International Journal of Rehabilitation Research最新文献

Caring for a child with cerebral palsy (CP) is challenging and can significantly impact caregivers' quality of life. This study aimed to examine the psychological state, perceived social support, and quality of life of parents of children with CP in Benin, West Africa. This cross-sectional, case-control design included 50 parents of children with CP (mean age 39.4 ± 8.3 years, 46 mothers) paired with 58 parents of typically developing children (mean age 38.1 ± 7.4 years, 52 mothers) as controls. Both groups completed the Social Provisions Scale (SPS-10), Patient Health Questionnaire-9 (PHQ-9), and Medical Outcome Study Short Form (SF-12) to assess social support, depression, and quality of life. Additionally, parents of children with CP completed the Impact on Family Scale to evaluate caregiving burden. The results showed that parents of children with CP reported lower social support and higher depression levels than controls (P < 0.05). However, their quality of life (both physical and mental scores) was similar to the control group (P > 0.05). Only depression was significantly linked to lower quality of life (P < 0.05) in parents of children with CP. In conclusion, parents of children with CP have a comparable physical and mental health-related quality of life to parents of typically developing children, despite experiencing lower perceived social support and higher levels of depression in Benin country. These findings underscore the need for enhanced social and psychological support systems to improve the well-being of families caring for children with CP in such environments.

The aim of this study was to determine the validity and reliability of the 10-meter walk test modified by adding 5 and 17 cm obstacles (10MWT-O) in community-dwelling older adults and to examine its ability to differentiate between older and younger adults. The study included 65 older adults and 55 younger adults. 10MWT-O (obstacle height: 0, 5, 17 cm) was performed on two different days (day 1 and day 2). All participants were assessed by the same assessor on days 1 and 2. Berg Balance Scale (BBS), Time Up and Go (TUG) test, Mini Mental State Test, and Functional Reach Test (FRT) assessments were performed on day 1. 10MWT-O speed for all obstacle heights showed moderate to good correlations with FRT distance (r = 0.474-0.539, P < 0.001), TUG Test time (r = -0.722 to -0.671, P < 0.001), and BBS score (r = 0.619-0.660, P < 0.001). Test-retest reliability (intraclass correlation coefficient = 0.924-0.960) was found to be within the excellent range for 10MWT-O speed across all obstacle heights. For obstacle heights of 0, 5, and 17 cm, the minimum detectable change for 10MWT-O speed was 0.16, 0.19, and 0.20 m/s, and the optimal cutoff values for differentiating older from young adults were 1.12, 0.98, and 0.85 m/s, respectively. The 10MWT-O is a reliable and valid clinical measure for assessing walking ability and adaptability in older adults. ClinicalTrials.gov identifier: NCT06307769.

Spondylodiscitis is a life-threatening neurological condition that, if not diagnosed early, can lead to severe complications, including progressive neurological deterioration. Diagnosis involves clinical evaluation, imaging, and microbiological testing. Delayed recognition, advanced age, virulent pathogens, and comorbidities increase the risk of poor outcomes. We report the case of a middle-aged male with diabetes, hypertension, and chronic kidney disease who developed noncontiguous multifocal spondylodiscitis. Initially presenting with progressive neck pain and urinary tract infection, his condition worsened over 3 months, resulting in lower limb weakness, bladder and bowel dysfunction, and quadriparesis. MRI spine revealed spinal infections at multiple levels and extended-spectrum beta-lactamase Escherichia coli in cultures. He underwent meropenem treatment, surgical decompression, and spinal fusion. Despite C6 quadriparesis, intensive rehabilitation enabled him to walk with assistance and achieve partial independence in daily activities within 6 months. This case underscores the necessity of early diagnosis, proper management, and long-term rehabilitation for optimal recovery.

The purpose of this study was to evaluate the separate effects of tactile stimulation (TS) and transcutaneous electrical nerve stimulation (TENS), combined with occupational therapy (OT) and physiotherapy (PT), on sensory-motor recovery in the upper limb of patients with stroke. Thirty-six patients were randomly assigned to three groups (mean age: TS group = 60.7, TENS group = 54.1, control group = 52.2 years). The average onset time was 9.7 months for the TS group, 11.1 months for the TENS group, and 10.2 months for the control group. Participants underwent a 2-week intervention provided in addition to standard OT and PT. The TS group received coarse sand stimulation (rubbing) over the affected hand and forearm for 15 min per session. The TENS group underwent electrical stimulation applied to the affected forearm for 30 min per session (10 Hz), while the control group received sham stimulation with 1 min of active current. Hand function was assessed with the Semmes-Weinstein monofilaments and grip strength, dexterity with the box and block test and Southampton hand assessment procedure, and performance in daily activities with the assessment of motor and process skills. In the TS group, patients significantly improved hand sensory perception, grip strength, and dexterity while the TENS group showed improvement in grip strength and dexterity. The control group exhibited no significant changes. Between-group comparisons revealed significant differences favoring TS for hand sensory perception and TENS for dexterity. These findings suggest that adding TS or TENS to OT and PT may enhance sensory-motor recovery after a stroke.

The secondary prevention benefits of cardiac rehabilitation and similar exercise classes for stroke survivors are well established, however post-stroke exercise participation remains low. This research aimed to explore the factors affecting participation and engagement in UK-based post-stroke cardiac rehabilitation and exercise, from the perspective of the service user and service provider. An exploratory study, using semi-structured interviews, was conducted ( n  = 8, service user = 4), adopting a phenomenological approach. All interviews applied a topic guide informed by the Health Belief Model and the International Classification of Functioning, Disability and Health, and were analysed using inductive thematic analysis. Post-stroke cardiac rehabilitation and exercise participation was influenced by numerous factors, encompassed into three themes: Accessibility (describing the environmental pre-class limiting factors), Programme Structure (valuing in-class supervision, socialisation and adaptations) and Patient Characteristics (encompassing the influence of the service user's personality and experiences). Effective secondary prevention of stroke through cardiac rehabilitation and other exercise-based rehabilitation requires policy development and commissioning to ensure appropriate delivery. Further research should determine the feasibility of novel exercise class formats, in addition to larger trials investigating their clinical benefit and cost effectiveness.

The objective of this study was to further validate the Goal Processing Scale (GPS), an ecologically valid functional assessment of executive functioning requiring planning and executing a complex goal. Veterans (N = 69, mean age = 44.5 years) with a history of chronic mild traumatic brain injury and self-reported cognitive difficulties completed the GPS and neuropsychological measures of working memory, sustained attention, mental flexibility, inhibition, and memory during participation in one of three studies. Associations between overall GPS performance and composite neuropsychological measures of attention/executive functioning and memory were significant and medium-to-large in magnitude. Associations of similar magnitude also emerged between subcomponents of the GPS (e.g. self-monitoring, attentional switching, attention maintenance) and neuropsychological subdomains (e.g. mental flexibility, inhibition, working memory). Results suggest that the GPS facilitates structured assessment of goal-directed performance requiring integration of multiple executive functioning subdomains. The GPS may be valuable in assessing and predicting real-world functional difficulties not captured by traditional neuropsychological assessment.

This study determined the characteristics of the phase angles (PhAs) of the trunk, affected limb, and unaffected limb at admission and their relationship with walking ability at discharge in patients with stroke and traumatic brain injury in a convalescent rehabilitation ward. Stroke and traumatic brain injury survivors with hemiplegia admitted to a convalescent rehabilitation ward were divided into independent- and dependent-walking groups. The trunk, affected limb, and unaffected limb PhAs were evaluated using bioelectrical impedance analysis and compared between the independent- and dependent-walking groups. Friedman's test was performed to analyze differences in the trunk, affected limb, and unaffected limb PhAs within each group. Multiple regression was performed to examine the association between walking ability and segmental PhAs. We enrolled 47 patients (independent-walking group: n  = 12; dependent-walking group: n  = 35). The dependent-walking group had a significantly lower trunk, affected limb, and unaffected limb PhAs. The segmental PhA was higher in the trunk than in the affected and unaffected limbs in the independent-walking group and lower in the affected limb than in the trunk and unaffected limb in the dependent-walking group. Only the trunk PhA at admission was significantly associated with walking ability at discharge ( β = 0.367; P  = 0.002). The trunk PhA at admission may be related to walking ability at discharge in patients undergoing stroke and traumatic brain injury rehabilitation.

We investigated the potential to improve motor learning and performance in people with multiple sclerosis (PwMS) with OPTIMAL theory conditions. OPTIMAL theory predicts that three main factors [i.e. autonomy support (AS), enhanced expectancies (EE), and external focus (EF)] facilitate performance and learning. We examined whether the implementation of all three combined in a consecutive manner during practice would be beneficial for the motor learning and performance in a clinical population facing physical, cognitive, and emotional challenges. Thirty PwMS with mild-to-moderate disability (Expanded Disability Status Scale = 2.0-5.0) were randomly assigned to one of two groups (optimized and control) and practiced a novel motor-cognitive task involving rapid square-stepping to memorized patterns. Following a pretest (no group difference), optimized group participants practiced under each of three factors across practice phase (EE: feedback after good trials; AS: choice of mat color; and EF: external focus to the mat). Control group participants practiced under neutral conditions. The optimized group had significantly shorter movement times than the control group in the practice phase [174.7 (27.4) s vs. 236.8 (35.8) s, P  < 0.0001], on the 24-h retention test [69.3 (9.3) s vs. 159.7 (15.5) s, P  < 0.0001], and the 24-h transfer test [146.1 (14.9) s vs. 223.1 (38.9) s, P  < 0.0001]. Thus, optimized practice combining AS, EF, and EE enhanced motor skill learning. Key factors in the OPTIMAL theory can be used to improve patients' motor learning. Further studies are warranted to extend these proof-of-concept observations for potential clinical applications.

Acute inpatient rehabilitation is crucial for improving mobility and balance for individuals with stroke. A potentially important factor in the recovery of mobility and balance is cognition. The purpose of this study was to determine the effect of cognition on mobility and balance in acute stroke rehabilitation. This was a longitudinal cohort study based on an inpatient rehabilitation unit at a large academic medical center. Participants were individuals with stroke admitted to acute rehabilitation after an acute care hospital stay ( N  = 281). Demographic data and predictor variables were collected on admission to the unit. Outcomes were collected at discharge from the unit. Multiple regression analyses were used to determine the associations between cognition (Montreal Cognitive Assessment) on mobility (Functional Independence Measure mobility subscale) and balance (Berg Balance Scale). Subtests from the Montreal Cognitive Assessment were also examined to determine if specific dimensions of cognition could predict balance after controlling for covariates. Dominance analysis was used to determine the relative importance of baseline predictors. In separate models, cognition was a significant predictor of mobility ( B  = 0.19) and balance ( B  = 0.28) at discharge after adjusting for admission mobility and balance, as well as age, sex, and length of stay. The most important predictors in both models were baseline mobility and balance, but cognition contributed to the models independently of baseline scores. Cognition was generally more important than age and sex while about equally important as length of stay. In separate models, the visuospatial/executive ( B  = 0.42) and the delayed recall ( B  = 0.37) subtests were also significant predictors of mobility. The models' most important predictors were baseline mobility and balance scores. Cognition is a clinically relevant predictor of mobility and balance in acute stroke rehabilitation. Specific dimensions of cognition, such as executive function, visuospatial function, and delayed recall, may be especially important. Cognitive challenges and meta-cognitive strategies should be included in mobility and balance tasks when possible. Studies that evaluate the efficacy of dual-task training and meta-cognitive approaches are needed.