Maternity care that involves a midwife as the main care provider leads to better outcomes for most women, according to a systematic review led by King

MEDICAL FAIR THAILAND 2013, the region

Researchers at Western University have furthered their game-changing neuroimaging techniques in communicating with patients believed to be in a vegetative state by connecting with an individual that has proved otherwise unresponsive for the past 12 years.
Lorina Naci, a postdoctoral fellow from Western’s Brain and Mind Institute and her colleague Adrian Owen, the Canada Excellence Research Chair in Cognitive Neuroscience and Imaging, reported their in a study titled ‘Making every word count for non-responsive patients.’
While inside the functional magnetic resonance imaging (fMRI) scanner, the patient answered several questions, such as ‘Are you in a hospital?,’ by concentrating on the specific words, ‘yes’ or ‘no.’ In this way, he reported that he knew what his name was and that he was in the hospital at the time of communication.
‘For the first time, we showed that a patient clinically diagnosed as ‘vegetative’ can use his attention to show that he is conscious, and to communicate with the outside world,’ says Lorina Naci, lead researcher on the new study. ‘Frequently, after a severe injury to the brain, patients lose their ability to make any physical responses. When we look at or talk to any such patient, we don’t know whether they are conscious, can understand what is happening around them, or have any thoughts about their condition.’
In two different hospital visits, five months apart, not only were Naci and Owen able to communicate with the patient but found that he was also aware of his environment, meaning he could maintain coherent thoughts and lead a rich mental life.
‘This new technique takes communication with some patients who are assumed to be in a vegetative state to the next level,’ says Owen. ‘It will make detecting who is conscious and who is not much faster and more reliable and for those who are conscious, communicating their wishes will be that much easier.’
Naci and Owen continue to utilise this novel method of communicating with behaviourally non-responsive patients, who, similarly, may have been misdiagnosed as being in a vegetative state. Western University

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A new ‘telerehabilitation’ approach lets physical therapists assess patients with low back pain (LBP) over the Internet, with good accuracy compared with face-to-face examinations, reports a study.

Taking advantage of Skype and other widely-used services may make telerehabilitation a more feasible alternative to in-person clinic visits, according to the new research by Prof. Manuel Arroyo-Morales and colleagues of University of Granada, Spain. They believe their results ‘give preliminary support to the implementation of web-based LBP assessment systems using video recordings that can be evaluated by different therapists.’

The researchers designed and evaluated a web-based telerehabilitation system for performing routine clinical assessments of patients with LBP. The telerehabilitation setup operated across a low-bandwidth Internet connection between two personal computers equipped with webcams.

The system included the popular Skype videoconferencing service, allowing the patient and physical therapist could see and talk to each other in real time. The therapist guided the patient in performing specific movements, and captured video clips for analysis using video motion analysis software (Kinovea). The therapist and patient were also able to complete standard back pain questionnaires using the web-based system.

Fifteen patients with chronic LBP underwent two assessments in random order: once face-to-face and once using the telerehabilitation setup. Accuracy was assessed by comparing the results of telerehabilitation assessment with those of in-person assessment.

The results showed good agreement between the two evaluations, supporting the use of telerehabilitation for clinical assessment of LBP. There was good correlation for measures made on video motion analysis, such as spine mobility and back muscle endurance; as well as questionnaire-based assessments such as disability, pain, and health-related quality of life.

The telerehabilitation setup showed consistent results for the same therapist at different times (intra-rater reliability) as well as for assessment by independent therapists (inter-rater reliability).

There is growing interest in Internet-based systems for assessment of patients with musculoskeletal disorders. Telerehabilitation approaches could be especially valuable for patient in rural or remote areas, who don’t have easy access to healthcare providers.

In the past, the use of telerehabilitation was limited by high equipment costs. The new study shows the successful use of telerehabilitation using widely available and familiar technology, including the use of free software such as Skype.

The telerehabilitation system evaluated in the new study may be useful in assessing patients with the very common problem of LBP, showing good agreement with the results of face-to-face assessment. However, there are still some factors limiting more widespread use