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Slik velger du riktig trykkfordelende madrass
Get PDFEnkle grep kan bidra til å redusere forekomsten av trykksår, blant annet ved å velge hensiktsmessig underlag i sengen og stolen til risikopasienten. I dag finnes det mange ulike typer madrasser. Hensikten med denne artikkelen er å gi en oversikt over madrasstyper og samtidig understreke at madrasser alene aldri kan redusere forekomsten av trykksår.måsjekke
Strength Training to Improve Gait in People with Multiple Sclerosis
Get PDFBackground: There are mixed reports on the effectiveness of strength training to improve gait performance in people with multiple sclerosis (MS), yet the reasons for these inconsistent results are not clear. Therefore, a critical review was conducted to explore dosage, frequency, mode, position, and muscle targets of studies that have included strength training in people with MS.
Methods: An electronic search was conducted through July 2017. Randomized controlled trials involving people with MS were included that implemented strength training with or without other interventions and assessed 1) strength in the lower extremities and/or trunk and 2) gait speed and/or endurance. Strength and gait results were extracted, along with exercise frequency, intensity, duration, mode, position, and muscle targets.
Results: Thirteen trials met the inclusion criteria; nine used dosing consistent with recommended guidelines. Overall, six studies reported significant between-group strength improvements, and four reported within-group changes. Four studies reported significant between-group gait improvements for gait speed and/or endurance, and two reported within-group changes. Most exercises were performed on exercise machines while sitting, supine, or prone. The most common intervention target was knee extension.
Conclusions: Studies generally improved strength, yet only two studies reported potentially meaningful between-group changes in gait. Future strength intervention studies designed to improve gait might consider dosing beyond that of the minimum intensity to improve strength and explore muscles targets, positions, and modes that are task-specific to walking.måsjekke
Feeling controlled or being in control? Apps for self-management among older people with neurological disability
Get PDFPurpose: The aim of this paper was to describe how people living with a neurological disability such as multiple sclerosis, Parkinson’s disease and stroke reason regarding using apps to facilitate self-management in everyday life.
Material and methods: A qualitative research approach with a focus group methodology was used. The sample comprised 16 participants, 11 men and 5 women, with an average age of 64 years (ranging from 51–80 years). Six participants were diagnosed with multiple sclerosis, six with Parkinson’s disease and four with stroke. Data were analyzed using thematic analysis, which is a method for identifying, analyzing and reporting patterns.
Results: The results formed two themes. The first theme “using apps to have control of my health” comprises two subthemes; “monitor and take responsibility for a healthy lifestyle” and “compensate to facilitate everyday life”. The second theme “using the app as a tool and means for communication” also comprised two subthemes; “dare to trust the app” and “feeling safe when sharing information with health care professionals”.
Conclusions: The use of apps put increased responsibility on the person and had the possibility to make them more involved in their own care. The use of an app can facilitate a healthy lifestyle and help to monitor disease-specific symptoms. In order to be able to use apps for communication with the health care sector legislation and safety issues need to be considered.
Implications for rehabilitation
Apps can be used for self-management if they are safe and can be trusted.
People with neurological disabilities want to be involved in their healthcare and needs to be addressed by health care professionals.
The use of apps grasp over a wide variety of areas this is something that may be considered in health care and something that can be addressed by interdisciplinary approaches.
Ordinary health-oriented apps and disease-specific apps were used differently and for different purposes
The Process of Exercise Participation in the Community for Functional Recovery Post Formal Rehabilitation among Survivors of Stroke: a grounded theory study
Get PDFThe effects of stroke pose a challenge on independence and community participation, which are common goals among survivors of stroke during recovery. Exercises are implemented during rehabilitation services and have a profound effect on functional recovery; however, services are limited, where adherence levels to exercise post discharge are less than ideal. The aim of this research was to understand the process of exercise participation for functional recovery among community living survivors of stroke following discharge from formal rehabilitation. Findings of this constructivist grounded theory study provided insight into the phases leading to exercise commitment – contact with a healthcare provider, desire to improve post stroke life, navigating options, and commitment to exercise. Further, the findings gave rise to key insights, which may foster healthcare providers and community services in promoting continued exercise participation among people living with the effects of stroke
Providing support for decision making to adults with intellectual disability: Perspectives of family members and workers in disability support services
Get PDFBackground: Supporting people with intellectual disability to make decisions is an important issue for policy implementation yet there is little evidence about the practice of providing support.
Method: This study aimed to understand the experiences of family members and disability support workers in providing support to adults with intellectual disability in Victoria, Australia. Twenty-three people drawn from these two groups participated in individual or focus group interviews.
Results: Three major themes emerged from inductive thematic analysis: their ideas about decision support, approaches to support, and challenges they faced. Overall these revolved around juggling rights, practicalities, and risks
Conclusions: This study identified some of the challenges and practical strategies for providing decision support that can be used to inform practice and capacity building resources for supporters
Recent advances in rehabilitation for Parkinson’s Disease with Exergames: A Systematic Review
Get PDFObjective
The goal of this contribution is to gather and to critically analyze recent evidence regarding the potential of exergaming for Parkinson’s disease (PD) rehabilitation and to provide an up-to-date analysis of the current state of studies on exergame-based therapy in PD patients.
Methods
We performed our search based on the conclusions of a previous systematic review published in 2014. Inclusion criteria were articles published in the indexed databases Pubmed, Scopus, Sciencedirect, IEEE and Cochrane published since January 1, 2014. Exclusion criteria were papers with a target group other than PD patients exclusively, or contributions not based on exergames. Sixty-four publications out of 525 matches were selected.
Results
The analysis of the 64 selected publications confirmed the putative improvement in motor skills suggested by the results of the previous review. The reliability and safety of both Microsoft Kinect and Wii Balance Board in the proposed scenarios was further confirmed by several recent studies. Clinical trials present better (n = 5) or similar (n = 3) results than control groups (traditional rehabilitation or regular exercise) in motor (TUG, BBS) and cognitive (attention, alertness, working memory, executive function), thus emphasizing the potential of exergames in PD. Pilot studies (n = 11) stated the safety and feasibility of both Microsoft Kinect and Wii Balance Board, potentially in home scenarios as well. Technical papers (n = 30) stated the reliability of balance and gait data captured by both devices. Related meta-analyses and systematic reviews (n = 15) further support these statements, generally citing the need for adaptation to patient’s skills and new input devices and sensors as identified gaps.
Conclusion
Recent evidence indicates exergame-based therapy has been widely proven to be feasible, safe, and at least as effective as traditional PD rehabilitation. Further insight into new sensors, best practices and different cognitive stadiums of PD (such as PD with Mild Cognitive Impairment), as well as task specificity, are required. Also, studies linking game parameters and results with traditional assessment methods, such as UPDRS scores, are required. Outcomes for randomized controlled trials (RCTs) should be standardized, and follow-up studies are required, particularly for motor outcomes
Realising ‘will, preferences and rights’: reconciling differences on best practice support for decisionmaking?
Get PDF‘Will, preferences and rights’ is the new guiding principle for all support for or exercise of decision-making under the Convention on Rights of Persons with Disabilities, but its meaning is disputed and practice implications are poorly understood. This article explores key debates across disciplines and draws on grounded theory fieldwork findings to bring greater clarity to the principle within law, policy and practice settings. It is argued that the principle calls for a nuanced understanding which cautions against expectations that mere enactment into law or adoption within programs of support will prove to be a panacea
Response heterogeneity in fitness, mobility and cognition with exercise‐training in MS
Get PDFBackground: Exercise‐training is a beneficial approach for improving function in per‐sons with multiple sclerosis (MS). However, it is unlikely that every participant who engages in an exercise‐training intervention will demonstrate similar benefits. Identifying factors that may influence the accrual of specific exercise‐training bene‐fits can aid in the development of optimized rehabilitation interventions for improv‐ing specific outcomes in MS.Objective: This study described possible response heterogeneity in physical fitness, mobility and cognitive outcomes with exercise‐training and identified baseline per‐formance, compliance and demographic/clinical outcomes as possible predictors of exercise‐related changes in those outcomes.Methods: Thirty‐two persons with MS‐related mobility disability completed 6‐months of multimodal exercise‐training. Physical fitness, mobility and cognitive pro‐cessing speed (CPS) were measured before and after the 6 months.Results: There was response heterogeneity in fitness, mobility and cognitive out‐comes with multimodal exercise‐training. Low baseline aerobic fitness, slow walking speed and slow CPS were associated with greater exercise‐related improvements in those respective outcomes.Conclusions: Those with MS‐related mobility disability who have the lowest aerobic fitness, walking speed and CPS might benefit the most from multimodal exercise‐training. This provides critical evidence for informing the development of a precision medicine framework for improving targeted outcomes with exercise‐training in MS.måsjekke
Forskning om koordinerte tjenester til personer med sammensatte behov. Kunnskapsnotat
Get PDFDenne kunnskapsstatusen har systematisert og oppsummert funn fra nyere forskning om koordinerte tjenestetilbud til personer med sammensatte behov i Norge.
Arbeidet har videre sett på hva som kjennetegner denne forskningen, og på hva som ses som de viktigste utfordringene og kunnskapsbehovene på området.
Vi ser for det første at hvordan koordinering og samhandling rettet mot personer med sammensatte behov for tjenester avgrenses, forstås og kommer til uttrykk i forskningen varierer, men finner generelt en forståelse som ligger nært opp til politiske begrep og reformer, og at forskningen ofte er innrettet mot å løse de velferdspolitiske målsetningene som er satt for områdene som utforskes. Det generelle bilde som tegnes i studiene er at koordinering og/eller samhandling er mangelfull, både mellom ulike tjenester og også nivå, og at tjenestene som ytes ikke henger godt nok sammen.
Vi finner en stor overvekt av studier som tar utgangspunkt i tjenesteyteres erfaringer med samhandling, studert gjennom kvalitative intervjustudier. Samtidig finner vi at stemmene til brukerne i mindre grad har vært fokus for undersøkelser rundt samhandling og koordinering av tjenester. Samlet sett er en stor del av forskningsbidragene publisert internasjonalt, og mange av disse befinner seg i tidsskrift som er relativt høyt rangert internasjonalt. Vi konkluderer gjennomgangen med at det er behov for mer forskning som gir tilgang til kunnskap om hvordan samhandling og koordinering faktisk foregår, hvilke problemer og hindringer som eksisterer, når og i hvilke situasjoner de oppstår, for på den måte å kunne utvikle kunnskap også om hvorfor ting ikke fungerer
Impact of virtual reality-based rehabilitation on functional outcomes in patients with acute stroke: a retrospective case-matched study
Get PDFBackground and objectives
To date, the efficacy of the virtual reality (VR) application for acute stroke compared with conventional therapy (CT) remains unclear. This retrospective study aims to assess the impact of adjuvant VR technology on multidimensional therapy for patients with acute-stage stroke.
Methods
100 acute ischemic stroke patients with onset within 7 days who underwent combined adjuvant VR-based rehabilitation program and CT (intervention group–VR + CT) were compared to an equal number of cross-matched patients who received CT alone. While the intervention group received 40-min CT plus 20-min VR program (seven times for 1 week), the comparison group received time-matched CT alone. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), medical cost-effectiveness, and shortening of hospital stay were used as outcome measures.
Results
Posttreatment, the VR + CT group revealed significantly improved NIHSS and mRS (P < 0.001), whereas only the mRS improvement was remarkable in the CT group. In between-group comparisons, the intervention group had better improvements of symptom severity (NIHSS percentage improvement from the baseline; 20.18% vs. 4.59%, P < 0.005), functional outcomes (mRS improvement from the baseline; − 0.58 vs. − 0.23, P < 0.001), and reduced medical cost (Taiwan dollar; 49474 vs. 66306, P < 0.005). Furthermore, the VR + CT group reached markedly higher proportion of functional independence in activities of daily living (mRS, 0–2) at discharge compared with the CT group (68% vs. 60%, P < 0.001).
Conclusions
This study suggests that the combination of VR-based rehabilitation and traditional therapy could be more effective for neurorehabilitation than CT alone in the early improvement of symptom severity, functional outcomes, and lower medical expenditure in acute stroke patients.måsjekke