Objective To optimize the ability of hospitalized patients isolated due to COVID-19 to participate in physical therapy. Design This was a prospective, quality improvement trial of the feasibility and acceptability of a “hybrid” in-person and telerehabilitation platform to deliver physical therapy to hospitalized adults. Setting Inpatient wards of a tertiary care, multi-specialty academic medical center in the greater New York City metropolitan area. Participants A convenience sample of 39 COVID-19+ adults, mean age 57.3 years, 69% male, all previously community dwelling agreed to participate in a combination of in-person and telerehabilitation sessions (TR). Intervention Initial in-person evaluation by physical therapist followed by twice daily PT sessions, one in-person and one via a telehealth platform meeting Health Insurance Portability and Accountability Act (HIPAA) confidentiality requirements. The communication platform was downloaded to each participant's personal smart device to establish audiovisual contact with the Physical Therapist. Measures The 6-clicks Activity Measure for Post-Acute Care (AM-PAC) was used to score self-reported functional status pre-morbidly by, and by the therapist at baseline and discharge. Results Functional status measured by AM-PAC 6-clicks demonstrated improvement from admission to discharge. Barriers to participation were identified and strategies are planned to facilitate use of the platform in future. Conclusions A consistent and structured protocol for engaging patient participation in PT delivered via a telehealth platform was successfully developed. A process was put in place to allow for further development, recruitment and testing in a randomized trial.
The Autonomous Sustainment Technologies for Rotorcraft Operations-Structures (ASTRO-S) project between U. S. Army Combat Capability Missile Center, Aviation Development Directorate-Eustis (FCDD-AMV-E) and Sikorsky developed and validated a range of technologies to enable reduced airframe maintenance burden, increase operational availability, and provide key enabling technologies relative to Army's transition to the new paradigm of Maintenance Free Operational Periods (MFOP) for the rotorcraft of the future. Methods were developed for autonomous characterization of major damage and residual strength expressed as a Structural Health Index (SHI) for advanced durable and damage tolerant composite aerospace structural assemblies with redundant load paths, enabling targeted inspections and strength-based fly / watch / repair decisions. A number of sensing technologies including fiber-optic strain measurement and piezo-based structural health assessment, along with a number of innovative advanced algorithms that intelligently use changes in monitored structural responses, were implemented in a comprehensive architecture to detect, localize, and assess the severity of structural damage. Extensive testing on full-scale, multiload-path composite structures to assess feasibility and effectiveness of the developed technologies, as well as understand application and transition challenges, has convincingly shown that damage detection, localization, and severity assessment in an autonomous fashion is feasible. Further, it was shown that the concept of a trendable SHI to assess residual strength, is viable, although additional full-scale test cases are needed to further validate and mature the approach. Overall, these key findings affirm suitability of the technical approach and associated algorithms for reducing maintenance burden by triggering rather than scheduling inspections and potentially deferring repairs in high op-tempo environments. These structural health management technologies will be key enablers supporting Army's future rotorcraft when operating in an untethered multi-domain battle space.
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