International Journal of Rehabilitation Research最新文献

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.

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.

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.

Cardiac rehabilitation (CR) is a cornerstone of heart disease (HD) management, enhancing functional capacity and quality of life. Hybrid cardiac rehabilitation (hCR), combining supervised center-based sessions with synchronous, real-time telerehabilitation at home, offers an alternative to conventional CR to overcome logistical barriers such as facility limitations, distance, and pandemic-related disruptions. This randomized controlled trial evaluated the noninferiority of hCR compared to standard CR in improving functional capacity in patients with chronic heart disease, including those with stable coronary artery disease. Seventy-five participants were randomized into two groups: the CR group, with exclusively center-based sessions, and the hCR group, with synchronous tele-rehabilitation sessions at home complemented by center-based sessions. Functional capacity was assessed using cardiopulmonary exercise testing, the six-minute walk test, and the wall squat test. Both groups showed significant improvements in functional outcomes, including walking distance (six-minute walk test), strength capacity (wall squat test), and cardiopulmonary exercise testing performance ( P  < 0.001). The improvements in the hCR group were statistically noninferior to those in the CR group. These findings demonstrate that hCR provides an effective alternative to conventional CR while addressing practical challenges in access to care. The hCR protocol represents a viable solution for expanding rehabilitation options without compromising outcomes, particularly for patients facing logistical constraints or during emergencies such as pandemics.

Approximately 10% of patients experience persistent symptoms following COVID-19, known as long-COVID syndrome. This cross-sectional study explored factors of quality of life (QoL) in 53 long-COVID patients. QoL was measured using the World Health Organization-Five Well-Being Index, fatigue with the Fatigue Visual Analogue Scale, and psychological health with the Depression-Anxiety-Stress-21 questionnaire. Six neuropsychological tests assessed information processing speed, verbal memory, visual memory, working memory, attention, language, fluency, recall, and visuospatial function with a composite score calculated by averaging z scores. Patients (76% female, mean age: 54.1 years) were assessed 8.7 months postinfection. Cognitive impairment, present in 49% of the sample, was not associated with QoL. In multiple linear regression, gender, fatigue, and psychological distress accounted for 42% of QoL variance, with fatigue and distress contributing 7% and 11%, respectively. Further studies are needed to determine if fatigue and psychological distress are causally related to QoL in long-COVID and could be treatment targets.

The purpose of this review was to examine the effects of hip muscle botulinum toxin injections for the treatment of hip instability reported in studies of children with cerebral palsy. Searches in PubMed , CINAHL , and Web of Science were performed using the term hips combined with botulinum toxin and its various abbreviations and brand names. Reference lists and citations of the reviewed studies were also searched. Nine studies were reviewed: two randomized controlled trials plus a subsequent long-term follow-up of one of them, and six nonrandomized studies of interventions with two including comparison group(s) and four being single group pre-post studies. Hip adductors were injected in all studies with other hip muscles added in most cases. The outcome measure analyzed was the change in migration percentage defined as postinjection minus preinjection migration percentage with the recommendation of a change of ±10% indicating a true change. Only two studies reported a change exceeding this criterion. One randomized controlled trial demonstrated a 10.4% improvement in the botulinum toxin-treated group, which was statistically significantly greater than a 2.95% worsening in the comparison group. Additionally, a preliminary study of five participants found a statistically significant median change of ≥10% at two of the eight follow-up time points. Therefore, the results of most studies showed neither postinjection improvement nor worsening of this magnitude. The low level of rigorousness of the reviewed studies suggests that any of the results should be viewed cautiously.

The ABILHAND is a widely used questionnaire assessing bimanual daily life activities in adults with stroke. A recently modified version tailored for the sub-Saharan African population (ABILHAND-Stroke Benin) has been created. This study aimed to investigate its test-retest reliability and responsiveness. The study included 132 adults with stroke with a mean (SD) age = 54.6 (11.2) years and 40% women. The mean (SD) time since stroke was 15.2 (12) months for the subsample ( n  = 51) included in the reliability analysis and 1 (0.6) month for the subsample ( n  = 81) of the responsiveness analysis. Participants were assessed within a week interval with the ABILHAND-Stroke Benin questionnaire for the reliability analysis. As for the responsiveness analysis, they were additionally assessed with the ACTIVLIM-Stroke questionnaire, the Box and Block Test (BBT), and the Stroke Impairment Assessment Set, at baseline (T1), 2-month later (T2), and on average of 1.5 (0.5) years after stroke (T3). The ABILHAND-Stroke Benin questionnaire showed an excellent test-retest reliability (intraclass correlation coefficient = 0.98, P  < 0.001, minimal detectable change = 10.3%). Regarding the responsiveness analysis, participants showed a larger improvement during the acute phase (T1-T2) compared with the chronic phase (T2-T3). Changes with the ABILHAND-Stroke Benin questionnaire were significantly correlated with changes with the other outcome measures (correlations ranged from 0.36 to 0.70, P  < 0.05) except with the BBT less affected hand. The ABILHAND-Stroke Benin questionnaire demonstrates an excellent test-retest reliability and was responsive to changes in adults with stroke.

Acquired brain injuries can profoundly impact executive functioning, yet traditional neuropsychological assessments often have limitations, such as being time-intensive, lacking ecological validity, or failing to engage patients effectively. To address these challenges, CCRacer, a serious game, was developed as a novel tool for assessing executive functions in clinical populations. This study evaluated the convergent and discriminant validity of CCRacer by applying it alongside established neuropsychological tests to a sample of 78 participants with acquired brain injury. Results revealed varying levels of convergent validity across tasks, with stronger correlations for measures of working memory (0.28-0.51) and planning (-0.46 to 0.34) and weaker correlations for inhibitory control (0.22). These findings suggest that CCRacer has the potential as a complementary tool in the neuropsychological assessment of an acquired brain injury, combining engaging and ecologically valid testing with the possibility of future use in cognitive training.

Mild traumatic brain injury (mTBI) can lead to lasting adverse outcomes, including post-traumatic stress disorder (PTSD) or post-traumatic stress symptoms (PTSS). This study examined whether PTSD and PTSS can occur even after mTBI and tracked the evolution of PTSD in the long term. A total of 85 youth post-mTBI (median age: 10.00, 25-75th percentile: 8.50-2.62; 24% girls) and their mothers participated in this study. Assessments included PTSS/PTSD, postconcussion symptoms, loss of consciousness status, child's anxiety, and maternal mental health, both shortly after mTBI (T1) and 1 year later (T2). Changes in PTSS scores from T1 to T2 were evaluated using the Wilcoxon test. T2 PTSS evolution was evaluated using correlations and partial correlations. To evaluate PTSD recovery trajectories, the percentage of youth in four recovery trajectories (chronic, delayed, recovery, and resilience) was calculated. Results showed a significant decrease in PTSS and PTSD rates from T1 (34%) to T2 (21%). PTSS at T2 was associated with PTSS and postconcussion symptoms at T1. After accounting for the child's sociodemographic and clinical characteristics, the child's self-reported PTSS at T1, along with self-reported postconcussion symptoms and symptom intensity, showed significant correlations with PTSS at T2 ( r  = 0.60, 0.32, and 0.37, respectively; P  < 0.05). Most youth fell into the 'resilient' (40%) or 'recovery' (35%) groups, with only 6% showing 'delayed' recovery. One year after mTBI, 20% of the youth still experienced PTSD. In conclusion, this study highlights the need for long-term monitoring of youth after mTBI, as a notable proportion continue to experience enduring PTSD or PTSS.