In the past, neurorehabilitation for individuals with neurological damage, such as spinal cord injury (SCI), was focused on learning compensatory movements to regain function. Presently, the focus of neurorehabilitation has shifted to functional neurorecovery, or the restoration of function through repetitive movement training of the affected limbs. Technologies, such as robotic devices and electrical stimulation, are being developed to facilitate repetitive motor training; however, their implementation into mainstream clinical practice has not been realized. In this commentary, we examined how current SCI rehabilitation research aligns with the potential for clinical implementation. We completed an environmental scan of studies in progress that investigate a physical intervention promoting functional neurorecovery. We identified emerging interventions among the SCI population, and evaluated the strengths and gaps of the current direction of SCI rehabilitation research. Seventy-three study postings were retrieved through website and database searching. Study objectives, outcome measures, participant characteristics and the mode(s) of intervention being studied were extracted from the postings. The FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) Framework was used to evaluate the strengths and gaps of the research with respect to likelihood of clinical implementation. Strengths included aspects of Feasibility, as the research was practical, aspects of Appropriateness as the research aligned with current scientific literature on motor learning, and Effectiveness, as all trials aimed to evaluate the effect of an intervention on a clinical outcome. Aspects of Feasibility were also identified as a gap; with two thirds of the studies examining emerging technologies, the likelihood of successful clinical implementation was questionable. As the interventions being studied may not align with the preferences of clinicians and priorities of patients, the Appropriateness of these interventions for the current health care environment was questioned. Meaningfulness and Economic Evidence were also identified as gaps since few studies included measures reflecting the perceptions of the participants or economic factors, respectively. The identified gaps will likely impede the clinical uptake of many of the interventions currently being studied. Future research may lessen these gaps through a staged approach to the consideration of the FAME elements as novel interventions and technologies are developed, evaluated and implemented.Electronic supplementary materialThe online version of this article (10.1186/s12984-018-0386-7) contains supplementary material, which is available to authorized users.
Personalized adapted locomotor training was positively regarded by participants. Addressing the perceived challenges may improve the training experience. Implications for Rehabilitation Personalized adapted locomotor training (PALT) is a high-intensity locomotor therapy tailored to an individual's goals. The experiences of individuals with iSCI highlight the impact of PALT on physical and psychological well-being. PALT has the potential to improve physical functioning and facilitate transitions from inpatient rehabilitation to community living. Findings suggest the need for adaptation of PALT to suit the unique needs of each individual.
BackgroundDue to the increased degree of modulation and complexity of volumetric-modulated arc therapy (VMAT) plans, it is necessary to have a pre-treatment patient-specific quality assurance (QA) programme. The gamma index is commonly used to quantitatively compare two dose distributions. In this study we investigated the sensitivity of single- and multi-gamma criteria techniques to detect multileaf collimator (MLC) positioning errors using the Varian TrueBeam Electronic Portal Imaging DeviceTM (EPID) dosimetry and the ArcCHECKTM device.Materials and methodsAll active MLC positions of seven intact prostate patients VMAT plans were randomly changed with a mean value of 0.25, 0.5, 1 and 2 mm and a standard deviation of 0.1 mm on 25, 50, 75 and 100% of the control points. The change in gamma passing rates of six gamma criteria of 3%/3 mm, 3%/2 mm, 3%/1 mm, 2%/2 mm, 2%/1 mm and 1%/1 mm were analysed individually (single-gamma criterion) and as a group (multi-gamma criteria) as a function of the simulated errors. We used the improved and global gamma calculation algorithms with a low dose threshold of 10% in the EPID and ArcCHECK software, respectively. The changes in the planning target volume dose distributions and the organs at risk due to the MLC positioning errors were also studied.ResultsWhen 25, 50, 75 and 100% of the control points were modified by the introduction of the simulated errors, the smallest detectable errors with the EPID were 2, 1, 0.5 and 0.5 mm, respectively, using the multi-gamma criteria technique. Similarly for the single-gamma criteria technique errors as small as 2, 1, 1 and 1 mm applied to 25, 50, 75 and 100% of the control points, respectively, were detectable using a 2%/2 mm criterion. However, the smallest detectable errors with the ArcCHECK when using the multi-gamma criteria technique were 2, 2 and 1 mm when MLC errors were applied on 50, 75 and 100% of the control points. When only 25% of the control points were affected the ArcCHECK were unable to detect any of the errors applied. No noticeable difference was observed in the sensitivity using the single- or the multi-gamma criteria techniques with the ArcCHECK.ConclusionThe Varian TrueBeam EPID dosimetry shows a higher sensitivity in detecting MLC positioning errors compared with the ArcCHECK regardless of using the single- or the multi-gamma criteria techniques. Higher sensitivity was observed using the multi-gamma criteria technique compared with the single-criterion technique when using the EPID.
Use of the GuideLiner catheter facilitated successful completion of PCI procedures in a majority of patients with complex lesions. Operators should be aware of the potential complications associated with GuideLiner use.
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