International Journal of Rehabilitation Research最新文献

This study aimed to translate the Gait Assessment and Intervention Tool (G.A.I.T.) into Japanese and evaluate its reliability and validity. Translation and adaptation followed established cross-cultural guidelines. To assess reliability and validity of Japanese versions of the G.A.I.T, a cohort design was implemented. Sixty-three stroke patients participated in interrater reliability and validity assessments, and 50 patients in the test-retest evaluation. Reliability and validity were evaluated using intraclass correlation coefficients (ICC) and Pearson's correlation coefficients, respectively. The Japanese G.A.I.T. demonstrated excellent reliability in interrater (ICC = 0.975) and retest (ICC = 0.988). Significant correlations were observed between the G.A.I.T. scores and Fugl-Meyer Assessment-Lower Extremity ( r  = -0.774), Functional Ambulation Category ( r  = -0.720), Functional Independence Measure motor scores ( r  = -0.647), functional independence measure mobility ( r  = -0.688), and comfortable walking speed ( r  = -0.839). These findings suggest that the Japanese version of the G.A.I.T. is a reliable and valid assessment tool for evaluating gait coordination in Japanese stroke survivors.

Cerebellar ataxia impairs motor coordination, leading to gait instability, irregular foot movements, and frequent falls. While studies have examined kinematic deficits in cerebellar patients, the potential for motor learning and transfer specific to foot position control is underexplored. This study aims to investigate the effects of lower-limb distance control practice on motor learning and generalization in patients with cerebellar disorders. Twelve individuals with cerebellar ataxia and 12 matched controls performed a foot-reaching task under controlled conditions. Participants practiced reaching three target distances without visual feedback. Kinematic data were collected using a motion tracking system, and performance was assessed during the practice, retention, and transfer phases. Statistical analyses evaluated learning effects and group differences. Both groups improved foot position control with practice, though cerebellar patients showed higher initial error rates. Retention tests confirmed learning, with reduced errors immediately and 24 h postpractice [ F(2,44)  = 25.20, P  < 0.01]. Transfer tests revealed significant improvements in novel distance tasks for cerebellar patients, but limited generalization to vertical distance conditions [ F(2,44)  = 7.43, P  < 0.01]. Repetitive foot position control practice promotes motor learning and partial generalization in cerebellar patients, indicating preserved neuroplasticity. These findings emphasize the importance of task-specific and variable training in rehabilitation programs to reduce fall risks and enhance functional mobility in this population.

Orthostatic hypotension is frequently observed in patients with neurodegenerative diseases such as multiple system atrophy (MSA) and Parkinson's disease (PD). This study aimed to investigate the immediate effects of ankle plantar-dorsal flexion (APDF) exercises on hemodynamics and autonomic nerve function in patients with orthostatic hypotension. Thirteen consecutively admitted patients diagnosed with MSA or PD and orthostatic hypotension were included in this study. This crossover study included two consecutive, randomly assigned intervention sessions: one exercise session and one control session. In both sessions, patients sat relaxed in a chair for 6 min before standing up for 5 min. During the exercise session, they performed APDF exercises at 60 cycles/min during the final minute of sitting. Blood pressure and autonomic nerve function were monitored continuously. Correlations between patient characteristics and changes in SBP after standing (ΔSBP) were also analyzed. After 1 min of standing, SBP was reduced by a median value of 17.5 mmHg during the control session, while it lowered to only 1.0 mmHg during the exercise session. There were no significant changes in heart rate frequencies during both sessions. These results suggest that APDF exercises mitigate the drop in SBP through improved venous return, without affecting autonomic nerve function. We conclude that a short bout of ankle exercises may be an effective and safe intervention to prevent orthostatic hypotension in patients with neurodegenerative diseases.

Tracheostomy is frequently performed in patients with acquired brain injury (ABI) requiring prolonged ventilatory support. However, prolonged tracheostomy use can impact communication, swallowing, and psychological well-being, making timely decannulation a crucial rehabilitation goal. This study examined the time to decannulation and associated factors in patients with ABI by conducting a retrospective review using medical records of patients with ABI admitted to the Department of Physical Medicine and Rehabilitation (2016-2024). Patients aged ≥18 years, with a tracheostomy tube at admission and who underwent decannulation, were included. The primary outcome was the time to attain decannulation (TAD), with secondary outcomes assessing clinical and functional predictors that may affect TAD. Seventy-seven patients met the inclusion criteria. A total of 77 subjects were included for the analysis, consisting of 19 patients with stroke, 52 patients with traumatic brain injury (TBI), and 6 patients of encephalopathy. The median TAD was 52 days in the overall sample. In simple linear regression, TAD was significantly longer in the stroke than in the TBI subsample (76 vs. 49.5 days, P  = 0.019), in younger patients ( P  = 0.01), and in those admitted earlier to inpatient rehabilitation ( P  < 0.001). In multiple linear regression, younger age, higher Glasgow Coma Scale scores at admission, and earlier inpatient admission were associated with shorter TAD ( P  = 0.028, 0.044, <0.001; adjusted R2  = 0.597). The findings of this study may aid in tracheostomy decannulation-related goal setting, patient stratification, managing patient's expectations, and planning appropriate timelines related to tracheostomy decannulation in patients with ABI.

While the impact of physical disabilities on daily activities is well documented, less is known about the influence of nonmotor symptoms on activities and participation. This study aims to fill this gap by examining how nonmotor symptoms affect activities and participation outcomes in wheelchair users with multiple sclerosis (MS). Data from 89 wheelchair users with MS collected through a nationwide survey were analyzed. Participants completed the Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function, PROMIS depression, PROMIS pain interference, Fatigue Severity Scale, and measures of self-efficacy and participation. Hierarchical multivariable linear regression was used to assess the impact of nonmotor symptoms on four self-efficacy and participation outcomes beyond physical function. As expected, physical function was a significant predictor of all outcomes: self-efficacy for managing daily activities (β = 0.59, P  < 0.01), control over community participation (β = -1.06, P  < 0.01), ability to participate (β = 0.46, P  < 0.01), and satisfaction with participation in social roles and activities (β = 0.70, P  < 0.01). Beyond physical function, nonmotor symptoms accounted for 6% of the variance in self-efficacy, 21% in control over community participation, 29% in ability to participate in social roles and activities, and 13% in satisfaction with participation in social activities. Among these, pain interference emerged as the most consistent nonmotor symptom, significantly associated with poorer outcomes across all domains ( P  < 0.05). This study demonstrates that nonmotor symptoms, particularly pain interference, are significantly associated with activities and participation outcomes in wheelchair users with MS.

Direct skeletal fixation (DSF) involves attaching the intramedullary portion of a prosthesis directly to the skeletal residuum, providing an alternative for amputees unable to mobilise with socket-based prostheses. This study investigates the effects of DSF on physical and mental health at 6- and 8-year follow-up for military bilateral transfemoral amputees in the UK. Eight male bilateral transfemoral military amputees who underwent implantation with the Osseointegration Group of Australia-Osseointegration Prosthetic Limb prosthesis consented to participate in the study. All patients are routinely reviewed annually in a dedicated clinic, and this paper reports the 6- and 8-year follow-ups. Patient-reported outcomes were assessed using the Short Form Health Survey (SF-36). Complications data were recorded at the 8-year follow-up. The SF-36 physical component score significantly increased from preoperative levels at 6 years (median: 29 vs. 47; P = 0.003) and 8 years (median: 29 vs. 45; P = 0.024). The SF-36 mental health component score improved significantly at 6 years from preop (median: 39 vs. 57; P = 0.011). Among 16 femoral residuums, there was one explantation because of infection at 8.5 years postimplantation, and two cases were managed with long-term suppressive antibiotics. A total of 17 additional procedures were performed on nine residuums: 11 for soft tissue revision, five for infection, and one for fracture repair. This research adds to the growing evidence base that DSF has the potential to enhance the health and well-being of amputee veterans and potentially the broader amputee population. Medical complications remain an important consideration.

Quick Disability of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) is commonly used in carpal tunnel syndrome, while the knowledge on its psychometrics in this disorder is limited. The objective of this study was to explore the internal consistency, factor structure, and floor/ceiling effect of QuickDASH among patients with carpal tunnel syndrome. This was a retrospective cross-sectional register-based study among 1597 patients with electromyography-confirmed carpal tunnel syndrome. The internal consistency was assessed using Cronbach's α . Exploratory factor analysis was used to evaluate factor structure. Of 1597 respondents, 896 (56%) were women. The average age was 55.0 (16.3) years. The mean QuickDASH score was 38 (23.2) points. QuickDASH demonstrated an excellent internal consistency with α of 0.92 (95% confidence interval: 0.92-0.93). Exploratory factor analysis demonstrated unidimensionality. Item loadings were moderate to substantial for all 11 items, varying from 0.55 to 0.83. A significant floor effect was observed for nine of 11 items varying from 20 to 51%. A ceiling effect was observed for one item (#6 'recreational activities'). Despite its significant floor effect, QuickDASH can be recommended as a valid and reliable scale to assess the severity of disability caused by carpal tunnel syndrome.

Valgus knee orthosis is a common conservative treatment for medial compartment knee osteoarthritis (OA), though its efficacy in diverse socioeconomic and cultural contexts remains understudied. This investigation evaluated the short-term effects of a valgus knee orthosis on knee OA patients from a developing country, while monitoring adherence, to address this gap in the literature. The study included 35 participants with radiographically confirmed OA (Kellgren-Lawrence grades 2-3). The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index tool was used to assess participants. All participants utilized the Össur Unloader One orthosis, which was equipped with an integrated activPAL sensor to monitor adherence during a 2-week intervention period. WOMAC index demonstrated statistically significant improvement, with mean scores decreasing from 0.67 (0.15) to 0.42 (0.18) at 1 week ( P  < 0.001) and to 0.32 (0.16) at 2 weeks ( P  < 0.001) of wearing the orthosis. Notably, after 2 weeks, 86% of participants exceeded established minimal clinically important difference thresholds. ActivPAL data for adherence revealed a significant positive correlation between brace wearing time and clinical improvement ( P  = 0.008), with participants achieving ≥8 h daily wear time exhibiting the best outcomes (51% improvement in WOMAC index). The findings shed light on the possible usefulness of valgus knee orthosis in controlling symptoms of knee OA patients from resource-variable settings with unique cultural habits (i.e. kneeling and floor-sitting behaviors) while highlighting the critical role of adherence monitoring.

The association between device-based (activPAL) and self-reported [Incidental Exercise and Planned Exercise Questionnaire (IPEQ)] measures of physical activity has not been investigated. This study aimed to determine the association between activPAL and IPEQ measures of physical activity in a sample of community-dwelling older people after stroke. Data from an exploratory analysis embedded within a randomized trial was used. Spearman correlation was used to assess the relationship between activPAL (upright time and step count) and IPEQ (self-reported total exercise time) measures at three timepoints [months 0 ( n  = 46), 6 ( n  = 39) and 12 ( n  = 36)] Strong Spearman correlation between upright time and self-reported total exercise time ( r  = 0.51-0.72) and step count and self-reported total exercise time was found at all timepoints ( r  = 0.54-0.62). Though further research could confirm these results in a larger sample, there is potential for the IPEQ to be used as a simple estimate of physical activity in a clinical setting.

We investigated if preinjury perceived social support moderated the association between pre- and postinjury functional status after hip fracture in older adults. Using data from the longitudinal Health and Retirement Study (biennial interviews from 1998 to 2018), we analyzed perceived social support measured preinjury and functional status [activities of daily living (ADL) or instrumental activities of daily living (IADL) limitations] measured at pre- and postinjury interviews. Among 709 respondents, 61% anticipated social support from friends or family if they required future assistance with personal care, 16% had difficulty with ADL preinjury, and 9% had difficulty with IADL preinjury. Among 1697 postinjury follow-up interviews (mean follow-up time: 2.8 years), ADL limitations and IADL limitations were reported in 752 and 683 interviews, respectively. During follow-up, any preinjury IADL limitations were associated with more postinjury IADL limitations among people without social support [adjusted incidence rate ratio (aIRR): 2.505, 95% confidence interval (CI): 1.765-3.555] but not among people with preinjury perceived social support (aIRR: 1.355, 95% CI: 0.950-1.940, interaction P  = 0.016). Any preinjury ADL limitations were associated with more postinjury ADL limitations among people with (aIRR: 1.471, 95% CI: 1.124-1.925) or without (aIRR: 2.084, 95% CI: 1.563-2.778) preinjury perceived social support. Preinjury perceived social support moderates the association between pre- and postinjury functional status in older adults experiencing a hip fracture. Older adults experiencing pre-existing IADL limitations without social support are at high risk for continued or increased activity limitations.