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Neuropsychological Rehabilitation - Science topic

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Greetings!
I, Darshan Prakashbhai Parmar, MPT student, from Government Physiotherapy College Jamnagar, am conducting a survey on 'EFFICACY OF PELVIC PNF TO IMPROVE TRUNK CONTROL, BALANCE AND GAIT PATTERN IN NEUROLOGICAL CONDITIONS' as a part of my Evidence Based Study(EBS) under the supervision of my Guide, Dr. Karishma Jagad (MPT-NEURO), Sr. Lecturer at Government Physiotherapy College Jamnagar.
We therefore request physiotherapists practicing in India to kindly fill this questionnaire, which will hardly take around 10-15 minutes. The link for the survey is provided below. The responses will be kept anonymous.
I further request you to forward the link to your friends or colleagues.
*(In case the link does not open, please copy and paste the link in your web browser or you can whatsapp me on +917984377793, I will share the form link there.)*
Thank you for your time and participation.
Take care and stay safe
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answer submitted
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What tool do you use to make clinical decisions?
Example:
a)sum of criteria (signs - symptoms);
b)the weighting of clinical scales;
c)use of RPS form and application of a CORE set ICF and thus obtain an operating profile?
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I suggest going through the down-mentioned article, which was published in the American Journal of Physical Medicine and Rehabilitation in 2020. The article argues that several factors (related to the service organization and health system, besides the contextual personal/environmental factors) have a relevant influence on the decision-making in evidence-based practice in rehabilitation.
Good luck!
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Please share your favorite overview of leave-one-out cross-validation technique applied to medical tests. I'm looking for the original paper/book or an overview close in time to when the technique was first introduced into the medical field. Preferably, with mathematically sound substantiation.
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sorry, i did not read your question carefully enough ; the following references are recent works around L1O
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A survey of cross-validation procedures for model selection
Sylvain Arlot, Alain Celisse
Used to estimate the risk of an estimator or to perform model selection, cross-validation is a widespread strategy because of its simplicity and its apparent universality. Many results exist on the model selection performances of cross-validation procedures. This survey intends to relate these results to the most recent advances of model selection theory, with a particular emphasis on distinguishing empirical statements from rigorous theoretical results. As a conclusion, guidelines are provided for choosing the best cross-validation procedure according to the particular features of the problem in hand.
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Stability revisited: new generalisation bounds for the Leave-one-Out
Alain Celisse, Benjamin Guedj
The present paper provides a new generic strategy leading to non-asymptotic theoretical guarantees on the Leave-one-Out procedure applied to a broad class of learning algorithms. This strategy relies on two main ingredients: the new notion of Lq stability, and the strong use of moment inequalities.
Lq stability extends the ongoing notion of hypothesis stability while remaining weaker than the uniform stability. It leads to new PAC exponential generalisation bounds for Leave-one-Out under mild assumptions. In the literature, such bounds are available only for uniform stable algorithms under boundedness for instance. Our generic strategy is applied to the Ridge regression algorithm as a first step.
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Theoretical analysis of cross-validation for estimating the risk of the k-Nearest Neighbor classiffer
Alain Celisse, Tristan Mary-Huard
The present work aims at deriving theoretical guaranties on the behavior of some cross-validation procedures applied to the k-nearest neighbors (kNN) rule in the context of binary {0,1}-classification. Here we focus on the leave-p-out cross-validation (LpO) used to assess the performance of the kNN classifier. Remarkably this LpO estimator can be efficiently computed using closed-form formulas derived by Celisse and Mary-Huard (2011).
We describe a general strategy to derive exponential concentration inequalities for the LpO estimator applied to the kNN classiffier. This relies on deriving upper bounds on the polynomial moments of the centered LpO estimator by first deriving such bounds for the leave-one-out (L1O) estimator. Such results are obtained by exploiting the connection between the LpO estimator and U-statistics as well as by making an intensive use of the generalized Efron-Stein inequality. One other contribution is the extension to the LpO of the consistency results previously established by Rogers and Wagner (1978) for the L1O as an estimator of the risk and/or the error rate of the kNN classifier.
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(... and other references from the same group of authors)
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I am a psychomotor therapist and I am implementing cognitive remediation approaches in child psychiatry. I would like exchange with researchers and therapists about clinical practice and deep clinical know how in this area...
Is there someone interested in ?
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Hi Simon,
Many thanks for your message and articles, I appreciate a lot. I am away of my desk yet for some hollidays... I will read your papers, and I will come back to you...
Have a nice days, talk to you soon
Jéerôme
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Within physiotherapy it seem to be well established that horse-riding has positive effects on motoric skills and brain activity on persons with physical disabilities. The rhythm of horse gait seems to be a good stimulation for people that have impaired ability to walk by themselves. At the same time they might get the chance to be outside and experience nature on horseback, with the stimulating effects of being in nature together with a big, friendly horse.
In some countries there are also some small-scale trials, but mainly practical experience, of camel riding for people with disabilities, both physical and mental. Here is some info in German: http://www.therapeutisches-kamelreiten.de/therapietier_kamel.html
I am interested in if there is any investigation of camel gait (ambling) and the effect of it from a physiotherapeutic point of view, as well as compared to horse gait (walk-pace, trotting) for the same purpose.
It is easy to see that a two-humped camel may give more comfort and support for people who are not able to sit on a horse, since they can sit quite safely between the humps. But what about differences between camel ambling and horse's walk-pace? Are these differences important or not, from a physiotherapeutic viewpoint?
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I see. You mean it is nearly impossible not because of lack of camels, but because it is not economically possible. That is another question. :)
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I am working with a mixed group of adults with post-traumatic-stress-disorder. Since it is my first time with such group I would like to know any clinical or therapy experts what is the most appropriate way to initiate therapy with such groups and if working on the periphery is a better option rather than going to the depth of the trauma.
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Beatrice, Rahul Chandavarkar and Kristen 
Thanks a lot for your contributions. 
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I wonder what would be the best rehabilitation for a ruptured anterior cruciate ligament by impact in a fall during a basketball game. After trying to rehabilitate by exercises with trx does not improve. which method should be used to improve this?
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ACL reconstruction followed by ACL protocol of strengthening Hamsrings and gradual Knee bending and Quadriceps build up. Hmsrings strenghthening is more important than Quadriceps which most of the Physiotherapists do not do
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I am currently writin a literature review on several tools for assessing prospective memory. Would you have the normative data (sample characteristics, reliability, validity, sensitivity, specificity, etc.) of the RBMT-III and the CAMPROMPT (Wilson et al., 2008;2005) ? 
Thanks in advance for your help.
Regards,
Geoffrey.
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Your question contains links to the best sources. The tests will come with detailed Manuals. If you don't have a budget to purchase, then try contacting a Pearson Clinical representative; I know they want to facilitate research/publications regarding their products.
Another good source would be the Mental Measurements Yearbook, published by the Buros Institute. Your library may have a subscription; otherwise, you have to pay about $15 US per article. These are commissioned reviews by assessment experts. I know they published one about the Cambridge Prospective Memory Test in 2005, and I think the most recent review of the Rivermead was in 2008.
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Hi. As we know by stimulating special cells, doctors and scientists are able to transfer different senses such as pain to patients. Now the question is: "Is it possible to import specific data such as words in other languages to brain by extracellular stimulation? "
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I am afraid that the question involves a confusion.  By stimulating certain areas of the brain you can give a subject a variety of experiences, including memory recall and pain.  But you are not transferring those experiences from anybody (or anywhere) else. You can also transfer genes into brains and give those brains new experiences.  For example, you can have mice experience colors that they could not experience before.  But I do not think it is possible to give some knowledge of specific words in a foreign language by transferring some cells.  First, being able to remember, understand, and use words involves many different and complex areas of the brain.  Such transplant would simply be impossible.  Second, even the attempt would be highly unethical since it would kill the donor.
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Rehabilitation normally consists of different types of therapies, neuropsychological rehabilitation and pharmacological treatments.
Has there been any new developments in the use of stem cell therapy in the hippocampus, use of the endocrine system to buffer against further deterioration (such as the use of melatonin), or other forms of advanced treatment that have occurred or are under way?
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Dear Cheryl,
I do agree with Geoffrey with regard to the effect of stem cells; there are recent reports about it. However, the problem, in TBI, for instance, or Diffuse Axonal Injury occurring as a consequence of it or due to Cardiac Arrest is the time needed for harvesting autologous stem cells, expanding them until arising a significant number and injecting them back to the patient. During this time the cascade of inflammatory signals turned on by diffuse axonal injury is progressively increasing, making the brain damage stronger. In my opinion, and in my experience, the best urgent solution for blocking pro-inflammatory cytokines and avoiding the dead cascade is to administer melatonin, at doses no lower than 10 mg, it can be increased through 200-400 mg though. 
Best regards
Jesús Devesa, MD, PhD
Professor of Physiology
Specialist in Endocrinology and Magister in Advanced Regenerative Therapies
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One aspect we lag behind in management is the timely rehabilitation in patients with TBI. Can anyone advise on the rational approach for the same in the resource restrained setup ?????
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A patient of mine who had TBI years ago from an MVA , with coma , subsequent motor and cognitive deficits and disfigurement, had spent a very long time in various excellent inpatient and outpatient  neuro-rehabilitation programs.
He shared with me a book, written by a U of Penn English Professor's husband. A true story about his experience and hers going thru recovery with top inpatient and outpatient facilities. The Book Title is Where is the Mango Princess.  don't  be dissuaded by the title.
Where Is the Mango Princess?: A Journey Back From Brain Injury Kindle Edition
by Cathy Crimmins (Author)
4.8 out of 5 stars 103 customer reviews
"5.0 out of 5 stars What an Amazing Book !!, October 15, 2000
By
BeachReader
This review is from: Where Is the Mango Princess? (Hardcover)
Cathy Crimmins has taught us all a lesson in this book.....that life isn't always as we had thought it would be and that we must be proactive in order to change it.
When her husband, Alan, a successful bank attorney in Philadelphia, suffers a Traumatic Brain Injury (TBI) in an accident, his life and his family's lives change forever. Crimmins takes us through the extensive rehab process which she handles with both tears and laughter. As a reader, I found myself experiencing feelings of anger, hope, sadness, and joy at the smallest improvement in her husband's condition and at the smallest victory over the system.
I could not believe how much I learned from this book. It should be "must reading" for everyone who works with brain-injured patients and also for all of those insurance company "voices on the phone" who make life and death decisions based on very little information, and with very little empathy. I learned about something called "perseveration" which is when a brain-injured person repeats an action or phrase over and over and over again. I also learned that with brain injuries such as this, inhibitions disappear, which means that socially inappropriate behaviors are often displayed. Crimmins also made the reader understand why these patients and their families become so frustrated. I could fill pages with what I learned.......
I read this book in one day and a friend who was visiting me read it the next. I then passed it on to my daughter who also read it in one day and then recommended it to her neurobiology professor who thought it was outstanding. If I had the power to make this book a bestseller, I would!"
This book I now require residents in GME training to read and perhaps it should be read at Medical Schools and by faculty.  Although written for the lay person, it provides insight and empathy for those who experience TBI and various recovery phases. Realistic STG and LTG enable coping strategies to kick in when despite remarkable or miraculous improvement the subtle cognitive and personality changes may never fully recover and (spoiler alert) preclude to previous employment setting (in this case a high powered Philadelphia law firm)
You will never look at someone with TBI (however minor appearing) the same again- this book can be trans- formative for patient's significant others and to physicians in creating true compassion.
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for instance ; plasticity?
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HI saroja,
 it depends on the
1) type of stroke  and lesion location
2) post stroke condition :  like  hemiparesis(loss of motor control , double vision, numbness, apraxia (altered voluntary movements) and dysarthria (slurred speech).  
3) the severity  and stage post stroke : acute, sub acute etc.
I study hemiparesis , and for that under  given supervisions from the medical (therapist) support, Neuro-rehabilitative treatment aids in faster motor recovery in movement coordination, motor learning.
please refer to this :
and 
for detailed exaplanation  of how plasticiy occurs
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I am particularly interested in the standard of care for cognitive rehabilitiation in adults or children who have suffered a stroke.
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Look at the ACRM evidence-based reviews on cognitive rehabilitation for stroke that are published in the Archives of Physical Medicine and Rehabiltiation. Those are the most authoritative references reviewed by the leaders in the field.
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Neurological physiotherapy.
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Hi Sridhar,
There is increasing evidence of the possitive effects of neurobics, brain training and brain fitness on cognitive performance. I recommend you to visit Lumosity, Cogmed or Cognifit's websites and have a look at their research works. I collaborated designing games for the brain at www.unobrain.com, but all the content is in Spanish :-(
I hope all of this will help you!
Best,
Marisa
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In neuropsychological & neuro-rehabilitation there are times when we meet clients who profoundly disagree with our analysis (which I accept is only ever a hypothesis). Sometimes the nature of the disagreement might be about expected outcomes. For example "when will my hand start moving again?" might be met with a therapist's view - this is a profound paralysis explained by extent of lesion and it might not voluntarily move again - that contrasts with the patient's view "if I keep seeking opinions, keep striving, someone might be able to help restore the lost function"). There are times when it is very difficult to shift from this narrative that seems to head into persisting disagreement&disappointment, preventing adjustment & acceptance. Playing into this context is a marketplace of people with their latest gadget or therapy approach. IN my view, this can perpetuate distress. I think there are some interesting therapeutic implications but not aware of much literature on this (?). I'd be fascinated to know if this is of interest to others in this forum. What therapeutic strategies would you try?
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I agree with Catherine on the need to work on acceptance in many cases. The problem [and this is my main point] is that acceptance is not as simple as it sounds. On the contrary it is an emotionally dynamic process, highly complex, for the patient [his family] and the therapists as well. I believe that more training [and the development of models] on this matter is needed. So professionals can facilitate this process and avoid interventions that are iatrogenic.
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Do older people receive less intensive rehab than younger ones? I am looking for articles dealing with the relationship between age and rehab intensity.
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Because other health factors influence tolerance to tolerance, at the extremes of age--very young infants asl well as the very old often have a lower tolerance. Age probably also changes optimal intensity of dose independent of tolerance but the study of dosage across the age spectrum is still being investigated.
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From my practice I could see that the therapy hall, in which the children are being treated has an impact in the outcome of neurologically deficit children like cerebral palsy. Most often what the kid observes from his or her surroundings varies in case of an open therapy (where all kids gets treated in a large hall) and closed therapy (where each kid gets treated in a separate room or partitioned) environment. How can you judge this from your clinical practice treating children?
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dear Joshua,
Every child, with or without a handicap of any sort will have to deal with his/her peers. In every situation, it will be dependent on the child's character, the child's background and the parental reactions as to whether seeing other that can 'do more'' is perceived as detrimental. I have found that children accept who they are very easily and accommodate. I am not too afraid of the negative impact you speak of.
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I am monitoring interventions for Parkinson's by pulse-oximeter readings for parasympathetic response, in a patient-centered design, and have seen progress in several rating scale domains, but keep having this nagging thought that if it were really possible, someone would have thought of it already.
If you could suggest holes in my reasoning it would help.
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For research purposes
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I am familiar with programs of cognitive rehabilitation. I will be happy to help.
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The importance of visual rehabilitation after a stroke has been increasingly acknowledged during the last years.
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In Germany, Prof. Dr. med. Susanne Trauzettel-Klosinski has been awarded a neurorehablitation price for her work on rehabilitation training for patients with visual field defects after stroke. Her work might be interesting for you.
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I know about using just the verbal tests from WAIS-1V and WMS-!V, but other suggestions would be helpful.
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Another test would be the TOMAL-R (Test of memory and learning) which has various verbal memory tasks. Also, some substest of the Woodckock Johnson Psychoeducational Battery. Finally, verbal reasoning from the FAVRES could be of use for some fucntional verbal problem solving... plus the BRIEF. The total loss of vision is not so frequent after a TBI. Is this due to bilateral damage to the primary visual cortex?