1,720,976 research outputs found
Interdisciplinary approach of arm-hand rehabilitation in cervical spinal cord injury: therapists' perspectives
No full textBackground
Rehabilitation improves arm-hand functioning in people with a cervical spinal cord injury (pwC-SCI), yet optimal training remains undefined in the literature. Therapists' practice-based evidence insights enhance clinical interventions.
Objectives
To explore the therapists' perspectives on the best practice of arm-hand function rehabilitation for pwC-SCI.
Methods
In this quantitative study with an exploratory approach, three focus groups were undertaken involving seven physiotherapists and seven occupational therapists, each with a minimum of two years of experience in spinal cord rehabilitation in Belgium or the Netherlands. The analysis employed an inductive thematic analysis.
Results
The study revealed six themes: person and client system, motivation, goals, analysis, training, and interdisciplinary approach. Therapists highlight the importance of a personalized rehabilitation plan, focusing on the person's diverse aspects and the role of the entire client system. Therapists emphasize the crucial role of a person's motivation in training. An ongoing analysis of the person and the client system, motivation, goals, and training is necessary to develop an individualized training. A personalized rehabilitation plan requires interdisciplinary collaboration.
Conclusion
Based on practice-based evidence, arm-hand rehabilitation should incorporate a continuously adjusted, individualized plan with a central focus on the person and his client system.
Keywords: spinal cord injury, practice-based evidence, therapist's perspective
Training variables crucial to optimize arm/hand training in subacute cervical spinal cord injury
No full textObjectives and main message of presentation
The project aims to identify crucial training components of arm-hand training in people with cervical spinal cord injury (pwC-SCI) in order to develop an arm-hand training framework guiding therapists to improved clinical practice.
Background and aim
Motor training may enhance arm-hand functioning in pwC-SCI. While the literature recommends task-specific motor training with a certain dose, the optimal training variables, motor training strategies, and dosages remain unknown.
Method
This study presents a multi-phase approach to optimize arm/hand training for pwC-SCI by developing a framework. (1) A systematic literature review to assess motor training strategies and dosages employed in active arm-hand motor training. (2) A longitudinal observational study across three rehabilitation centers in Belgium and the Netherlands to observe motor training strategies and therapy dosages in usual active arm-hand training. (3) Three focus groups comprising experienced therapists from the aforementioned rehabilitation centers to capture practice-based evidence and identify needs to optimize arm/hand training.
Results
The systematic review revealed that enhancing arm-hand functioning at the activity level can be achieved through skill training involving at least 8 task-oriented training components and additional strength and endurance training, with a minimum training duration of 8 weeks. On the contrary, the observational study demonstrates that motor training strategies are distributed as follows: 31% skill training, 25.9% strength training, and 6.3% endurance training, with the remainder 36.8% dedicated to analytical training. Actual session length fulfills 75% of the planned duration; within arm-hand training session length 56.3% comprises active training. Patients reported a mean subjective difficulty level of 4.1/10 and a mean perceived intensity of 4/10. Focus groups ass the importance of the centrality of the person, his motivational aspects, and the client system in the rehabilitation. Therapists want to individualize the training based on the continued analysis of the person, therapy, and goals within a multidisciplinary approach. However, it is challenging for therapists to individualize therapy doses.
Discussion
Conventional arm/hand rehabilitation in pwC-SCI does not align with the literature's recommendations on motor training strategies and therapy dose. Therapists call for individualized rehabilitation programs but struggle with dosing customization. Therefore, we propose and assess a framework for arm/hand training incorporating the crucial training variables
Interdisciplinary approach of arm-hand rehabilitation in cervical spinal cord injury: therapists' perspectives
No full textBackground
Rehabilitation improves arm-hand functioning in people with a cervical spinal cord injury (pwC-SCI), yet optimal training remains undefined in the literature. Therapists' practice-based evidence insights enhance clinical interventions.
Objectives
To explore the therapists' perspectives on the best practice of arm-hand function rehabilitation for pwC-SCI.
Methods
In this quantitative study with an exploratory approach, three focus groups were undertaken involving seven physiotherapists and seven occupational therapists, each with a minimum of two years of experience in spinal cord rehabilitation in Belgium or the Netherlands. The analysis employed an inductive thematic analysis.
Results
The study revealed six themes: person and client system, motivation, goals, analysis, training, and interdisciplinary approach. Therapists highlight the importance of a personalized rehabilitation plan, focusing on the person's diverse aspects and the role of the entire client system. Therapists emphasize the crucial role of a person's motivation in training. An ongoing analysis of the person and the client system, motivation, goals, and training is necessary to develop an individualized training. A personalized rehabilitation plan requires interdisciplinary collaboration.
Conclusion
Based on practice-based evidence, arm-hand rehabilitation should incorporate a continuously adjusted, individualized plan with a central focus on the person and his client system.
Keywords: spinal cord injury, practice-based evidence, therapist's perspective
Training variables to optimize arm/hand training in subacute cervical spinal cord injury
No full textBackground
Motor training may enhance arm-hand functioning in people with cervical spinal cord injury (pwC-SCI), but the optimal training variables remain unknown.
Objectives
To identify crucial training variables of arm-hand training in pwC-SCI.
Method
This project optimizes arm-hand training for pwC-SCI through (1) a systematic review evaluating motor training strategies and dosages, (2) a multi-center longitudinal observation study examining motor training strategies and therapy dosages in usual care, and (3) focus groups with experienced therapists capturing practice-based evidence.
Results
Literature suggests enhancing arm-hand function with skill training involving at least 8 task-oriented training components and additional strength and endurance training over a minimum of 8 weeks. Contrarily, the observation study revealed that 31% of the time is allocated to skill training, 32.2% to strength and endurance training, and the remaining 36.8% to analytical training. Active training constitutes 56.3% of the total time, with patients reporting a mean subjective difficulty of 4.1/10 and a mean perceived intensity of 4/10. Focus groups emphasize the importance of individualized training through ongoing analysis of the person, therapy, and goals within a multidisciplinary approach.
Discussion
Conventional arm/hand rehabilitation for pwC-SCI diverges from literature recommendations. Therapists call for individualized rehabilitation programs but struggle with dosing
Evidence-based framework to optimize active upper limb motor training in subacute cervical spinal cord injury
No full textIntroduction
Motor training may enhance upper limb (UL) functioning in people with cervical spinal cord injury. While the literature recommends task-specific motor training with a certain dose, in clinical practice, the use of specific training variables, such as motor training strategies and dosages, to optimize UL training is unclear. This project aims to develop a framework for arm-hand training incorporating crucial training variables to guide therapists to improved clinical practice.
Methods
The framework is established using a multiphase and multidimensional approach to gather evidence. (1) A systematic literature review to assess motor training strategies and dosages utilized in active UL motor training. (2) A longitudinal observational study across three rehabilitation centers in Belgium and the Netherlands to observe motor training strategies and therapy dosages in usual UL training. (3) A qualitative study with three focus groups comprising experienced therapists from the aforementioned rehabilitation centers to capture practice-based evidence and identify needs to optimize UL training.
Results
Within the framework, a four-phase approach is proposed consisting of 1) gathering knowledge about the person and the client system, which is needed for 2) the process of thinking in which a goal-setting process leads to a patient-tailored therapy plan; 3) the process of acting by providing the goal and task-oriented therapy content and individualized therapy dose; and 4) providing practice beyond therapy. This individualized training approach aims to enhance persons' motivation and the execution of the relearned UL activities beyond therapy.
Concerning the intervention, the systematic review and focus groups revealed that the content should include skill training incorporating task-oriented training components with additional strength and endurance training. Although therapists indicated the importance of task-oriented training, this was not seen yet in clinical practice, where observations revealed that analytical training (62,5%) is most used, followed by skill training (52.5%), strength training (42.9%) and endurance training (10.8%) and only three task-oriented training components, i.e., functional movements, exercise variety, and multiple movement planes are employed over 50% of the sessions.
About therapy dose, the results of the systematic review indicated a minimum of eight weeks of training to enhance UL functioning; information on other dose dimensions was not available.
While therapists stress the need for personalized training doses, the observation study found that therapists tend to overestimate the active therapy time, difficulty, and intensity of the training. Patients scored the dose elements relatively low. Therapists ask for guidance in applying customized motor training strategies and therapy doses into individualized UL therapy.
A personalized goal-oriented approach is advised to improve patients' motivation, leading to enhanced rehabilitation engagement. Participating in meaningful tasks during therapy leads to executing these tasks beyond therapy, increasing the therapy dose, and optimizing functional outcomes.
Conclusions
The proposed UL framework, employing a multi-methodological approach, outlines a highly individualized approach. It involves four phases, where the personalized goal-setting process leads toward goal-and-task-oriented interventions using individualized motor training strategies and therapy doses. Therapists need guidance in the application of the different essential training variables. Therefore, clinical practice tools will be developed based on this framework
Evidence-based framework to optimize active upper limb motor training in subacute cervical spinal cord injury
No full textIntroduction
Motor training may enhance upper limb (UL) functioning in people with cervical spinal cord injury. While the literature recommends task-specific motor training with a certain dose, in clinical practice, the use of specific training variables, such as motor training strategies and dosages, to optimize UL training is unclear. This project aims to develop a framework for arm-hand training incorporating crucial training variables to guide therapists to improved clinical practice.
Methods
The framework is established using a multiphase and multidimensional approach to gather evidence. (1) A systematic literature review to assess motor training strategies and dosages utilized in active UL motor training. (2) A longitudinal observational study across three rehabilitation centers in Belgium and the Netherlands to observe motor training strategies and therapy dosages in usual UL training. (3) A qualitative study with three focus groups comprising experienced therapists from the aforementioned rehabilitation centers to capture practice-based evidence and identify needs to optimize UL training.
Results
Within the framework, a four-phase approach is proposed consisting of 1) gathering knowledge about the person and the client system, which is needed for 2) the process of thinking in which a goal-setting process leads to a patient-tailored therapy plan; 3) the process of acting by providing the goal and task-oriented therapy content and individualized therapy dose; and 4) providing practice beyond therapy. This individualized training approach aims to enhance persons' motivation and the execution of the relearned UL activities beyond therapy.
Concerning the intervention, the systematic review and focus groups revealed that the content should include skill training incorporating task-oriented training components with additional strength and endurance training. Although therapists indicated the importance of task-oriented training, this was not seen yet in clinical practice, where observations revealed that analytical training (62,5%) is most used, followed by skill training (52.5%), strength training (42.9%) and endurance training (10.8%) and only three task-oriented training components, i.e., functional movements, exercise variety, and multiple movement planes are employed over 50% of the sessions.
About therapy dose, the results of the systematic review indicated a minimum of eight weeks of training to enhance UL functioning; information on other dose dimensions was not available.
While therapists stress the need for personalized training doses, the observation study found that therapists tend to overestimate the active therapy time, difficulty, and intensity of the training. Patients scored the dose elements relatively low. Therapists ask for guidance in applying customized motor training strategies and therapy doses into individualized UL therapy.
A personalized goal-oriented approach is advised to improve patients' motivation, leading to enhanced rehabilitation engagement. Participating in meaningful tasks during therapy leads to executing these tasks beyond therapy, increasing the therapy dose, and optimizing functional outcomes.
Conclusions
The proposed UL framework, employing a multi-methodological approach, outlines a highly individualized approach. It involves four phases, where the personalized goal-setting process leads toward goal-and-task-oriented interventions using individualized motor training strategies and therapy doses. Therapists need guidance in the application of the different essential training variables. Therefore, clinical practice tools will be developed based on this framework
The use of patient-reported outcome measures during the day and in the evening to capture therapy dose dimensions in the active upper limb rehabilitation in subacute cervical spinal cord injury
No full textIntroduction
Rehabilitation improves arm-hand functioning in people with a cervical spinal cord injury (pwC-SCI); however, the optimal training dose is unknown. Therapists indicate the necessity of individualized therapy but lack the tools to capture the therapy dose. Patient-reported outcome measures after therapy sessions, as well as in the evening, might support therapists in evaluating individual therapy load. This study aims to (1) investigate the association between the perceived therapy dose during the therapy session and in the evening, as reported by the patient, and (2) investigate the association between the difficulty of the session and the general and physical fatigue, as reported by the patient.
Methods
A longitudinal observation study executed in three rehabilitation centers (in Belgium and the Netherlands) included pwC-SCI (i.e., lesions ranging from C1 to Th1 and AIS A-D and between 4-8 post-injury weeks at inclusion). Participants conducted a self-reported questionnaire before and after every active UL training session to rate the therapy dose dimensions, general fatigue, physical fatigue (as an indicator for the dose dimension' perceived intensity'), session difficulty (as the dose dimension perceived difficulty), and additional pain on a visual analogue scale from 0 to 10. A mean score of the different sessions during the day was calculated. Furthermore, an end-of-day questionnaire was administered in the evening, questioning the day's average general and physical fatigue and pain. These questionnaires were completed three days a week over three distinct weeks, with eight-week intervals during rehabilitation. Patient characteristics and dose dimensions were reported in means (M) and standard deviations (SD). Associations were calculated with Spearman's Rho.
Results
Data from 85 questionnaires during the day and 85 questionnaires in the evenings were analyzed involving 13 participants, all males (AIS B-D, C1-5, mean age 54.4 years (SD 12.9), mean time post-injury at inclusion 6.7 weeks (SD 1.8)). General and physical fatigue during the day (M=3.4; SD=1.3 and M=3.5; SD=1.4 respectively) shows a significant moderate (r=0.51; p<0.001 and r=0.65; p<0.001 respectively) correlation with these scores reported in the evening (M=4.7; SD=1.8 and M=4.1; SD=1.8). Pain during the day (M=2; SD=1) shows a significant but low correlation (r=0.44; p<0.001) with the pain scores reported in the evening (M=2.9; SD=1.4). Difficulty scores during the day (M=4.3; SD=1.6) show a significant low correlation with general (r=0.37; p<0.05) and physical fatigue (r=0.44; p<.001) in the evening. Difficulty scores during the day demonstrate a significant moderate correlation with general (r=0.58; p<.001) and physical (r=0.59; p<.001) fatigue during the day.
Conclusion
The moderate association between general and physical fatigue during the day and evening might indicate that end-of-day questionnaires can be used to estimate the dose dimension 'perceived intensity' in general. The perceived difficulty of a session is linked with the perceived general and physical fatigue during the day. As the correlation between pain after the session and in the evening is low, it is advised to ask about pain during the day
Training variables to optimize arm/hand training in subacute cervical spinal cord injury
No full textBackground
Motor training may enhance arm-hand functioning in people with cervical spinal cord injury (pwC-SCI), but the optimal training variables remain unknown.
Objectives
To identify crucial training variables of arm-hand training in pwC-SCI.
Method
This project optimizes arm-hand training for pwC-SCI through (1) a systematic review evaluating motor training strategies and dosages, (2) a multi-center longitudinal observation study examining motor training strategies and therapy dosages in usual care, and (3) focus groups with experienced therapists capturing practice-based evidence.
Results
Literature suggests enhancing arm-hand function with skill training involving at least 8 task-oriented training components and additional strength and endurance training over a minimum of 8 weeks. Contrarily, the observation study revealed that 31% of the time is allocated to skill training, 32.2% to strength and endurance training, and the remaining 36.8% to analytical training. Active training constitutes 56.3% of the total time, with patients reporting a mean subjective difficulty of 4.1/10 and a mean perceived intensity of 4/10. Focus groups emphasize the importance of individualized training through ongoing analysis of the person, therapy, and goals within a multidisciplinary approach.
Discussion
Conventional arm/hand rehabilitation for pwC-SCI diverges from literature recommendations. Therapists call for individualized rehabilitation programs but struggle with dosing
Essential training variables of arm-hand training in people with cervical spinal cord injury: a systematic review
No full textCan therapists estimate therapy dose dimensions? A comparison between patient, therapist, and objective outcomes in (sub)acute rehabilitation
No full textIntroduction
Arm-hand training at an intensive and individualized dosage potentially provides a powerful stimulus for neurological recovery. The current dosage is based on therapists' experience and subjective feelings, which might differ from patients' perceived dosage.
Main objective
To assess differences in therapy dose dimensions (TDD) between patients' and therapists' perceptions and between therapists' perceptions and objective measured TDD in (sub)acute arm-hand therapy in PwC-SCI.
Methods
In this longitudinal observational study in 3 rehabilitation centers, PwC-SCI and their therapists estimated TDD difficulty and intensity of arm-hand therapy using a VAS. Active minutes within a session were estimated by the therapist and objectively measured using video recordings of the therapy. Measurements were taken during 3 weeks between 4-24 weeks post-injury, with an interval of 8 weeks, during 3 days per week. Paired sample T-test was used to assess differences.
Result and discussion
The ongoing study measured 73 arm-hand sessions, including 8 patients (lesion C1-C5, mean age of 56.13 years SD(12.11) and mean post-injury weeks 7.5 SD(1.6) at inclusion) and 16 therapists (mean experience of 11.7 years SD(9.22)). Therapists estimated the difficulty (M(4.89);SD(2.08)) and intensity (M(4.97); SD(2.19)) significantly higher (p<0.005) than perceived difficulty (M(4.03); SD(2.43)) and intensity (M(3.66); SD(2.26)) by the patients. Fifty sessions (mean session length 40’03’’; SD(25’12’’)) were included for estimating active time. Therapists estimated the active time (M(29’44’’); SD(20’30’’)) significantly higher (p=0.003) than objectively measured (M(23’22’’);SD(12’21’’)).
Conclusion
These preliminary results indicate that therapists overestimate all TDD compared to patient perception and objective measurement
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