"Adelante" is a Spanish word meaning forward. It may also refer to:.
BACKGROUND:While most people fully recover after mild traumatic brain injury (mTBI), a substantial minority experience persistent symptoms and incomplete recovery. This may be prevented by early interventions specifically targeting patients at risk of incomplete recovery. The UPFRONT-model was developed to identify patients at risk of poor functional outcome. This study aimed to externally validate the UPFRONT-model in an independent sample. METHODS:A prospective, longitudinal, multicenter cohort study with 126 mTBI patients recruited from emergency and neurology departments (ED) of six hospitals in the Netherlands was performed. Predictors in the UPFRONT-model included educational level, Glasgow Coma Scale (GCS), neck pain at injury, alcohol intoxication, Post Traumatic Amnesia (PTA), pre-injury mental health, anxiety, depression, coping, and the number and severity of post-traumatic complaints. Functional recovery at 6 months was assessed using the Glasgow Outcome Scale Extended (GOS-E). The external validity of the UPRFONT model was assessed with measures of calibration and discrimination. RESULTS:The model showed acceptable discriminative ability (AUC = 0.74), comparable to the development sample (AUC = 0.77). However, calibration revealed systematic underestimation of recovery (predicted: 46%; observed: 75%), with a calibration intercept of 1.52 and a slope of 0.70. Despite differences in some predictor effects, psychological variables were robust and consistent across samples. CONCLUSION:The UPFRONT-model demonstrated solid discriminative performance in an external cohort, but tended to underestimate the likelihood of complete recovery. Further validation and optimization are needed before clinical implementation. The model holds promise for early identification of at-risk patients, enabling targeted interventions following mTBI.
A small percentage of patients with mild traumatic brain injury (mTBI) does not follow the expected recovery trajectory but develop persistent post-concussion symptoms (PCS). The fear-avoidance model (FAM) is a general biopsychosocial model that may potentially explain the development and continuation of persistent PCS for a subgroup of patients. The aim of the present study was to investigate if the FAM can (at least partially) explain PCS at 3 and 6 months post-mTBI by investigating associations between the elements of the FAM. A prospective, longitudinal, multicenter cohort study with outcome assessments at 2 weeks, 3 months, and 6 months post-mTBI was conducted in 163 patients with mTBI recruited from the emergency department and neurology department within 2 weeks post-mTBI. The FAM components PCS, catastrophizing, fear-avoidance behavior and depressive symptoms correlated significantly with each other at 3 months post-mTBI (p < 0.01) and correlations ranged from 0.40 to 0.72. No significant correlations were found between disuse and the other components. Depressive symptoms at 3 months post-mTBI significantly correlated with PCS at 6 months post-mTBI. Our results suggest that the FAM could be an explanatory model for the development of persistent PCS. This implies that treatment development for patients with persistent PCS could be aimed at the components of the FAM, such as exposure therapy to reduce catastrophizing and avoidance behavior.
OBJECTIVE:Approximately half of out-of-hospital cardiac arrest (OHCA) survivors have enduring cognitive impairment. This study investigated the effectiveness of a combined cognitive rehabilitation approach, combining metacognitive strategy training with direct computerized-training, to improve cognitive functioning in daily life after OHCA. METHOD:A single-case experimental design with a non-concurrent multiple baseline was used including five participants. The intervention (6-10 weeks) entailed therapist-guided metacognitive and direct training, with a randomized starting date. Participants completed daily visual analog scales on personal problems and subjective cognition (memory, attention, executive functioning). Cognitive tests and questionnaires on cognition, memory failures, societal participation, and quality of life were administered pre- and post-intervention. Statistical analysis included visual analysis, (weighted) TAU-U tests, and multilevel regression. RESULTS:Visual analysis showed improvements in personal daily problems for all adherent participants (n=4). Weighted TAU-U scores were small but significant for the personal problems (TAU-U=.19, p<.01) and attention (TAU-U=.18, p=.02). Three participants showed a significant decrease in personal problem severity during and after treatment. Descriptive cognitive test scores suggested an improvement. Participants reportedfewer memory failures and greater societal participation, but no statistical analyses were conducted. Subjective cognitive changes were mixed, life satisfaction remained stable. CONCLUSIONS:The combined treatment improved daily cognitive functioning after OHCA.
In this article, gait data of typically developing (TD) children (24 boys/31 girls, mean (95% confidence interval) age 9.38 (8.51 - 10.25) years, body mass 35.67 (31.40 - 39.94) kg, leg length 0.73 (0.70 - 0.76) m, and height 1.41 (1.35 - 1.46) m) walking at different walking speeds is shared publicly. Raw and processed data is presented for each child separately and includes data of each single step of both legs. Beside, the subject demographics and the results from the physical examination are presented allowing to select TD children from the database to create a matched group, based on specific parameters (e.g. sex and body weight). For clinical application, gait data is also presented per age group, which provides quick insight into the normal gait pattern of TD children of varying age. Gait analysis was performed during treadmill walking in a virtual environment using the Computer Assisted Rehabilitation Environment (CAREN). The human body lower limb model with trunk markers (HBM2) was used as biomechanical model. Children walked at comfortable walking speed, 30% slower and 30% faster (random sequence) while wearing gymnastic shoes and a safety harness to prevent falling. For each speed condition, 250 steps were recorded. Data quality check, step detection and the calculation of gait parameters was done by custom made Matlab algorithms. Raw data files are provided per walking speed, for each child separately. The raw data is exported from the CAREN software (D-flow) and is provided in .mox and .txt files. It includes the output from the models such as subject data, marker and force data, kinematic data (joint angles), kinetic data (joint moments, GRFs, joint powers), as well as CoM data and EMG data (the last two are not described in this manuscript), for each speed condition and each child. Unfiltered and filtered data are included. C3D files with raw marker and GRF data were recorded in Nexus (Vicon software) and are available upon request. After analyzing the raw data into Matlab (R2016a, Mathworks) using custom made Matlab algorithms, processed data is obtained. The processed data is provided in .xls files and is also presented for each child separately. It contains spatiotemporal parameters, 3D joint angles, anterior-posterior and vertical ground reaction forces (GRF), 3D joint moments and sagittal joint power of each step of the left and right leg. In addition to each individual's data, overview files (.xls) are created per walking speed condition. These overviews present the averaged gait parameter (e.g. joint angle), calculated over all valid steps, of each child.
Objectives:Chronic tinnitus is effectively treated through cognitive-behavioral therapy (CBT). Both group and individual CBT for tinnitus are effective, but no study has directly compared the two. The current study explores group versus individual CBT for tinnitus. Design:A multiple-baseline single-case experimental design was employed to observe changes within/between individual and group treatments. Six participants started a 10-week CBT protocol and were equally divided into individual or group treatment. Participants were exchanged between treatments at random time points. Diary data included 14 variables on tinnitus experience (e.g. annoyance and distraction) and wellbeing (e.g. happiness and stress). Five male participants (59- to 67-year-old) completed treatment. Results:Randomization tests comparing means between individual and group treatments did not reveal significant differences. Analysis of data overlap and trend (Tau-U) revealed minor significant improvements for seven variables (50%) in group treatment as compared to individual treatment. Diminished happiness and activity levels were observed in participants who went from group to individual treatment. Conclusions:Low effect sizes and homogeneity of sample restrict the generalizability of data. Group CBT indicated potential benefits when compared to individual CBT. Social learning may be an underlying process in group delivery boosting tinnitus recovery. Findings are limited to male patients with chronic disabling tinnitus.
