The experience of falls and fall risk during the subacute phase of spinal cord injury: a mixed methods study

Purpose: To understand the circumstances, causes and consequences of falls experienced by individuals with subacute SCI, and to explore their perspectives on how falls/fall risk impacted their transition to community living. Materials and methods: Sixty adults with subacute SCI participated. A sequential explanatory mixed methods design was adopted. In Phase I, falls were monitored for six months post-inpatient rehabilitation discharge through a survey. In Phase II, a qualitative focus group (n = 5) was held to discuss participants’ perspectives on Phase I results and falls/fall risk. Descriptive statistics and thematic analysis were used to analyze Phase I and II data, respectively. Results: Falls commonly occurred in the daytime, at home and about half resulted in minor injury. Three themes reflecting participants’ perspectives were identified in Phase II. 1) Lack of preparedness to manage fall risk upon returning home from inpatient rehabilitation. 2) Adjusting to increased fall risk following discharge from inpatient rehabilitation. 3) Psychological impact of the transition to living at home with an increased fall risk. Conclusions: The findings highlight the need for fall prevention initiatives during subacute SCI, when individuals are learning to manage their increased fall risk. Falls are common in the subacute phase of spinal cord injury (SCI), with falls commonly occurring in the daytime at home while walking or changing positions and resulting in minor injury.Individuals living with SCI feel unprepared to manage the increased fall risk experienced after discharge from inpatient rehabilitation, and the possibility of falling can cause anxiety and fear.Following the transition from inpatient rehabilitation to living at home, individuals with SCI would like continued support from health professionals and/or peers to prevent falls and adjust to living independently with SCI. Falls are common in the subacute phase of spinal cord injury (SCI), with falls commonly occurring in the daytime at home while walking or changing positions and resulting in minor injury. Individuals living with SCI feel unprepared to manage the increased fall risk experienced after discharge from inpatient rehabilitation, and the possibility of falling can cause anxiety and fear. Following the transition from inpatient rehabilitation to living at home, individuals with SCI would like continued support from health professionals and/or peers to prevent falls and adjust to living independently with SCI.</p

Robot-assisted upper extremity rehabilitation for cervical spinal cord injuries: a systematic scoping review

<p><b>Purpose:</b> To provide an overview of the feasibility and outcomes of robotic-assisted upper extremity training for individuals with cervical spinal cord injury (SCI), and to identify gaps in current research and articulate future research directions.</p> <p><b>Materials and methods:</b> A systematic search was conducted using Medline, Embase, PsycINFO, CCTR, CDSR, CINAHL and PubMed on June 7, 2017. Search terms included 3 themes: (1) robotics; (2) SCI; (3) upper extremity. Studies using robots for upper extremity rehabilitation among individuals with cervical SCI were included. Identified articles were independently reviewed by two researchers and compared to pre-specified criteria. Disagreements regarding article inclusion were resolved through discussion. The modified Downs and Black checklist was used to assess article quality. Participant characteristics, study and intervention details, training outcomes, robot features, study limitations and recommendations for future studies were abstracted from included articles.</p> <p><b>Results:</b> Twelve articles (one randomized clinical trial, six case series, five case studies) met the inclusion criteria. Five robots were exoskeletons and three were end-effectors. Sample sizes ranged from 1 to 17 subjects. Articles had variable quality, with quality scores ranging from 8 to 20. Studies had a low internal validity primarily from lack of blinding or a control group. Individuals with mild-moderate impairments showed the greatest improvements on body structure/function and performance-level measures. This review is limited by the small number of articles, low-sample sizes and the diversity of devices and their associated training protocols, and outcome measures.</p> <p><b>Conclusions:</b> Preliminary evidence suggests robot-assisted interventions are safe, feasible and can reduce active assistance provided by therapists.Implications for rehabilitation</p><p>Robot-assisted upper extremity training for individuals with cervical spinal cord injury is safe, feasible and can reduce hands-on assistance provided by therapists.</p><p>Future research in robotics rehabilitation with individuals with spinal cord injury is needed to determine the optimal device and training protocol as well as effectiveness.</p><p></p> <p>Robot-assisted upper extremity training for individuals with cervical spinal cord injury is safe, feasible and can reduce hands-on assistance provided by therapists.</p> <p>Future research in robotics rehabilitation with individuals with spinal cord injury is needed to determine the optimal device and training protocol as well as effectiveness.</p

Nanocarrier Composed of Magnetite Core Coated with Three Polymeric Shells Mediates LCS‑1 Delivery for Synthetic Lethal Therapy of BLM-Defective Colorectal Cancer Cells

Synthetic lethality is a molecular-targeted therapy for selective killing of cancer cells. We exploited a lethal interaction between superoxide dismutase 1 inhibition and Bloom syndrome gene product (BLM) defect for the treatment of colorectal cancer (CRC) cells (HCT 116) with a customized lung cancer screen-1-loaded nanocarrier (LCS-1-NC). The drug LCS-1 has poor aqueous solubility. To overcome its limitations, a customized NC, composed of a magnetite core coated with three polymeric shells, namely, aminocellulose (AC), branched poly­(amidoamine), and paraben-PEG, was developed for encapsulating LCS-1. Encapsulation efficiency and drug loading were found to be 74% and 8.2%, respectively. LCS-1-NC exhibited sustained release, with ∼85% of drug release in 24 h. Blank NC (0.5 mg/mL) exhibited cytocompatibility toward normal cells, mainly due to the AC layer. LCS-1-NC demonstrated high killing selectivity (104 times) toward BLM-deficient HCT 116 cells over BLM-proficient HCT 116 cells. Due to enhanced efficacy of the drug using NC, the sensitivity difference for BLM-deficient cells increased to 1.7 times in comparison to that with free LCS-1. LCS-1-NC induced persistent DNA damage and apoptosis, which demonstrates that LCS-1-NC effectively and preferentially killed BLM-deficient CRC cells. This is the first report on the development of a potential drug carrier to improve the therapeutic efficacy of LCS-1 for specific killing of CRC cells having BLM defects

sj-pdf-1-otj-10.1177_15394492231161283 – Supplemental material for Occupational Therapists in Patient Navigation: A Scoping Review of the Literature

Supplemental material, sj-pdf-1-otj-10.1177_15394492231161283 for Occupational Therapists in Patient Navigation: A Scoping Review of the Literature by Kristina M. Kokorelias, Hardeep Singh, Alexandra N. Thompson, Amy E. Nesbitt, Jessica E. Shiers-Hanley, Michelle L. A. Nelson and Sander L. Hitzig in OTJR: Occupation, Participation and Health</p

sj-docx-2-otj-10.1177_15394492231161283 – Supplemental material for Occupational Therapists in Patient Navigation: A Scoping Review of the Literature

Supplemental material, sj-docx-2-otj-10.1177_15394492231161283 for Occupational Therapists in Patient Navigation: A Scoping Review of the Literature by Kristina M. Kokorelias, Hardeep Singh, Alexandra N. Thompson, Amy E. Nesbitt, Jessica E. Shiers-Hanley, Michelle L. A. Nelson and Sander L. Hitzig in OTJR: Occupation, Participation and Health</p

Database search strategies.

BackgroundCo-design methodology seeks to actively engage end-users in developing interventions. It is increasingly used to design stroke interventions; however, limited guidance exists, particularly with/for individuals with stroke who have diverse cognitive, physical and functional abilities. Thus, we describe 1) the extent of existing research that has used co-design for stroke intervention development and 2) how co-design has been used to develop stroke interventions among studies that explicitly used co-design, including the rationale, types of co-designed stroke interventions, participants involved, research methodologies/approaches, methods of incorporating end-users in the research, co-design limitations, challenges and potential strategies reported by researchers.Materials and methodsA scoping review informed by Joanna Briggs Institute and Arksey & O’Malley methodology was conducted by searching nine databases on December 21, 2022, to locate English-language literature that used co-design to develop a stroke intervention. Additional data sources were identified through a hand search. Data sources were de-duplicated, and two research team members reviewed their titles, abstracts and full text to ensure they met the inclusion criteria. Data relating to the research objectives were extracted, analyzed, and reported numerically and descriptively.ResultsData sources used co-design for stroke intervention development with (n = 89) and without (n = 139) explicitly using the term ‘co-design.’ Among studies explicitly using co-design, it was commonly used to understand end-user needs and generate new ideas. Many co-designed interventions were technology-based (65%), and 48% were for physical rehabilitation or activity-based. Co-design was commonly conducted with multiple participants (82%; e.g., individuals with stroke, family members/caregivers and clinicians) and used various methods to engage end-users, including focus groups and workshops. Limitations, challenges and potential strategies for recruitment, participant-engagement, contextual and logistical and ethics of co-designed interventions were described.ConclusionsGiven the increasing popularity of co-design as a methodology for developing stroke interventions internationally, these findings can inform future co-designed studies.</div

Summary of co-design limitations and challenges and potential strategies to overcome these limitations and challenges.

Summary of co-design limitations and challenges and potential strategies to overcome these limitations and challenges.</p

Overview of 89 studies analyzed in this review that explicitly used the term co-design.

Overview of 89 studies analyzed in this review that explicitly used the term co-design.</p

PRISMA flow diagram.

BackgroundCo-design methodology seeks to actively engage end-users in developing interventions. It is increasingly used to design stroke interventions; however, limited guidance exists, particularly with/for individuals with stroke who have diverse cognitive, physical and functional abilities. Thus, we describe 1) the extent of existing research that has used co-design for stroke intervention development and 2) how co-design has been used to develop stroke interventions among studies that explicitly used co-design, including the rationale, types of co-designed stroke interventions, participants involved, research methodologies/approaches, methods of incorporating end-users in the research, co-design limitations, challenges and potential strategies reported by researchers.Materials and methodsA scoping review informed by Joanna Briggs Institute and Arksey & O’Malley methodology was conducted by searching nine databases on December 21, 2022, to locate English-language literature that used co-design to develop a stroke intervention. Additional data sources were identified through a hand search. Data sources were de-duplicated, and two research team members reviewed their titles, abstracts and full text to ensure they met the inclusion criteria. Data relating to the research objectives were extracted, analyzed, and reported numerically and descriptively.ResultsData sources used co-design for stroke intervention development with (n = 89) and without (n = 139) explicitly using the term ‘co-design.’ Among studies explicitly using co-design, it was commonly used to understand end-user needs and generate new ideas. Many co-designed interventions were technology-based (65%), and 48% were for physical rehabilitation or activity-based. Co-design was commonly conducted with multiple participants (82%; e.g., individuals with stroke, family members/caregivers and clinicians) and used various methods to engage end-users, including focus groups and workshops. Limitations, challenges and potential strategies for recruitment, participant-engagement, contextual and logistical and ethics of co-designed interventions were described.ConclusionsGiven the increasing popularity of co-design as a methodology for developing stroke interventions internationally, these findings can inform future co-designed studies.</div

List of all data sources that used co-design for stroke intervention development, including data sources that aligned with co-design or associated methodology with and without explicitly using the term co-design.

List of all data sources that used co-design for stroke intervention development, including data sources that aligned with co-design or associated methodology with and without explicitly using the term co-design.</p