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Journal articleKaramchandani U, Bhattacharyya R, Patel R, et al., 2021, , AMERICAN JOURNAL OF SPORTS MEDICINE, Vol: 49, Pages: 2341-2350, ISSN: 0363-5465
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- Citations: 2
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Conference paperMcGregor A, Harrison A, 2021,
Building the right homes for adults with learning disabilities and autism: A multi-agency approach
, Publisher: WILEY, Pages: 1276-1276, ISSN: 1360-2322 -
Journal articleFormstone L, Huo W, Wilson S, et al., 2021, , IEEE Transactions on Neural Systems and Rehabilitation Engineering, Vol: 29, Pages: 1158-1167, ISSN: 1534-4320
Subjective clinical rating scales represent the goldstandard diagnosis of motor function following stroke, however in practice they suffer from well-recognised limitations including variance between assessors, low inter-rater reliability and low resolution. Automated systems have been proposed for empirical quantification but have significantly impacted clinical practice. We address translational challenges in this arena through: (1) implementation of a novel sensor suite fusing inertial measurement and mechanomyography (MMG) to quantify hand and wrist motor function; and (2) introduction of a new range of signal features extracted from the suite to supplement predicted clinical scores. The wearable sensors, signal features, and sensor fusion algorithms have been combined to produce classified ratings from the Fugl-Meyer clinical assessment rating scale. Furthermore, we have designed the system to augment clinical rating with several sensor-derived supplementary features encompassing critical aspects of motor dysfunction (e.g. joint angle, muscle activity, etc.). Performance is validated through a large-scale study on a poststroke cohort of 64 patients. Fugl-Meyer Assessment tasks were classified with 75% accuracy for gross motor tasks and 62% for hand/wrist motor tasks. Of greater import, supplementary features demonstrated concurrent validity with Fugl-Meyer ratings, evidencing their utility as new measures of motor function suited to automated assessment. Finally, the supplementary features also provide continuous measures of sub-components of motor function, offering the potential to complement low accuracy but well-validated clinical rating scales when high-quality motor outcome measures are required. We believe this work provides a basis for widespread clinical adoption of inertial-MMG sensor use for post-stroke clinical motor assessment.Index Terms—Stroke, Fugl-Meyer assessment, automated upper-limb assessment, wearables, machine learning, mechanomyogra
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Journal articleRouhani MJ, Clunie G, Thong G, et al., 2021, , The Laryngoscope, Vol: 131, Pages: E1918-E1925, ISSN: 0023-852X
ObjectiveThe COVID‐19 pandemic has led to unprecedented demands on healthcare with many requiring intubation. Tracheostomy insertion has often been delayed and the enduring effects of this on voice, swallow, and airway outcomes in COVID‐19 tracheostomy patients are unknown. The aim of this study was to prospectively assess these outcomes in this patient cohort following hospital discharge.MethodsAll COVID‐19 patients who had undergone tracheostomy insertion, and were subsequently decannulated, were identified at our institution and followed up 2 months post‐discharge. Patient‐reported (PROMS) and clinician‐reported outcome measures, endoscopic examination, and spirometry were used to assess voice, swallow, and airway outcomes.ResultsForty‐one patients were included in the study with a mean age of 56 years and male:female ratio of 28:13. Average duration of endotracheal intubation was 24 days and 63.4% of tracheostomies were performed at day 21 to 35 of intubation. 53.7% had an abnormal GRBAS score and 30% reported abnormal swallow on EAT‐10 questionnaire. 81.1% had normal endoscopic examination of the larynx, however, positive endoscopic findings correlated with the patient self‐reported VHI‐10 (P = .036) and EAT‐10 scores (P = .027). 22.5% had spirometric evidence of fixed upper airway obstruction using the Expiratory‐Disproportion Index (EDI) and Spearman correlation analysis showed a positive trend between abnormal endoscopic findings and EDI scores over 50 (P < .0001).ConclusionThe preliminary results of this study reveal a high incidence of laryngeal injury among patients who underwent intubation and tracheostomy insertion during the COVID‐19 pandemic. As these patients continue to be followed up, the evolution of these complications will be studied.Level of EvidenceLevel 3. Laryngoscope, 2020
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Journal articleAllen JE, Clunie GM, Winiker K, 2021, , Current Opinion in Otolaryngology and Head and Neck Surgery, Vol: 29, Pages: 213-218, ISSN: 1068-9508
PURPOSE OF REVIEW: Videofluoroscopy (VFSS) and fibreoptic endoscopic evaluation of swallowing (FEES) are established instrumental techniques to support differential diagnosis and treatment of oropharyngeal dysphagia. Whilst their value is undisputed, each tool is not without limitations. The COVID-19 pandemic has restricted access to VFSS and FEES leading clinicians to explore alternative or augmentative tools to support swallowing assessment.Ultrasound (US) is an established tool for visualisation of head and neck anatomy, including structures implicated in swallowing. Although US has been utilised in swallowing research for many years, its application has not translated into common clinical practice. This review presents and debates the evidence for and against use of US for clinical swallowing assessment. RECENT FINDINGS: Evaluation of swallowing muscle morphometry and measurement of isolated swallowing kinematics are two primary uses of US in swallowing assessment that have been identified in the literature. Use of US to detect bolus flow, aspiration and residues is in its early stages and needs further research. SUMMARY: US shows promise as an adjunctive modality to support assessment of swallowing. With standardisation, these measurements may have potential for transition into clinical care. Reliability and validity testing and development of normative data are imperative to ensure its use as an evidence-based instrumentation.
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Journal articleSanz-Pena I, Arachchi S, Halwala-Vithanage D, et al., 2021, , Applied Sciences, Vol: 11, Pages: 1-13, ISSN: 2076-3417
The plaster-casting method to create a scoliosis brace consists of mould generation and rectification to obtain the desired orthosis geometry. Alternative methods entail the use of 3D scanning and CAD/CAM. However, both manual and digital design entirely rely on the orthotist expertise. Characterisation of the rectification process is needed to ensure that digital designs are as efficient as plaster-cast designs. Three-dimensional scans of five patients, pre-, and post-rectification plaster moulds were obtained using a Structure Mark II scanner. Anatomical landmark positions, transverse section centroids, and 3D surface deviation analyses were performed to characterise the rectification process. The rectification process was characterised using two parameters. First, trends in the external contours of the rectified moulds were found, resulting in lateral tilt angles of 81 ± 3.8° and 83.3 ± 2.6° on the convex and concave side, respectively. Second, a rectification ratio at the iliac crest (0.23 ± 0.04 and 0.11 ± 0.02 on the convex and concave side, respectively) was devised, based on the pelvis width to estimate the volume to be removed. This study demonstrates that steps of the manual rectification process can be characterised. Results from this study can be fed into software to perform automatic digital rectification.
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Journal articleFavier C, McGregor A, Phillips A, 2021, , Frontiers in Bioengineering and Biotechnology, Vol: 9, ISSN: 2296-4185
Public health organisations typically recommend a minimum amount of moderate intensity activities such as walking or cycling for two and a half hours a week, combined with some more demanding physical activity on at least 2 days a week to maintain a healthy musculoskeletal condition. For populations at risk of bone loss in the lumbar spine, these guidelines are particularly relevant. However, an understanding of how these different activities are influential in maintaining vertebral bone health is lacking. A predictive structural finite element modelling approach using a strain-driven algorithm was developed to study mechanical stimulus and bone adaptation in the lumbar spine under various physiological loading conditions. These loading conditions were obtained with a previously developed full-body musculoskeletal model for a range of daily living activities representative of a healthy lifestyle. Activities of interest for the simulations include moderate intensity activities involving limited spine movements in all directions such as, walking, stair ascent and descent, sitting down and standing up, and more demanding activities with large spine movements during reaching and lifting tasks. For a combination of moderate and more demanding activities, the finite element model predicted a trabecular and cortical bone architecture representative of a healthy vertebra. When more demanding activities were removed from the simulations, areas at risk of bone degradation were observed at all lumbar levels in the anterior part of the vertebral body, the transverse processes and the spinous process. Moderate intensity activities alone were found to be insufficient in providing a mechanical stimulus to prevent bone degradation. More demanding physical activities are essential to maintain bone health in the lumbar spine.
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Conference paperSubbiah Ponniah H, Ahmed M, Edwards T, et al., 2021, , ASiT/MedAll Virtual Surgical Summit, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
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Journal articleRivière C, Logishetty K, Villet L, et al., 2021, , Revue De Chirurgie Orthopedique Et Traumatologique, Vol: 107, ISSN: 1877-0517
This note describes a surgical technique to kinematically align a medial Oxford® UKA. Applying kinematic alignment principles is an alternative, personalised, physiological, and potentially clinically advantageous method for implanting the medial Oxford® UKA. Further investigations are needed to better define the reproducibility and clinical impact of this new surgical technique.
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Journal articleLex JR, Edwards TC, Packer T, et al., 2021, , Journal of Arthroplasty, Vol: 36, Pages: E42-E43, ISSN: 0883-5403
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Journal articleFreeman-Sanderson A, Ward EC, Miles A, et al., 2021, , Archives of Physical Medicine and Rehabilitation, Vol: 102, Pages: 835-842, ISSN: 0003-9993
ObjectiveTo identify core practices for workforce management of communication and swallowing functions in COVID-19 positive patients within the ICU.DesignA modified Delphi methodology was utilized, with 3 electronic voting rounds. AGREE II and an adapted COVID-19 survey framework from physiotherapy were used to develop survey statements. Sixty-six statements pertaining to workforce planning and management of communication and swallowing function in the ICU were included.SettingElectronic modified Delphi process.Participants35 speech-language pathologists (SLPs) from 6 continents representing 12 countries.InterventionsNot applicable.Main Outcome MeasuresThe main outcome was consensus agreement, defined a priori as ≥70% of participants with a mean Likert score ≥7.0 (11-point scale: “0” = strongly disagree, “10” strongly agree). Prioritization rank order of statements in a 4th round was also conducted.ResultsSLPs with a median of 15 years ICU experience, working primarily in clinical (54%), in academic (29%) or managerial (17%) positions, completed all voting rounds. After the third round, 64 statements (97%) met criteria. Rank ordering identified issues of high importance.ConclusionsA set of global consensus statements to facilitate planning and delivery of rehabilitative care for patients admitted to the ICU during the COVID-19 pandemic were agreed by an international expert SLP group. Statements focus on considerations for workforce preparation, resourcing and training, and the management of communication and swallowing functions. These statements support and provide direction for all members of the rehabilitation team to use for patients admitted to the ICU during a global pandemic.
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Journal articleRiviere C, Logishetty K, Villet L, et al., 2021, , ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 107, ISSN: 1877-0568
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- Citations: 13
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Journal articleEdwards TC, Naqvi AZ, Dela Cruz N, et al., 2021, , ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, Vol: 37, Pages: 1599-1609, ISSN: 0749-8063
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- Citations: 22
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Journal articleNewington L, Wells M, Adonis A, et al., 2021, , BMC Health Services Research, Vol: 21, ISSN: 1472-6963
Background: There are increasing opportunities for healthcare professionals outside medicine to be involved in and lead clinical research. However, there are few roles within these professions that include time for research. In order to develop such roles, and evaluate effective use of this time, the range of impacts of this clinical academic activity need to be valued and understood by healthcare leaders and managers. To date, these impacts have not been comprehensively explored, but are suggested to extend beyond traditional quantitative impact metrics, such as publications, citations and funding awards. Methods: Ten databases, four grey literature repositories and a naïve web search engine were systematically searched for articles reporting impacts of clinical academic activity by healthcare professionals outside medicine. Specifically, this did not include the direct impacts of the research findings, rather the impacts of the research activity. All stages of the review were performed by a minimum of two reviewers and reported impacts were categorised qualitatively according to a modified VICTOR (making Visible the ImpaCT Of Research) framework. Results: Of the initial 2,704 identified articles, 20 were eligible for inclusion. Identified impacts were mapped to seven themes: impacts for patients; impacts for the service provision and workforce; impacts to research profile, culture and capacity; economic impacts; impacts on staff recruitment and retention; impacts to knowledge exchange; and impacts to the clinical academic. Conclusions: Several overlapping sub-themes were identified across the main themes. These included the challenges and benefits of balancing clinical and academic roles, the creation and implementation of new evidence, and the development of collaborations and networks. These may be key areas for organisations to explore when looking to support and increase academic activity among healthcare professionals outside medicine. The modified VICTO
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Journal articleDeane J, Clunie G, 2021, , BMC Medical Education, Vol: 21, ISSN: 1472-6920
BackgroundHealthcare professionals outside of medicine (HCPs), including nurses, midwives and allied health professionals, are increasingly involved in research for patient benefit. Their challenge is to negotiate inter-professional or professionally isolated contexts. The aims of this study were to evaluate the ‘Healthcare Professionals in Research’ (HPiR) Facebook group (a self-directed and confidential peer support group for doctoral and postdoctoral HCPs) including engagement, the experiences of doctoral and postdoctoral HPiR members and to identify future career challenges using an on-line survey.MethodsThe HPiR Facebook group was launched in May 2019. Five HCP Community managers (CMs) were trained in on-line platform curation, moderation and screening. An on-line survey was designed to capture data from HPiR members. A purposive sampling approach was applied. Respondents were required to be doctoral and postdoctoral HCPs and a registered member of the HPiR group. Respondents represented a range of healthcare professions, 79 % of whom had over ten years clinical experience. Membership growth and engagement was analysed. Descriptive statistics were used to present numerical data. Qualitative data were analysed thematically.Results96 members were admitted to the group within the first month. All members were actively engaged with group content. 34/96 doctoral and postdoctoral HCPs completed the survey. Most members joined for networking (88 %) and peer support (82 %) purposes. Analysis of text responses showed difficulties in balancing a clinical academic career and highlighted the consequences of undefined clinical academic roles and pathways.ConclusionsDoctoral and postdoctoral HCPs value the opportunities that HPiR provides for peer support and connection with fellow HCPs. HPiR has the potential to strengthen research capacity, support research skill development and drive change within the clinical academic community. Clinical
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Journal articleJaggard MKJ, Boulange CL, Graca G, et al., 2021, , JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL ANALYSIS, Vol: 197, ISSN: 0731-7085
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- Citations: 5
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Journal articleClunie GM, Belsi A, Roe JWG, et al., 2021, , Dysphagia, Vol: 37, Pages: 365-374, ISSN: 0179-051X
Acquired laryngotracheal stenosis (LTS) is a rare condition causing dyspnea and stridor. Patients often require multiple surgical procedures with no guarantee of a definitive outcome. Difficulty swallowing is a recognised problem associated with LTS and the reconstructive surgeries required to manage the condition. The breathlessness patient’s experience impacts on swallowing, and the vulnerable structures of the larynx are implicated during complex surgeries. This leads to dysphagia post-surgery, with some patients experiencing more chronic symptoms depending on the biomechanical impact of the surgery, or a pre-existing dysphagia. Despite this there is limited observational research about the dysphagia associated with LTS, with no exploration of the patient experience. Our aim was to investigate patient experience of living with LTS focussing on dysphagia in order to guide clinical practice. A qualitative study was completed using focus groups and semi-structured interviews with 24 patients who have had reconstructive surgery for LTS. Thematic analysis was used to identify three over-arching themes: The Physical Journey, The Emotional Journey and The Medical Journey. Key sub-themes included the importance of self-management and control, presence of symptoms, benefits of therapy, living with a life-long condition, fear and anxiety, autonomy, medicalisation of normal processes and the dichotomy between staff expertise and complacency. Swallowing was connected to all themes. The results are reviewed with consideration of the wider literature of lived experience particularly in relation to other chronic conditions and those that carry a high symptom burden such as head and neck cancer. Future clinical and research recommendations have been made. Akin to other clinical groups, adults with LTS are keen that management of their swallowing is person-centred and holistic.
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Journal articleAbel R, Behforootan S, Boughton O, et al.,
Ultrasound and Bone Disease: A Systematic Review
, World Journal of Surgery and Surgical Research -
Journal articleZakieh O, Park C, Hornby K, et al., 2021, , Br J Hosp Med (Lond), Vol: 82, Pages: 1-9
The number of paediatric anterior cruciate ligament injuries is rising at a greater rate than in the adult population, as a result of the increased participation of children and adolescents in sports. This review explores the key presentations, diagnostic and management plans, and prevention methods associated with paediatric anterior cruciate ligament injuries. This injury presents as an acute pop and effusion, with limitations in gait, and can be extremely debilitating. Clinical examination and magnetic resonance imaging are used to diagnose the injury. The pivot shift and Lachman test remain the most valid exams when suspecting an anterior cruciate ligament tear. Management of the injury can be surgical or non-surgical depending on the severity of the tear and associated injuries. The surgical approach chosen is determined by the patient's Tanner classification, considering potential damage to the physes of the bone. Management plans should include rehabilitation consisting of strength, proprioception and neuromuscular training, to maximise the patient's recovery. Injury prevention programmes, consisting of strength training and neuromuscular training, should be followed by young athletes to reduce anterior cruciate ligament injuries. Compliance and earlier implementation coupled with an understanding of the biomechanics of anterior cruciate ligament injuries and verbal feedback maximise the benefit of neuromuscular training.
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Journal articleDeane JA, Lim AKP, McGregor AH, et al., 2021, , PLoS One, Vol: 16, ISSN: 1932-6203
People with chronic low back pain (LBP) exhibit changes in postural control. Stereotypical muscle activations resulting from external perturbations include anticipatory (APAs) and compensatory (CPAs) postural adjustments. The aim and objective of this study was to determine differences in postural control strategies (peak amplitude, APAs and CPAs) between symptomatic and asymptomatic adults with and without Lumbar Disc Degeneration (LDD) using surface electromyography during forward postural perturbation. Ninety-seven subjects participated in the study (mean age 50 years (SD 12)). 3T MRI was used to acquire T2 weighted images (L1-S1). LDD was determined using Pfirrmann grading. A bespoke translational platform was designed to deliver horizontal perturbations in sagittal and frontal planes. Electromyographic activity was analysed bilaterally from 8 trunk and lower limb muscles during four established APA and CPA epochs. A Kruskal-Wallis H test with Bonferroni correction for multiple comparisons was conducted. Four groups were identified: no LDD no pain (n = 19), LDD no pain (n = 38), LDD pain (n = 35) and no LDD pain (n = 5). There were no significant differences in age or gender between groups. The most significant difference between groups was observed during forward perturbation. In the APA and CPA phases of predictable forward perturbation there were significant differences ankle strategy between groups (p = 0.007–0.008); lateral gastrocnemius and tibialis anterior activity was higher in the LDD pain than the LDD no pain group. There were no significant differences in the unpredictable condition (p>0.05). These findings were different from the remaining groups, where significant differences in hip strategy were observed during both perturbation conditions (p = 0.004–0.006). Symptomatic LDD patients exhibit different electromyographic strategies to asymptomatic LDD controls. Future LBP electromyographic research should benefit from considering asses
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