Chockalingam Manigandan

Relative motion orthoses (RM orthoses) are finger-based orthoses used in adult hand rehabilitation to protect healing structures or optimist movement patterns while permitting active hand use. Existing reviews have mapped RM-orthosis indications, configuration, and clinical outcomes, and the most recent has begun to incorporate patient-experience findings; however, patient-perspective evidence has not yet been mapped as the primary object of a synthesis, organised against defined dimensions of acceptability, usability, and everyday impact. The objective of this scoping review is to map the extent, range, and nature of patient-perspective evidence on the acceptability, usability, and everyday impact of RM orthoses in adult hand rehabilitation. The review will follow Joanna Briggs Institute methodology for scoping reviews and be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Sources will include adults aged 18 years or older who have used an RM orthosis for hand rehabilitation. Any adult hand rehabilitation context will be considered. Qualitative, quantitative, mixed-methods, case-based, survey, and grey literature sources will be included when patient-perspective data can be extracted. Ovid MEDLINE, Embase, CINAHL Complete, PsycINFO, Scopus, and Web of Science Core Collection will be searched, together with Google Scholar, ProQuest Dissertations and Theses Global, and Overton. Two reviewers will independently screen and extract data, with a third reviewer available for adjudication. Critical appraisal will not be undertaken. The protocol has been prospectively registered on the Open Science Framework ( https://osf.io/dcyf8/overview ). Findings will be presented in tabular, diagrammatic, and narrative form, including a summary-of-characteristics table and a concept-mapping matrix. This review will provide an evidence map to guide patient-centred orthotic practice and identify research priorities.

Introduction: Upper-limb (UL) impairment following stroke significantly limits independence in activities of daily living (ADLs). Although tabletop functional task-oriented training (FTOT) is a cornerstone of neurorehabilitation, both conventional therapist-led and technology-supported FTOT face limitations in consistency, supervision, progression and continuity across settings. The objectives are to characterise current clinical practices in UL tabletop FTOT and identify stroke survivor–caregiver dyads’ needs, constraints and support requirements across clinical and home contexts to inform user-centred technology development. Methods and analysis: A multi-phase mixed-methods design will be employed. Phase-A will be an explanatory sequential design including a quantitative online survey of rehabilitation therapists (target minimum n=100) to characterise UL tabletop training delivery (eg, task selection, dose, progression). Survey findings will inform subsequent data collection through virtual qualitative interviews with a purposive subsample of therapists (anticipated n≈10–20) to examine task orchestration, adaptation and clinical decision-making in depth. Phase-B will use a descriptive qualitative design involving semi-structured interviews of stroke survivor–caregiver dyads (target n=15 dyads) to explore FTOT experiences across clinical and non-clinical contexts. Quantitative data will be analysed descriptively, and qualitative data will be analysed using inductive content analysis. Mixed-methods integration, within Phase-A and between the two phases, will examine convergence, complementarity, expansion and divergence. Integration will be illustrated using joint displays, visual tools that present the findings from both strands side-by-side using a table or figure. Patient and public involvement activities (n=5) and a pilot dyadic interview (two dyads) were completed to refine study materials and procedures. Ethics and dissemination: Ethical approval was obtained from the Institutional Review Board of Christian Medical College, Vellore (IRB Min No. 2511113 ). Electronic informed consent will be obtained from therapists for the survey and qualitative interviews. Written informed consent will be obtained from the dyadic participants before the interviews. All study procedures will adhere to ethical principles for human research. Study findings will be disseminated through conference presentations and publication in peer-reviewed journals, with stakeholder-oriented dissemination to support clinical and technology development.

Background: Individuals with dementia experience a progressive deterioration in their cognitive and functional abilities, and as a result, require support from informal family caregivers. Non-pharmacological interventions, such as cognitive stimulation, are increasingly being used to address this deterioration. This study explored the participant and caregiver experiences of CS-ADL (Cognitive Stimulation in Activities of Daily Living), an activities of daily living-focused group cognitive stimulation program for individuals with mild-to-moderate dementia. Methods: A descriptive qualitative design was implemented. CS-ADL participants and caregivers were recruited in dyads through a Psychiatry of Later Life service where CS-ADL was delivered. Semi-structured interviews were completed with each dyad either in-person or via the telephone. Data retrieved were analyzed through reflexive thematic analysis. Results: CS-ADL was experienced as an acceptable intervention that positively influenced the everyday life of both dyad members, with benefits reported in the memory, mood, daily routine, and social interaction of participants. Furthermore, the facilitation style of group facilitators positively influenced participants’ engagement in CS-ADL. Limited data was gathered regarding the experience of activities of daily living. Conclusion: This is the first study to explore experiences of CS-ADL, producing a preliminary addition to the evidence-base for CS-ADL. However, further research is required to confirm study findings and explore the experiences of activities of daily living in greater depth.

Introduction: Cognitive stimulation, an individual or group intervention approach aiming to improve cognitive and social functioning among individuals with mild-to-moderate dementia, is often considered a complex intervention. The patient’s experience of a complex intervention is unique and often determines its effectiveness. This proposed qualitative systematic review aims to comprehensively synthesise the experiences of individuals with dementia and their informal caregivers who have participated in cognitive stimulation programs, identifying perceived benefits, challenges, barriers, and facilitators to this approach to intervention. Methods: This review will consider qualitative studies that evaluate the experiences of individuals with a diagnosis of dementia and/or the informal caregivers of individuals with dementia who have participated in a cognitive stimulation program. Searches will be conducted across MEDLINE (Ovid), Embase (Elsevier), PsycINFO, Scopus, CINAHL (EBSCO) and Web of Science. Quality of eligible studies will be assessed using the JBI Critical Appraisal Checklist for Qualitative Research, and a standardised data extraction tool in JBI SUMARI will be used to extract data from relevant studies. The meta-aggregation approach will be used to pool qualitative research findings, which will then be synthesised to produce a single set of findings in narrative format. Discussion: This qualitative systematic review will identify and synthesise the evidence regarding the experiences of individuals with dementia who have taken part in a cognitive stimulation program and the experience of their informal caregivers. As a variety of cognitive stimulation programs exist, our findings will summarise the experiences of these interventions to inform the future development and delivery of cognitive stimulation programs. Trial registration: PROSPERO registration number: CRD42022383658.

Introduction Emerging evidence suggests that robotic devices for upper limb rehabilitation after a stroke may improve upper limb function. For robotic upper limb rehabilitation in stroke to be successful, patients’ experiences and those of the rehabilitation professionals must be considered. Therefore, this review aims to synthesise the available evidence on experiences of patients after a stroke with rehabilitation robots for upper limb rehabilitation and the experiences of rehabilitation professionals with rehabilitation robots for upper limb stroke rehabilitation. Methods and analysis Database search will include MEDLINE (Ovid), EMBASE (Elsevier), Cochrane CENTRAL, PsycINFO, Scopus, Web of Science, IEEE and CINAHL (EBSCOhost). Grey literature from Open Grey, PsyArXiv, bioRxiv, medRxiv and Google Scholar will also be searched. Qualitative studies or results from mixed-method studies that include adult patients after a stroke who use upper limb rehabilitation robots, either supervised by rehabilitation professionals or by patients themselves, at any stage of their rehabilitation and/or stroke professionals who use upper limb rehabilitation robots will be included. Robotic upper limb rehabilitation provided by students, healthcare assistants, technicians, non-professional caregivers, family caregivers, volunteer caregivers or other informal caregivers will be excluded. Articles published in English will be considered regardless of date of publication. Studies will be screened and critically appraised for methodological quality by two independent reviewers. A standardised tool from JBI System for the Unified Management, Assessment and Review of Information for data extraction, the meta-aggregation approach for data synthesis and the ConQual approach for confidence evaluation will be followed. Ethics and dissemination As this systematic review is based on previously published research, no informed consent or ethical approval is required. It is anticipated that this systematic review will highlight the experiences of patients after a stroke and perceived facilitators and barriers for rehabilitation professionals on this topic, which will be disseminated through peer-reviewed publications and national and international conferences. PROSPERO registration number CRD42022321402.

The importance of neurorehabilitation services for people with disabilities is getting well-recognized in low- and middle-income countries (LMICs) recently. However, accessibility to the same has remained the most significant challenge, in these contexts. This is especially because of the non-availability of trained specialists and the availability of neurorehabilitation centers only in urban cities owned predominantly by private healthcare organizations. In the current COVID-19 pandemic, the members of the Task Force for research at the Indian Federation of Neurorehabilitation (IFNR) reviewed the context for tele-neurorehabilitation (TNR) and have provided the contemporary implications for practicing TNR during COVID-19 for people with neurological disabilities (PWNDs) in LMICs. Neurorehabilitation is a science that is driven by rigorous research-based evidence. The current pandemic implies the need for systematically developed TNR interventions that is evaluated for its feasibility and acceptability and that is informed by available evidence from LMICs. Given the lack of organized systems in place for the provision of neurorehabilitation services in general, there needs to be sufficient budgetary allocations and a sector-wide approach to developing policies and systems for the provision of TNR services for PWNDs. The pandemic situation provides an opportunity to optimize the technological innovations in health and scale up these innovations to meet the growing burden of neurological disability in LMICs. Thus, this immense opportunity must be tapped to build capacity for safe and effective TNR services provision for PWNDs in these settings.

Background: People with neurological dysfunction have been significantly affected by the ongoing coronavirus disease 2019 (COVID-19) crisis in receiving adequate and quality rehabilitation services. There are no clear guidelines or recommendations for rehabilitation providers in dealing with patients with neurological dysfunction during a pandemic situation especially in low- and middle-income countries. The objective of this paper was to develop consensus-based expert recommendations for in-hospital based neurorehabilitation during the COVID-19 pandemic for low- and middle-income countries based on available evidence. Methods: A group of experts in neurorehabilitation consisting of neurologists, physiotherapists and occupational therapists were identified for the consensus groups. A scoping review was conducted to identify existing evidence and recommendations for neurorehabilitation during COVID-19. Specific statements with level 2b evidence from studies identified were developed. These statements were circulated to 13 experts for consensus. The statements that received ≥80% agreement were grouped in different themes and the recommendations were developed. Results: 75 statements for expert consensus were generated. 72 statements received consensus from 13 experts. These statements were thematically grouped as recommendations for neurorehabilitation service providers, patients, formal and informal caregivers of affected individuals, rehabilitation service organizations, and administrators. Conclusions: The development of this consensus statement is of fundamental significance to neurological rehabilitation service providers and people living with neurological disabilities. It is crucial that governments, health systems, clinicians and stakeholders involved in upholding the standard of neurorehabilitation practice in low- and middle-income countries consider conversion of the consensus statement to minimum standard requirements within the context of the pandemic as well as for the future.

Identification of the primary source of pain determines the success of musculoskeletal pain management. A detailed history and physical examination are the current gold standards for identifying musculoskeletal pain source in day-to-day clinical practice. This process, at times, may potentially result in inadequate/inappropriate identification of the pain source. In this case report, we present the usefulness of a simple and inexpensive vacuum cup. We found that this accurately identified the primary pain source, distant from and unrelated to the site of pain presentation in a 30-year-old man with back pain. Routine use of this simple technique in conjunction with the regular musculoskeletal examination may better identify primary restrictions in the body tissues. Based on our experience, we propose that this approach has the potential to offer better outcomes in the treatment of musculoskeletal pain in the future.

Approximately 6.2% of the world's population (466 million people) suffer from disabling hearing impairment [1]. Hearing impairment impacts negatively on one's education, financial success [2][3], cognitive development in childhood [4], including increased risk of dementia in older adulthood [5]. Lack of or reduced social interaction due to hearing impairment affects creating or maintaining healthy relationships at home, school and work [5]. Hence, hearing impairment genuinely affects the overall quality of life and wellbeing. The cocktail party effect, which is a healthy hearing individual's ability to understand one voice in a cacophony of other voices or sounds, is an important ability lacking in people with hearing impairment. This inability results in difficulties with simple daily activities such as partaking in group discussions or conversing in noisy restaurants [6]. This smart hearing aid aims to provide much-needed assistance with understanding speech in noisy environments. For example, if a person wants to partake in a group discussion, he/she needs to place the microphone array based unit on a flat surface in front of him/her, such as a table. When conversations take place, the microphone array will capture and process sound from all directions, intelligently prioritise and provide the lead speaker's voice by suppressing unwanted noises, including speeches of other people. This device selects and alternates voices between speakers automatically using voice algorithms. Additionally, the user has the option of further fine-tuning the acoustic parameters as needed through a smartphone interface. This paper describes the development and functions of this new Smart Hearing Aid.