New Frontiers in Rehabilitation Medicine : The Post-COVID Condition and Neuromodulation in Chronic Spinal Cord Injury
Notice bibliographique
Résumé
This thesis reflects two recent changes relevant to the field of rehabilitation medicine. Firstly, the COVID-19 pandemic illustrated that new disorders may benefit from the involvement of rehabilitation medicine. Secondly, advances in neurobiology pave new ways for therapeutic interventions among disorders already well known in the specialty, i.e. neuromodulation for improving motor function in chronic spinal cord injury (SCI). Paper I is a cross-sectional study on 23 adults with chronic clinically complete SCI (verified using standardized neurological examination) exploring the prevalence of residual functional connectivity, using a battery of neurophysiological tests. Unequivocal indications of residual translesional connectivity (i.e.” discomplete” SCI) were found in 17% of participants. Applying more liberal criteria, the potentially discomplete group comprised 39-52%. Paper II is a prospective interventional study where five adults with cervical SCI received a series of paired associative stimulation (PAS) treatments. Lesions in this study were incomplete, rather than discomplete. PAS combines peripheral nerve stimulation and navigated transcranial magnetic stimulation (TMS), both targeted towards the neural structures subserving one arm. The aim was to corroborate findings from earlier studies suggesting that spinally targeted PAS improves upper extremity motor function in chronic incomplete SCI. Manual muscle testing scores in the targeted extremity increased by a mean 0,5 points (0-5 scale). Grip strength, assessed with hand dynamometry, increased by 3 kg in the stimulated hand and by 2 kg in the contralateral hand. Performance and Satisfaction of individually specified goals, as reflected by the Canadian Occupational Performance Measure (COPM), increased by 2 points. Improvements remained one month after stimulation. Paper III: The Linköping COVID-19 study (LinCoS) included all 745 individuals hospitalized for COVID-19 during the first wave of the pandemic (March 1st−May 31st, 2020) in our region. Survivors of this cohort with persisting symptoms corresponding to the diagnosis of a Post-COVID-19 Condition (PCC) at a screening telephone interview four months post-discharge, were invited to a comprehensive, interdisciplinary clinical assessment which 85% attended (n=158). Persisting impairments were reported and corroborated, including cognitive impairment (reported by almost 50% and corroborated by neuropsychological testing in almost 40%), weakness in extremities and pain (reported by about a third of subjects, respectively), as well as a large number of other (respiratory, visual, auditory, sensory) symptoms. In total, 16% of survivors in the total regional cohort was deemed to require further rehabilitative interventions at the clinical assessment. Paper IV: In follow-up telephone interviews at 2 years post-discharge of individuals with PCC at five months post-discharge, 84% of patients reported persisting problems affecting everyday life, although significant improvements were seen in symptom prevalence and impact compared with the situation at four months post-discharge. Cognitive, sensorimotor symptoms and fatigue were the most common persisting symptoms, and 21% had been readmitted to hospital in the interim period. Half of those on sick leave related to PCC at four months were still on sick leave. No differences in outcomes were evident between previously Intensive Care Unit (ICU)-treated and non-ICU-treated individuals. Summary: PAS improved upper extremity motor function in patients with incomplete SCI, corroborating prior studies. Evidence of discomplete SCI was demonstrated using standard neurophysiological techniques in a substantial subset of individuals with chronic, clinically complete SCI. Thus, PAS may also be a potential therapeutic intervention for people with such lesions, but this requires further investigation. PCC is highly prevalent in the medium to long term (4-24 months) after hospital-treated COVID-19. To ensure adequate care and rehabilitation, extensive examination of patients with symptoms indicating PCC is warranted. In conclusion, this thesis explores new frontiers in rehabilitation medicine by suggesting new possibilities for therapeutic interventions as well as identifying rehabilitation needs in new conditions that may benefit from our attention. Results of the studies on COVID-19 and SCI reported in this thesis, suggest the potential both for expansion of the specialty in terms of new diagnostic categories and the inclusion of new treatment modalities.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,003 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».