PM&R最新文献

Background: Portable technology that records movements with high accuracy provides potential for sensitive clinical movement tests for individuals who experienced a traumatic brain injury (TBI).

Objective: (1)To present impairments assessed using markerless motion capture (MMC) and (2) to compare the sensitivity and specificity of the MMC-mediated tests to each other and to common clinical tests.

Design: Screening study, using as criterion standard the ability to classify participant with TBI versus control participant.

Setting: Research laboratory.

Participants: The study included 30 individuals with TBI and 101 control participants. Entry criteria included most recent head injury <5 years old, no history of movement issues prior to injury, no movement-affecting medications, and sufficient cognitive ability to follow instructions.

Interventions: Not applicable.

Main outcome measures: Performance on MMC-mediated tests and existing clinical analogs. MMC-mediated tests included finger oscillation, simple reaction time, and visually guided movement tasks. For comparison, participants also completed the following clinical tests: Halstead-Reitan finger tapping, simple reaction time test, and Beery Visuomotor Integration test. Impairments were identified as test scores of participants with TBI that fell outside of the 95% interval of control participants' test scores. Random forest analysis was used to calculate the sensitivity and specificity of MMC and clinical tests according to their ability to correctly classify participants with TBI and control participants.

Results: MMC-mediated tests revealed impairments in more participants with TBI than clinical tests in all three TBI groups (mild, repeated, and moderate to severe). Similarly, MMC-mediated tests revealed a higher percentage of scores as impairments than clinical tests in all three groups with TBI. Furthermore, MMC-mediated tests proved more sensitive and more specific than clinical tests (70% versus 50% and 98% versus 93%, respectively).

Conclusion: MMC-mediated tests are sensitive and specific (compared to traditional clinical tests) and have potential to fill a gap in clinical care of TBI.

Background: Therapeutic tools are critical for poststroke rehabilitation. The potential benefits of dual-task training assisted by a lower-extremity exoskeleton robot to enhance gait and postural control have yet to be studied.

Objective: To determine the effects of lower-extremity exoskeleton robot-assisted dual-task training on gait and postural control after stroke.

Design: Single-blind, randomized controlled trial.

Setting: Outpatient clinic and ward, Department of Rehabilitation Medicine, Huadong Hospital affiliated with Fudan University.

Participants: Forty-four participants in the recovery and sequela phases of stroke with deficits in gait and postural control.

Interventions: Participants were randomly assigned to two groups: lower-extremity exoskeleton robot-assisted walking cognitive dual-task training (experimental group) or lower-extremity exoskeleton robot-assisted walking training (control group). Each participant received 40 minutes per intervention, 1 time per day, 6 times per week for 3 weeks.

Main outcome measures: The primary outcome was gait variability performance. The secondary outcomes included the Timed Up and Go, Berg Balance Scale, Montreal Cognitive Assessment, Fugl-Meyer assessment of lower extremity, and International Classification of Functioning, Disability and Health-activities and participation assessment scale.

Results: Individuals who participated in exoskeleton robot-assisted walking cognitive dual-task training improved more than those in the control group in partial gait variability performance analysis, Timed Up and Go test, Berg Balance Scale, and Fugl-Meyer assessment for the lower extremities (p < .05).

Conclusions: Compared to lower-extremity exoskeleton robot-assisted walking training, robot-assisted dual-task training improves gait and postural control, walking, balance, and lower extremity motor function in survivors of stroke.

Objective: Balance training with visual occlusion positively affects the improvement of proprioception and reduction of visual dependence in individuals with chronic ankle instability (CAI). However, the effect of visual occlusion balance training alone on postural control in individuals with CAI remains controversial. This review conducted a meta-analysis of existing randomized controlled trials (RCTs) to investigate the influence of balance training with visual occlusion on the postural control of individuals with CAI.

Literature survey: PubMed, Embase, The Cochrane Library, Web of Science, EBSCO, China National Knowledge Infrastructure (CNKI), and WanFang database were searched until July 20, 2024. RCTs were eligible if they compared the effects of balance training with visual occlusion with balance training on the postural control of individuals with CAI.

Methodology: The following information from the included articles was extracted: basic study information, interventions, and outcomes. The primary outcomes included Y-balance test (YBT) distance and center of pressure (COP) area, and the secondary outcomes were Cumberland ankle instability tool (CAIT) and Foot and Ankle Ability Measure (FAAM) scores.

Synthesis: Eight RCTs were included in this work. The results show that balance training with visual occlusion significantly improved YBT distance (standardized mean difference [SMD] = 0.40 [95% confidence interval [CI], 0.23-0.57], p < .001) and CAIT scores (mean difference [MD] = 3.03 [95% CI, 1.76-4.29], p < .001) in individuals with CAI compared with balance training alone. However, no significant difference was found between the two groups in terms of the COP area (SMD = 0.18 [95% CI, 0.51-0.86], p = .62) and FAAM scores (MD = 1.79 [95% CI, -0.03 to 3.62], p = .05).

Conclusions: Compared with balance training alone, balance training with visual occlusion may help improve the dynamic postural control ability of individuals with CAI. However, its effect on static postural control ability still needs further study.

Background: Femoral neck stress fractures are prevalent injuries among young female runners, yet biomechanical and strength features have not been well-described in adolescents and young adults.

Objective: To compare running gait biomechanics and strength measures of female runners diagnosed with a femoral neck bone stress injury (BSI) to healthy female runner controls.

Design: Retrospective case-control study.

Setting: Outpatient sports medicine department.

Patients: There were 18 female runners with a history of femoral neck BSI (age: 20.3 ± 1.0 years, BMI: 19.8 ± 0.6 kg/m²) and 18 healthy female runners without femoral neck BSI (age: 18.3 ± 0.7 years, BMI: 21.5 ± 0.6 kg/m²).

Methods: Participants underwent instrumented running gait analyses with 2-dimensional videos, and standardized handheld dynamometry hip strength measures.

Main outcome measures: Primary outcomes included spatiotemporal, kinematic, and kinetic running gait biomechanics, and tri-planar hip muscle strength. Non-parametric Mann-Whitney U tests were used to compare participant demographics. Linear regressions were used to compare strength and continuous gait outcomes, and logistic regressions were used to compare categorical gait outcomes between groups, covarying for age and body mass index (α = .05).

Results: A higher proportion of those with a history of femoral neck BSI demonstrated limb midline cross-over (Adjusted Probability [Adj.]: 65.0% vs. 38.5 %; p = .04), contralateral pelvic drop (Adj.: 99.0% vs. 52.9%; p = .02), medial knee displacement (Adj.: 67.0% vs. 37.9%; p = .03), and pronation at midstance (Adj.: 86.5% vs. 41.2%; p = .02) compared to those without a history of BSI. Those with a history of femoral neck BSI had lower hip abduction strength on dynamometry testing (1.64 ± 0.30 Nm/kg vs. 1.99 ± 0.66 Nm/kg; p = .01).

Conclusions: Female runners with a history of femoral neck BSI demonstrated characteristic coronal plane gait and hip abductor strength deficits, suggesting an association between impaired lower limb proximal and distal biomechanics during femoral neck BSI recovery.

Background: Children with cerebral palsy and other disabilities face barriers in obtaining equitable medical care. Although many factors contribute to these disparities, physicians' lack of knowledge and comfort when caring for patients with cerebral palsy have been reported to play a role. We propose that this gap in understanding may reflect a deficit in disability education during medical school.

Objective: To (1) obtain insight into medical students' knowledge regarding cerebral palsy at two medical schools in the United States; and (2) determine whether viewing a brief educational video increases short-term knowledge regarding cerebral palsy.

Methods: All medical students attending Wayne State University School of Medicine and Central Michigan University College of Medicine in November-December 2023 were invited to participate in the study. Respondents completed a three-step survey, in which they answered nine multiple-choice knowledge-based questions about cerebral palsy, viewed a 10-minute educational video, and responded to the same nine knowledge-based questions after viewing the video.

Results: A total of 221 surveys were received (response rate: 14%). For the submitted surveys in which paired data were available, the percentage of correct responses at baseline (prevideo), averaged for the nine knowledge-based questions, was 45 ± 15% and increased to 67 ± 11% after viewing the educational video (p < .01).

Conclusions: Our results reveal that medical students' knowledge of cerebral palsy is limited and that a brief, focused educational session may have a short-term beneficial effect in mitigating this gap in knowledge.

Background: Lower limb motor dysfunction is a common sequela of stroke. Further research is needed to identify effective rehabilitation methods to improve motor function.

Objective: To investigate the therapeutic effects of transcranial direct current stimulation (tDCS) and isokinetic strength training (IST), both individually and in combination, on two primary outcomes: lower limb motor function and lower limb muscle strength in individuals with chronic stroke. Additionally, it also explored the effects on balance, gait, and muscle tone as secondary outcomes.

Design: Randomized controlled trial.

Setting: Inpatient department of university hospital.

Participants: A total of 56 individuals with chronic stroke (aged 35 to 77 years) were selected and randomly divided into four groups: control group (n = 14), tDCS group (n = 14), IST group (n = 13), and combined group (n = 15).

Intervention: Two intervention techniques were employed: (1) 20 minutes of 2 mA tDCS, and (2) 20 minutes of IST. In addition, all participants received 80 minutes of standard rehabilitation therapy.

Outcome measures: The primary outcomes were peak torque (PT) of knee flexion and extension and the Fugl-Meyer Assessment of Lower Extremity (FMA-LE) score. The secondary outcomes included the Berg Balance Scale, the 10-meter Walk Test, and the Modified Ashworth Scale scores. Data were collected at baseline and 4 weeks after the treatment.

Results: After 4 weeks of treatment, the tDCS group showed a significant increase in knee extension PT and FMA-LE scores compared to baseline data by 3.59 (p = .009) and 2.07 (p = .009) respectively. In the IST group, knee flexion, extension PT, and FMA-LE scores were significantly higher than baseline data by 5.67 (p = .001), 7.18 (p < .001), and 3.00 (p = .007), respectively. The combined group showed significant increases in knee flexion, extension PT, and FMA-LE scores compared to baseline data by 10.13 (p < .001), 13.04 (p < .001), and 5.27 (p < .001). The combined group showed significantly superior treatment effects compared to the control group, tDCS group, and IST group.

Conclusion: Both tDCS and IST were effective in improving lower limb muscle strength and motor function in individuals with chronic stroke, but the combination of these two techniques was more effective.

Background: Despite targeted national quality improvement initiatives, opioid prescription and use patterns after lower limb amputation are not well studied.

Objective: To determine risk factors associated with extended opioid use and rates of high-risk opioid prescribing after lower limb amputation.

Design and setting: A retrospective population-based study was performed by querying a 20% national sample of Medicare claims of patients undergoing lower limb amputation from 2009 to 2018. Patients were excluded if they did not discharge home or had subsequent surgery 180 days after discharge. Extended opioid use was defined as one opioid prescription filled within 90 days after discharge and another within 90-180 days. Chronic opioid users were defined as having a 180-day supply over the preoperative surgical period and at least one opioid prescription within 60 days of surgery. High-risk opioid prescribing included overlapping opioid prescriptions, overlapping benzodiazepine-opioid prescriptions, high daily doses >100 oral morphine milligram equivalents, multiple prescribers, and new long-acting opioid use within 90 days postoperatively. Multilevel mixed-effects logistic regression and the Cochran-Armitage Trend Test was used.

Main outcome: New persistent and prolonged opioid use following lower extremity amputation.

Results: The study included 5191 patients (nonchronic opioid users = 3759, chronic opioid users = 1432). Among the nonchronic opioid users, 873 (23.2%) had new persistent opioid use after surgery. In these patients, age < 55 years (odds ratio [OR], 1.41, p = .04), concurrent gabapentinoid fills (OR, 1.92, p < .001), and sedative/anxiolytic fills (OR, 1.75, p < .001) were associated with new persistent use. Of the chronic opioid users, 1306 (91.2%) had prolonged opioid use after surgery. Rates of high-risk prescribing did not change significantly during the study period, and 82.3% of chronic opioid users were exposed to high-risk prescribing.

Conclusions: Extended opioid use is common following lower extremity amputation. Moreover, high-risk prescribing practices remain common and have not changed over time.