We systematically reviewed and analyzed the literature to find randomized controlled trials (RCTs) that employed robotic devices in upper-limb rehabilitation of people with stroke. Out of 574 ...studies, 12 matching the selection criteria were found. The Fugl-Meyer, Functional Independence Measure, Motor Power Scale, and Motor Status Scale outcome measures from the selected RCTs were pooled together, and the corresponding effect sizes were estimated. We found that when the duration/intensity of conventional therapy (CT) is matched with that of the robot-assisted therapy (RT), no difference exists between the intensive CT and RT groups in terms of motor recovery, activities of daily living, strength, and motor control. However, depending on the stage of recovery, extra sessions of RT in addition to regular CT are more beneficial than regular CT alone in motor recovery of the hemiparetic shoulder and elbow of patients with stroke; gains are similar to those that have been observed in intensive CT.
Inertial measurement units (IMUs) have been increasingly popular in rehabilitation research. However, despite their accessibility and potential advantages, their uptake and acceptance by health ...professionals remain a big challenge. The development of an IMU-based clinical tool must bring together engineers, researchers and clinicians. This study is part of a developmental process with the investigation of clinicians' perspectives about IMUs. Clinicians from four rehabilitation centers were invited to a 30-minute presentation on IMUs. Then, two one-hour focus groups were conducted with volunteer clinicians in each rehabilitation center on: 1) IMUs and their clinical usefulness, and 2) IMUs data analysis and visualization interface. Fifteen clinicians took part in the first focus groups. They expressed their thoughts on: 1) categories of variables that would be useful to measure with IMUs in clinical practice, and 2) desired characteristics of the IMUs. Twenty-three clinicians participated to the second focus groups, discussing: 1) functionalities, 2) display options, 3) clinical data reported and associated information, and 4) data collection duration. Potential influence of IMUs on clinical practice and added value were discussed in both focus groups. Clinicians expressed positive opinions about the use of IMUs, but their expectations were high before considering using IMUs in their practice.
Unilateral spatial neglect (USN) is a highly prevalent post-stroke deficit. Currently, there is no gold standard USN assessment which encompasses the heterogeneity of this disorder and that is ...sensitive to detect mild deficits. Similarly, there is a limited number of high quality studies suggesting that conventional USN treatments are effective in improving functional outcomes and reducing disability. Virtual reality (VR) provides enhanced methods for USN assessment and treatment. To establish best-practice recommendations with respect to its use, it is necessary to appraise the existing evidence. This systematic review aimed to identify and appraise existing VR-based USN assessments; and to determine whether VR is more effective than conventional therapy. Assessment tools were critically appraised using standard criteria. The methodological quality of the treatment trials was rated by two authors. The level of evidence according to stage of recovery was determined. Findings were compiled into a VR-based USN Assessment and Treatment Toolkit (VR-ATT). Twenty-three studies were identified. The proposed VR tools augmented the conventional assessment strategies. However, most studies lacked analysis of psychometric properties. There is limited evidence that VR is more effective than conventional therapy in improving USN symptoms in patients with stroke. It was concluded that VR-ATT could facilitate identification and decision-making as to the appropriateness of VR-based USN assessments and treatments across the continuum of stroke care, but more evidence is required on treatment effectiveness.
Candida albicans is a fungal pathobiont, able to cause epithelial cell damage and immune activation. These functions have been attributed to its secreted toxin, candidalysin, though the molecular ...mechanisms are poorly understood. Here, we identify epidermal growth factor receptor (EGFR) as a critical component of candidalysin-triggered immune responses. We find that both C. albicans and candidalysin activate human epithelial EGFR receptors and candidalysin-deficient fungal mutants poorly induce EGFR phosphorylation during murine oropharyngeal candidiasis. Furthermore, inhibition of EGFR impairs candidalysin-triggered MAPK signalling and release of neutrophil activating chemokines in vitro, and diminishes neutrophil recruitment, causing significant mortality in an EGFR-inhibited zebrafish swimbladder model of infection. Investigation into the mechanism of EGFR activation revealed the requirement of matrix metalloproteinases (MMPs), EGFR ligands and calcium. We thus identify a PAMP-independent mechanism of immune stimulation and highlight candidalysin and EGFR signalling components as potential targets for prophylactic and therapeutic intervention of mucosal candidiasis.
Motor learning of appropriate manual wheelchair propulsion is critical, as incorrect technique elevates risk for upper extremity pain. Virtual reality simulators allow users to practice this complex ...task in a safe and realistic environment. Additionally, augmented feedback (AF) may be provided in order to optimize learning. The purpose of this study was to investigate the effects of providing AF with various delivery schedules on motor learning and transfer of this skill to over-ground propulsion.
Thirty healthy young adults were randomly assigned to three groups. During a virtual reality propulsion training session, the high-frequency AF group received AF in the form of knowledge of performance throughout all propulsion training; the faded AF group received this AF in a faded schedule (high relative frequency of AF early in practice, with relative frequency of AF provision diminishing throughout practice); and the control group underwent training with no AF. Propulsion assessments were performed at baseline and 48 h after practice in both virtual and real environments to measure retention and transfer, respectively.
Compared to the control group, both feedback groups exhibited significant improvements in contact angle and push frequency in both environments after training. Small, non-significant between-group differences were also found between the high-frequency and faded feedback groups.
Virtual reality training is an effective learning intervention for acquisition, retention, and transfer of appropriate manual wheelchair propulsion technique when such training includes AF regarding propulsion biomechanics.
Partnership research has the potential to contribute to a more inclusive society for people with disabilities.
Challenges and facilitators are identified for the stages of creating, implementing, and ...completing a partnership research project.
Suggested solutions are offered to facilitate the conduct of a partnership research project and to increase the project's chances of success.
Partnership research could benefit from using tools from other fields such as community development and social innovation to successfully implement some of the facilitators and overcome specific barriers to partnership research.
To identify partnership research challenges and facilitators, as experienced by members of the Inclusive Society (IS) initiative.
A case study was conducted on all partnership research projects conducted between 2017 and 2019 under the IS initiative through surveys, interviews with the IS community, logbooks, and focus group. Thematic analysis and descriptive analysis were undertaken.
To work effectively with a diversity of stakeholders, winning conditions must be created for the project from the outset. These include determining the team functioning, project objectives, the expectations of each party, and agreeing on a realistic action plan. Project implementation with concern for sustained stakeholder commitment, good working relationships, and achieving project objectives requires organizational planning that favours partner involvement, shared leadership, agreed methods for communicating, conflict resolution methods, recognition of each participant's expertise, and creating a climate of trust. Upon concluding a partnership research project, it is essential to devote time to implement project results in local environments and to ascertain their usefulness to partners.
IS partnership research challenges and facilitators are similar to those identified in past research. Despite this knowledge, challenges persist. Future research could explore tools and practices from other domain to overcome partnership research challenges.
Polymicrobial infections often include both fungi and bacteria and can complicate patient treatment and resolution of infection. Cross-kingdom interactions among bacteria, fungi, and/or the immune ...system during infection can enhance or block virulence mechanisms and influence disease progression. The fungus
and the bacterium
are coisolated in the context of polymicrobial infection at a variety of sites throughout the body, including mucosal tissues such as the lung.
,
and
have a bidirectional and largely antagonistic relationship. Their interactions
remain poorly understood, specifically regarding host responses in mediating infection. In this study, we examine trikingdom interactions using a transparent juvenile zebrafish to model mucosal lung infection and show that
and
are synergistically virulent. We find that high
burden, fungal epithelial invasion, swimbladder edema, and epithelial extrusion events serve as predictive factors for mortality in our infection model. Longitudinal analyses of fungal, bacterial, and immune dynamics during coinfection suggest that enhanced morbidity is associated with exacerbated
pathogenesis and elevated inflammation. The
quorum-sensing-deficient Δ
mutant also enhances
pathogenicity in coinfection and induces extrusion of the swimbladder. Together, these observations suggest that
cross talk
can benefit both organisms to the detriment of the host.
Hydrogen is a promising energy vector for storing renewable energies: obtained from water-splitting, in electrolysers or photoelectrochemical cells, it can be turned back to electricity on demand in ...fuel cells (FCs). Proton exchange membrane (PEM) devices with low internal resistance, high compactness and stability are an attractive technology optimized over decades, affording fast start-up times and low operating temperatures. However, they rely on the powerful catalytic properties of noble metals such as platinum, while lower cost, more abundant materials would be needed for economic viability. Replacing these noble metals at both electrodes has long proven to be a difficult task, so far incompatible with PEM technologies. Here we take advantage of newly developed bio-inspired molecular H
oxidation catalysts and noble metal-free O
-reducing materials, to fabricate a noble metal-free PEMFC, with an 0.74 V open circuit voltage and a 23 μW cm
output power under technologically relevant conditions. X-ray absorption spectroscopy measurements confirm that the catalysts are stable and retain their structure during turnover.
The aim of the current study was to examine the role of environment, whether virtual or physical, on robot-assisted reaching movements in chronic stroke and healthy individuals, within a single ...session. Twenty-three subjects participated in the current study divided into three groups: nine chronic stroke individuals able to perform a reaching task with no need for the robot assistance, nine chronic stroke individuals who needed robot assistance to complete the reaching task, and five healthy individuals. The task was to reach six target buttons in two identical physical and virtual environments. The outcomes consisted of specific kinematic measures (amount of movement completion without robot assistance, mean speed, peak speed, straightness, and shakiness) and a custom questionnaire to assess how the stroke subjects perceived and experienced the reaching task in both environments. The results showed no differences between the two environments in terms of the outcome measures in any of the groups. Our findings suggest that the choice of environment, whether physical or virtual, is not a key factor in designing a simple robot-assisted reaching task for stroke survivors. Further studies are required for more complex environments and tasks as well as robot-assisted training protocols.
Throughout the world pastoralists today face a particularly daunting challenge of intensified rangeland fragmentation combined with human population growth and climate change. In many pastoral ...settings, rangelands are undergoing processes of fragmentation due to tenure transformations, as previously communal lands are privatized into individual holdings. Such processes of enclosure have raised concerns over the long-term costs on pastoral communities and on rangeland eco-systems. This paper explores pastoral responses and adaptations to enclosure based on long-term ethnographic engagement in a Maasai community in Southern Kenya that has recently privatized. Detailed family case studies and herd tracking illuminate the ways in which families try to re-create the commons by relying on social networks for free access to resources. In particular, women’s social networks (for example, their kin, affines, friends, or religious associates) seem to play an important role. This paper calls attention to the need to better understand women’s changing roles in pastoral governance and production and the implications these new roles have for women’s well-being and for pastoralism in the face of fragmentation.
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