Michal Kafri

People living with stroke (PLwS) face enduring multidimensional health-related needs. Physical therapy, occupational therapy, and speech-language therapy &

Background: Sustainable utilization of neurology and allied health professions’ services is pivotal for effective management of Parkinson disease (PD) and is correlated with positive health-related outcomes. Objectives: (1) To describe the utilization of neurology and allied health services by people with PD (PwP); (2) to explore the associations between demographic and structural variables and utilization; and (3) to test associations between utilization and unplanned hospitalizations. Methods: A retrospective observational cohort study of 1761 PwP in the years 2014-2019 was conducted. Utilization of neurology and allied health services was mapped. Regression models were examined to test associations between demographic and structural variables, utilization of neurology and physical therapy (PT), and unplanned hospitalizations. Results: Approximately 50% of the study population utilized neurology services. Utilization rate of allied health services ranged between 0% and 19%. The likelihood of utilizing neurology services increased for people with extended health insurance and people with more years since diagnosis and decreased for women and for people living at a great distance from a neurology service. The likelihood of utilizing PT increased for Jews and people with extended health insurance and decreased for people with more years since diagnosis and for people living at a great distance from a PT service. Among patients with fewer years since diagnosis (<5 years), those who utilized PT had a higher likelihood of unplanned hospitalization. Conclusions: Neurology and allied health services are underutilized by PwP, particularly by minorities and women. Policymakers should take proactive steps to increase utilization. Video Abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A496)

Concealment of diagnosis in chronic conditions has proven benefits as a coping strategy to avoid stigmatization and discrimination and allows people to be treated “normally” by society. However, concealment is related to negative health, physical, quality of life outcomes, exhaustion and loneliness. In addition, diagnosis concealment has a detrimental impact on self-management behaviors. In Parkinson’s disease (PD), information regarding the aspects related to concealment is limited. A better understanding of the contributors and consequences of concealment in PD may facilitate the development of strategies to support patients who conceal. We conducted a cross-sectional study to explore concealment in PD by examining rates of diagnosis concealment and associations of concealment with socio-demographic factors, self-management behaviors, stigma, social support, and quality of life. The study was conducted at an outpatient movement disorders clinic or at the participant’s home, at the participant’s preference. One hundred and fifty people with PD completed questionnaires assessing disclosure of their diagnosis, socio-demographic variables, disease severity, self-management behaviors (knowledge, activation, exercise), stigma, social support, and health-related quality of life (HRQoL). Differences between disclosers and concealers were analyzed and associations between disclosure, stigma, social support and emotional aspects of HRQoL were tested using mediation models. Close to one-quarter (22.7%) conceal their PD diagnosis from their family. Concealers were more often women, Muslim, religious, and lacking academic degrees compared to disclosers. Concealers also had lower patient activation, and less social support. They engaged less in physical activity and experienced greater stigma. Concealment had a significant total effect on lower emotional aspects of HRQoL, mediated by greater stigma but not by social support. Healthcare providers should be attuned to both the prevalence of PD diagnosis concealment and its detrimental impacts on patients’ emotional support needs and facilitation of health behaviors. Moreover, treating neurologists should deliver diagnoses carefully, discuss disclosure consequences, maintain open dialogue on concealment, and advise informing family. Interventions targeting stigma reduction in this population may have downstream benefits for emotional aspects of HRQoL. Trial registration: NCT05209698; Registration Date: 23/1/2022.

Feedback is an essential component of training focused on acquisition or modification of motor skills, i.e. motor learning. External feedback augments task performance information, can be provided by a human instructor/therapist or a digital agent and can impact motor learning. External feedback is often accompanied by emotional content (e.g., the tone of voice or intonation could be negative or positive). The ability to process emotional feedback and its effect on learning may vary depending on the learner's personal characteristics (personality, emotional regulation). This work evaluated the effect of emotional feedback from a virtual agent on learning of a bimanual motor task. Sixty women practiced a virtual archery task while receiving either positive (n=31) or negative (n=29) emotional feedback from a virtual robot for 5 minutes. Movement accuracy and kinematics were measured using a head-mounted display (HTC Vive) and task engagement using electroencephalography. Training improved shot accuracy and movement characteristics in both groups. Positive emotional feedback (e.g., “good job!”) was associated with longer bow-pulling during and after training, and lower task engagement after training, compared with negative feedback (e.g., “I'm disappointed”). Finally, participants with higher trait negative affect tended to improve more under negative feedback, while those with a higher tendency for cognitive reappraisal improved less. These results suggest that virtual agents can harness the social influence of emotions and provide emotional feedback for motor learning. The effects of feedback valence and learners’ characteristics need to be considered when designing digital environments for motor rehabilitation.

Objective: To test associations between socio-clinical factors, self-management and patient activation among patients with Parkinson's disease (PD), and to explore the use of regression tree to find the cut-off levels of socio-clinical factors which associate with lower or higher self-management behaviours and patient's activation. Methods: A cross-sectional study of patients with PD ( n = 62) who underwent assessment of their socio-clinical factors including age, gender, cognitive status, comorbidities, disease severity (motor and non-motor symptoms) and social support. The associations of these factors to specific aspects of self-management behaviours including utilization of rehabilitative treatments, physical activity and patient activation were tested. Results: Most patients did not utilize rehabilitative treatments. Non-motor symptoms and cognitive status were significantly associated with physical activity ( R² = 0.35, F_{(3, 58)} = 10.50, p < 0.001). Non-motor symptoms were significantly associated with patient activation ( R² = 0.30, F_{(1, 30)} = 25.88, p < 0.001). Patients with Mini-Mental State Exam score ≤24 performed less physical activity, relative to those with a higher score. Patients with ≤5 non-motor symptoms showed higher activation relative to those with >5. Conclusion: In PD, disease-specific clinical characteristics overshadow other personal factors as determinants of self-management behaviours. The role of non-motor symptoms in reduced self-management behaviours and activation is highlighted.

Background: The application of motor learning (ML) principles and research in physical therapy can optimize patient outcomes. However, the translation of the accumulated knowledge in ML to clinical practice is limited. Knowledge translation interventions, which are designed to promote changes in clinical behaviors, have the potential to address this implementation gap. We developed, implemented, and evaluated a knowledge translation intervention for ML implementation that focuses on building clinical capacity among physical therapists for the systematic application of ML knowledge in clinical practice.Methods: A total of 111 physical therapists underwent the intervention, which consisted of the following: (1) an interactive didactic 20-hour course; (2) an illustrated conceptual model of ML elements; and (3) a structured clinical-thinking form. Participants completed the Physical Therapists’ Perceptions of Motor Learning (PTP-ML) questionnaire pre and post intervention. The PTP-ML was used to assess ML-related self-efficacy and implementation. Participants also provided post-intervention feedback. A sub-sample (n = 25) provided follow-up feedback more than a year after the completion of the intervention. Pre–post and post-follow-up changes in the PTP-ML scores were calculated. The information gathered from the open-ended items of the post-intervention feedback was analyzed to identify emerging themes.Results: Comparing pre- and post-intervention scores, significant changes were found in the total questionnaire scores, self-efficacy subscale scores, reported implementation subscale scores (P < .0001), and general perceptions and work environment subscale score (P < .005). The mean changes in the total questionnaire and self-efficacy scores also significantly exceeded the Reliable Change Index. In the follow-up sample, these changes were maintained. Participants felt that the intervention helped them organize their knowledge in a structured manner and consciously link their practice elements to concepts in ML. Discussion of clinical cases was reported to be the most valuable educational method, and the illustrated conceptual model of ML elements was the least valued. Respondents also suggested support activities to maintain and enhance the learning experience, including on-site mentorship and hands-on experience.Conclusions: Findings support the positive effect of an educational tool, most prominently on physical therapists’ ML self-efficacy. The addition of practical modeling or ongoing educational support may enhance intervention effects.

This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) inclu...

Background: Multiple Sclerosis is an incurable, chronic, and progressive disease that affects an individual's function and health-related quality of life (HR-QoL). Self-management refers to activities the individual performs in order to reduce the impact of illness on his function and HR-QoL, and includes aspects such as medical management (treatment by health care professionals) and lifestyle (regular exercise). A subjective aspect of patient activation is also part of the broader approach, and refers to the knowledge, skills, and confidence individuals have to manage their health. Although this approach has been studied in people with Multiple Sclerosis, there is limited data about its associations with activation level, function, and HR-QoL. Objectives: 1. To describe self-management and the level of patient activation among people with Multiple Sclerosis. 2. To examine the correlation between self-management and patient activation and between function, mobility and HR-QoL. Method: A digital survey was conducted and included self-report questionnaires to assess self-management, activation levels, function, mobility and HR-QoL. Results: The survey was completed by 79 people. Self-management and levels of activation were high. Most participants did not receive health-profession treatment. Regression analysis showed that visits to the neurologist and receiving treatments from the health professions contribute to mobility (R2 = 0.05, R2 = 0.16 respectively). Exercise was found to be related to mobility status (r = -0.23, p <0.05) and the level of activation was found to be related to HR-QoL (r = -0.24, p <0.05) but both were not found to be significant in the regression model. Discussion and conclusions: In people with Multiple Sclerosis, self-management, including physical activity, but mainly visits to the neurologist and treatments by health professions, is related to mobility and HR-QoL. However, the relationships found are complex and differ from those seen for other chronic diseases, and this may be due to the fluctuating nature of the disease.

Early activity post-stroke reduces secondary complications and improves rehabilitation outcomes. This study aimed to describe the physical activities of stroke patients in an acute hospital setting, compare activity patterns between working shifts, and assess associations between activity and clinical status. Twenty-one patients (mean age 69.4 ± 33.4 years,13 men) admitted due to acute ischemic stroke wore activity monitors for two weeks or until discharge. During the morning and evening shifts, the activity monitor collected daily data on walking and body position. The study discovered that patients’ overall activity levels were low and that activity was higher during morning shifts than evening shifts (sitting time: 185.31 ± 109.31 min and 91.8 ± 98.46 min, p = 0.002; number of steps: 58.3 ± 32.73 and 30.4 ± 17.6 steps, p < 0.001). Upright and sitting time increased in morning shifts (p = 0.002), while the number of steps increased in both morning and evening shifts (p = 0.002). In the evening shift, there was a fair (r = 0.28, p = 0.02) positive correlation between grip strength and the number of steps, such that patients with higher grip strength took more steps. In addition, there were poor (r = −0.2, p = 0.02) correlations between motor function (Trunk Control Test and Functional Ambulation Category) and time in an upright position, such that patients with lower functional ability sat longer. Clinical characteristics and level of activity did not show any other correlations. To conclude, the main out-of-bed activity of patients was sitting during morning shifts. The findings highlight the temporal differences in activity throughout the day, as well as the disconnect between clinical characteristics and activity levels.