NeuroRehabilitation最新文献

Background: The impact of different stroke types on specific activities of daily living (ADL) is unclear.

Objective: To investigate how differences between intracerebral hemorrhage (ICH) and cerebral infarction (CI) affect improvement of ADL in patients with stroke within a hospital by focusing on the sub-items of the Functional Independence Measure (FIM).

Methods: Patients with first-stroke hemiplegia (n = 212) were divided into two groups: ICH (86 patients) and CI (126 patients). Primary assessments included 13 motor and 5 cognitive sub-items of the FIM assessed at admission and discharge. Between-group comparisons and multiple regression analyses were performed.

Results: Upon admission, the ICH group exhibited significantly lower FIM scores than those of the CI group across various activities, including grooming, dressing (upper body and lower body), toileting, bed/chair transfer, toilet transfer, walking/wheelchair, and stairs. Age and FIM motor scores at admission influenced both groups' total FIM motor scores at discharge, whereas the duration from onset affected only the CI group.

Conclusion: Several individual FIM motor items were more adversely affected by ICH than by CI. Factors related to ADL at discharge may differ depending on stroke type. Recognizing these differences is vital for efficient rehabilitation practices and outcome prediction.

Background: It is important to investigate satisfaction and perception of the effectiveness of telerehabilitation and its outcomes post-COVID-19 pandemic.

Objective: Evaluate the patients' and healthcare providers' level of satisfaction with telerehabilitation and perception of its efficacy and describe how it became an established resource in a network of rehabilitation hospitals post-pandemic.

Methods: The online survey about their experience with telerehabilitation was completed by 2,755 patients (322 new patients and 2,433 existing patients), and 668 providers from 26 different specialties.

Results: Most patients and providers rated remote care as effective. There were no differences in scores between existing patients and new patients and the majority reported that their expectations were met. Most patients described their remote consults as good as or better than in-person, while providers mostly preferred in-person sessions. Despite most modalities having returned to in-person practice, there is still a significant percentage of telerehabilitation consults.

Conclusion: Three years after the start of the pandemic, despite a return to in-person treatment, we see a telerehabilitation culture being constructed as a resource to supplement the rehabilitation process, with potential for establishing this model in a network of rehabilitation hospitals.

Background: Facial nerve dysfunction can be a devastating trouble for post-parotidectomy patients.

Objective: To assess rehabilitation outcomes concerning patients with post-parotidectomy facial nerve dysfunction, comparing benign versus malignant neoplasms.

Methods: Prospective study enrolling adults who underwent parotidectomy with facial nerve sparing between 2016 and 2020. The Modified Sunnybrook System (mS-FGS) was used for facial assessments. Physiotherapy began on the first post-operative day with a tailored program of facial exercises based on Neuromuscular Retraining, to be performed at home 3 times/day. From the first outpatient consultation, Proprioceptive Neuromuscular Facilitation was added to the treatment of cases with moderate or severe facial dysfunctions.

Results: Benign and malignant groups had a statistically significant improvement in mS-FGS (p < 0.001 and p = 0.005, respectively). There was no significant difference between groups regarding treatment duration or number of physiotherapy sessions performed. The history of previous parotidectomy resulted in more severe initial dysfunctions and worse outcome. Age over 60 years and initially more severe dysfunctions impacted the outcome.

Conclusion: Patients with benign and malignant parotid neoplasms had significant and equivalent improvement in postoperative facial dysfunction following an early tailored physiotherapy program, with no significant difference in the final facial score, treatment duration, or number of sessions required.

Background: Pediatric cervical spine injuries (CSIs) from blunt trauma carry a high risk of neurological damage. Accurate diagnosis is vital for preventing harm and aiding recovery, yet the diagnostic accuracy of clinical decision rules (CDRs) remains unclear.

Objective: To assess the effectiveness of triage tools for detecting CSI in pediatric trauma patients.

Methods: A summary of the Cochrane Review by Tavender et al. (2024), with comments from a rehabilitation perspective.

Results: Five studies with 21,379 participants assessed seven CDRs. Direct comparisons showed high sensitivity but low specificity across different CDRs. Indirect comparison studies also demonstrated varying sensitivities and specificities.

Conclusions: Insufficient evidence exists to determine the best tools for deciding if imaging is necessary for diagnosing potential CSI in children. Better quality studies are needed to assess the accuracy of CDRs for cervical spine clearance in this population.

Background: Hispanics are a significant demographic in the U.S., with diverse cultures and languages. Assessing cognition in this group is complex as cultural and linguistic factors have been found to affect test performance.

Objective: To generate normative data on the World Health Organization-University of California Los Angeles Auditory Verbal Learning Test (WHO-UCLA AVLT) in a sample of Spanish-speaking Hispanics residing in the U.S.

Methods: The sample included 245 Spanish-speaking individuals aged 18-80 across the U.S. (California, Connecticut, Florida, Indiana, New Jersey, Oregon, Virginia, and Wisconsin). Participants were administered the WHO-UCLA AVLT as part of a comprehensive neuropsychological battery. A Bayesian regression approach was used to estimate normative data, including covariates found to be important for predicting performances on measures of learning and memory.

Results: Bayesian models showed a logarithmic link between education and all WHO-UCLA AVLT trials, except recognition. For delayed recall, increased Spanish proficiency benefited women's performance exclusively. Time in the U.S. was a significant predictor for total recall, indicating worse performance with longer residency.

Conclusion: Recognizing cultural factors like language proficiency and duration of U.S. residence is essential for accurately evaluating cognitive function among Spanish-speaking Hispanics. This research emphasizes the importance of accounting for cultural nuances in developing norms for neuropsychological assessments, thereby improving their relevance and effectiveness in diverse communities.

Background: Hispanics/Latinos are the largest racial/ethnic group among underrepresented populations in the U.S. and multiple sociodemographic, cultural, and linguistic factors have been found to impact their performances on cognitive testing. Despite this, few normative data are available for the heterogeneous Spanish-speaking population in the U.S.

Objective: To generate normative data on the Trail-Making Test (TMT), Bells Test, Symbol-Digit Modalities Test (SDMT), and the Brief Test of Attention (BTA) for Spanish speakers residing in the U.S.

Methods: The sample included 245 Spanish-speaking individuals aged 18- 80 from eight states across the U.S. (California, Connecticut, Florida, Indiana, New Jersey, Oregon, Virginia, and Wisconsin). Participants were administered attention and processing speed measures as part of a comprehensive neuropsychological battery. We used a Bayesian regression approach to estimate normative data, including covariates found to be important for predicting performances on measures of attention and processing speed.

Results: Sociodemographic factors including education, time in the U.S., acculturation, age, and/or sex had differential effects on the TMT-A, TMT-B, SDMT, and the BTA whereas the Bells Test was not influenced by any of these sociodemographic factors.

Conclusion: Our findings indicate that while sex, age, and educational attainment are important factors to consider, language and acculturation can also influence attention and processing speed performances among Spanish speakers in the U.S.

Background: Despite the promising effects of robot-assisted gait training (RAGT) on balance and gait in post-stroke rehabilitation, the optimal predictors of fall-related balance and effective RAGT attributes remain unclear in post-stroke patients at a high risk of fall.

Objective: We aimed to determine the most accurate clinical machine learning (ML) algorithm for predicting fall-related balance factors and identifying RAGT attributes.

Methods: We applied five ML algorithms- logistic regression, random forest, decision tree, support vector machine (SVM), and extreme gradient boosting (XGboost)- to a dataset of 105 post-stroke patients undergoing RAGT. The variables included the Berg Balance Scale score, walking speed, steps, hip and knee active torques, functional ambulation categories, Fugl- Meyer assessment (FMA), the Korean version of the Modified Barthel Index, and fall history.

Results: The random forest algorithm excelled (receiver operating characteristic area under the curve; AUC = 0.91) in predicting balance improvement, outperforming the SVM (AUC = 0.76) and XGboost (AUC = 0.71). Key determinants identified were knee active torque, age, step count, number of RAGT sessions, FMA, and hip torque.

Conclusion: The random forest algorithm was the best prediction model for identifying fall-related balance and RAGT determinants, highlighting the importance of key factors for successful RAGT outcome performance in fall-related balance improvement.

Background: Stroke can lead to permanent and severe disability. Provision of information to stroke survivors and their carers could help them cope with consequences of stroke and aware of secondary prevention.

Objective: The aim of this Cochrane review was to assess the effects of active or passive information provision for stroke survivors or their carers.

Methods: The population addressed in this review included stroke survivors, their carers, or both. The intervention studied was provision of active or passive information compared to standard care or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision. The primary outcomes were knowledge about stroke and stroke services, and anxiety.

Conclusions: The authors concluded that the active provision of information may improve stroke survivors stroke-related knowledge and quality of life. It may reduce the cases and symptoms of anxiety and probably depression. The effect of active information provision to carers and passive information provision is still unclear; however, passive information may worsen stroke patients' symptoms of anxiety and depression.

Background: Hispanics are the largest growing ethnic minority group in the U.S. Despite significant progress in providing norms for this population, updated normative data are essential.

Objective: To present the methodology for a study generating normative neuropsychological test data for Spanish-speaking adults living in the U.S. using Bayesian inference as a novel approach.

Methods: The sample consisted of 253 healthy adults from eight U.S. regions, with individuals originating from a diverse array of Latin American countries. To participate, individuals must have met the following criteria: were between 18 and 80 years of age, had lived in the U.S. for at least 1 year, self-identified Spanish as their dominant language, had at least one year of formal education, were able to read and write in Spanish at the time of evaluation, scored≥23 on the Mini-Mental State Examination, <10 on the Patient Health Questionnaire- 9, and <10 on the Generalized Anxiety Disorder scale. Participants completed 12 neuropsychological tests. Reliability statistics and norms were calculated for all tests.

Conclusion: This is the first normative study for Spanish-speaking adults in the U.S. that uses Bayesian linear or generalized linear regression models for generating norms in neuropsychology, implementing sociocultural measures as possible covariates.

Background: Impaired upper limb function in stroke survivors is characterized by muscle weakness, increased muscle tone, contracture, or impaired motor control.

Objective: We aimed to evaluate the effectiveness of Kinesio-taping application for functional recovery on the affected arm and forearm during rehabilitation.

Methods: Forty-one patients eligible for this study were randomly assigned to either the Kinesio-taping group (n = 21), receiving Kinesio-taping intervention and conventional therapy, or control group (n = 20), receiving sham Kinesio-taping intervention and conventional therapy. The whole intervention lasted for 3 weeks. Fugl-Meyer assessment of the upper extremity, Barthel Index, the Stroke Impact Scale, and modified Ashworth scale were measured at 3 time points: baseline, post-treatment (3rd week), and follow-up (6th week).

Results: In the Kinesio-taping group, there were significant differences in the upper extremity (p = 0.003), wrist (p = 0.000) and hand (p = 0.000) parts of the Fugl-Meyer assessment of the upper extremity between the three assessment times. On the other hand, the Barthel Index showed significant differences in both groups after therapy.

Conclusion: Combining conventional rehabilitation with Kinesio-taping intervention may improve functional motor performance of both the proximal and distal parts of the affected upper extremity in stroke survivors, with potential benefits for activity of daily living.