Telerehabilitation has increasingly been used since the COVID-19 pandemic but with limited guidance available on undertaking physical assessments using remote methods. We aimed to provide such ...guidance by developing a Telerehab Toolkit, an online information and training resource for practitioners, patients, and carers on telerehabilitation for people with physical disabilities and movement impairment.
Development and evaluation of the toolkit were informed by the Knowledge to Action framework and took place iteratively in two phases-knowledge creation and action. Information was collated from various sources including literature review, online survey, service evaluation, and focus group discussions. The toolkit has been evaluated using think-aloud interviews, e-mail and social media feedback from users, and analytics data on user engagement with the website.
The Telerehab Toolkit focuses on remote physical assessments, and contains information on technology, digital skills, remote assessment tools, information governance, and safety for telerehabilitation. Resources include top tips from practitioners and patients, how-to guides, checklists, videos, and links to evidence.
The Telerehab Toolkit has been well-received by practitioners, healthcare students, patients, and carers, is being disseminated widely, and is freely available (
www.plymouth.ac.uk/research/telerehab
).
IMPLICATIONS FOR REHABILITATION
Telerehabilitation has been increasingly used since the COVID-19 pandemic, but with limited guidance and training for practitioners on undertaking safe and effective remote physical assessments.
The Telerehab Toolkit has been developed iteratively using the Knowledge to Action framework; it is a free online resource for practitioners and patients with specific guidance on telerehabilitation for physical disabilities and movement impairment.
It is anticipated that the resource will help to improve the knowledge, skills, and confidence of the current and future rehabilitation workforce.
Posterior glottis impairment alters breathing, voicing, and swallowing. Bilateral vocal fold movement impairment (BVFMI) occurs when the vocal cords are fixed/remain midline. Studies inadequately ...assessed endoscopic posterior costal cartilage grafting (enPCCG) for BVFMI across broad ages. We aim to assess decannulation and prosthesis free airway in children and adults who have undergone enPCCG.
Retrospective cohort.
Referral center.
This study included adults and children who received enPCCG for BVFMI (2010-2018) and were followed for 35 months on average. The main outcome was successful decannulation of patients, or airway improvement in those without tracheostomy. Data on comorbidities, surgical complications, and interventions following surgery were collected.
Ten children and 11 adults underwent enPCCG for BVFMI. Eighty-one percent of patients had a tracheostomy at surgery; adults were more likely to have a tracheostomy at surgery (P = 0.035), and to undergo double-staged procedure (P = 0.035) and stent (P = 0.008). Average stent duration was 29.7 days. Overall decannulation rate was 76% (90% for children; 70% for adults). Children were more likely to receive postoperative intensive care unit care (P = 0.004). Adults had mean 4.4 post-enPCCG interventions per patient compared to children's mean 3.91 interventions. The most common interventions were steroid injection (17.6%) and balloon dilation (16%). Preliminary analysis suggests postoperative dysphonia was reported in 66.7% of patients; postoperative dysphagia was rare.
EnPCCG was more successful at achieving decannulation in children. Adults required additional interventions. A double-staged operation with prolonged stenting is recommended for adult patients. A majority of patients were decannulated at last follow-up.
Children undergoing cervical and/or thoracic operations are at risk for recurrent laryngeal nerve injury, resulting in vocal fold movement impairment (VFMI). Screening for VFMI is often reserved for ...symptomatic patients.
Identify the prevalence of VFMI in screened preoperative patients prior to an at-risk operation to evaluate the value of screening all patients at-risk for VFMI, regardless of symptoms.
A single center, retrospective review of all patients undergoing a preoperative flexible nasolaryngoscopy between 2017 and 2021, examining the presence of VFMI and associated symptoms.
We evaluated 297 patients with a median (IQR) age of 18 (7.8, 56.3) months and a weight of 11.3 (7.8, 17.7) kilograms. Most had a history of esophageal atresia (EA, 60%), and a prior at-risk cervical or thoracic operation (73%). Overall, 72 (24%) patients presented with VFMI (51% left, 26% right, and 22% bilateral). Of patients with VFMI, 47% did not exhibit the classic symptoms (stridor, dysphonia, and aspiration) of VFMI. Dysphonia was the most prevalent classic VFMI symptom, yet only present in 18 (25%) patients. Patients presenting with a history of at-risk surgery (OR 2.3, 95%CI 1.1, 4.8, p = 0.03), presence of a tracheostomy (OR 3.1, 95%CI 1.0, 10.0, p = 0.04), or presence of a surgical feeding tube (OR 3.1, 95%CI 1.6, 6.2, p = 0.001) were more likely to present with VFMI.
Routine screening for VFMI should be considered in all at-risk patients, regardless of symptoms or prior operations, particularly in those with a history of an at-risk surgery, presence of tracheostomy, or a surgical feeding tube.
3 Laryngoscope, 133:3564-3570, 2023.
Low back pain (LBP) is a leading cause of disability. However, the processes contributing to disability are not well understood. Therefore, this study (1) empirically derived LBP subgroups and (2) ...validated these subgroups using walking performance, pain, and disability measures. Seventy adults with LBP underwent testing for a priori determined sensory (temporal summation; conditioned pain modulation), psychological (positive affect/coping; negative coping), and motor (trunk extensor muscle activation during forward bending and walking) measures. A hierarchical cluster analysis determined subgroups that were then validated using walking (walking speed; Timed Up and Go TUG; TUG-Cognitive TUG-Cog; obstacle negotiation) and clinical (Brief Pain Inventory; Oswestry Disability Index; low back pressure pain threshold) measures. Two subgroups were derived: (1) a "Maladaptive" subgroup (n = 21) characterized by low positive affect/coping, high negative coping, low pain modulation, and atypical trunk extensor activation and (2) an "Adaptive" subgroup (n = 49) characterized by high positive affect/coping, low negative coping, high pain modulation, and typical trunk extensor activation. There were subgroup differences on 7 of 12 validation measures. The Maladaptive subgroup had reduced walking performance (slower self-selected walking speed, TUG completion, and obstacle approach and crossing speed) and worse clinical presentation (higher pain intensity, pain interference, and disability) (moderate to large effect sizes; P's < 0.05). Findings support the construct validity of this multidimensional subgrouping approach. Longitudinal studies are needed to determine whether the Maladaptive subgroup is predictive of poor outcomes, such as pain chronicity or persistent disability.
Globally improved life expectancy has led to a significant increase in the incidence of Parkinson's disease (PD). It is widely thought that dietary factors are crucial modifiers of the PD risk. ...Previous studies of the association between PD and diet have mainly focused on single food components and specific nutrients, whereas comprehensive reviews of the role of general dietary patterns in PD are limited.
Thus, this review discusses the effects of adopting a Western, Mediterranean, ketogenic, protein-restricted, calorie-restricted, intermittent fasting, or fast-mimicking diet on PD, and summarizes the underlying mechanisms by which these dietary patterns affect molecular markers of the disease. Specifically, we examine the potential associations among these dietary patterns, the gut microbiome composition, and PD development. Furthermore, we suggest a framework that can be used to develop personalized microbiota-directed dietary interventions for PD based on the individual gut microbiome composition.
The Mediterranean diet reduces the risk of PD with favorable alternations of intestinal microbiota, increases levels of SCFAs, and reduces the TMAO level. Calorie restriction and Fasting-mimicking diet show some neuroprotective effects on PD via increasing β-HB, FGF21, and Ghrelin levels. Meanwhile, both ketogenic and protein-restricted diets show a striking effect on ameliorating motor impairment and fluctuations. Conversely, Western diet correlates with an increased incidence of PD and exacerbates the severity of PD with unfavorable changes of intestinal microbiome and increases neuroinflammation. Clarifying these roles of dietary patterns in PD will be meaningful for future personalized-dietary interventions in patients with PD.
•Focus has been placed on dietary patterns for the influence of Parkinson's disease (PD).•The potential mechanisms underlying dietary patterns-induced effects on PD have been summarized.•The microbiota-gut-brain axis mediates dietary patterns-induced effects on PD.•Personalized microbiota-directed dietary intervention for PD has been suggested.
Parkinson’s disease (PD) is closely linked to lifestyle factors, particularly dietary patterns, which have attracted interest as potential disease-modifying factors. Eating a low-protein, ...high-carbohydrate (LPHC) diet is a promising dietary intervention against brain aging; however, its protective effect on PD remains elusive. Here, we found that an LPHC diet ameliorated 1-methyl-4-phenyl-1,2,3,6-tetrathydropyridine (MPTP)-induced motor deficits, decreased dopaminergic neuronal death, and increased the levels of striatal dopamine, serotonin, and their metabolites in PD mice. Levels of fibroblast growth factor 21 (FGF-21), a member of the fibroblast growth factor family, were elevated in PD mice following LPHC treatment. Furthermore, the administration of FGF-21 exerted a protective effect on MPTP-induced PC12 cells, similar to the effect of an LPHC diet in MPTP-induced mice. Sequencing of the 16S rDNA from fecal microbiota revealed that an LPHC diet normalized the gut bacterial composition imbalance in PD mice, as evidenced by the increased abundance of the genera Bifidobacterium, Ileibacterium, Turicibacter, and Blautia and decreased abundance of Bilophila, Alistipes, and Bacteroides. PICRUSt-predicted fecal microbiome function revealed that an LPHC diet suppressed lipopolysaccharide biosynthesis and the citrate cycle (TCA cycle), biosynthesis of ubiquinone and other terpenoid-quinones, and oxidative phosphorylation pathways caused by MPTP, and enhanced the biosynthesis of amino acids, carbohydrate metabolism, and biosynthesis of other secondary metabolites. A nonmetabolomic analysis of the serum and feces showed that an LPHC diet significantly increased the levels of aromatic amino acids (AAAs), including tryptophan, tyrosine, and phenylalanine. In addition, an LPHC diet elevated the serum concentrations of bile acids (BAs), particularly tauroursodeoxycholic acid (TUDCA) and taurine. Collectively, our current findings point to the potential mechanism of administering an LPHC diet in attenuating movement impairments in MPTP-induced PD mice, with AAAs, microbial metabolites (TUDCA and taurine), and FGF-21 as key mediators along the gut-microbiota–brain axis.
Traditional therapist-based rehabilitation training for patients with movement impairment is laborious and expensive. In order to reduce the cost and improve the treatment effect of rehabilitation, ...many methods based on human–computer interaction (HCI) technology have been proposed, such as robot-assisted therapy and functional electrical stimulation (FES). However, due to the lack of active participation of brain, these methods have limited effects on the promotion of damaged nerve remodeling.
Based on the neurofeedback training provided by the combination of brain–computer interface (BCI) and exoskeleton, this paper proposes a multimodal brain-controlled active rehabilitation system to help improve limb function. The joint control mode of steady-state visual evoked potential (SSVEP) and motor imagery (MI) is adopted to achieve self-paced control and thus maximize the degree of brain involvement, and a requirement selection function based on SSVEP design is added to facilitate communication with aphasia patients.
In addition, the Transformer is introduced as the MI decoder in the asynchronous online BCI to improve the global perception of electroencephalogram (EEG) signals and maintain the sensitivity and efficiency of the system.
In two multi-task online experiments for left hand, right hand, foot and idle states, subject achieves 91.25% and 92.50% best accuracy, respectively.
Compared with previous studies, this paper aims to establish a high-performance and low-latency brain-controlled rehabilitation system, and provide an independent and autonomous control mode of the brain, so as to improve the effect of neural remodeling. The performance of the proposed method is evaluated through offline and online experiments.
•A self-paced online BCI-based rehabilitation training system is designed and implemented.•SSVEP-based demand selection function to timely understand the treatment status of patients with aphasia.•The feasibility of the system was verified by offline and online experiments.
Objectives
Non‐selective laryngeal reinnervation (NSLR) using the ansa cervicalis to the recurrent laryngeal nerve (RLN) is a promising treatment option for pediatric unilateral neuronal vocal fold ...movement impairment (VFMI). The aim is to describe our clinical outcomes with this technique and to identify preoperative characteristics that may predict postoperative voice outcomes.
Methods
This is a cohort study of pediatric patients with unilateral neuronal VFMI, who underwent NSLR from March 2012 to July 2018. Pre‐ and postoperative Pediatric Voice Related Quality of Life (PVRQOL) questionnaires, Consensus Auditory Perceptual Evaluation of Voice (CAPE‐V) ratings, and objective voice measures were obtained. In addition, patients underwent preoperative laryngeal electromyography (LEMG).
Results
Thirty‐two patients were identified. Twenty‐one had complete data sets for analysis. The mean duration of VFMI was 9.02 years (range 1.1–26.1 years). There were significant improvements in PVRQOL (P = .0005), in all CAPE‐V subsets (P ≤ .0001 to .0195), mean and maximum intensities (P = .0342 and 0.0110, respectively), cepstral peak prominence (P = .0001), and cepstral spectral index of dysphonia (P ≤ .0001). A worse preoperative LEMG correlated with a greater change in maximum phonation time (P = .0162) and maximum intensity (P = .0346). Age at injury and duration of injury had no significant impact on voice outcomes; however, patients with concurrent posterior glottic insufficiency did have smaller changes in PVRQOL (P = .012).
Conclusion
NSLR is an effective treatment for pediatric unilateral neuronal VFMI even many years after initial RLN injury. LEMG may help predict voice outcomes of reinnervation in pediatric patients, but further data is still needed.
Level of Evidence
4 Laryngoscope, 130:1525–1531, 2020
Objectives/Hypothesis
Vocal fold movement impairment (VFMI) in infants and children is most commonly evaluated by flexible nasolaryngoscopy (FNL). FNL in this population can be challenging due to ...movement, floppy supraglottic structures, or secretions. Laryngeal ultrasound (LUS) may be an alternative, less invasive means of evaluating VFMI that also decreases aerosolization during the COVID‐19 pandemic. The primary objective was to examine LUS interpretation proficiency for VFMI via an educational module. A secondary outcome was to determine whether quantitative measurements increase interpretation accuracy.
Study Design
Prospective cohort trial.
Methods
Medical students, residents, fellows, faculty, and staff were recruited to complete the module, composed of a 13‐minute teaching video followed by 20 cases. Participants determined both qualitatively (subjective assessment) and then quantitatively (through protractor measurements of the vocal fold to arytenoid angle) whether there was normal versus impaired vocal fold mobility.
Results
Thirty participants completed the LUS training module, and about one‐third were otolaryngology residents. On average, each participant correctly identified 18 cases. The mean rank percent correct for quantitative measurements was significantly higher than that of qualitative interpretations (P < .0001). Measurements significantly caused participants to change their answer correctly compared to incorrectly (P < .0001). As the module progressed, there was no significant trend of more correct interpretations (P = .30). The sensitivity was higher for quantitative interpretations (89.0% vs. 87.3%) but specificity remained unchanged (92.6%).
Conclusion
Quantitative measurements may increase LUS interpretation accuracy. There was not a specific number of cases interpreted to achieve learning proficiency. LUS is an easily learned method to evaluate for VFMI across all training levels.
Level of Evidence
3 (local cohort study nonrandomized) Laryngoscope, 131:2545–2549, 2021
