In search of Kipling’s six honest serving men in upper limb rehabilitation: within participant case-crossover experiment nested within a web-based questionnaire

Notice exactly how fucking bad this is. Therapists don't have protocols and think
30- to 60-min per day as the optimal dose to provide. With 85% of time is spent in bed not moving you will never recover on 60 minutes a day. Your therapists should have protocols on all these you can do without a therapist present;

1. action observation, 

2. mirror therapy,

3. thermal therapy, 

4. lucid dreaming 

5. Music therapy

6. Sensation overload 

In search of Kipling’s six honest serving men in upper limb rehabilitation: within participant case-crossover experiment nested within a web-based questionnaire

K. S. Hayward , L. Jolliffe , L. Churilov , A. Herrmann , G. C. Cloud & N. A. Lannin

Received 13 Jan 2020, Accepted 24 Aug 2020, Published online: 22 Sep 2020

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• https://doi.org/10.1080/09638288.2020.1815873
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Abstract

Purpose

In search of Kipling’s six honest serving men in upper limb rehabilitation after stroke, we sought to investigate clinicians’ perspective of when and where to begin therapy, how much and what therapy to provide, and who and why (or not) to provide therapy.

Materials & methods: Within-participant case cross-over experiments were nested within an anonymous web-based questionnaire (21 questions, three cases). Graph theory-based voting to produce ranked ordered lists and mixed-effect logistic regression were performed.

Results

In total, 225 Australian stroke clinicians responded: 53% occupational therapists, 61% working in acute/inpatient stroke setting. Most respondents indicated they did not have a protocol/expectation regarding when (62%), how much (84%) or what (60%) therapy to provide in their setting. Respondents ranked 24-h to 7-days post-stroke as the optimal time to commence therapy, and 30- to 60-min per day as the optimal dose to provide. Within-participant experiments demonstrated that greater motor recovery as time progressed increased the odds of offering therapy, while lack of motor recovery, shoulder pain, neurological decline and sole therapist reduced the odds.

Conclusion

We need to develop an evidence base concerning Kipling’s six honest serving men and equip clinicians with clinical decision-making skills aligned with this focus.

• IMPLICATIONS FOR REHABILITATION

• Most clinicians did not have access to a protocol / clinical pathway which defines when, how much and what upper limb therapy to provide after stroke, which may be improved by providing individual clinicians with organisational support to make therapy decisions.

• To improve the personalisation of upper limb rehabilitation in clinical practice, we need to understand when and where after stroke to begin therapy, how much and what therapy to provide, as well as who and why (clinical decision-making) to provide therapy.

• Clinicians perceive clinical trials as successful if the therapy can demonstrate recovery that is greater than a minimal clinical important difference (MCID).

 

Breaking Up Sitting Time After Stroke Study - Australia

Join if you can. With the 85% inactivity that stroke patients have there should also be a study on:

1. action observation, 

2. mirror therapy,

3. thermal therapy, 

4. lucid dreaming 

5. Music therapy

6. Sensation overload 

to determine the efficacy of these interventions. We need protocols not just, 'Hey this seems to work sometimes, but we know nothing about dosing. You'll just have to guess.'  And then your medical staff can blame you for not recovering because you didn't do the therapy right or long enough

Breaking Up Sitting Time After Stroke Study - Australia

BUST-BP-Dose Study

Researchers at the Hunter Medical Research Institute (HMRI) are looking at the effects of reducing long periods of sitting, with regular activity breaks, to improve blood pressure in those who have had a stroke.
The BUST-BP-Dose study will monitor blood pressure and blood sugar levels in people who have had a stroke between 3 months and 10 years ago. The study will look at the amount of short activity breaks needed to improve blood pressure in stroke survivors and reduce their risk of having another stroke.
The study is being supported by a Heart Foundation Vanguard Grant, Hunter Medical Research Institute research support grant and Priority Research Centre for Stroke and Brain Injury research support grant.

Register your interest

To find out more or to register your interest please contact Dr Gary Crowfoot on 02 40420759 (Gary.Crowfoot@newcastle.edu.au) or Mr Paul Mackie on 0420881472 (Paul.I.Mackie@uon.edu.au).

Doctors Are Now Calling For Safety Warning Stickers On Avocados

Be careful out there. Since stroke I have never attempted avocadoes, the left hand can't be opened enough to hold one and then it would instantly smash it flat.  Onions done one-handed are frustrating but can be done with the rocker knife.
I got no ADL training on anything to do with using a knife to cut anything. Those protocols should be publicly available to every stroke survivor.  Videos on that should be used to fill up the 85% wasted rehab time while in the hospital.
https://www.yahoo.com/beauty/doctors-now-calling-safety-warning-194500400.html

Refinery29May 11, 2017

There's a new menace wreaking havoc in kitchens across the land. And it's probably lurking in your fruit bowl right now. Growing numbers of amateur chefs are visiting accident and emergency departments thanks to our obsession with avocados.

Their affliction? So-called "avocado hand" — serious stab and slash wounds resulting from failed attempts at penetrating the fruit's tough skin, and slippery collisions with the inner stone.

Doctors say some cases even result in serious damage to nerve and tendon damage, requiring complex surgery, and some may never regain full use of their hand. Almost laughably, doctors have even reported a "post-brunch surge" in victims on Saturdays, The Times reported.

Doctors are now calling for safety warning stickers to be stuck on the fruit. “People do not anticipate that the avocados they buy can be very ripe and there is minimal understanding of how to handle them," Simon Eccles, honorary secretary of the British Association of Plastic, Reconstructive and Aesthetic Surgeons, who treats about four avocado-hand sufferers a week, told The Times. "Perhaps we could have a cartoon picture of an avocado with a knife, and a big red cross going through it?”

While there are currently no hard statistics on the number of victims, there's good evidence that avocado hand is widespread – and not just the scourge of middle-class homes in Britain. Meryl Streep lost her battle with an avocado back in 2012 and was photographed with a bandage, and more than 300 people have sought compensation for avocado injuries in New Zealand in the past five years. The wife of a New York Times staffer recently fell victim to the buttery fruit, leading the paper to cover the issue.

But avocados aren't the only foods to be wary of in the kitchen, with popular brunch ingredients proving particularly hazardous. Bagels are notorious for causing similar hand injuries, especially when over-eager brunchers attempt to slice them while frozen. Sourdough toast, too, can cause jaw ache and wrist pain when attempting to cut it with a knife and fork.

Knives aren't the only kitchen appliances to watch out for, either. Fingers can easily call prey to a mezzaluna, used to finely chop herbs, or a mandolin, when you're shredding veggies for your summer salad.

How to cut and de-stone an avocado safely

It's as simple as placing the avocado on a flat surface with your hand on top and gently making incisions around the outside, Jeff Bland, executive chef at the Michelin-starred Balmoral Hotel in Edinburgh, told The Times.

When de-stoning, it may be worth wrapping the fruit in a towel if you're injury-prone, leaving the stone exposed, David Shewring, vice-president of the British Society for Surgery of the Hand, told The Times. Then, "use the edge of a heavy sharp knife to chop into the summit of the soft pip, so that it is slightly buried. Holding the knife, so that the pip is stabilised, use a towel to twist the pip out.”

Because a mangled hand isn't a price worth paying for an Instagrammable brunch.

Association between 7 days per week rehabilitation and functional recovery of patients with acute stroke: A retrospective cohort study based on the Japan rehabilitation database

 Yes, but would 5 and 6 day a week be just as good if all the dead time in the hospital is used for rehabilitation? And since you are inactive 85% of the time while in the hospital your doctor is allowing you to deteriorate.
http://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J75824&phrase=no&rec=133372&article_source=Rehab&international=0&international_language=&international_location=
Archives of Physical Medicine and Rehabilitation , Volume 98(4) , Pgs. 701-706.

NARIC Accession Number: J75824.  What's this?
ISSN: 0003-9993.
Author(s): Kinoshita, Shoji; Momosaki, Ryo; Kakuda, Wataru; Okamoto, Takatsugu; Abo, Masahiro.
Publication Year: 2017.
Number of Pages: 6.
Abstract: Study examined the effect of 7 days per week (7d/wk) of rehabilitation on the functional recovery of patients with acute stroke. Seven days per week of rehabilitation was defined as rehabilitation therapy administrated by a physical or occupational therapist on every weekday, Saturday, and Sunday. Researchers tested the hypothesis that functional outcome of patients with stroke who receive 7d/wk of rehabilitation is generally better than that of similar patients who undergo 5 or 6d/wk of rehabilitation. Data were collected from the Japan Rehabilitation Database for 3,072 patients with stroke who were admitted to acute hospitals and received 7d/wk of rehabilitation. The primary outcome was favorable functional independence in daily living, defined as a modified Rankin Scale score of 0 to 2 at the time of discharge. A total of 1075 (35.0 percent) patients received 7d/wk of rehabilitation. Univariate analysis demonstrated a significant difference in favorable functional recovery between the 7d/wk rehabilitation group and non-7d/wk rehabilitation group (43.3 versus 37.6 percent, respectively). Multivariate logistic regression analysis using the generalized estimating equations method showed that 7d/wk of rehabilitation was independently associated with favorable functional recovery. This study demonstrated that 7d/wk of rehabilitation in early rehabilitation for patients with acute stroke can lead to functional recovery.
Descriptor Terms: ACUTE CARE, FUNCTIONAL STATUS, INDEPENDENT LIVING, INTERNATIONAL REHABILITATION, OCCUPATIONAL THERAPY, OUTCOMES, PHYSICAL THERAPY, REHABILITATION SERVICES, SERVICE DELIVERY, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Kinoshita, Shoji, Momosaki, Ryo, Kakuda, Wataru, Okamoto, Takatsugu, Abo, Masahiro. (2017). Association between 7 days per week rehabilitation and functional recovery of patients with acute stroke: A retrospective cohort study based on the Japan rehabilitation database.  Archives of Physical Medicine and Rehabilitation , 98(4), Pgs. 701-706. Retrieved 5/13/2017, from REHABDATA database.


* The majority of journal articles, books, and reports in our collection are only available by regular mail, rather than downloadable electronic format. Learn more about our digital collection and our document delivery service.

More information about this publication:
Archives of Physical Medicine and Rehabilitation.

How Inactivity Changes the Brain

And since you are inactive 85% of the time while in the hospital your doctor is allowing you to deteriorate.

How Inactivity Changes the Brain

Rethinking Recovery and Rehabilitation after Stroke - John Krakauer

I've got 7 posts on Dr. John Krakauer already, he has some great ideas, virtual dolphins, calls stroke rehab medieval. You in the first days after your stroke will need to see what your doctor knows about this. Krakauer mentions lots of problems in stroke that your doctor should already know about and be addressing.
https://smartech.gatech.edu/handle/1853/56529

There are critical differences in the potential for rehabilitation of impairment early and late after stroke. Early after stroke the proportional recovery rule for spontaneous biological recovery applies, as does the idea of a sensitive period. Late after stroke, rehabilitation relies on motor learning principles. We will need new behavioral treatments augmented by pharmacology and perhaps non-invasive brain stimulation to rectify the overall ineffectiveness of current neurorehabilitation

Go to the mp4 file, it contains a 1 hour lecture which is wonderful.
Some tidbits from there:
'No computational or algorithmic theory of practice'. So we know nothing about stroke rehab.
' I have no idea why we do robotics for rehabilitation'.
'Current rehab seems to have no impact whatsoever'.
'Sensitive period can be reset with second stroke' slide.
Fluoxetine slide is good, does your doctor know about that?
85% of time is spent in bed not moving.