International Journal of Rehabilitation Research最新文献

Since early interventions have improved survival in traumatic spinal cord injury (TSCI), there is a shift toward addressing long-term outcomes like community reintegration and social participation. Despite its importance, community reintegration remains under-researched, particularly in Northern India. This study aims to explore societal reintegration in people with TSCI in Northern India using the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF). The CHART-SF examines the impact of age, gender, injury level, terrain, and the ASIA impairment scale (AIS) on physical independence, cognitive independence, mobility, occupation, social integration, and economic self-sufficiency. This cross-sectional observational study included 91 individuals with TSCI who had an injury duration greater than 1 year and received inpatient and outpatient services from our department in a tertiary health care centre between October 2022 and April 2024. Community reintegration scores were low in all areas measured by the CHART-SF, such as physical independence (38.5), cognitive independence (64.5), mobility (38.9), social integration (70.9), and economic self-sufficiency, with occupation (13.6) being the most affected domain. The mean CHART-SF score was 226.4 (56.8) out of a maximum of 600, indicating poor reintegration. Being motor complete (AIS A-B) was moderately-to-strongly associated with worse physical independence ( rpb = 0.91, P  < 0.001), mobility (0.87, P  < 0.001), occupation status (0.56, P  < 0.001), and overall community reintegration (0.84, P  < 0.001). The cognitive independence (64.5) and social integration scores (70.93) were not correlated with any demographic and injury variables assessed and were among the highest-scoring domains. The results suggest significant challenges in societal reintegration among individuals with TSCI in Northern India, particularly in mobility, physical independence, and occupation. While cognitive and social integration were relatively better, overall reintegration remained low. The injury severity, terrain, and other demographic factors influenced outcomes, especially in physical domains.

The Visual Function Classification System (VFCS) provides a standardised framework for grading visual functioning in children with cerebral palsy (CP). This study evaluated the reliability and construct validity of the Croatian VFCS, and its ability to distinguish visual functioning across CP subtypes and functional classifications. Ninety-five children with CP (mean age: 11.8 years, range: 4-18) were assessed using VFCS, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS). Reliability was tested using quadratic weighted kappa and intraclass correlation coefficients (ICCs); differences across CP types with the Kruskal-Wallis, and construct validity with Spearman correlations. The Croatian VFCS showed excellent interrater ( κ = 0.87) and intrarater reliability ( κ = 0.92), with ICCs greater than 0.90. VFCS levels differed significantly by CP subtype ( χ ² = 8.30, P = 0.016), with preliminary evidence suggesting that unilateral spastic CP may be associated with better visual function than bilateral spastic or dyskinetic CP. Moderate correlations with CFCS ( ρ = 0.557), MACS ( ρ = 0.392), and GMFCS ( ρ = 0.308) revealed clinically relevant divergences between visual and motor abilities. The Croatian VFCS is a reliable, valid, and clinically sensitive tool. This study provides preliminary evidence of its discriminative utility across CP subtypes and supports integrating VFCS into multidisciplinary assessment and individualised rehabilitation planning.

The aim of this study was to determine the validity of the Stroke Upper Limb Capacity Scale (SULCS) and its three hand categories in an acute inpatient stroke rehabilitation setting. We included 312 persons, about 10 days poststroke, with a mean National Institutes of Health Stroke Score (NIHSS) of 7.3. Participants were also assessed on the functional independence measure (FIM), Upper Extremity-Motricity Index (UE-MI), modified Charlson Comorbidity Index, and proportion of home discharges. Spearmans rho between total SULCS and FIM-self-care score and UE-MI at admission were strong at 0.72 and 0.82, respectively. Correlations were stronger between SULCS and individual FIM items of eating, grooming, and bathing [rho= 0.52-0.57, that is, 'more' activity of daily living (ADL)-like items] rather than walking, bowel, and expression (rho= 0.28-0.51, that is, 'less' ADL-like items). Admission and discharge FIM, NIHSS, and proportion of home discharges were higher with more favorable SULCS hand categories. Floor effect was 11.9% and ceiling effect was 14.7% with an acceptable internal consistency (Cronbach's alpha of 0.92). The SULCS is a valid measure of upper extremity capacity at admission to inpatient stroke rehabilitation. Further examination regarding ceiling effects and responsiveness in inpatient stroke rehabilitation is recommended.

The objective was to investigate the agreement between face-to-face and telephone application of the Fatigue Severity Scale (FSS) in the elderly. The participants were assessed using the FSS by telephone and face-to-face. Intraclass correlation coefficient (ICC-3,1) investigated the agreement between the FSS scores, for both scoring methods (sum and average), and quadratic weighted Kappa statistics to investigate the agreement between the individual items. The 55 individuals showed a total score ranging from 9 to 57 for the sum scoring method, from 1 to 6.3 for the average scoring method, and from 1 to 7 for the individual items. The level of agreement for the total scores was high ICC for the sum (0.84) and average (0.86) scoring method, while for each item, eight were considered moderate (0.21 ≤ κ ≤ 0.52), and one was low ( κ = 0.19). This study showed that the FSS is a reliable scale, for both scoring methods, to be applied by telephone in elderly individuals.

The 6-min walk test (6MWT) is used to assess gait capacity in patients with stroke; however, the standard 30-m version (6MWT-30 m) is often impractical in clinical settings because of space limitations. We investigated the validity and reliability of a 15-m version (6MWT-15 m) in 29 individuals with subacute stroke. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC), minimal detectable change (MDC), and Bland-Altman analysis. Validity was evaluated through correlations with the 10-m walk test (10mWT), Berg Balance Scale (BBS), and Fugl-Meyer Assessment for the Lower Extremities (FMA-LE). The 6MWT-15 m demonstrated excellent reliability (ICC = 0.997) and acceptable measurement error (MDC = 19.5 m), with strong correlations with the 10mWT, BBS, FMA-LE, and 6MWT-30 m, supporting its validity. Regression analysis identified the 6MWT-15 m as the sole significant predictor of 6MWT-30 m ( R2 = 0.98) walking distance. These findings support the 6MWT-15 m as a reliable, valid, and practical alternative for assessing walking capacity in patients suffering from subacute stroke, particularly in space-limited clinical settings.

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.