Precise detection and quantification of white matter hyperintensities (WMH) observed in T2–weighted Fluid Attenuated Inversion Recovery (FLAIR) Magnetic Resonance Images (MRI) is of substantial interest in aging, and age related neurological disorders such as Alzheimer’s disease (AD). This is mainly because WMH may reflect comorbid neural injury or cerebral vascular disease burden. WMH in the older population may be small, diffuse and irregular in shape, and sufficiently heterogeneous within and across subjects. Here, we pose hyperintensity detection as a supervised inference problem and adapt two learning models, specifically, Support Vector Machines and Random Forests, for this task. Using texture features engineered by texton filter banks, we provide a suite of effective segmentation methods for this problem. Through extensive evaluations on healthy middle–aged and older adults who vary in AD risk, we show that our methods are reliable and robust in segmenting hyperintense regions. A measure of hyperintensity accumulation, referred to as normalized Effective WMH Volume, is shown to be associated with dementia in older adults and parental family history in cognitively normal subjects. We provide an open source library for hyperintensity detection and accumulation (interfaced with existing neuroimaging tools), that can be adapted for segmentation problems in other neuroimaging studies.
Inpatient rehabilitation services do not operate in isolation; they are a critical link in the healthcare continuum. There is a mounting body of evidence that the introduction of weekend rehabilitation services has a positive impact on patient outcomes. To maximize health outcomes, access to critical services and patient flow, organizations and staff need to move away from the long-standing 5-day/week inpatient rehabilitation model and start transitioning to a model that incorporates weekend therapy services.
Background and purpose
Due to global ageing, more people will suffer from hip fracture in the future, and many will be left with permanent physical impairments. The care burden for people post hip fracture is high. The aim of this study is to measure longitudinal changes in physical activity levels and fear of falling in people after hip fracture who return home after inpatient rehabilitation.
Methods
Longitudinal observational study. Participants were recruited from three rehabilitation centres in Victoria, Australia. Self‐reported fear of falling (Short Falls Efficacy Scale – International) and physical activity levels (Human Activity Profile – Adjusted Activity Score and Frenchay Activity Index) were assessed at 2 weeks, 3 and 6 months after discharge. Mobility (walking speed) and balance (Timed Up‐and‐Go test and Step Test) were measured at discharge from rehabilitation.
Results
Thirty‐four participants (mean age: 82 years [SD 8]; 62% female) with unilateral hip fracture were recruited. Participants had moderately impaired balance and mobility at discharge compared to age‐matched normative data; they were all discharged with a walking aid and were 40% slower in their walking speed. Participants had increased fear of falling and reduced physical activity 2 weeks after discharge, which improved significantly (p < 0.01) over the following 6 months, but scores were still lower than the normative values. At 6 months, participants also had moderate to high levels of fear of falling and were less active than the general population of similar age.
Discussion
Although fear of falling and physical activity improved in the 6 months following discharge, both remained negatively affected compared to normative data. Rehabilitation post hip fracture should include routine assessment of fear of falling as a potential barrier for return of physical activities.
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