INTRODUCTION: Upper limb (UL) impairment is common in people with multiple sclerosis (pwMS), and functional recovery of the UL is a key rehabilitation goal. Technology-based approaches, like virtual reality (VR), are increasingly promising. While most VR environments are task-oriented, our clinical approach integrates neuroproprioceptive 'facilitation and inhibition' (NFI) principles. To advance this, we developed immersive VR software based on NFI principles targeting UL function and sit-to-stand ability. This study aims to evaluate the effectiveness of this VR therapy compared with conventional NFI-based physical therapy in pwMS. Our study uniquely applies advanced imaging techniques, along with biological molecular assessments, to explore adaptive processes induced by VR rehabilitation. METHODS AND ANALYSIS: This double-arm, randomised, assessor-blinded, controlled trial runs over 2 months (1 hour, 2 times per week). PwMS with mild to severe disability will receive either VR therapy or real-world physical therapy. Primary outcomes include the nine-hole peg test, box and block test, handgrip strength, tremor and five times sit-to-stand test. Secondary measures include the Multiple Sclerosis Impact Scale, the 5-level EQ-5D questionnaire and kinematic analysis. Adaptive processes will be monitored using imaging techniques (functional MRI and tractography), molecular genetic methods (long non-coding RNAs) and immune system markers (leukocytes, dendritic cells). The International Classification of Functioning, Disability and Health brief set for MS will map the bio-psycho-social context of participants. ETHICS AND DISSEMINATION: This project and its amendments were approved by the Ethics Committee of the Institute for Clinical and Experimental Medicine and Thomayer Hospital (1983/21+4772/21 (G-21-02) and the Ethics Committee of Kralovske Vinohrady University Hospital (EK-VP/38/0/2021) in Prague, Czechia (with single enrolment). The findings of this project will be disseminated through scientific publications, conferences, professional networks, public engagement, educational materials and stakeholder briefings to ensure a broad impact across clinical, academic and public domains. TRIAL REGISTRATION NUMBER: clinicaltrials.gov (NCT04807738).
- Klíčová slova
- Functional Magnetic Resonance Imaging, IMMUNOLOGY, Multiple sclerosis, Neuroradiology, REHABILITATION MEDICINE, Virtual Reality,
- MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- horní končetina * patofyziologie MeSH
- kvalita života * MeSH
- lidé MeSH
- magnetická rezonanční tomografie * metody MeSH
- postura těla MeSH
- randomizované kontrolované studie jako téma MeSH
- roztroušená skleróza * diagnostické zobrazování MeSH
- síla ruky MeSH
- techniky fyzikální terapie * MeSH
- terapie pomocí virtuální reality metody MeSH
- virtuální realita MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- protokol klinické studie MeSH
INTRODUCTION: While the role of physiotherapy as part of a comprehensive inpatient rehabilitation is indisputable, clear evidence concerning the effectiveness of different rehabilitation managements [interdisciplinary implementing the International Classification of Functioning, disability and health (ICF) vs. multidisciplinary model] and physiotherapy categories (neuroproprioceptive "facilitation, inhibition" vs. motor/skill acquisitions using technologies) are still lacking. In this study, four kinds of comprehensive inpatient rehabilitation with different management and content of physical therapy will be compared. Moreover, focus will be placed on the identification of novel biological molecules reflective of effective rehabilitation. Long non-coding RNAs (lncRNAs) are transcripts (>200 bps) of limited coding potential, which have recently been recognized as key factors in neuronal signaling pathways in ischemic stroke and as such, may provide a valuable readout of patient recovery and neuroprotection during therapeutic progression. METHODS AND ANALYSIS: Adults after the first ischemic stroke in an early sub-acute phase with motor disability will be randomly assigned to one of four groups and undergo a 3 weeks comprehensive inpatient rehabilitation of different types: interdisciplinary team work using ICF model as a guide; multidisciplinary teamwork implementing neuroproprioceptive "facilitation and inhibition" physiotherapy; multidisciplinary teamwork implementing technology-based physiotherapy; and standard multidisciplinary teamwork. Primary (the Goal Attainment Scale, the Patient-Reported Outcomes Measurement Information System, and the World Health Organization Disability Assessment Schedule) and secondary (motor, cognitive, psychological, speech and swallowing functions, functional independence) outcomes will be measured. A blood sample will be obtained upon consent (20 mls; representing pre-rehabilitation molecular) before and after the inpatient program. Primary outcomes will be followed up again 3 and 12 months after the end of the program. The overarching aim of this study is to determine the effectiveness of various rehabilitation managements and physiotherapeutic categories implemented by patients post ischemic stroke via analysis of primary, secondary and long non-coding RNA readouts. This clinical trial will offer an innovative approach not previously tested and will provide new complex analysis along with public assessable molecular biological evidence of various rehabilitation methodology for the alleviation of the effects of ischemic stroke. CLINICAL TRIAL REGISTRATION: NCT05323916, https://clinicaltrials.gov/ct2/show/NCT05323916.
OBJECTIVE: Tropical neuroinfections are still cause of substantial mortality in travelers. Therefore, good knowledge of early symptoms is very important for nurses acting as first contact persons. METHODS: Nurse's practical skills and knowledge of signs and early recognition of tropical neuroinfections, providing first aid and quick action has been studied among graduates of two Tropical Nursing PhD programs (in EU-Countries vs. tropical country) using a standardized questionnaire. Statistical package EPI info was used to determine potential differences between both groups of graduates. RESULTS: Acceptable knowledge on early symptoms and signs of cerebral malaria and meningococcal meningitis in returning travelers was found among 121 graduates of two PhD programs who were included in the study. Of these, 99 questionnaires were filled in Slovakia, Czech Republic and Germany and another 22 were filled in Malaysia, as a part of the Tropical Nursing PhD Study Programs. CONCLUSION: Nursing students and recent graduates in two PhD programs demonstrated acceptable, although not large-scaled, knowledge of early signs and symptoms of tropical neuroinfections.
- Publikační typ
- časopisecké články MeSH
