Method: Initially, a pilot study was conducted to investigate the feasibility of ultrasound visual feedback during swallow tasks. The protocol was then replicated using a single-case experimental designed study to investigate therapeutic effect. Swallow, speech, and oromotor functions were measured across multiple baselines using an A-B-A intervention study design.
Results: During intervention, both participants were able to interpret ultrasound tongue images during swallow tasks. Following intervention, positive therapeutic effect was achieved with reduced frequency of aspiration and self-initiated swallow strategies. Generalization of intervention was evidenced by reduced bolus transit duration on videofluoroscopy and improved functional oral intake scores. Speech and oromotor functions remained stable throughout the study demonstrating experimental control.
Conclusions: This study establishes that ultrasound visual feedback is feasible in dysphagia rehabilitation following partial glossectomy. In addition, the predicted therapeutic effect specifically to swallow but not speech or oromotor functions were demonstrated.
- Implications for Rehabilitation
Partial glossectomy results in altered tongue shape, movement, and function which negatively impact on speech and swallowing
There is limited research evidence to support previously used speech pathology interventions (in particular, tongue range of movement exercises) to rehabilitate dysphagia following tongue cancer surgery
The tongue, and hence oral phase of swallowing, can be viewed by placing an ultrasound probe under the chin
Ultrasound scanning of the tongue is not invasive, can be repeated without dosage side effect. It’s also comfortable for the patient and if a portable probe and monitor are used, can be performed within a variety of clinical settings for assessment or therapy
This study shows specific therapeutic benefit following ultrasound visual feedback along with a motor learning approach to rehabilitate swallow function following partial glossectomy
Visual and verbal feedback that focus specifically on the motor movements undergoing adaptation (e.g., tongue wave movement, tongue elevation, bolus clearance) following partial glossectomy are recommended
Patients who are able to see the ultrasound monitor, hear the feedback given, are cognitively able to self-evaluate tongue movement, and remember intervention goals will most benefit from ultrasound tongue visual feedback in therapy
Clinicians also benefit from visualizing the tongue with ultrasound during assessment and therapy as a direct view reduces the subjectivity of rating task performance
Methods: From 101 articles initially identified, 14 articles met the study criteria. Eleven papers described the effects of carbonation on swallowing in healthy participants whereas three described the impact of carbonation in dysphagic populations. A narrative synthesis of papers was undertaken given the diversity of identified studies.
Results: Synthesis of findings was challenging given the exploratory phase of most research activity with diverse populations described and extensive differences in research methodologies. There is currently weak, but potentially positive evidence to support using carbonation as a compensatory technique in dysphagia rehabilitation.
Conclusion: Despite future potential, existing evidence fails to provide clear direction for the clinical implementation of carbonation. Validation of carbonation use with the dysphagic population requires further research with consistent, controlled methodologies, and larger cohorts of participants to inform potential for dysphagia rehabilitation.
- Implications for Rehabilitation
The use of carbonated liquids has been proposed as a possible sensory enhancement technique which may facilitate changes to swallow physiology.
However to date, there is limited information to direct clinical implementation.
This paper provides a narrative synthesis of existing knowledge and highlights possible limitations of findings reported.
Research to date has used disparate research methodologies in varied populations making synthesis of current findings challenging.
- Implications for rehabilitation
TBI rehabilitation might benefit from:
??Increased transparency in rehabilitation options
??More systematic follow-up programs
??Age-appropriate rehabilitation facilities
??Inclusion of patient and family in the planning of long-term rehabilitation
Emergency operations and training conducted while wearing protective clothing and respirators is physiologically and cognitively demanding.
The heat stress and fatigue created by working in protective clothing and respirators creates additional risk of illness/injury for the public safety provider.
Emergency incident rehabilitation provides a structured rest period for rehydration and correction of abnormal body core temperature following work in protective clothing and respirators.
Emergency incident rehab should be conducted at incidents (e.g. fireground, hazardous materials, and heavy rescue emergencies) and trainings involving activities that may lead to exceeding safe levels of physical and mental exertion.
Emergency incident rehabilitation is incident care, not fitness for duty, and meant to reduce physiologic strain and prepare the responder to return to duty at the current incident and for the remainder of the shift.
EMS should play a role in emergency incident rehabilitation with providers trained to understand the physiologic response of healthy individuals to environmental, exertional, and cognitive stress and implement appropriate mitigation strategies.
An appropriately qualified physician should have oversight over the creation and implementation of emergency incident rehabilitation protocols and may be separate from the roles and responsibilities of the occupational medicine physician.
There are no peer-reviewed data related to cold weather rehabilitation. Future studies should address this limitation to the literature.
Methods: Medical records, primary caregiver report, and clinical assessment were used to compile detailed case histories and assess current dysphagia and feeding skills.
Results: Both cases demonstrated heterogeneous oral motor and feeding outcomes, including delayed oral motor skills, restricted dietary variety, and difficult mealtime behaviors that contributed to protracted recovery of age-appropriate PO intake. Both children required ongoing diet and/or fluid modification and supplemental non-PO feeding via gastrostomy at the time of review, that is, 2-year post-injury.
Conclusions: Recovery from dysphagia post-alkali ingestion is protracted and complex. Dysphagia, delayed oral motor skills, and difficult mealtime behaviors may persist secondary to ingestion injury and its associated complications. These cases highlight the importance of considering early referral for feeding assessment and intervention to assist children and families with recovery. Progression through safe and effective oral (per os, PO) intake is needed, as well as provision of support for primary caregivers.
- Implications for Rehabilitation
Pediatric chemical ingestion injury can cause long-term dysphagia and long-term feeding difficulties
Initial injury severity does not reliably correlate with eventuating level of aerodigestive impairment.
Clinical and instrumental assessment is required to monitor swallow function to enable commencement of targeted rehabilitation when appropriate.
Early involvement of a feeding therapist is recommended to minimize the long-term effects on oral motor skill development, progression to age-appropriate diet, and provision of family-centered care.
- Implications for Rehabilitation
It remains challenging to correctly predict the outcome of treatment from patients’ baseline sociodemographic and psychological characteristics; predictors other than baseline scores of the outcome variables are only slightly associated with treatment outcome.
Patients with chronic musculoskeletal pain and poor physical functioning or mental health benefit most from pain rehabilitation.
Older patients benefit less from a pain rehabilitation program than younger patients in terms of physical functioning.
Pain reduction during a pain rehabilitation program is greatest in patients with high pain intensity who are not at work at the start of the rehabilitation program.
Coping style influences the outcome of rehabilitation of patients with chronic musculoskeletal pain.
Methods: This algorithm is based on 30 years of clinical experience with DMD in a specialised Centre for Neuromuscular Disorders (Inkendaal Rehabilitation Hospital, Belgium) and is supported by literature where available.
Results: Dysphagia can worsen the condition of ageing patients with DMD. Apart from the difficulties of chewing and oral fragmentation of the food bolus, dysphagia is rather a consequence of an impairment in the pharyngeal phase of swallowing. By contrast with central neurologic disorders, dysphagia in DMD accompanies solid rather than liquid intake. Symptoms of dysphagia may not be clinically evident; however laryngeal food penetration, accumulation of food residue in the pharynx and/or true laryngeal food aspiration may occur. The prevalence of these issues in DMD is likely underestimated.
Conclusions: There is little guidance available for clinicians to manage dysphagia and improve feeding for young men with DMD. This report aims to provide a clinical algorithm to facilitate the diagnosis of dysphagia, to identify the symptoms and to propose practical recommendations to treat dysphagia in the adult DMD population.
- Implications for Rehabilitation
Little guidance is available for the management of dysphagia in Duchenne dystrophy.
Food can penetrate the vestibule, accumulate as residue or cause aspiration.
We propose recommendations and an algorithm to guide management of dysphagia.
Penetration/residue accumulation: prohibit solid food and promote intake of fluids.
Aspiration: if cough augmentation techniques are ineffective, consider tracheostomy.
Method: The medical history of two HIV-positive patients with PML was reviewed; information on their neurological impairments, rehabilitation treatment and outcome was gathered.
Results: The patients, a 47-year-old married man and a 34-year-old single man, both suffered from dense right hemiplegia and motor aphasia. Their rehabilitation course was delayed and prolonged: they were suitable for intensive multidisciplinary rehabilitation only 8 months or more after the initial presentation. Their treatment in outpatient rehabilitation daycare three times a week, that lasted 7 months on average, resulted in slow and steady functional improvement. At the end of the rehabilitation treatment, both patients were living at home, able to express themselves, and able to walk independently with an assistive device. They remained with moderate disability (modified Rankin scale of 3).
Conclusion: PML patients require prolonged multidisciplinary rehabilitation treatment; however, considerable progress can be achieved.
- Implications for Rehabilitation
Progressive multifocal leukoencephalopathy (PML) is a disabling disease occurring in particular in the context of Human Immunodeficiency Virus (HIV).
Presently a growing number of HIV-positive PML patients eventually survive the disease and remain with severe neurological impairments.
PML patients require prolonged multidisciplinary rehabilitation treatment, and considerable progress can be achieved.
Method: A scoping review with systematic searching of relevant databases and review of reference lists of included studies was conducted. Key search terms included brain injury, group and rehabilitation OR therapy OR intervention. Studies were included if at least some participants had a TBI diagnosis and they investigated rehabilitation interventions conducted in a group setting. Articles were collated, summarised and key findings are presented.
Results: The total number of included articles was 99. The results indicated group interventions are widely practised in TBI rehabilitation. Existing research consists mostly of pre–post intervention studies addressing cognitive impairments with outpatient participants. Most studies have identified significant positive changes on some targeted outcome measures suggesting group interventions are effective.
Conclusions: Studies of the effectiveness of interventions targeting ‘real-world’ activities and participation-based goals are under-represented in the TBI rehabilitation literature. Further research investigating the effectiveness of group processes and the perceptions of patients and clinicians is warranted to guide clinical practice.
- Implications for Rehabilitation
Group-based interventions are common in TBI rehabilitation, usually targeting cognitive skills and impairments. The majority of studies demonstrated positive changes pre–post group interventions on some outcome measures.
Few studies directly compare the outcome of an intervention delivered in a group setting to the same intervention delivered in an individual setting.
Patients perceive group interventions to be beneficial for sharing experiences and reducing isolation, receiving help and feedback and, assisting with adjustment and adaptation to life after TBI, however, this research is limited.
Greater emphasis on group-delivered interventions that target ‘real world’ activities, or participation may be beneficial with this population.
Further research regarding consumer experiences and processes that facilitate effective group interventions in TBI rehabilitation is recommended.
- Implications for Rehabilitation
Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care.
Views of stroke unit team members on nurses’ involvement in rehabilitation have not been reported previously.
Nurses can routinely incorporate rehabilitation principles in their care.
Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.
- Implications for Rehabiliation
Incontinentia pigmenti (Bloch-Sulzberger syndrome).
Incontinentia pigmenti is a rare X-linked dominant genetic disorder with multisystemic involvement.
Skin lesions, neurological impairments, motormental retardation, skeletal congenital defects and ophthalmologic involvement are IP most frequent manifestations.
Due to the complex multisystem involvement resulting in severe long-term disability, patients with IP require a multidisciplinary team approach for rehabilitation.
In IP patients, rehabilitation interventions should always take into consideration the individual phenotype expression, child’s physical development and personal needs.
- Implications for Rehabilitation
Technology-based distance physical rehabilitation interventions increase physical activity among persons with MS.
This study was unable to identify if the technologies (Internet, telephone, or combinations) lead to differing effects on physical activity or walking in the distance physical rehabilitation interventions in MS.
Further research on the effectiveness of technology-based distance physical rehabilitation interventions on walking in MS is needed.
- Implications for rehabilitation
Ten practice guidelines provide guidance to facilitate sound community-based rehabilitation (CBR) program evaluation decisions. Key indications of good practice include:
??being as participatory and empowering as possible;
??ensuring that all, including the most affected, have a real opportunity to share their thoughts;
??highly considering mixed methods and participatory tools;
??adapting to fit evaluation context, local culture and language(s);
??defining evaluation questions and reporting findings using shared CBR language when possible, which the framework offered may facilitate.
Implications for Rehabilitation
Rehabilitation of a bilateral lower limb amputee requires a team effort and constitutes a very difficult challenge for the subject.
Low prosthesis ownership is largely due to subjects’ inability to afford a pair of prostheses in a developing country like India.
Activities of daily living improve significantly with use of prostheses.
Though it is well documented that the potential for successful rehabilitation is best for a bilateral TT amputee, higher prosthesis rehabilitation among bilateral TF subjects in this study indicates that successful rehabilitation is possible in most subjects irrespective of the level of amputation.
Method: Two focus groups, conducted with 15 rehabilitation professionals from various disciplines and working with people with disabilities of all ages were structured around two topics: (i) The usage of malls for rehabilitation and (ii) Factors that facilitate or limit rehabilitation professionals’ use of the mall as an environment for clinical assessment and/or intervention.
Results: The thematic analysis revealed that shopping malls were used to achieve several rehabilitation goals targeting physical and cognitive skills, psychological health and socialization. This real-life environment is motivating and helps foster independence and normalization. Factors affecting mall use during rehabilitation included personal factors (e.g. clients’ personality and level of readiness) and environmental factors (e.g. clinical context, accessibility of the mall and social attitudes of store owners).
Conclusion: Shopping malls may be a relevant rehabilitation assessment and treatment environment that could contribute to optimizing community integration of people with disabilities.
- Implications for rehabilitation
To ensure successful community reintegration, clients could be trained at some point during their rehabilitation, to perform activities in real-life settings, such as a shopping mall.
Shopping malls appear to enable the attainment of rehabilitation goals targeting a variety of skills.
This real-life environment appears to be motivating and helps foster independence and normalization.
Factors felt to affect mall use during rehabilitation include personal factors (e.g. clients’ personality and level of readiness) and environmental factors (e.g. clinical context, accessibility of the mall and social attitudes of store owners).
The shopping mall may be an untapped resource as it appears to be a relevant rehabilitation assessment and treatment environment that could contribute to optimizing community integration of people with disabilities.
- Implications for rehabilitation
People with visual impairments often show a worse quality of life than normal-sighted people.
The degree of severity of the visual impairment does not affect quality of life.
Sport and physical activity are effective means of improving quality of life.
An active leisure time activity supports the improvement of the quality of life of visual-impaired people that participated in a vocational rehabilitation.
- Implications for Rehabilitation
Programs for balance rehabilitation can improve balance but their effects in fall prevention are unclear.
Twenty treatments sessions 2/3 times per week did not reduced frequency of falls in MS.
The comparison with similar studies suggests that higher intensity of practice of highly challenging balance activities appears to be critical to maximizing effectiveness.
- Implications for Rehabilitation
GAS seems to be an appropriate outcome measure in neuropsychological rehabilitation in MS.
GAS-rated personal goals were well achieved, and GAS was found to tap changes in the areas not covered with standardized outcome measures.
GAS seems to offer a possibility to take into account the specific needs of each individual patient.
The ICF can be used to classify goals in neuropsychological rehabilitation in MS.