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Background Chemotherapy-induced peripheral neuropathy (CIPN) can affect functional performance and quality of life considerably. Since balance training has proven to enhance physical function, it might be a promising strategy to manage CIPN-induced functional impairments. Methods Fifty cancer survivors with persisting CIPN after finishing their treatment were randomly allocated to an intervention (IG) or active control group (CG). The IG did endurance plus balance training, the CG only endurance training (twice weekly over 12 weeks). Pre- and post-assessments included functional performance, cardiorespiratory fitness, vibration sense, and self-reported CIPN symptoms (EORTC QLQ-CIPN20). Results Intention-to-treat analyses ( n  = 41) did not reveal a significant group difference (CG minus IG) for sway path in semi-tandem stance after intervention (primary endpoint), adjusted for baseline. However, our per-protocol analysis of 37 patients with training compliance ≥70% revealed: the IG reduced their sway path during semi-tandem stance (− 76 mm, 95% CI -141 – -17; CG: -6 mm, 95% CI -52 – 50), improved the duration standing on one leg on instable surface (11 s, 95% CI 8–17; CG: 0 s, 95%CI 0–5) and reported decreased motor symptoms (−8points, 95% CI -18 – 0; CG: -2points 95% CI -6 – 2). Both groups reported reduced overall- (IG: -10points, 95% CI -17 – -4; CG: -6points, 95% CI -11 – -1) and sensory symptoms (IG: -7points, 95% CI -15 – 0; CG: -7points, 95% CI -15 – 0), while only the CG exhibited objectively better vibration sense (knuckle: 0.8points, 95% CI 0.3–1.3; IG: 0.0points, 95% CI -1.1 – 0.9; patella: 1.0points, 95% CI 0.4–1.6: IG: -0.8points, 95% CI -0.2 – 0.0). Furthermore, maximum power output during cardiopulmonary exercise test increased in both groups (IG and CG: 0.1 W/kg, 95% CI 0.0–0.2), but only the CG improved their jump height (2 cm, 95% CI 0.5–3.5; IG: 1 cm, 95% CI -0.4 – 3.2). Conclusion We suppose that endurance training induced a reduction in sensory symptoms in both groups, while balance training additionally improved patients’ functional status. This additional functional effect might reflect the IG’s superiority in the CIPN20 motor score. Both exercises provide a clear and relevant benefit for patients with CIPN. Trial registration German Clinical Trials Register (DRKS) number: DRKS00005419 , prospectively registered on November 19, 2013.

* A comprehensive guide to managing spastic hypertonia after brain injury and the first full overview of this area * The ideal reference for therapeutic interventions that optimise arm and hand function to support goal achievement * An extensive clinical manual for neurological practice, a key reference for students and qualified practitioners, and a valuable resource for all occupational therapists and physiotherapists working with brain-injured clients

Background Yoga is a meditative movement therapy focused on mind‐body awareness. The impact of yoga on health‐related quality of life (HRQOL) outcomes in patients with chemotherapy‐induced peripheral neuropathy (CIPN) is unclear. Methods We conducted a pilot randomized wait‐list controlled trial of 8 weeks of yoga (n = 21) versus wait‐list control (n = 20) for CIPN in 41 breast and gynecological cancer survivors with persistent moderate to severe CIPN. HRQOL endpoints were Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), and Insomnia Severity Index (ISI). The Treatment Expectancy Scale (TES) was administered at baseline. We estimated mean changes and 95% confidence intervals (CIs) from baseline to weeks 8 and 12 and compared arms using constrained linear mixed models. Results At week 8, HADS anxiety scores decreased −1.61 (−2.75, −0.46) in the yoga arm and −0.32 (−1.38, 0.75) points in the wait‐list control arm (p = 0.099). At week 12, HADS anxiety scores decreased −1.42 (−2.57, −0.28) in yoga compared to an increase of 0.46 (−0.60, 1.53) in wait‐list control (p = 0.017). There were no significant differences in HADS depression, BFI, or ISI scores between yoga and wait‐list control. Baseline TES was significantly higher in yoga than in wait‐list control (14.9 vs. 12.7, p = 0.019). TES was not associated with HADS anxiety reduction and HADS anxiety reduction was not associated with CIPN pain reduction. Conclusions Yoga may reduce anxiety in patients with CIPN. Future studies are needed to confirm these findings. Clinical Trial Registration Number: ClinicalTrials.gov Identifier: NCT03292328. The impact of yoga on health‐related quality of life (HRQOL) outcomes in patients with chemotherapy‐induced peripheral neuropathy (CIPN) is unclear. We conducted a pilot randomized wait‐list controlled trial of 8 weeks of yoga versus wait‐list control for CIPN in breast and gynecological cancer survivors with persistent moderate to severe CIPN. Our results showed a trend for yoga to decrease anxiety, but not Hospital Anxiety and Depression Scale depression scores, Brief Fatigue Inventory, or the Insomnia Severity Index, at weeks 8 and 12 compared to wait‐list control; future studies are needed to confirm these findings.

Changes in the focus of neurological practice worldwide have led to the need for new standard texts that reflect the current state of this expanding area of clinical expertise. The second edition of the Handbook of Neurological Rehabilitation is a major reference source that fulfils this need, providing an invaluable resource for all professions that work with patients suffering from neurological disorders. It brings restorative neurology to the bedside and shows how a reiterative, goal-oriented, problem-solving training programme can benefit patients, sometimes on a scale not achieved by pharmacological or surgical interventions. The book is divided into three sections all of which have been updated. Section One explores the clinical and biological principles underpinning rehabilitation practice in the context of neurological disablement. Section Two describes the assessment, treatment, and management of the major physical, cognitive and behavioural impairments, and the resulting functional deficits that may follow or accompany neurological disease. The final section explores in more detail these problems and their management in relation to the more common specific disorders of the nervous system. The text emphasises the fact that rehabilitation is an ongoing process involving multidisciplinary problem-solving, goal-setting and education; in which organised care is more effective than unorganised care; and the breakdown of professional barriers within rehabilitation, to facilitate the use of combined treatment techniques, improves outcome. It describes the contribution made by neural reorganisation and compensatory mechanisms to recovery of function, focuses on the avoidance of secondary deficit, and explores the physical, cognitive, affective and behavioural problems that may occur after neurological damage. At a time when new medical technologies threaten to fragment the integrity of medical care at individual and societal levels, it is crucial that all those involved in the management of chronic neurological disease have a working knowledge of the contents of this book. Their perspective on clinical practice will then be truly integrated and holistic and their patients will benefit accordingly. All doctors actively managing chronic disabling neurological disease should become familiar with this book. In many cases, it will also be a more useful first reference for therapists and nurses than a neurology or neurosurgery textbook. - Stephen G.B. Kirker, Cambridge University, in ACNR magazine Section 1: Principles of Practice. Part A: Clinical Aspects. R. Langton Hewer, A. Tennant, Epidemiology of Disabling Neurological Disorders. C.D. Ward, S. McIntosh, The Rehabilitation Process: A Neurological Perspective. M.P. Barnes, Organisation of Neurological Rehabilitation Services. R. Ll. Wood, The Rehabilitation Team. C. Collin, Measurement of Disability and Handicap. M. Saunders, Ethical Implications of Disablement. Part B: Mechanisms of Recovery. A.J. Larner, M.V. Sofroniew, Mechanisms of Cellular Damage and Recovery. L.G. Cohen, M. Hallett, Neural Plasticity and Recovery of Function. S.B. Dunnett, Neural Tissue Transplantation. L.L. Pinnington, C.D. Ward, Learning and Skill Acquisition. T. Mulder, J. Hochstenbach, Motor Control and Learning: Implications for Neurological Rehabilitation. Section 2: Assessment and Treatment of Functional Deficits. Part A: Mobility. M.P. Barnes, Spasticity. R.J. Hardie, J. Rothwell, Tremor and Ataxia. S. Edwards, S. Mawson, R.J. Greenwood, Physical Therapies. G. Yarney, R.J. Greenwood, Physical Consequences of Neurological Disablement. G.R. Johnson, Biomechanics and Rehabilitation Engineering. N.C.M. Fyfe, E.J.W. McClemont, E. Panton, L. Sandles, Assistive Technology: Mobility Aids, Environmental Control Systems and Communication Aids. D. Rushton, Functional Neurostimulation in Rehabilitation. Part B: Other Physical Disability. D.M. Justins, M. Paes, P.H. Richardson, Pain Relief in Neurological Rehabilitation. C. Kennard, A. Pambakian, A.J. Wilkins, Special Senses. J.F. Hussain, C. Haslam, C.J. Fowler, Neurogenic Bladder Dysfunction and its Management. B. Chandler, Sex and Relationships in Neurological Disability. R.S. Howard, Neurogenic Respiratory Failure. S. Wessely, D. El Kabir, T. Chalder, Chronic Fatigue. J. Whittaker, A. Dunnachie, The Assessment and Management of Neurogenic Swallowing Disorders. P.M. Enderby, Dysarthria. Part C: Cognitive Function. S. Byng, E.V. Jones, Therapy for the Language Impairment in Aphasia. B.A. Wilson, L. Clare, Rehabilitation of Memory Disorders. N. Alderman, P. Burgess, Assessment and Rehabilitation of the Dysexecutive Syndrome. I.H. Robertson, The Rehabilitation of Visuospatial, Visuoperceptual and Apraxic Disorders. Part D: Personality and Behaviour. L.H. Goldstein, Behaviour Problems. A. House, Psychiatric Aspects of Neurological Rehabilitation. H. Merskey, Psychosomatic Disorders. M. Oddy, Psychosocial Consequences of Brain Injury. Section 3: Specific Disorders. T.M. McMillan, R.J. Greenwood, Head Injury. D.T. Wade, Stroke Rehabilitation: The Evidence. P.J. Thompson, S.D. Shorvon, D. Heaney, The Epilepsies. B. Pentland, Parkinsonism and Dystonia. M.P. Barnes, Multiple Sclerosis. C.D. Ward, N.R. Dennis, Huntington's Disease. R.T. Woods, Rehabilitation in Alzheimer's Disease and Other Dementias. C. Murray-Leslie, P. Critchley, The Young Adult with Neurological Disabilities with Particular Reference to Cerebral Palsy and Spinal Bifida. E.A. Davies, C.R.A. Clark, Malignant Cerebral Gliomas: Rehabilitation and Care. J. Allibone, B. Taylor, F.R.I. Middleton, Spinal Injury. J.C. Chawla, D. Playford, Non-traumatic Myelopathy. P. Shaw, Motor Neurone Disease. R. Birch, Management of Brachial Plexus Injuries. M. Reilly, R.J. Greenwood, Disorders of the Peripheral Nerve. N. Davies, G. Cochrane, M. Hanna, Muscle Disorders. Index.

OBJECTIVE:The aim of this study was to study the effects of a short-term cognitive behavior therapy on work-anxiety and sickness-absence in patients with work-anxiety. METHODS:Three-hundred forty-five inpatients who suffered from cardiologic, neurological, or orthopedic problems and additionally work-anxiety were randomly assigned into two different group interventions. Patients got four sessions of a group intervention, which either focused on cognitive behavior–therapy anxiety–management (work-anxiety coping group, WAG) or unspecific recreational activities (RG). RESULTS:No differences were found between WAG and RG for work-anxiety and subjective work ability. When looking at patients who were suffering only from work-anxiety, and no additional mental disorder, the duration of sickness absence until 6 months follow-up was shorter in the WAG (WAG11 weeks, RG16 weeks, P = 0.050). CONCLUSION:A short-term WAG may help return to work in patients with work-anxieties, as long as there is no comorbid mental disorder.

ObjectivesThe objective of this study was to test the feasibility of conducting a randomised controlled trial (RCT) of an intervention targeted at activities of daily living (ADL), delivered by an occupational therapist, in homecare reablement.DesignFeasibility parallel group RCT.SettingSingle-site local authority homecare reablement service.ParticipantsPeople referred for homecare reablement with ability to consent. Exclusion criteria were as follows: inability to speak English, receiving other community therapy services, needing two or more to assist transfer and receiving end-of-life care.Control‘Usual care’ was 6 weeks of homecare reablement delivered by social care workers (no routine health professional input).InterventionA targeted ADL programme, delivered by an occupational therapist incorporating goal setting, teaching/practising techniques, equipment/adaptations and provision of advice/support. This was in addition to usual care.Outcome measuresAspects of feasibility including eligibility, recruitment, intervention delivery, attrition and suitability and sensitivity of outcome measures. Participant outcomes were personal and extended ADL, quality of life, falls and use of health and social care services.Results30 participants were recruited, 15 to each arm, which was 60% of those eligible. Data from 22 (73%) were analysed at 6 months. Of the 15 participants, 13 (86%) received the intervention and were able to set one or more ADL goals. There were improvements from baseline in both groups, although overall improvements were greater in the occupational therapy (OT) intervention group. The biggest threat to feasibility was a change in service configuration during the trial, involving additional occupational therapy input, affecting usual care and recruitment.ConclusionsDespite the service reconfiguration, it was feasible to recruit and retain participants, deliver the intervention and collect outcome data that were responsive to change. The choice of primary outcome measure remains unclear. A further powered study is feasible and warranted; however, the design will require careful consideration because of ongoing national changes in service configurations.Trial registration numberISRCTN21710246; Results.

Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritised in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury. To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability (YLDs) of 25 diseases, impairments, or bespoke aggregations of sequelae that were selected as amenable to rehabilitation. All analyses were done at the country level and then aggregated to seven regions: World Bank high-income countries and the six WHO regions (ie, Africa, the Americas, Southeast Asia, Europe, Eastern Mediterranean, and Western Pacific). Globally, in 2019, 2·41 billion (95% uncertainty interval 2·34–2·50) individuals had conditions that would benefit from rehabilitation, contributing to 310 million [235–392] YLDs. This number had increased by 63% from 1990 to 2019. Regionally, the Western Pacific had the highest need of rehabilitation services (610 million people [588–636] and 83 million YLDs [62–106]). The disease area that contributed most to prevalence was musculoskeletal disorders (1·71 billion people [1·68–1·80]), with low back pain being the most prevalent condition in 134 of the 204 countries analysed. To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need. Bill & Melinda Gates Foundation.

Background Hybrid research designs targeting adults with neurologic disability are critical for improving the efficiency of models that can identify, track and intervene on identified health issues. Methods Our Russian doll framework encompasses three study phases. Phase 1 involves prospectively following a cohort of participants with disability to examine the relationships between rates of health and functional deficits (e.g., pain, fatigue, deconditioning), functional measures (e.g., cardiorespiratory endurance, strength, balance), and environmental and sociocultural factors. In Phase 2, eligible participants with neurologic disability from Phase 1 (in our example, individuals with multiple sclerosis) are screened and randomized to a clinical exercise efficacy trial. In Phase 3, study participants are enrolled in a home-based teleexercise trial to test the feasibility and replicability of delivering the clinical exercise study in the home. Discussion This unique three-in-one Russian doll framework serves as a foundation for informing and guiding researchers and clinicians in treating certain health and functional deficits in people with neurologic disability using exercise as a primary treatment modality in both the clinical and home settings. It offers a unique perspective for understanding the critical issues of functioning, health maintenance and quality of life for people with neurologic disability across a longitudinal framework. Trial registration Study 2 ClinicalTrials.gov identifier NCT02533882 (retroactively registered 03/06/2015). Study 3 ClinicalTrials.gov identifier NCT03108950 (retroactively registered 04/05/2017).

Objective Traditional posturography measurements characterize postural instability in patients with chemotherapy‐induced peripheral neuropathy (CIPN), while underlying postural control mechanisms remain unclear. Taking a model‐based approach can yield insights into these mechanisms. This study’s aim was to characterize the modifications in postural control of CIPN patients associated with exercise in relation to the postural behavior of healthy control participants (hCON) via an exploratory approach. Methods Thirty‐one CIPN patients were randomly assigned to two interventions (balance plus moderate endurance training vs. moderate endurance training only) and exercised twice per week over 12 weeks. Baseline data were compared to 36 matched hCONs. We recorded spontaneous sway and postural reactions to platform tilts using Optotrak and a Kistler force platform pre‐ and post‐intervention. Data interpretation relied on a model‐based parameter identification procedure. Results Spontaneous sway amplitudes were larger and postural reactions smaller, with a relative phase advance, in our pre‐intervention patients than the hCONs. Post‐intervention, spontaneous sway, and postural reactions were reduced and the sensory‐motor ratio larger in both groups, while the postural reaction timing differed between groups. Interpretation The abnormally small postural reactions in CIPN patients before the intervention can be interpreted as the consequence of abnormally strong velocity control—a strategy modification that may serve as a prediction mechanism to compensate for the lack of timely and accurate proprioceptive signals. While both groups reduced postural sway and showed an adapted sensory‐motor ratio post‐intervention, the interventions seemed to trigger different velocity control strategies. This study emphasizes the need for taking a more differentiated perspective on intervention effects. Trial registration German Clinical Trials Register (DRKS) number: DRKS00005419, prospectively registered on November 19, 2013.

Objectives: The recent National Service Framework for Long Term Conditions recommends that patients participate more in decision making about their care. However, few protocols exist to support this. One potentially useful method is goal setting, but little has been done to evaluate the added value of increasing patient participation in this way. Therefore, this study examined the impact of an increased participation goal setting protocol in a neurorehabilitation setting. Design: The study was an AB optimised balance block design with each block lasting 3 months, over an 18 month period. Setting and participants: Patients (n = 201) were recruited from an inpatient neurological rehabilitation unit. Interventions: Patients (n = 100) recruited in phase A were involved in “usual practice” goal setting. Patients (n = 101) recruited in phase B were involved in “increased participation” goal setting, which included a protocol to help them define and prioritise their own goals. Main outcome measures: Patients’ perceptions of the relevance of goal setting and their autonomy within the process; the number, type and outcome of goals; and level of functional ability. Results: Phase B patients (“increased participation”) set fewer goals, of which significantly more were participation related. These patients perceived the goals to be more relevant, and expressed greater autonomy and satisfaction with goal setting. There were no differences in functional outcomes between the groups. Conclusion: This study has shown that patients prefer increased participation in the goal setting process over standard procedures, perceiving their goals as more relevant and rehabilitation more patient centred despite the absence of functional gains. Effective patient centred care can be realised by using structures that help support patients to identify and communicate their priorities. As such, our findings suggest patients would benefit from greater participation in this aspect of clinical decision making.