Browsing by Subject "REHABILITATION"

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  • Kallio, Eeva-Liisa; Öhman, Hanna; Kautiainen, Hannu; Hietanen, Marja; Pitkala, Kaisu (2017)
    Background: Cognitive training (CT) refers to guided cognitive exercises designed to improve specific cognitive functions, as well as enhance performance in untrained cognitive tasks. Positive effects of CT on cognitive functions in healthy elderly people and persons with mild cognitive impairment have been reported, but data regarding the effects of CT in patients with dementia is unclear. Objective: We systematically reviewed the current evidence from randomized controlled trials (RCTs) to find out if CT improves or stabilizes cognition and/or everyday functioning in patients with mild and moderate Alzheimer's disease. Results: Altogether, 31 RCTs with CT as either the primary intervention or part of a broader cognitive or multi-component intervention were found. A positive effect was reported in 24 trials, mainly on global cognition and training-specific tasks, particularly when more intensive or more specific CT programs were used. Little evidence of improved everyday functioning was found. Conclusions: Despite some positive findings, the inaccurate definitions of CT, inadequate sample sizes, unclear randomization methods, incomplete datasets at follow-up and multiple testing may have inflated the results in many trials. Future high quality RCTs with appropriate classification and specification of cognitive interventions are necessary to confirm CT as an effective treatment option in Alzheimer's disease.
  • Turunen, Merita; Hokkanen, Laura; Bäckman, Lars; Stigsdotter-Neely, Anna; Hänninen, Tuomo; Paajanen, Teemu; Soininen, Hilkka; Kivipelto, Miia; Ngandu, Tiia (2019)
    The possibilities of computer-based cognitive training (CCT) in postponing the onset of dementia are currently unclear, but promising. Our aim is to investigate older adults ' adherence to a long-term CCT program, and which participant characteristics are associated with adherence to the CCT. This study was part of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Participants were 60-77-year-old individuals with increased dementia risk, recruited from previous population-based studies. The participants included in this study (n = 631) had been randomized to receive a multi-domain lifestyle intervention, including CCT. The measure of adherence was the number of completed CCT sessions (max = 144) as continuous measure. Due to a substantial proportion of participants with 0 sessions, the zero inflated negative binomial regression analyses were used to enable assessment of both predictors of starting the training and predictors of completing a higher number of training sessions. Several cognitive, demographic, lifestyle, and health-related variables were examined as potential predictors of adherence to CCT. Altogether, 63% of the participants participated in the CCT at least once, 20% completed at least half of the training, and 12% completed all sessions. Previous experience with computers, being married or cohabiting, better memory performance, and positive expectations toward the study predicted greater odds for starting CCT. Previous computer use was the only factor associated with a greater number of training sessions completed. Our study shows that there is a large variation in adherence to a long-lasting CCT among older adults with an increased risk of dementia. The results indicate that encouraging computer use, and taking into account the level of cognitive functioning, may help boost adherence to CCT.
  • Hyytiäinen, Heli K.; Mölsä, Sari H.; Junnila, Jouni J. T.; Laitinen-Vapaavuori, Outi M.; Hielm-Björkman, Anna K. (2018)
    This study aimed at developing a quantitative testing battery for dogs' stifle functionality, as, unlike in human medicine, currently none is available in the veterinary field. Forty-three dogs with surgically treated unilateral cranial cruciate ligament rupture and 21 dogs with no known musculoskeletal problems were included. Eight previously studied tests: compensation in sitting and lying positions, symmetry of thrust in hindlimbs when rising from lying and sitting, static weight bearing, stifle flexion and extension and muscle mass symmetry, were summed into the Finnish Canine Stifle Index (FCSI). Sensitivities and specificities of the dichotomised FCSI score were calculated against orthopaedic examination, radiological and force platform analysis and a conclusive assessment (combination of previous). One-way analysis of variance (ANOVA)was used to evaluate FCSI score differences between the groups. Cronbach's alpha for internal consistency was calculated. The range of the index score was 0-263, with a proposed cut-off value of 60 between 'adequate' and 'compromised' functional performance. In comparison to the conclusive assessment, the sensitivity and specificity of the FCSI were 90 per cent and 90.5 per cent, respectively. Cronbach's alpha for internal reliability of the FCSI score was 0.727. An estimate of the surgically treated and control dogs' FCSI scores were 105 (95 per cent CI 93 to 116) and 20 (95 per cent CI 4 to 37), respectively. The difference between the groups was significant (P
  • Wikstrom, Miia; Anttila, Heidi; Savinainen, Minna; Kouvonen, Anne; Joensuu, Matti (2020)
    BackgroundThe unemployed have lower work ability and poorer health than the employed. This situation deteriorates when unemployment continues. The long-term unemployed often have co-morbidities and face many other challenges. This increases the need for a multidimensional assessment of work ability and functioning in different service settings. In this study, we describe the development and analyse the content validity of the Abilitator, a self-report questionnaire on work ability and functioning for those in a weak labour market position.MethodsThe Abilitator was developed in 2014-2017. Its construct was assessed by members of academic expert panels (n=30), practical expert panels of professionals (n=700) and target group clients (n=28). The structure and the content of the questionnaire was co-developed in 29 workshops and adjusted twice based on the expert panels' feedback. The Abilitator was also implemented among target group clients (n=3360) in different services and projects. During its development the Abilitator was linked to the International Classification of Functioning, Disability and Health (ICF). The content validation process followed the guidelines recommended by the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) panel.ResultsThe construct of the Abilitator combines the multidimensional and biopsychosocial models of work ability and functioning. It also includes aspects of social inclusion and employability. It evaluates social, psychological, cognitive and physical functioning, and the ability to cope with everyday life. The content of these concepts was validated by the academic and practical expert panels. The Abilitator's 79 ICF codes covered 57% of the Generic, 77% of the Brief Vocational Rehabilitation, and 8% of the Minimal Environmental ICF Core Sets. When compared with the Work Ability Index (WAI) and the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the direct equivalences of the ICF codes were 36 and 44%, respectively.ConclusionThe Abilitator sufficiently comprehensively covers the relevant aspects to enable the assessment of the overall work ability and functioning of the population in a weak labour market position.
  • Boström, Anna Fredrika; Hyytiäinen, Heli Katariina; Koho, Petteri; Cizinauskas, Sigitas; Hielm-Björkman, Anna Katrina (2018)
    Background: The Finnish neurological function testing battery for dogs (FINFUN) was developed to meet the increasing demand for objective outcome measures in veterinary physiotherapy. The testing battery should provide consistent, reproducible results and have established face and content validity. Internal consistency and intra-and inter-rater reliability of the FINFUN were also investigated. Results: The FINFUN comprised 11 tasks: lying, standing up from lying, sitting, standing up from sitting, standing, proprioceptive positioning, starting to walk, walking, trotting, walking turns and walking stairs. A score from 0 to 4, (0: unable to perform task, 4: performing task with normal motor function) was given for each task, the maximum score being 44. Twenty-six dogs were filmed when performing the FINFUN. Seven observers scored the performances from the video recordings. The FINFUN was considered to have appropriate face and content validity based on a pilot study, clinical experience and critical reflection of the development process. Its internal consistency was excellent, with no Cronbach's alpha values below 0.922. The intra-rater reliability for total score of experienced observers was almost perfect: 0.999 (observer 1) and 0.994 (observer 2). The inter-rater reliability for both experienced and novice observers' total scores was also almost perfect (0.919-0.993). Analysis of each individual task showed substantial intra-rater and inter-rater agreement for the tasks "lying" and "sitting". Conclusions: The FINFUN is an objective, valid and reliable tool with standardized scoring criteria for evaluation of motor function in dogs recovering from spinal cord injury.
  • Soukkio, Paula; Suikkanen, Sara; Kääriä, Sanna; Kautiainen, Hannu; Sipilä, Sarianna; Kukkonen-Harjula, Katriina; Hupli, Markku (2018)
    Background: Health concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation. We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture. Methods: This is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age >= 65) and 300 persons with a recent hip fracture (age >= 60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried's frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant's home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant's home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months. Discussion: Our trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services.
  • Boström, Anna F.; Parzefall, Birgit; Blutke, Andreas; Davies, Emma S. (2022)
    Cross-sectional area (CSA) decreases and fat infiltration increases in epaxial muscles of Dachshunds with intervertebral disc disease (IVDD), but less is known about large breed dogs with IVDD. The aim here was to investigate thoracolumbar epaxial muscle CSA and fat infiltration in large breed dogs with compressive IVDD and acute non-compressive nucleus pulposus extrusion (ANNPE) or fibrocartilaginous embolism (FCE). This retrospective study included large breed dogs with MRI-confirmed IVDD (n = 17) and ANNPE or FCE (n = 13). The CSA and fat infiltration of the thoracolumbar M. longissimus and Mm. multifidi were assessed from T1-weighted transverse MR images using Osirix. The CSA was significantly smaller in dogs with compressive IVDD than in dogs with non-compressive ANNPE or FCE for Mm. multifidi (p = 0.015), M. longissimus (p = 0.070), and these two muscles combined (p = 0.016). Fat infiltration in all muscle measurements was significantly higher in dogs with compressive IVDD than in dogs with non-compressive ANNPE or FCE (all P < 0.050). A significant positive correlation existed between age, duration of clinical signs, and fat infiltration, suggesting more fat infiltration in older dogs with more chronic signs. These signs of muscle atrophy are likely caused by denervation and secondary disuse due to chronic spinal cord compression and prolonged duration of clinical signs.
  • Kallio, Eeva-Liisa; Ohman, H.; Carlson, S.; Kautiainen, H.; Hietanen, M.; Pitkala, K. H. (2017)
    Introduction: Evidence is unclear whether cognitive training (CT) has efficacy in patients with dementia. We present the recruitment and baseline findings of a carefully designed Finnish cognitive training (FINCOG) trial exploring the effectiveness of CT among community-dwelling older persons with mild-to-moderate dementia. Methods: Participants were recruited from adult day care centres in Helsinki, Finland, and randomised into two groups: (1) day care with systematic CT twice a week for 12 weeks (n = 76) and (2) day care as usual (n = 71). Demographics, diagnoses and drug use were retrieved from medical records, and baseline cognition, functioning, health-related quality of life (HRQoL) and psychological well-being were assessed. A subgroup of participants was planned to undergo functional magnetic resonance imaging (fMRI) to measure changes in brain activity. Feedback from those attending CT was collected. Primary trial outcomes will be participants' cognition and HRQoL. Results: The mean (SD) age of the randomised participants was 83.1 (5.4) years, 72% were female and 37% at a moderate stage of dementia. The intervention and control groups were comparable at baseline. Compliance with CT was good, with a mean attendance of 22/24 sessions. General subjective gain was achieved by three-fourths of the feedback respondents. However, the fMRI was not feasible in this patient group. Conclusions: We successfully randomised 147 persons with mild-to-moderate dementia in the FINCOG trial. The feedback from participants in cognitive intervention was favourable. The trial will provide important information on the effects of CT in patients with dementia. (C) 2017 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
  • Olafsdottir, Steinunn A.; Jonsdottir, Helga; Bjartmarz, Ingibjorg; Magnusson, Charlotte; Caltenco, Hector; Kyto, Mikko; Maye, Laura; McGookin, David; Arnadottir, Solveig Asa; Hjaltadottir, Ingibjorg; Hafsteinsdottir, Thora B. (2020)
    BackgroundTechnical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors. Caregivers are often able and willing to assist with home-based exercise and physical activity but lack the knowledge and resources to do so. ActivABLES was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. The aim of our study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality.MethodsA convergent design of mixed methods research in which quantitative results were combined with personal experiences of a four-week use of ActivABLES by community-dwelling stroke survivors with support from their caregivers. Data collection before, during and after the four-week period included the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG) and Five Times Sit to Stand Test (5xSST) and data from motion detectors. Semi-structured interviews were conducted with stroke survivors and caregivers after the four-week period. Descriptive statistics were used for quantitative data. Qualitative data was analysed with direct content analysis. Themes were identified related to the domains of feasibility: acceptability, demand, implementation and practicality. Data was integrated by examining any (dis)congruence in the quantitative and qualitative findings.ResultsTen stroke survivors aged 55-79years participated with their informal caregivers. Functional improvements were shown in BBS (+2.5), ABC (+0.9), TUG (-4.2) and 5xSST (-2.7). More physical activity was detected with motion detectors (stand up/sit down +2, number of steps +227, standing +0.3h, hours sitting/lying -0.3h). The qualitative interviews identified themes for each feasibility domain: (i) acceptability: appreciation, functional improvements, self-initiated activities and expressed potential for future stroke survivors; (2) demand: reported use, interest in further use and need for follow-up; (3) implementation: importance of feedback, variety of exercises and progression of exercises and (4) practicality: need for support and technical problems. The quantitative and qualitative findings converged well with each other and supported the feasibility of ActivABLES.ConclusionsActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes. Further studies are needed with larger samples.
  • Pohju, Anne; Pakarinen, Mikko P.; Sipponen, Taina (2019)
    Objectives: Parenteral support (PS) is the first-line therapy for intestinal failure (IF). Optimal patient outcomes require experienced multidisciplinary teams adhering to structured protocols. As practices to provide long-term PS for adult IF patients in Finland are unknown, this cross-sectional nationwide study aimed to evaluate current management of PS for adult IF across the country.Materials and methods: An internet-based survey was emailed to all Finnish hospitals and hospital-at-home services with the potential to provide PS for adult IF. The survey included 20 items addressing the provision of long-term PS for adult IF patients (aged >= 18years). Data were analysed using descriptive statistics.Results: Overall, 52 (47%) of the 111 identified units responded. Of responding units, 38 (73%) had at some point provided long-term (>= 120days) PS for adult IF, and 23 (44%) had done so during the preceding year. Only three units currently managed >= 3 adult patients. Most (65%) of the respondents worked in a hospital and were either physicians (38%) or dietitians (39%). Only 65% of respondents reported that their unit had an assigned physician responsible for PS provision, and 28% reported that a team was responsible for long-term PS. Only 26% of respondents reported having a written protocol to guide PS management.Conclusions: Health care providers with very limited experience and a fragmented approach manage most Finnish adult IF patients. Evidence-based protocols and multidisciplinary teams are scarce. The care for adult IF patients on long-term PS needs to be improved in Finland.
  • Rajavaara, Marketta; Saikku, Peppi; Määttä, Anne (2019)
    Työvoimapolitiikan pohjoismainen suunta painottaa heikossa työmarkkina-asemassa olevien henkilöiden aktivointia henkilökohtaisin ratkaisuin. Työllistymistä edistävässä monialaisessa yhteispalvelussa (TYP) selvitetään pitkään työttöminä olleiden palvelutarpeita ja pyritään tarjoamaan asiakkaille yksilöllisesti räätälöityjä palvelukokonaisuuksia kuntien työllistämis-, sosiaali- ja terveyspalvelujen sekä TE-palvelujen ja Kelan yhteistyönä. Henkilökohtaisen palvelun edellytyksiä ovat asiakkaiden tarkoituksenmukainen ohjaus palveluun, monialaisen palvelutarpeen tunnistaminen, palvelujen riittävyys ja yhteensovittaminen sekä palvelun todennettu vaikuttavuus.
  • Ala-Nikkola, Taina; Pirkola, Sami; Kaila, Minna; Joffe, Grigori; Kontio, Raija; Oranta, Olli; Sadeniemi, Minna; Wahlbeck, Kristian; Saarni, Samuli I. (2018)
    The challenges of mental health and substance abuse services (MHS) require shifting of the balance of resources from institutional care to community care. In order to track progress, an instrument that can describe these attributes of MHS is needed. We created a coding variable in the European Service Mapping Schedule-Revised (ESMS-R) mapping tool using a modified Delphi panel that classified MHS into centralized, local services with gatekeeping and local services without gatekeeping. For feasibility and validity, we tested the variable on a dataset comprising MHS in Southern Finland, covering a population of 2.3 million people. There were differences in the characteristics of services between our study regions. In our data, 41% were classified as centralized, 37% as local without gatekeeping and 22% as local services with gatekeeping. The proportion of resources allocated to local services varied from 20% to 43%. Reclassifying ESMS-R is an easy way to compare the important local vs. centralized balance of MHS systems globally, where such data exists. Further international studies comparing systems and validating this approach are needed.
  • ESO Hlth Econ Working Grp; Cadilhac, Dominique A.; Kim, Joosup; Wilsno, Alastair; Meretoja, Atte; Lees, Kennedy R. (2020)
    Introduction Approaches to economic evaluations of stroke therapies are varied and inconsistently described. An objective of the European Stroke Organisation (ESO) Health Economics Working Group is to standardise and improve the economic evaluations of interventions for stroke. Methods The ESO Health Economics Working Group and additional experts were contacted to develop a protocol and a guidance document for data collection for economic evaluations of stroke therapies. A modified Delphi approach, including a survey and consensus processes, was used to agree on content. We also asked the participants about resources that could be shared to improve economic evaluations of interventions for stroke. Results Of 28 experts invited, 16 (57%) completed the initial survey, with representation from universities, government, and industry. More than half of the survey respondents endorsed 13 specific items to include in a standard resource use questionnaire. Preferred functional/quality of life outcome measures to use for economic evaluations were the modified Rankin Scale (14 respondents, 88%) and the EQ-5D instrument (11 respondents, 69%). Of the 12 respondents who had access to data used in economic evaluations, 10 (83%) indicated a willingness to share data. A protocol template and a guidance document for data collection were developed and are presented in this article. Conclusion The protocol template and guidance document for data collection will support a more standardised and transparent approach for economic evaluations of stroke care.
  • Merras-Salmio, Laura; Pakarinen, Mikko P. (2022)
    Short bowel syndrome (SBS) is a rare disease with potentially life-threatening consequences. In addition to intestinal failure-associated liver disease, infections and other complications related to central venous catheters (CVCs) cause a significant burden to patients with SBS and may even necessitate an intestinal transplant eventually. The need for long-term central venous access and the intestinal dysfunction associated with SBS drive the need for intestinal failure-specific approach to prevent and treat infections in patients with SBS. In bacterial infections, the line can often be salvaged with proficient antibiotic therapy. Repeated catheter replacements are predisposed to recurrent infections and thrombotic complications, which may limit the long-term survival of patients with SBS. Protocol-based CVC access procedures and daily care including taurolidine and ethanol catheter locks have been shown to reduce infection rates substantially. Compromised intestinal function in SBS predisposes to small bowel bacterial overgrowth, mucosal injury, and increased permeability. These pathophysiological changes are concentrated in a subset of patients with excessive bowel dilatation and frequent bowel-derived infections. In such patients, reconstructive intestinal surgery may be indicated. Probiotics have not been effective in infection prevention in SBS and carry a significant risk of complications. While more studies focusing on the prevention of infections and their complications are needed, protocol-based approach and multidisciplinary teams in the care of patients with SBS have been shown to reduce complications and improve outcomes.
  • Kluger, Nicolas; Charlier, Philippe; Perciaccante, Antonio (2020)
    Introduction: Visual narratives such as manga, comics and cartoons can play an important role in educating readers on various aspects of life including medicine and disabilities. Methods: We reviewed the animated series entitled "Captain Tsubasa", focusing our analysis on the episodes which introduced the character Jun Misugi, a football player suffering from an unspecified congenital heart disease (CHD). Discussion: For a child with a CHD, the practice of sports could be risky but also an opportunity to improve heart function and reach personal fulfillment. CHD have an important impact on children's quality of life, and sports participation has beneficial effects on quality of life, weight loss, and exercise capacity, in patients with CHD. Restricting sports could have a negative impact on quality of life, and on the disease acceptance in children with CHD. The story of Jan Misugi could be considered as an educational medical tool to sensitize children with CHD who face sport' restriction.
  • Kausto, Johanna; Pentti, Jaana; Oksanen, Tuula; Virta, Lauri J.; Virtanen, Marianna; Kivimaki, Mika; Vahtera, Jussi (2017)
    Objectives The aim of this study was to investigate the association between the length of sickness absence and sustained return to work (SRTW) and the predictors of SRTW in depression, anxiety disorders, intervertebral disc disorders, and back pain in a population-based cohort of employees in the Finnish public sector. Methods We linked data from employers' registers and four national population registers. Cox proportional hazards regression analysis with a cluster option was applied. SRTW was defined as the end of the sickness benefit period not followed by a recurrent sickness benefit period in 30 days. Results For depression, the median time to SRTW was 46 and 38 days among men and women, respectively. For anxiety disorders, the figures were 24 and 22 days, for intervertebral disc disorders, 42 and 41 days, and, for back pain, 21 and 22 days among men and women respectively. Higher age and the persistence of the health problem predicted longer time to SRTW throughout the diagnostic categories. Comorbid conditions predicted longer time to SRTW in depression and back pain among women. Conclusions This large cohort study adds scientific evidence on the length of sickness absence and SRTW in four important diagnostic categories among public sector employees in Finland. Further research taking into account, eg, features of the work environment is suggested. Recommendations on the length of sickness absence at this point should be based on expert opinion and supplemented with research findings.
  • Lemmetyinen, Sanna; Hokkanen, Laura; Klippi, Anu (2020)
    Background: Left hemisphere stroke often causes a severe communication disorder that is usually attributed to aphasia. While aphasia refers to linguistic problems, communication is also accomplished by voluntarily articulate and gestural movements, which may be compromised due to apraxia. Along with aphasia, apraxia is a common disorder in left hemisphere stroke, which in severe cases can limit the use of verbal and nonverbal communication methods. The discussion about apraxia from a communicative perspective is still scarce, although the disorder is regularly experienced among left hemisphere stroke patients with aphasia. The rehabilitation of the disorder in severe apraxia-aphasia is challenging and recovery is slow. Aims: The purpose of this study is to provide an overview of the research on long-term recovery from apraxia and to discuss the meaning of these findings in observing the recovery of communication abilities in a person with a severe apraxia-aphasia. The search was not restricted to any specific type of apraxia, as this review assumes that communication may be influenced by apraxia in its different manifestations. The review is based on a systematic literature search, which includes English-language studies retrieved from the databases of Ovid Medline, PsycINFO, and Scopus. Main Contribution: Seven long-term follow-up studies of apraxia were found; one case study of apraxia of speech (AOS), four group studies of ideomotor apraxia (IMA), one case study of IMA (and aphasia), and one group study of limb apraxia. Conclusions: The reviewed group studies of patients with left hemisphere stroke indicate that apraxia is a persistent disorder, but the steepest recovery occurs within the first few months post-stroke. Imitation skills and actions involving real-tool use in activities of daily functions show the best recovery. Real-tool use also continues to improve longer, while recovery of gesturing after verbal command may not show clear signs of recovery in the chronic stage post-stroke. There is some evidence that the pace of recovery from oral apraxia and limb apraxia is comparable, and recovery from apraxia and aphasia would not correlate. Some of the studies used only imitation to assess changes in gesturing, which cannot be regarded as an ecologically valid measure to compare gesturing in natural communicative situations or even gesturing after verbal command. Finally, no follow-up studies were found that would have discussed apraxia from a communicative perspective. Overall, the field is lacking research on long-term follow-up of patients with apraxic-aphasic disorder.
  • Vasankari, Sini; Hartikainen, Juha; Vasankari, Ville; Anttila, Vesa; Tokola, Kari; Vähä-Ypyä, Henri; Husu, Pauliina; Sievänen, Harri; Vasankari, Tommi; Halonen, Jari (2022)
    Background: We investigated preoperative physical activity (PA) and sedentary behaviour (SB) in patients scheduled for elective cardiac procedures and compared them with population-based sample of Finnish adults. Methods: Cardiac patients (n=139) undergoing cardiac operations carried a triaxial accelerometer for seven days during the month before the procedure. Patients were categorised into four groups according to the procedure: percutaneous coronary intervention or coronary angiography (PCI-CA), coronary artery bypass grafting (CABG), aortic valve replacement (AVR) and mitral valve surgery (MVS). The raw accelerometer data was analyzed with dedicated algorithms to determine metabolic equivalents (METs, 3.5 mL/kg/min of oxygen consumption) of PA. The intensity of PA was divided into two categories: light (LPA, 1.5-2.9 METs) and moderate-to-vigorous (MVPA, >= 3.0 METs), while SB represented intensity < 1.5 MET without movements. SB and PA were described as daily means and accumulation from different bout lengths. Daily standing, steps and mean and peak MET-values were calculated. The results were compared between the patient groups and against the reference group from a population-based study FinFit2017. Results: Cardiac patients had fewer daily steps than the FinFit population (p= 0.01), and less SB accumulating from 10 min bouts (p< 0.001) than the FinFit population. Conclusions: We found large differences in PA and SB between the patient groups and the FitFit population, CABG group having the worst activity profile. Also, the variation within the patient groups was wide, which should be considered to individualise the rehabilitation programs postoperatively.
  • Jäppinen, Anna-Maija; Munoz, Minna; Kettunen, Tarja; Piirainen, Arja (2020)
    Objective The aim of this study was to explore patients' narratives of patient education in physiotherapy after a total hip arthroplasty (THA). Method The data was collected via open thematic interviews from ten patients who had had a primary THA. The interviews were analysed using a qualitative, narrative method. Results Three story models of patient education in physiotherapy were identified: Supportive patient education in physiotherapy, Co-operative patient education in physiotherapy and Contradictory patient education in physiotherapy. The emphasis of narration in the first story model was on the trust in the guidance, functioning interaction in the second and insufficient patient education in physiotherapy in the third story model. Discussion According to the results of this study, patients with THA experience functioning interaction and trust in the patient education in physiotherapy as enhancing the rehabilitation process. Conversely insufficient patient education about exercising and follow-up physiotherapy made the patients feel insecure and according to them might have slowed down the rehabilitation process. These findings can be utilized in planning and improving patient education in physiotherapy after THA.
  • Sihvonen, Aleksi J.; Soinila, Seppo; Sarkamo, Teppo (2022)
    Post-stroke neuroplasticity and cognitive recovery can be enhanced by multimodal stimulation via environmental enrichment. In this vein, recent studies have shown that enriched sound environment (i.e., listening to music) during the subacute post-stroke stage improves cognitive outcomes compared to standard care. The beneficial effects of post-stroke music listening are further pronounced when listening to music containing singing, which enhances language recovery coupled with structural and functional connectivity changes within the language network. However, outside the language network, virtually nothing is known about the effects of enriched sound environment on the structural connectome of the recovering post-stroke brain. Here, we report secondary outcomes from a single-blind randomized controlled trial (NCT01749709) in patients with ischaemic or haemorrhagic stroke (N = 38) who were randomly assigned to listen to vocal music, instrumental music, or audiobooks during the first 3 post-stroke months. Utilizing the longitudinal diffusion-weighted MRI data of the trial, the present study aimed to determine whether the music listening interventions induce changes on structural white matter connectome compared to the control audiobook intervention. Both vocal and instrumental music groups increased quantitative anisotropy longitudinally in multiple left dorsal and ventral tracts as well as in the corpus callosum, and also in the right hemisphere compared to the audiobook group. Audiobook group did not show increased structural connectivity changes compared to both vocal and instrumental music groups. This study shows that listening to music, either vocal or instrumental promotes wide-spread structural connectivity changes in the post-stroke brain, providing a fertile ground for functional restoration.