Handmade Task Tracking Applied to Cognitive Rehabilitation

This article presents research focused on tracking manual tasks that are applied in cognitive rehabilitation so as to analyze the movements of patients who suffer from Apraxia and Action Disorganization Syndrome (AADS). This kind of patients find executing Activities of Daily Living (ADL) too difficult due to the loss of memory and capacity to carry out sequential tasks or the impossibility of associating different objects with their functions. This contribution is developed from the work of Universidad Politécnica de Madrid and Technical University of Munich in collaboration with The University of Birmingham. The KinectTM for Windows© device is used for this purpose. The data collected is compared to an ultrasonic motion capture system. The results indicate a moderate to strong correlation between signals. They also verify that KinectTM is very suitable and inexpensive. Moreover, it turns out to be a motion-capture system quite easy to implement for kinematics analysis in ADL.

Cognitive neurorehabilitation based on interactive video technology

Cognitive impairment is the main cause of disability in developed societies. New interactive technologies help therapists in neurorehabilitation in order to increase patients’ autonomy and quality of life. This work proposes Interactive Video (IV) as a technology to develop cognitive rehabilitation tasks based on Activities of Daily Living (ADL). ADL cognitive task has been developed and integrated with eye-tracking technology for task interaction and patients’ performance monitoring.

Modelado y Evaluación de Entornos Virtuales Interactivos para Rehabilitación Cognitiva en Daño Cerebral

El Daño Cerebral (DC) se refiere a cualquier lesión producida en el cerebro y que afecta a su funcionalidad. Se ha convertido en una de las principales causas de discapacidad neurológica de las sociedades desarrolladas. Hasta la más sencilla de las actividades y acciones que realizamos en nuestro día a día involucran a los procesos cognitivos. Por ello, la alteración de las funciones cognitivas como consecuencia del DC, limita no sólo la calidad de vida del paciente sino también la de las persona de su entorno. La rehabilitación cognitiva trata de aumentar la autonomía y calidad de vida del paciente minimizando o compensando los desórdenes funciones causados por el episodio de DC. La plasticidad cerebral es una propiedad intrínseca al sistema nervioso humano por la que en función a la experiencia se crean nuevos patrones de conectividad. El propósito de la neurorrehabilitación es precisamente modular esta propiedad intrínseca a partir de ejercicios específicos, los cuales podrían derivar en la recuperación parcial o total de las funciones afectadas. La incorporación de la tecnología a las terapias de rehabilitación ha permitido desarrollar nuevas metodologías de trabajo. Esto ha ayudado a hacer frente a las dificultades de la rehabilitación que los procesos tradicionales no logran abarcar. A pesar del gran avance realizado en los Ãoltimos años, todavía existen debilidades en el proceso de rehabilitación; por ejemplo, la trasferencia a la vida real de las habilidades logradas durante la terapia de rehabilitación, así como su generalización a otras actividades cotidianas. Los entornos virtuales pueden reproducir situaciones cotidianas. Permiten simular, de forma controlada, los requisitos conductuales que encontramos en la vida real. En un contexto terapéutico, puede ser utilizado por el neuropsicólogo para corregir en el paciente comportamientos patológicos no deseados, realizar intervenciones terapéuticas sobre Actividades de Vida Diaria que estimulen conductas adaptativas. A pesar de que las tecnologías actuales tienen potencial suficiente para aportar nuevos beneficios al proceso de rehabilitación, existe cierta reticencia a su incorporación a la clínica diaria. A día de hoy, no se ha podido demostrar que su uso aporte una mejorar significativa con respecto a otro tipo de intervención; en otras palabras, no existe evidencia científica de la eficacia del uso de entornos virtuales interactivos en rehabilitación. En este contexto, la presente Tesis Doctoral trata de abordar los aspectos que mantienen a los entornos virtuales interactivos al margen de la rutina clínica diaria. Se estudian las diferentes etapas del proceso de rehabilitación cognitiva relacionado con la integración y uso de estos entornos: diseño de las actividades, su implementación en el entorno virtual, y finalmente la ejecución por el paciente y análisis de los respectivos datos. Por tanto, los bloques en los que queda dividido el trabajo de investigación expuesto en esta memoria son: 1. Diseño de las AVD. La definición y configuración de los elementos que componen la AVD permite al terapeuta diseñar estrategias de intervención terapéutica para actuar sobre el comportamiento del paciente durante la ejecución de la actividad. En esta parte de la tesis se pretende formalizar el diseño de las AVD de tal forma que el terapeuta pueda explotar el potencial tecnológico de los entornos virtuales interactivos abstrayéndose de la complejidad implícita a la tecnología. Para hacer viable este planteamiento se propone una metodología que permita modelar la definición de las AVD, representar el conocimiento implícito en ellas, y asistir al neuropsicólogo durante el proceso de diseño de la intervención clínica. 2. Entorno virtual interactivo. El gran avance tecnológico producido durante los Ãoltimos años permite reproducir AVD interactivas en un contexto de uso clínico. El objetivo perseguido en esta parte de la Tesis es el de extraer las características potenciales de esta solución tecnológica y aplicarla a las necesidades y requisitos de la rehabilitación cognitiva. Se propone el uso de la tecnología de Vídeo Interactivo para el desarrollo de estos entornos virtuales. Para la evaluación de la misma se realiza un estudio experimental dividido en dos fases con la participación de sujetos sanos y pacientes, donde se valora su idoneidad para ser utilizado en terapias de rehabilitación cognitiva. 3. Monitorización de las AVD. El uso de estos entornos virtuales interactivos expone al paciente ante una gran cantidad de estímulos e interacciones. Este hecho requiere de instrumentos de monitorización avanzado que aporten al terapeuta información objetiva sobre el comportamiento del paciente, lo que le podría permitir por ejemplo evaluar la eficacia del tratamiento. En este apartado se propone el uso de métricas basadas en la atención visual y la interacción con el entorno para conocer datos sobre el comportamiento del paciente durante la AVD. Se desarrolla un sistema de monitorización integrado con el entorno virtual que ofrece los instrumentos necesarios para la evaluación de estas métricas para su uso clínico. La metodología propuesta ha permitido diseñar una AVD basada en la definición de intervenciones terapéuticas. Posteriormente esta AVD has sido implementada mediante la tecnología de vídeo interactivo, creando así el prototipo de un entorno virtual para ser utilizado por pacientes con déficit cognitivo. Los resultados del estudio experimental mediante el cual ha sido evaluado demuestran la robustez y usabilidad del sistema, así como su capacidad para intervenir sobre el comportamiento del paciente. El sistema monitorización que ha sido integrado con el entorno virtual aporta datos objetivos sobre el comportamiento del paciente durante la ejecución de la actividad. Los resultados obtenidos permiten contrastar las hipótesis de investigación planteadas en la Tesis Doctoral, aportando soluciones que pueden ayudar a la integración de los entornos virtuales interactivos en la rutina clínica. Esto abre una nueva vía de investigación y desarrollo que podría suponer un gran progreso y mejora en los procesos de neurorrehabilitación cognitiva en daño cerebral. ABSTRACT Brain injury (BI) refers to medical conditions that occur in the brain, altering its function. It becomes one of the main neurological disabilities in the developed society. Cognitive processes determine individual performance in Activities of Daily Living (ADL), thus, the cognitive disorders after BI result in a loss of autonomy and independence, affecting the patient’s quality of life. Cognitive rehabilitation seeks to increase patients’ autonomy and quality of life minimizing or compensating functional disorders showed by BI patients. Brain plasticity is an intrinsic property of the human nervous system whereby its structure is changed depending on experience. Neurorehabilitation pursuits a precise modulation of this intrinsic property, based on specific exercises to induce functional changes, which could result in partial or total recovery of the affected functions. The new methodologies that can be approached by applying technologies to the rehabilitation process, permit to deal with the difficulties which are out of the scope of the traditional rehabilitation. Despite this huge breakthrough, there are still weaknesses in the rehabilitation process, such as the transferring to the real life those skills reached along the therapy, and its generalization to others daily activities. Virtual environments reproduce daily situations. Behavioural requirements which are similar to those we perceive in real life, are simulated in a controlled way. In these virtual environments the therapist is allowed to interact with patients without even being present, inhibiting unsuitable behaviour patterns, stimulating correct answers throughout the simulation and enhancing stimuli with supplementary information when necessary. Despite the benefits which could be brought to the cognitive rehabilitation by applying the potential of the current technologies, there are barriers for widespread use of interactive virtual environments in clinical routine. At present, the evidence that these technologies bring a significant improvement to the cognitive therapies is limited. In other words, there is no evidence about the efficacy of using virtual environments in rehabilitation. In this context, this work aims to address those issues which keep the virtual environments out of the clinical routine. The stages of the cognitive rehabilitation process, which are related with the use and integration of these environments, are analysed: activities design, its implementation in the virtual environment, and the patient’s performance and the data analysis. Hence, the thesis is comprised of the main chapters that are listed below: 1. ADL Design.Definition and configuration of the elements which comprise the ADL allow the therapist to design intervention strategies to influence over the patient behaviour along the activity performance. This chapter aims to formalise the AVD design in order to help neuropsychologists to make use of the interactive virtual environments’ potential but isolating them from the complexity of the technology. With this purpose a new methodology is proposed as an instrument to model the ADL definition, to manage its implied knowledge and to assist the clinician along the design process of the therapeutic intervention. 2. Interactive virtual environment. Continuous advancements make the technology feasible for re-creating rehabilitation therapies based on ADL. The goal of this stage is to analyse the main features of virtual environments in order to apply them according to the cognitive rehabilitation’s requirements. The interactive video is proposed as the technology to develop virtual environments. Experimental study is carried out to assess the suitability of the interactive video to be used by cognitive rehabilitation. 3. ADL monitoring system. This kind of virtual environments bring patients in front lots of stimuli and interactions. Thus, advanced monitoring instruments are needed to provide therapist with objective information about patient’s behaviour. This thesis chapter propose the use of metrics rely on visual patients’ visual attention and their interactions with the environment. A monitoring system has been developed and integrated with the interactive video-based virtual environment, providing neuropsychologist with the instruments to evaluate the clinical force of this metrics. Therapeutic interventions-based ADL has been designed by using the proposed methodology. Interactive video technology has been used to develop the ADL, resulting in a virtual environment prototype to be use by patients who suffer a cognitive deficits. An experimental study has been performed to evaluate the virtual environment, whose overcomes show the usability and solidity of the system, and also its capacity to have influence over patient’s behaviour. The monitoring system, which has been embedded in the virtual environment, provides objective information about patients’ behaviour along their activity performance. Research hypothesis of the Thesis are proven by the obtained results. They could help to incorporate the interactive virtual environments in the clinical routine. This may be a significant step forward to enhance the cognitive neurorehabilitation processes in brain injury.

Qualidade do sono, atividade física e funcionamento físico de pessoas idosas independentes

O objetivo deste estudo foi analisar associações entre a qualidade do sono, a atividade física e o funcionamento físico (aptidão física e atividades da vida diária (AVD)) de pessoas idosas independentes. Metodologia: A amostra incluiu 437 pessoas idosas independentes (143 homens e 294 mulheres; 65-103 anos). A qualidade do sono e as AVD foram avaliadas através de questionário, a atividade física através de acelerometria e a aptidão física através do Senior Fitness Test. Resultados: A análise da regressão logística tendo como variável dependente a qualidade do sono e como variáveis independentes a atividade física, a aptidão física e as AVD, revelou que as AVD foi a única variável explicativa da discriminação entre má e boa qualidade do sono. O aumento de um ponto nas AVD correspondeu a uma diminuição de 91,4% na probabilidade de ter uma má qualidade de sono. Os resultados não foram alterados quando se incluiu no modelo o género, a idade ou o escalão etário. Conclusões: Um melhor funcionamento físico parece estar associado a uma melhor qualidade do sono em pessoas idosas. A obtenção de 19 pontos nas AVD revelou ser discriminatória da qualidade do sono de pessoas idosas.

Energy expenditure during daily activities as measured by two motion sensors in patients with COPD

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Objective metrics for functional evaluation of upper limb during the ADL of drinking: application in SCI

Three-dimensional kinematic analysis provides quantitative assessment of upper limb motion and is used as an outcome measure to evaluate movement disorders. The aim of the present study is to present a set of kinematic metrics for quantifying characteristics of movement performance and the functional status of the subject during the execution of the activity of daily living (ADL) of drinking from a glass. Then, the objective is to apply these metrics in healthy people and a population with cervical spinal cord injury (SCI), and to analyze the metrics ability to discriminate between healthy and pathologic people. 19 people participated in the study: 7 subjects with metameric level C6 tetraplegia, 4 subjects with metameric level C7 tetraplegia and 8 healthy subjects. The movement was recorded with a photogrammetry system. The ADL of drinking was divided into a series of clearly identifiable phases to facilitate analysis. Metrics describing the time of the reaching phase, the range of motion of the joints analyzed, and characteristics of movement performance such as the efficiency, accuracy and smoothness of the distal segment and inter-joint coordination were obtained. The performance of the drinking task was more variable in people with SCI compared to the control group in relation to the metrics measured. Reaching time was longer in SCI groups. The proposed metrics showed capability to discriminate between healthy and pathologic people. Relative deficits in efficiency were larger in SCI people than in controls. These metrics can provide useful information in a clinical setting about the quality of the movement performed by healthy and SCI people during functional activities.

Measurement and correlates of caregiver self-efficacy amongst family caregivers of persons with dementia living in Shanghai, China

Background: Caring for family members with dementia can be a long-term, burdensome task resulting in physical and emotional distress and impairment. Research has demonstrated significantly lower levels of selfefficacy among family caregivers of people with dementia (CGs) than caregivers of relatives with non-dementia diseases. Intervention studies have also suggested that the mental and physical health of dementia CGs could be improved through the enhancement of their self-efficacy. However, studies are limited in terms of the influences of caregiver self-efficacy on caregiver behaviour, subjective burden and health-related quality of life. Of particular note is that there are no studies on the applicability of caregiver self-efficacy in the social context of China. Objective: The purpose of this thesis was to undertake theoretical exploration using Bandura’s (1997) self-efficacy theory to 1) revise the Revised Caregiving Self-Efficacy Scale (C-RCSES) (Steffen, McKibbin, Zeiss, Gallagher-Thompson, & Bandura, 2002), and 2) explore determinants of caregiver self-efficacy and the role of caregiver self-efficacy and other conceptual constructs (including CGs’ socio-demographic characteristics, CRs’ impairment and CGs’ social support) in explaining and predicting caregiver behaviour, subjective burden and health-related quality of life among CGs in China. Methodology: Two studies were undertaken: a qualitative elicitation study with 10 CGs; and a cross-sectional survey with 196 CGs. In the first study, semi-structured interviews were conducted to explore caregiver behaviours and corresponding challenges for their performance. The findings of the study assisted in the development of the initial items and domains of the Chinese version of the Revised Caregiving Self-Efficacy Scale (C-RCSES). Following changes to items in the scale, the second study, a cross-sectional survey with 196 CGs was conducted to evaluate the psychometric properties of C-RCSES and to test a hypothesised self-efficacy model of family caregiving adapted from Bandura’s theory (1997). Results: 35 items were generated from the qualitative data. The content validity of the C-RCSES was assessed and ensured in Study One before being used for the cross-sectional survey. Eight items were removed and five subscales (caregiver self-efficacy for gathering information about treatment, symptoms and health care; obtaining support; responding to problematic behaviours; management of household, personal and medical care; and controlling upsetting thoughts about caregiving) were identified after principal component factor analysis on the cross-sectional survey data. The reliability of the scale is acceptable: the Cronbach’s alpha coefficients for the whole scale and for each subscale were all over .80; and the fourweek test-retest reliabilities for the whole scale and for each subscale ranged from .64 to .85. The concurrent, convergent and divergent validity were also acceptable. CGs reported moderate levels of caregiver self-efficacy. Furthermore, the level of self-efficacy for management of household, personal and medical care was relatively high in comparison to those of the other four domains of caregiver self-efficacy. Caregiver self-efficacy was also significantly influenced by CGs’ socio-demographic characteristics and the caregiving external factors (CR impairment and social support that CGs obtained). The level of caregiver behaviour that CGs reported was higher than that reported in other Chinese research. CGs’ socio-demographics significantly influenced caregiver behaviour, whereas caregiver self-efficacy did not influence caregiver behaviour. Regarding the two external factors, CGs who cared for highly impaired relatives reported high levels of caregiver behaviour, but social support did not influence caregiver behaviour. Regarding caregiver subjective burden and health-related quality of life, CGs reported moderate levels of subjective burden, and their level of healthrelated quality of life was significantly lower than that of the general population in China. The findings also indicated that CGs’ subjective burden and health-related quality of life were influenced by all major factors in the hypothesised model, including CGs’ socio-demographics, CRs’ impairment, social support that CGs obtained, caregiver self-efficacy and caregiver behaviour. Of these factors, caregiver self-efficacy and social support significantly improved their subjective burden and health-related quality of life; whereas caregiver behaviour and CRs’ impairment were detrimental to CGs, such as increasing subjective burden and worsening health-related quality of life. Conclusion: While requiring further exploration, the qualitative study was the first qualitative research conducted in China to provide an in-depth understanding of CGs’ caregiving experience, including their major caregiver behaviours and the corresponding challenges. Meanwhile, although the C-RCSES needs further psychometric testing, it is a useful tool for assessing caregiver self-efficacy in Chinese populations. Results of the qualitative and quantitative study provide useful information for future studies regarding the explanatory power of caregiver self-efficacy to caregiver behaviour, subjective burden and health-related quality of life. Additionally, integrated with Bandura’s theory, the findings from the quantitative study also suggested a further study exploring the role of outcome expectations in caregiver behaviour, subjective burden and healthrelated quality of life.

Nutrition and Nutritional Care of Elderly People in Finnish Nursing Homes and Hospitals

Background: Malnutrition is a common problem for residents of nursing homes and long-term care hospitals. It has a negative influence on elderly residents and patients health and quality of life. Nutritional care seems to have a positive effect on elderly individuals nutritional status and well-being. Studies of Finnish elderly people s nutrition and nutritional care in institutions are scarce. Objectives: The primary aim was to investigate the nutritional status and its associated factors of elderly nursing home residents and long-term care patients in Finland. In particular, to find out, if the nursing or nutritional care factors are associated with the nutritional status, and how do carers and nurses recognize malnutrition. A further aim was to assess the energy and nutrient intake of the residents of dementia wards. A final objective was to find out, if the nutrition training of professionals leads to changes in their knowledge and further translate into better nutrition for the aged residents of dementia wards. Subjects and methods: The residents (n=2114) and patients (n=1043) nutritional status was assessed in all studies using the Mini Nutritional Assessment test (MNA). Information was gathered in a questionnaire on residents and patients daily routines providing nutritional care. Residents energy and nutrient intake (n=23; n=21) in dementia wards were determined over three days by the precise weighing method. Constructive learning theory was the basis for educating the professionals (n=28). A half-structured questionnaire was used to assess professionals learning. Studies I-IV were cross-sectional studies whereas study V was an intervention study. Results: Malnutrition was common among elderly residents and patients living in nursing homes and hospitals in Finland. According to the MNA, 11% to 57% of the studied elderly people suffered from malnutrition, and 40-89% were at risk of malnutrition, whereas only 0-16% had a good nutritional status. Resident- and patient-related factors such as dementia, impaired ADL (Activities of Daily Living), swallowing difficulties and constipation mainly explained the malnutrition, but also some nutritional care related factors, such as eating less than half of the offered food portion and not receiving snacks were also related to malnutrition. The intake of energy and some nutrients by the residents of dementia wards were lower than those recommended, although the offered food contained enough energy and nutrients. The proportion of residents receiving vitamin D supplementation was low, although there is a recommendation and known benefits for the adequate intake of vitamin D. Nurses recognized malnutrition poorly, only one in four (26.7%) of the actual cases. Keeping and analysing food diaries and reflecting on nutritional issues in small group discussions were effective training methods for professionals. The nutrition education of professionals had a positive impact on the energy and protein intake, BMIs, and the MNA scores of some residents in dementia wards. Conclusions: Malnutrition was common among elderly residents and patients living in nursing homes and hospitals in Finland. Although residents- and patient related factors mainly explained malnutrition, nurses recognized malnutrition poorly and nutritional care possibilities were in minor use. Professionals nutrition education had a positive impact on the nutrition of elderly residents. Further studies describing successful nutritional care and nutrition education of professionals are needed.

Associations between BMI and home, school and route environmental exposures estimated using GPS and GIS: do we see evidence of selective daily mobility bias in children?

BACKGROUND: This study examined whether objective measures of food, physical activity and built environment exposures, in home and non-home settings, contribute to children's body weight. Further, comparing GPS and GIS measures of environmental exposures along routes to and from school, we tested for evidence of selective daily mobility bias when using GPS data. METHODS: This study is a cross-sectional analysis, using objective assessments of body weight in relation to multiple environmental exposures. Data presented are from a sample of 94 school-aged children, aged 5-11 years. Children's heights and weights were measured by trained researchers, and used to calculate BMI z-scores. Participants wore a GPS device for one full week. Environmental exposures were estimated within home and school neighbourhoods, and along GIS (modelled) and GPS (actual) routes from home to school. We directly compared associations between BMI and GIS-modelled versus GPS-derived environmental exposures. The study was conducted in Mebane and Mount Airy, North Carolina, USA, in 2011. RESULTS: In adjusted regression models, greater school walkability was associated with significantly lower mean BMI. Greater home walkability was associated with increased BMI, as was greater school access to green space. Adjusted associations between BMI and route exposure characteristics were null. The use of GPS-actual route exposures did not appear to confound associations between environmental exposures and BMI in this sample. CONCLUSIONS: This study found few associations between environmental exposures in home, school and commuting domains and body weight in children. However, walkability of the school neighbourhood may be important. Of the other significant associations observed, some were in unexpected directions. Importantly, we found no evidence of selective daily mobility bias in this sample, although our study design is in need of replication in a free-living adult sample.

A 6-month open-label study of the effectiveness and tolerability of galantamine in patients with Alzheimer's disease

The objective of this study was to assess the effectiveness and tolerability of galantamine in patients with mild-to-moderate Alzheimer's disease (AD) in everyday clinical practice. Patient selection was made on 36 sequential patients attending Belfast City Hospital Memory Clinic between December 2000 and June 2001. Patients were treated with galantamine for 6 months, starting from 4 mg twice daily increasing to 8 mg twice daily and then to 12 mg twice daily at 4-weekly intervals. Patients (25 females, 11 males), mean age 78 years (59-90), were diagnosed with probable AD and had a mini-mental state examination (MMSE) score of 10-26. Efficacy was assessed using the MMSE, neuropsychiatric inventory (NPI), neuropsychiatric inventory caregiver distress (NPI-D) scale and the Bristol activities of daily living (B-ADL) scale at baseline and after 3 and 6 months of treatment. Mean improvements were noted on all four measures of efficacy at 3 and 6 months; improvements were significant on the MMSE, NPI and NPI-D at 3 months and on the NPI-D at 6 months. Galantamine was overall well tolerated. The most common adverse events were gastrointestinal, particularly nausea. Four patients stopped treatment due to adverse events, and seven were stabilised on 8 mg twice daily as they were unable to tolerate the target dose. This naturalistic study confirms clinical trial data, which shows galantamine improves cognition and behavioural symptoms and is overall well tolerated. © 2004 Blackwell Publishing Ltd.

Rehabilitation needs for older adults with stroke living at home: perceptions of four populations

The BRAD group is composed of/ Le groupe BRAD est composé de : Sylvie Belleville, Gina Bravo, Louise Demers, Philippe Landreville, Louisette Mercier, Nicole Paquet, Hélène Payette, Constant Rainville, Bernadette Ska and René Verreault.

Functional capacity and assistance from the caregiver during daily activities in Brazilian children with cerebral palsy

Background: Cerebral Palsy (CP) presents changes in posture and movement as a core characteristic, which requires multiprofessional clinical treatments during childrens habilitation or rehabilitation. Besides clinical treatment, it is fundamental that professionals use evaluation systems to quantify the difficulties presented to the individual and their families in their daily lives. We aimed to investigate the functional capacity of individuals with CP and the amount of assistance required by the caregiver in day-to-day activities. Methods. Twenty patients with CP, six-year-old on average, were evaluated. The Pediatric Evaluation Inventory of Incapacities was used (PEDI - Pediatric Evaluation Disability Inventory), a system adapted for Brazil that evaluates child's dysfunction in three 3 dimensions: self-care, mobility and social function. To compare the three areas, repeated measures analysis of variance (ANOVA) were used. Results: We found the following results regarding the functional capacity of children: self-care, 27.4%, ±17.5; mobility, 25.8%, ±33.3 and social function, 36.3%, ±27.7. The results of the demand of aid from the caregiver according to each dimension were: self-care, 9.7%, ±19.9; mobility, 14.1%, ± 20.9 and social function, 19.8%, ±26.1. Conclusion: We indicated that there was no difference between the performance of the subjects in areas of self-care, mobility and social function considering the functional skills and assistance required by the caregiver. © 2013 Monteiro et al; licensee BioMed Central Ltd.

Functional capacity and assistance from the caregiver during daily activities in Brazilian children with cerebral palsy

Abstract Background Cerebral Palsy (CP) presents changes in posture and movement as a core characteristic, which requires multiprofessional clinical treatments during children’s habilitation or rehabilitation. Besides clinical treatment, it is fundamental that professionals use evaluation systems to quantify the difficulties presented to the individual and their families in their daily lives. We aimed to investigate the functional capacity of individuals with CP and the amount of assistance required by the caregiver in day-to-day activities. Methods Twenty patients with CP, six-year-old on average, were evaluated. The Pediatric Evaluation Inventory of Incapacities was used (PEDI - Pediatric Evaluation Disability Inventory), a system adapted for Brazil that evaluates child's dysfunction in three 3 dimensions: self-care, mobility and social function. To compare the three areas, repeated measures analysis of variance (ANOVA) were used. Results We found the following results regarding the functional capacity of children: self-care, 27.4%, ±17.5; mobility, 25.8%, ±33.3 and social function, 36.3%, ±27.7. The results of the demand of aid from the caregiver according to each dimension were: self-care, 9.7%, ±19.9; mobility, 14.1%, ± 20.9 and social function, 19.8%, ±26.1. Conclusion We indicated that there was no difference between the performance of the subjects in areas of self-care, mobility and social function considering the functional skills and assistance required by the caregiver.

The role of occupational therapy for individuals living with sickle cell disease

The purpose of the research study was to determine the role occupational therapy plays in the management of sickle cell disease (SCD). A descriptive survey was administered to 39 persons living with or caring for persons living with SCD. This survey was administered at two sickle cell foundations and one hospital. ^ The research study determined that none of the 10.3% of the sample who had rehabilitative therapy received occupational therapy. Furthermore, at least 50% of persons surveyed agreed that SCD affected their activities of daily living; at least 38.5% agreed that work and productive activities were hampered; and at least 18% agreed that play/leisure activities were affected. No one within the sample received gene therapy. ^ It was concluded that occupational therapy is relevant for persons who are disabled by SCD. It is recommended that occupational therapists realize the importance of treating patients with SCD from a more holistic perspective. ^

Functional outcome and usage of the prosthesis of lower limb amputees fitted with osseointegrated fixation

This study established that the core principle underlying categorisation of activities have the potential to provide more comprehensive outcomes than the recognition of activities because it takes into consideration activities other than directional locomotion.