Monday, June 26, 2017

No changes in functional connectivity during motor recovery beyond 5 weeks post-stroke. A resting-state fMRI study.

Spontaneous motor recovery after stroke appears to be associated with structural and functional changes in the motor network. The aim of the current study was to explore time-dependent changes in resting-state (rs) functional connectivity in motor-impaired stroke patients, using rs-functional MRI at 5 weeks and 26 weeks post-stroke onset. For this aim, 13 stroke patients from the EXPLICIT-stroke Trial and age and gender-matched healthy control subjects were included. Patients’ synergistic motor control of the paretic upper-limb was assessed with the upper extremity section of the Fugl-Meyer Assessment (FMA-UE) within 2 weeks, and at 5 and 26 weeks post-stroke onset. Results showed that the ipsilesional rs-functional connectivity between motor areas was lower compared to the contralesional rs-functional connectivity, but this difference did not change significantly over time. No relations were observed between changes in rs-functional connectivity and upper-limb motor recovery, despite changes in upper-limb function as measured with the FMA-UE. Last, overall rs-functional connectivity was comparable for patients and healthy control subjects.

To conclude, the current findings did not provide evidence that in moderately impaired stroke patients the lower rs-functional connectivity of the ipsilesional hemisphere changed over time.

The LCAP - Lateral Chain Arm Pull Test

WCPT Launches World Physical Therapy Day Toolkit

Infographics,  postcards and booklets are available to help you get people moving!

The WCPT has launched the toolkit for World Physical Therapy Day 2017. The theme this year is ‘Physical activity for life’ which is emphasising the importance and role of physical therapists in supporting people of all ages to keep moving.

This year’s toolkit focusses on how physical therapists help people to achieve activity goals through advice and exercise programmes.

“World PT Day is an opportunity to recognise the fantastic work that physical therapists do for their patients and community. We recognise that World PT Day is a time of great celebration for the physical therapy community, and encourage all member organisations to download the toolkit and start planning events and activities to showcase how we keep people physically active for life.” – WCPT Chief Executive Jonathon Kruger.

World Physical Therapy Day takes place on 8th September. WCPT encourages member organisations to organise events, publicity and campaigns which celebrate the global physical therapy community.

The toolkit demonstrates how physical therapists can help keep people of all ages active, including World Health Organization recommendations for moderate and vigorous activity, and a range of research and reports showing the benefits of physical activity in maintaining health.

Get the poster and postcards here

Don’t miss out on the infographic

Understanding knee osteoarthritis from the patients’ perspective: a qualitative study

No studies of Health Coach Interventions for knee OA sufferers that include patients’ perspectives have been published. This study assesses current clinical practice and primary care professionals’ advice from the patients’ perspective, in order to obtain a participative design for a complex intervention based on coaching psychology. Moreover, wants to analyse the experiences, perceptions, cognitive evaluation, values, emotions, beliefs and coping strategies of patients with knee osteoarthritis, and secondly the impact of these factors in the Self-management of this condition.

It is an interpretative qualitative study. The study included patients with diagnosis of knee osteoarthritis (OA) from 4 primary health care centres in Barcelona. A theoretical sampling based on a prior definition of participants’ characteristics was carried out. Ten semi-structured interviews with knee OA patients were carried out. A content thematic analysis was performed following a mixed-strategy text codification in Lazarus framework and in emerging codes from the data.

The results are structured in two blocks: Experiences and perceptions of informants and Experiences of knee osteoarthritis according to the Lazarus model. Regarding experiences and perceptions of informants: Some participants reported that the information was mostly provided by health professionals. Informants know which food they should eat to lose weight and the benefits of weight loss. Moreover, participants explained that they like walking but that sometimes it is difficult to put into practice. Regarding experiences of knee osteoarthritis according Lazarus model: Cognitive evaluation is influenced by cognitive distortions such as obligation, guilt, dramatization and catastrophism. Values: Family is the value most associated with wellbeing. Helping others is another recurring value. Emotions: Most participants explain that they feel anxiety, irritability or sadness. Beliefs: To some, physiotherapy helps them feel less pain. However, others explain that it is of no use to them. Participants are aware of the association overweight– pain. Coping strategies: The strategies for coping with emotions aim to reduce psychological distress (anxiety, sadness, anger) and some are more active than others.

The study highlights that patients with knee osteoarthritis require a person-centered approach that provides them with strategies to overcome the psychological distress caused by this condition.

Sunday, June 25, 2017

Modern pain neuroscience in clinical practice: applied to post-cancer, paediatric and sports-related pain.

In the last decade, evidence regarding chronic pain has developed exponentially. Numerous studies show that many chronic pain populations show specific neuroplastic changes in the peripheral and central nervous system. These changes are reflected in clinical manifestations, like a generalized hypersensitivity of the somatosensory system. Besides a hypersensitivity of bottom-up nociceptive transmission, there is also evidence for top-down facilitation of pain due to malfunctioning of the endogenous descending nociceptive modulatory systems. These and other aspects of modern pain neuroscience are starting to be applied within daily clinical practice. However, currently the application of this knowledge is mostly limited to the general adult population with musculoskeletal problems, while evidence is getting stronger that also in other chronic pain populations these neuroplastic processes may contribute to the occurrence and persistence of the pain problem.

Therefore, this masterclass article aims at giving an overview of the current modern pain neuroscience knowledge and its potential application in post-cancer, paediatric and sports-related pain problems.

Saturday, June 24, 2017

Woebot, a bridge to Artificially Intelligent Physiotherapy?

It is human nature to make tools to make our lives easier. In recent history the development of automation changed lives substantially. Now at first this makes you think of huge clunky machines which lift heavy things onto conveyor belts and performed physical tasks, and this is true. Now refine that concept, add smarter technology and make it smaller and you have a different beast. Now you have something which can learn new tasks and perform complex analysis faster and cheaper than a person.

As this recent article in Wired explains, chatbots are beginning to work in sensitive areas of society such advising refugees, something which you would think only a human would be able to do. Advising a person what to do from a strict list of commands is one thing and never has a chatbot treated a clinical condition before. This line has now been crossed and we are now on a precipice of a dramatic shift in the delivery healthcare.

Woebot was created by Stanford psychologists and AI experts acts as a mental health therapeutic assistant. It provides a therapeutic experience to the users via concepts similar to those used in CBT. Obviously Woebot is not a doctor and is unable to make diagnoses or prescribe medication and advises you to seek ‘real world’ help if it detects a crisis however evidence has shown it to be effective at reducing stress and anxiety.

The technology works through Facebook messenger and asks you questions about your mood. Depending on your answer Woebot follows your answers along a decision tree and offers personal responses. The conversations are tracked and this allows further personalised answers.

The project is based on a previous project called ‘Ellie’ which showed that computers actually make good therapists. Now it is important to say that I am an advocate of technology such as Woebot. It improve the mental health of those unable to access psychiatric healthcare or those who are unlikely to seek help in the first place.

Let’s be honest it is only a matter of time before this sort of tech is changing the landscape of physiotherapy.

Apply this concept to something like exercise prescription and this could alter the future of physiotherapy dramatically. We are already seeing novel telerehab ideas which reduce the need for face to face follow up sessions. Add virtual reality technology into the mix and suddenly a face-to-face consultation is (kind of-)replicated.

(Disclaimer – I’m oversimplifying what we do a physiotherapists in the next part to allow critical discussion)

In a crude sense (I really mean crude sense) some aspects of physiotherapy assessments are either pattern recognition or fitting a particular set of movement restrictions or pain into a diagnostic algorithm. We do this all the time as clinicians, a positive test with a restriction in a movement along with a history will normally tell you what the diagnosis is and therefore your treatment plan. Use the example of an ankle sprain, the assessment can be simple and the rehab can be very specific. Listen to Calibe Doherty and you’ll see what I mean. It is possible with the right combinations of technology could form an advanced form of a PhysioBot. Imagine a Woebot with movement sensors.

Obviously this isn’t happening now and there is a big chance it isn’t happening soon, I haven’t even begun to discuss the ethical implications and the complex clinical reasoning that goes into a physiotherapy assessment and treatment plan or the human contact. It is important we think ahead though.

As a profession we need to embrace this technology and have our say with how it should be used. It is important we don’t see this as a threat or we run the risk of being cast aside, we won’t win in a battle against technology. If we embrace it we will flourish alongside and work together to improve health around the world.

Comparison Between Chronic Migraine & Temporomandibular Disorders in Pain-Related Disability & Fear-Avoidance

The aim of this study was to compare patients with chronic migraine (CM) and chronic temporomandibular disorders (TMD) on disability, pain, and fear avoidance factors and to associate these variables within groups. A total of 50 patients with CM and 51 patients with chronic TMD, classified by international criteria classifications were included in the study. The variables evaluated included pain intensity (visual analog scale [VAS]), neck disability (NDI), craniofacial pain and disability (CF-PDI), headache impact (HIT-6), pain catastrophizing (PCS), and kinesiophobia (TSK-11).

Statistically significant differences were found between the CM group and the chronic TMD group in CF-PDI ( P  < 0.001), PCS ( P  = 0.03), and HIT-6 ( P  < 0.001); however, there were no differences between the CM group and the VAS, NDI, and TSK-11 groups ( P  > 0.05). For the chronic TMD group, the combination of NDI and TSK-11 was a significant covariate model of CF-PDI (adjusted R 2  = 0.34). In the CM group, the regression model showed that NDI was a significant predictive factor for HIT-6 (adjusted R 2  = 0.19).

Differences between the CM group and the chronic TMD group were found in craniofacial pain and disability, pain catastrophizing, and headache impact, but they were similar for pain intensity, neck disability, and kinesiophobia. Neck disability and kinesiophobia were covariates of craniofacial pain and disability (34% of variance) for chronic TMD. In the CM group, neck disability was a predictive factor for headache impact (19.3% of variance).