants should, therefore, be made aware of government guidance on the safe decoration or remodelling of older properties where leaded paint is pervasive

Development and initial validation of the Northwick Park Therapy Dependency Assessment

Objectives: To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation

The Glasgow outcome at discharge scale: an inpatient assessment of disability after brain injury

This study assesses the validity and reliability of the Glasgow Outcome at Discharge Scale (GODS), which is a tool that is designed to assess disability after brain injury in an inpatient setting. It is derived from the Glasgow Outcome Scale-Extended (GOS-E), which assesses disability in the community after brain injury. Inter-rater reliability on the GODS is high (quadratic-weighted kappa 0.982; 95% confidence interval [CI] 0.968, 0.996) as is concurrent validity with the Disability Rating Scale (DRS) (Spearman correlation −0.728; 95% CI −0.819, −0.601). The GODS is significantly associated with physical and fatigue subscales of the short form (SF)-36 in hospital. In terms of predictive validity the GODS is highly associated with the GOS-E after discharge (Spearman correlation 0.512; 95% CI 0.281, 0.687), with the DRS, and with physical, fatigue, and social subscales of the SF-36. The GODS is recommended as an assessment tool for disability after brain injury pre-discharge and can be used in conjunction with the GOS-E to monitor disability between hospital and the community

Symptomatic Therapy and Rehabilitation in Primary Progressive Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system and a major cause of chronic neurological disability in young adults. Primary progressive MS (PPMS) constitutes about 10% of cases, and is characterized by a steady decline in function with no acute attacks. The rate of deterioration from disease onset is more rapid than relapsing remitting and secondary progressive MS types. Multiple system involvement at onset and rapid early progression have a worse prognosis. PPMS can cause significant disability and impact on quality of life. Recent studies are biased in favour of relapsing remitting patients as treatment is now available for them and they are more likely to be seen at MS clinics. Since prognosis for PPMS is worse than other types of MS, the focus of rehabilitation is on managing disability and enhancing participation, and application of a “neuropalliative” approach as the disease progresses. This chapter presents the symptomatic treatment and rehabilitation for persons with MS, including PPMS. A multidisciplinary approach optimizes the intermediate and long-term medical, psychological and social outcomes in this population. Restoration and maintenance of functional independence and societal reintegration, and issues relating to quality of life are addressed in rehabilitation processes

Educational Environments at Housatonic Community College

Martin Ralda-Martinez's, Corey Stokes', Lindsey Toper's, and Jennifer Turner's poster discussing the physical, constructed, organizational, and aggregate evironments at Housatonic Community College

Impact of specialist rehabilitation services on hospital length of stay and associated costs

Background: Provision of specialist rehabilitation services in North Yorkshire and Humberside may be suboptimal. Local commissioning bodies need to prioritise investments in health care, but previous studies provide limited evidence to inform the decision to expand existing services on the basis of cost-effectiveness. We examine the impact of specialist rehabilitation services in the subregion on hospital length of stay (LoS) and associated costs compared to routine care. Methods: Comparison of hospital LoS and associated costs in centres with greater access (Hull) and limited access (i.e. routine care, York and Northern Lincolnshire), to specialist rehabilitation services for patients with complex disabilities following illness or injury, using Hospital Episodes Statistics data. Results: Average LoS and duration costs by Healthcare Resource Group (HRG) were lower for the majority of patients with greater access to specialist rehabilitation compared to routine care. Difference in LoS between groups widened with level of complexity within each HRG. For the more frequent HRG codes, the LoS difference was as high as 34 days longer for York compared to Hull and £7900 more costly. Conclusion: Rehabilitation patients within York and Northern Lincolnshire areas appear to have longer LoS and higher associated costs compared to those admitted to the Hull Trust. This analysis suggests that specialist rehabilitation may be cost saving compared to routine care and supports the case for expansion of the existing services to improve coverage in the area

Excess mortality for care home residents during the first 23 weeks of the COVID-19 pandemic in England: a national cohort study

Background: To estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics. Methods: Daily number of deaths in all residential and nursing homes in England notified to the Care Quality Commission (CQC) from 1 January 2017 to 7 August 2020. Care home-level data linked with CQC care home register to identify home characteristics: client type (over 65s/children and adults), ownership status (for-profit/not-for-profit; branded/independent) and size (small/medium/large). Excess deaths computed as the difference between observed and predicted deaths using local authority fixed-effect Poisson regressions on pre-pandemic data. Fixed-effect logistic regressions were used to model odds of experiencing COVID-19 suspected/confirmed deaths. Results: Up to 7 August 2020, there were 29,542 (95% CI 25,176 to 33,908) excess deaths in all care homes. Excess deaths represented 6.5% (95% CI 5.5 to 7.4%) of all care home beds, higher in nursing (8.4%) than residential (4.6%) homes. 64.7% (95% CI 56.4 to 76.0%) of the excess deaths were confirmed/suspected COVID-19. Almost all excess deaths were recorded in the quarter (27.4%) of homes with any COVID-19 fatalities. The odds of experiencing COVID-19 attributable deaths were higher in homes providing nursing services (OR 1.8, 95% CI 1.6 to 2.0), to older people and/or with dementia (OR 5.5, 95% CI 4.4 to 6.8), amongst larger (vs. small) homes (OR 13.3, 95% CI 11.5 to 15.4) and belonging to a large provider/brand (OR 1.2, 95% CI 1.1 to 1.3). There was no significant association with for-profit status of providers. Conclusions: To limit excess mortality, policy should be targeted at care homes to minimise the risk of ingress of disease and limit subsequent transmission. Our findings provide specific characteristic targets for further research on mechanisms and policy priority

Glacial geomorphology of the Great Glen Region of Scotland

This paper presents a detailed glacial Main Map of the Great Glen region of Scotland, UK, covering an area of over 6800 km2 extending from 56°34′7″ to 57°41′1″ N and from 3°44′2″ to 5°33′24″ W. This represents the first extensive mapping of the glacial geomorphology of the Great Glen and builds upon previous studies that conducted localised field mapping or ice-sheet wide mapping using remote sensing. Particular emphasis is placed on deriving medium-scale glacial retreat patterns from these data, and examining differences in landsystem assemblages across the region. Features were typically mapped at a scale of 1:8000 to 1:10,000 and will be used to investigate the pattern and dynamics of the British-Irish Ice Sheet during deglaciation. Mapping was conducted using the NEXTMap digital terrain model. In total, 17,637 glacial landforms were mapped, with 58% identified as moraines, 23% as meltwater channels, 10% as bedrock controlled glacial lineations, 3% as eskers, 2% as cirques or arêtes, 2% as kame topography or kame terraces, and 1% as drumlins. Additionally, 10 palaeo-lake shorelines were identified. Complex landform assemblages in the form of streamlined subglacial bedforms, moraines and glaciofluvial features exist across the region. Extensive subglacial meltwater networks are found over the Monadhliath Mountain Range. Transverse and longitudinal moraine ridges generally arc across valley floors or are located on valley slopes respectively. Hummocky moraines are found almost exclusively across Rannoch Moor. Finally, eskers, meltwater channels and kame landforms form spatial relationships along the axis of Strathspey. These glacial landsystems reveal the dynamics and patterns of retreat of the British-Irish Ice Sheet during the last deglaciation