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Antibody responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in serum and cerebrospinal fluid (CSF) samples from 16 patients with coronavirus disease 2019 and neurological symptoms were assessed using 2 independent methods. Immunoglobulin G (IgG) specific for the virus spike protein was found in 81% of patients in serum and in 56% in CSF. SARS-CoV-2 IgG in CSF was observed in 2 patients with negative serological findings. Levels of IgG in both serum and CSF were associated with disease severity (P < .05). All patients with elevated markers of central nervous system damage in CSF also had CSF antibodies (P = .002), and CSF antibodies had the highest predictive value for neuronal damage markers of all tested clinical variables.

BackgroundA proportion of patients with mild traumatic brain injury (mTBI) suffer long-term consequences, and the reasons behind this are still poorly understood. One factor that may affect outcomes is cognitive reserve, which is the brain's ability to maintain cognitive function despite injury. It is often assessed through educational level or premorbid IQ tests. This study aimed to explore whether there were differences in post-concussion symptoms and symptom resolution between patients with mTBI and minor orthopedic injuries one week and three months after injury. Additional aims were to explore the relationship between cognitive reserve and outcome, as well as functional connectivity according to resting state functional magnetic resonance imaging (rs-fMRI).MethodFifteen patients with mTBI and 15 controls with minor orthopedic injuries were recruited from the emergency department. Assessments, including Rivermead Post-Concussion Questionnaire (RPQ), neuropsychological testing, and rs-fMRI scans, were conducted on average 7 days (SD = 2) and 122 days (SD = 51) after injury.ResultsAt the first time point, significantly higher rates of post-concussion symptoms (U = 40.0, p = 0.003), state fatigue (U = 56.5, p = 0.014), and fatigability (U = 58.5, p = 0.025) were observed among the mTBI group than among the controls. However, after three months, only the difference in post-concussion symptoms remained significant (U = 27.0, p = 0.003). Improvement in post-concussion symptoms was found to be significantly correlated with cognitive reserve, but only in the mTBI group (Spearman's rho = -0.579, p = .038). Differences in the trajectory of recovery were also observed for fatigability between the two groups (U = 36.5, p = 0.015). Moreover, functional connectivity differences in the frontoparietal network were observed between the groups, and for mTBI patients, functional connectivity differences in an executive control network were observed over time.ConclusionThe findings of this pilot study suggest that mTBI, compared to minor orthopedic trauma, is associated to both functional connectivity changes in the brain and concussion-related symptoms. While there is improvement in these symptoms over time, a small subgroup with lower cognitive reserve appears to experience more persistent and possibly worsening symptoms over time. This, however, needs to be validated in larger studies.Trial registrationNCT05593172. Retrospectively registered.

Background: Stroke is increasing in Africa and consequences such as limitations in the performance of activities in everyday life persist a long time. A family member might need to care for and assist the person who has had a stroke. The life situation of these caregivers thereby changes, which could lead to increased workload and new responsibilities in caring for which they lack but request knowledge. During the F@ce rehabilitation program, the caregivers received counseling, which is uncommon in the African context. The aim of the study was twofold; (1) to investigate the perceived caregiver burden and life satisfaction and, (2) to explore and describe the life situation for caregivers to persons that have had a stroke and received the mobile phone supported rehabilitation F@ce in urban areas in Uganda.

Method: A mixed method design was used. Twelve caregivers took part in a semi-structured interview regarding their everyday life situation and responded to questionnaires on caregiver burden and life satisfaction. Latent qualitative content analysis was used to analyse the interviews.

Results: Five categories were identified in the caregivers' experiences of their life situation: Feels obligated but is just a natural commitment; a tightly scheduled everyday life; being the supporting relative; the caregivers approach as rehabilitators; and being supported by the rehabilitation intervention. The caregivers rated relatively high on the Caregiver Burden Scale and two thirds of the sample rated their satisfaction with life as a whole as dissatisfying. Further ratings on the Life Satisfaction checklist revealed that the financial, vocational, leisure and family situations were dissatisfying.

Conclusions: Even if it was viewed as a natural commitment to be a caregiver when a family member had had a stroke, the life situation changed substantially for those who took on the caregiving role. Caregiving responsibilities were challenging as well as a heavy workload and a strained financial situation as many were giving up on jobs. The participants felt burdened and rated a low life satisfaction. The F@ce intervention was, however, expressed as valued and involved support and advice in their caregiving situation as well as information on stroke which relieved stress among them.

Objective: To compare changes in the perceived impact of stroke on everyday life over time in a rehabilitation sample that received a client-centred activities of daily living (CADL) intervention or usual ADL (UADL) intervention.

Design: Longitudinal follow-up of a randomized controlled trial.

Methods: A total of 145 persons with stroke were assigned into CADL or UADL. Groups were assessed using the Stroke Impact Scale (SIS) at 3 months, 12 months and 5 years post-intervention. Changes in SIS domain scores over time were compared within and between groups.

Results: Changes in the impact of stroke over time were not related to which intervention the groups received. There were no significant differences in the SIS domains or stroke recovery between groups at the 3-month, 12-month and 5-year follow-ups. Despite an increased impact of stroke over time in some domains in both groups, both groups perceived a decreased impact of stroke in the Participation domain at 12 months. Perceived participation was sustained at the same level at 12 months as at 5 years in both groups.

Conclusion: These findings stress the importance of access to follow-up rehabilitation interventions 1-year post-stroke to enable participation in daily activities. Such follow-up and enablement would support the use of self-management strategies in the performance of persons’ valued activities, which might be difficult to perform, due to, for example, impact on hand function or mobility. The results of this study emphasize the importance of prioritizing participation in activities that are meaningful from a personal perspective.

Lay abstract

In this study, perceived impact of stroke on everyday life over time was compared among 145 persons with stroke who received the client-centred or usual activities of daily living intervention. They were followed up at 3, 12 months and 5-years post-stroke. No differences were found in the impact of stroke over time between groups. Despite increased impact of stroke (indicating more problems) over time in some areas, the groups perceived decreased impact of stroke (less problems) in their participation at 12 months. Perceived participation was sustained at the same level at 12 months as at 5 years in both groups. Findings stress the importance of access to follow-up rehabilitation interventions one-year post-stroke to enable participation in daily activities, and to support the use of self-management strategies to facilitate participation in valued and meaningful activities that might be difficult due to person’s functional limitations.

Background

An intervention that contains several interacting components can be defined as a complex intervention. This intervention was developed in accordance with the Medical Research Council (MRC) guidance for complex interventions.

Aim

To describe the development, theoretical framework, and content of a client-centred activities in daily living intervention (CADL) for people with stroke.

Material and methods

Different steps were used; identifying the evidence base, identifying/developing theory and the modelling process and outcomes in the development of the CADL. The remodelling of the process and content of the intervention that emerged are defined.

Results

Findings from a series of qualitative studies of people with stroke demonstrated the need to develop an ADL intervention based on the clients’ lived experiences. The theoretical framework is based on empirical research, theories about human occupation and client-centredness. The CADL is applying an occupational and phenomenological perspective in order to enable agency in daily activities and participation in everyday life among persons with stroke.

Conclusions and significance

The article can be used as an example of how to present the development and theoretical framework of a new complex intervention in occupational therapy.

Background: There is a need for research to identify the impact of mild stroke on occupational engagement. The Occupational Gaps Questionnaire (OGQ) measures the difference between a person's actual and preferred occupational engagement. Aims/objectives: This study aimed to test the feasibility of the English version of the OGQ, and describe occupational gaps of people with mild stroke. Material and methods: A mixed methods, cross-sectional study involving 10 people with mild stroke at 1 and/or 9 months after stroke. Quantitative data were summarised descriptively and thematic analysis explored qualitative responses. Results: Participants reported a mean of 6.7 (SD 5.1) gaps at 1-month and 3.00 (SD 2.1) gaps at 9-months. Outdoor activities, work, sports, and light home and heavy-duty maintenance were identified as gaps at both time-points. Two themes emerged from the qualitative analysis: Drivers of occupation and Occupations can be challenged or enabled. An additional finding in terms of feasibility was drawn from qualitative data: Feasibility of Conducting the OGQ with people with mild stroke.

Purpose: To generate knowledge about how professional stakeholders organise and experience the support of the return-to-work (RTW) process for persons with spinal cord injury (SCI).

Methods: Constructivist grounded theory approach. Professional stakeholders (n = 34) involved in the RTW process and representing three Swedish Regions were recruited into seven focus groups. Analysis followed initial, focussed, and theoretical coding.

Findings: The core category - mediating intentions to support work and possibilities of working through social, labour market, and societal context - illustrates complexities of when and how to support a person with SCI in the RTW process, and a risk of delayed, unequal, or absent RTW processes. Analysis outlines: (1) Assessment of ability to work - uncertainty of how and when; (2) Planning RTW - divide between dynamic and rule-based perspectives; (3) Work re-entry - unequal paths towards viable solutions.

Conclusions: In RTW after SCI, it is critical to acknowledge how the RTW process is situated in relation to the person and context. A possible direction - grounded in an occupational perspective - through early identification of needs and resources and coordination derived from the SCI rehabilitation setting within healthcare is suggested. This can facilitate a time-sensitive and equal RTW process.

BACKGROUND: About half of those that have had stroke in working age return to work (RTW). Few rehabilitation programmes exist focussing RTW after stroke.

AIM: To produce a clear replicable description of the ReWork-Stroke rehabilitation programme targeting RTW for people of working age who have had stroke.

MATERIALS AND METHODS: The Template for Intervention Description and Replication 12 item checklist was used to describe the ReWork-Stroke programme developed 2013-2014. This paper presents the development, rationale and processes in the programme to enable replication and provide evidence for implementation.

RESULTS: Occupational therapists (OTs) skilled in stroke rehabilitation contribute knowledge about consequences of stroke and coordinate stakeholders involved. The ReWork-Stroke is person-centred, includes individual plans and generic components, consists of a preparation and a work trial phase. During the preparation phase, resources and hindrances for RTW are mapped and a plan for work trial is elaborated. During the work trial phase, the intervention is located at the workplace. The OT conducts recurrent follow-ups and collaborates with employers/co-workers.

CONCLUSIONS: A person-centred programme has advantages in its flexibility to meet different needs between people and by this thorough description of ReWork-Stroke, others can replicate the programme and its fidelity and evidence can be strengthened.

BACKGROUND: The ReWork-Stroke program was developed to meet the need for a person-centered rehabilitation program addressing return to work after stroke and was provided by occupational therapists (OTs). OBJECTIVE: To gain knowledge on the implementation process of the ReWork-Stroke program, the mechanisms of impact, and the contextual factors that might have affected the process. METHODS: A case study design was used. Data were collected by interviews with two ReWork-Stroke providers and their logbooks of 13 clients. Content analysis was applied. RESULTS: The ReWork-Stroke program varied in duration (12-48 weeks) and was largely implemented according to plan regarding components and how they were provided. It was mostly delivered at the workplace. Mechanisms of impact were building alliances with clients, providing intervention at the workplace, informing about stroke, assigning co-workers as tutors for clients, and collaboration between stakeholders. CONCLUSIONS: The ReWork-Stroke program can be implemented according to plan and is a flexible person-centered program in which stakeholders, coordinated by an OT, plan and take actions, mostly at the workplace, for the client's return to work. A key factor was recognizing the current work ability after stroke. Further program development includes a more structured evaluation and technical solutions for supporting stakeholders.

 Background:  Pilocytic astrocytoma is the most common brain tumour type in childhood located in the posterior fossa, and treated mainly with surgery. These tumours have low mortality, but knowledge concerning its long-term outcome is sparse.

 Aims:  The aim was to investigate if patients treated for pilocytic astrocytoma in the posterior fossa had motor complications, including balance, motor and process skills.

 Methods and results:  This descriptive single-centre study includes eight children and 12 adults, treated for pilocytic astrocytoma as children. Motor performance was investigated with Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, and dynamic balance with the mini-balance evaluation systems test. Physiological cost index, six-minute walk test, hand grip strength and assessment of motor and process skills were also evaluated. Ten patients reported motor difficulties, mainly from the upper limbs. The motor performance test showed results within normal limits except for manual dexterity, which was significantly below mean (p = .008). In the dynamic balance test patients had significantly lower results compared with controls (p = .036). Physiological cost index, six-minute walk tests and hand grip strength showed results within normal limits. In the Assessment of Motor and Process Skills, patients over 16 years had significantly lower results compared with test norms for motor activities of daily living (ADL) and 30% of all patients scored below the cut-off level for difficulties with motor skills.

 Conclusions:  Motor performance for patients treated for pilocytic astrocytoma in the posterior fossa in childhood is satisfactory but some patients display difficulties with balance, manual dexterity and ADL motor skills. Thus, it is important to identify those in need of motor follow-up and training.

Background and purpose: Neurological symptoms have been frequently reported in hospitalized patients with coronavirus disease 2019 (COVID-19), and biomarkers of central nervous system (CNS) injury are reported to be increased in plasma but not extensively studied in cerebrospinal fluid (CSF). This study examined CSF for biomarkers of CNS injury and other pathology in relation to neurological symptoms and disease severity in patients with neurological manifestations of COVID-19.

Methods: Nineteen patients with neurological symptoms and mild to critical COVID-19 were prospectively included. Extensive analysis of CSF, including measurement of biomarkers of CNS injury (neurofilament light chain [NfL] protein, glial fibrillary acidic protein [GFAp], and total tau), was performed and compared to neurological features and disease severity.

Results: Neurological symptoms included altered mental status (42%), headache (42%), and central (21%) and peripheral weakness (32%). Two patients demonstrated minor pleocytosis, and four patients had increased immunoglobulin G levels in CSF. Neuronal autoantibody testing using commercial tests was negative in all patients. Increased CSF levels of NfL protein, total tau, and GFAp were seen in 63%, 37%, and 16% of patients, respectively. Increased NfL protein correlated with disease severity, time in intensive care, and level of consciousness. NfL protein in CSF was higher in patients with central neurological symptoms.

Conclusions: Although limited by the small sample size, our data suggest that levels of NfL protein, GFAp, and total tau in CSF are commonly elevated in patients with COVID-19 with neurological symptoms. This is in contrast to the standard CSF workup where pathological findings are scarce. NfL protein, in particular, is associated with central neurological symptoms and disease severity.