Assessment and training in home-baesd telerehabilitation ofr arm mobility impairment

The aging population and limited healthcare capacities call for a change in how rehabilitation care is provided. There is a need to provide more autonomous and scalable care that can be more easily transferred out of the clinic and into home environments. One important barrier to this objective is achieving reliable assessment of motor performance using low-cost technology. Toward this end, an assessment framework and methodology is proposed. The framework uses 4 sequential games to measure aspects of range of motion, range of force, control of motion, and control of force. Parameters derived from the range of motion task are used to define motion requirements in all subsequent assessment games, while parameters derived from the range of force task are used to define subsequent lifting force requirements. A 12-week usability study was conducted in which 9 patients completed the clinical testing phase and 6 therapists and 7 patients completed the questionnaire. Feedback from the questionnaire shows the system is easy to use and integrates well in the clinical setting. The most commonly requested modifications were the inclusion of more games and the incorporation of hand training. Some initial position and force data are shown for one subject and discussion on implications for mobility assessment using the developed device are provided.Peer Reviewe

Assessment and training in home-based telerehabilitation of arm mobility impairment

In an era where rehabilitation services are diminishing under the weight of the growing demands and fewer therapists, home-based telerehabilitation offers a way of increasing duration and intensity of post-stroke training. Novel systems that guide the therapist and patient in planning, executing, and assessing the training can reduce the burden on the healthcare system while maintaining or improving the quality of care. To achieve this effectively, a unified approach is needed that can address the diverse needs of the users and adequately assess the level of mobility deficits remotely. This document presents a methodology and prototype system for assessment and training adaptation within a telerehabilitation framework targeting home-based rehabilitation of the upper limbs after stroke. The framework uses 4 games for assessment of motor performance based on measures of range and control of movement. Assessment games include range of motion, range of force, control of motion, and control of force. The initial assessment games are used to tune the deficit-specific parameters in each successive game for assessment and training. Games are administered over the web-based TeleREHA platform through a novel arm rehabilitation device called the ArmAssist. An overview of the developments in each project is presented including the basic assessment parameters and a methodology for making patient-specific adaptation to game levels. Preliminary feedback from an ongoing usability evaluation is also presented and discussed

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Improving patient motivation in game development for motor deficit rehabilitation

It has been stated repeatedly that active participation in rehabilitation programs increases the benefit and effectiveness of therapy. In developing robotic devices for stroke rehabilitation, the existing use of boring task interfaces produces a significant reduction in elderly patient motivation. To combine robot-aided therapy with appealing games, then, is not only a matter of creating entertainment, but a real necessity for motor recovery. Besides emphasizing a lack of attention to elderly patients in conceiving games for post-stroke rehabilitation, this paper launches a challenge to two fields with tremendous collaborative potential. As a precursor to this collaboration, the following research consolidates the gaming scenario criteria for both rehabilitation and elderly entertainment. Conclusions are then formed from the adaptability of existing games to identify the direction of future game development.Peer reviewe

'Senior moments'

Everyone occasionally experiences momentary confusion about the intent of an action in the midst of doing an ordinary task ("Why did I come into this room?"). As we age, these momentary confusions, referred to here by the colloquial term senior moments become more frequent. Lapses of this sort can also be the result of specific cognitive degeneration associated with aging and can have an impact on day-to-day living that ranges from annoying to incapacitating. This paper discusses the current understanding of senior moments in relation to cognitive decline and depicts scenarios depicting typical instances of them and common sense techniques to repair the memory slips. We present a discussion of the challenges involved in the design of a computationally based system for supporting lapse remediation, and specific implementation issues involved in providing such a systemPeer reviewe

Development of computer games for assessment and training in post-stroke arm telerehabilitation

Stroke is the leading cause of long term disability among adults in industrialized nations. The majority of these disabilities include deficiencies in arm function, which can make independent living very difficult. Research shows that better results in rehabilitation are obtained when patients receive more intensive therapy. However this intensive therapy is currently too expensive to be provided by the public health system, and at home few patients perform the repetitive exercises recommended by their therapists. Computer games can provide an affordable, enjoyable, and effective way to intensify treatment, while keeping the patient as well as their therapists informed about their progress. This paper presents the study, design, implementation and user-testing of a set of computer games for at-home assessment and training of upper-limb motor impairment after stroke