Annals of Rehabilitation Medicine-ARM最新文献

Management of upper limb deformities in patients with cerebral palsy is crucial, given its impact on activities of daily living, social interaction, and self-esteem. While medical management and rehabilitative therapy-including the use of assistive devices-remain the foundation of treatment, significant advancements have been made in surgical reconstruction techniques aimed at enhancing functional outcomes. Despite this, many eligible patients may miss the opportunity for surgical intervention due to limited awareness of appropriate indications, candidate selection criteria, and the availability of specialized expertise. This article provides an overview intended to guide pediatric rehabilitation physicians in recognizing common upper limb presentations in cerebral palsy, conducting appropriate assessments, selecting candidates, and understanding available surgical reconstructive options.

Objective: To compare the efficacy, safety, and patient compliance of tele-cardiac rehabilitation (T-CR) versus center-based cardiac rehabilitation (C-CR) in patients with coronary artery disease (CAD). A secondary aim was to assess the effects of both interventions on quality of life (QoL) and kinesiophobia.

Methods: This nonrandomized, patient-preference controlled trial included 40 CAD patients (83% post-myocardial infarction) at a university hospital. Participants selected either C-CR or T-CR. The four-week intervention included supervised in-hospital exercise (C-CR) or telemonitored exercise with heart rate feedback (T-CR). The primary outcome was peak oxygen uptake (VO2 peak). Secondary outcomes included VO2 at ventilatory anaerobic threshold (VO2 at VAT), time to VAT, oxygen pulse, QoL, Fear of Activity in Patients with Coronary Artery Disease (Fact-CAD) scores, and exercise adherence.

Results: Baseline VO2 peak was higher in the T-CR group (23.2±3.5 vs. 19.4±4.2, p=0.004). Rehabilitation improved VO2 peak (p<0.001), VO2 at VAT (p=0.004), and time to VAT (p<0.001) in both groups. Fact-CAD scores decreased (p=0.004), and QoL improved (p<0.001). However, C-CR led to greater kinesiophobia reduction (p=0.038) and slightly higher QoL improvements (p=0.05). T-CR participants completed more exercise sessions (14.9±2.9 vs. 12.0±0, p<0.001), with no serious adverse events reported.

Conclusion: T-CR is a safe and effective alternative to C-CR, providing similar physiological benefits. However, C-CR may be superior in reducing kinesiophobia. Future studies should assess long-term adherence and psychological outcomes in diverse populations.

Objective: To examine the effect of the telerehabilitation program on sleep quality and fatigue level in patients with multiple sclerosis (MS) was aimed in this study. MS is a demyelinating disease defined by various signs and symptoms that affects physical, emotional, social, and cognitive functioning. Fatigue, depression, sleep disturbance and cognitive impairment are the among common symptoms of MS.

Methods: The study implemented an individual exercise program for twice a week for 12 weeks via telerehabilitation. In the home-based video exercise group, the same exercises were given as video recordings and the patients were asked to do the exercises twice a week for 12 weeks. Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Multiple Sclerosis Quality of Life Scale-54 and Timed 25 Foot Walk Test were used in the evaluation. The trial is registered with the number of NCT04979845 on ClinicalTrials.gov.

Results: PSQI scores changed from 5.6 (2.1) to 3.66 (2.09) in telerehabilitation group (p=0.03) while no significant change were seen in the video exercise group. Similarly FSS scores decreased from 4.37 (1.42) to 3.67 (1.68) in telerehabilitation group (p=0.04) while no significant changes were seen in the video based exercise group.

Conclusion: The telerehabilitation program is thought to be an effective and accessible non-pharmacological application that can be used in the treatment of sleep quality and fatigue in individuals with MS.

Objective: To investigate the temporal and kinematic parameters of hyoid bone excursion (HBE) in head and neck cancer (HNC) patients with and without aspiration.

Methods: Videofluoroscopic swallowing study images from 28 HNC patients were divided into aspiration and non-aspiration groups. The kinematic parameters of HBE, including displacement, instantaneous velocity, and instantaneous acceleration, as well as the timing of reaching maximal values in these parameters, were analyzed.

Results: The timings of reaching maximal horizontal (2.37±1.10 seconds vs. 1.09±1.58 seconds, p=0.010; 0.68±0.28 vs. 0.37±0.26, p=0.010 for percentage of time), vertical (1.83±2.06 seconds vs. 0.86±1.42 seconds, p=0.020) and hypotenuse instantaneous velocities (2.36±1.96 seconds vs. 0.79±1.20 seconds, p=0.006; 0.60±0.33 vs. 0.33±0.24, p=0.028 for percentage of time), as well as the timings of reaching maximal horizontal (2.22±1.50 seconds vs. 0.90±1.26 seconds, p=0.009; 0.60±0.32 vs. 0.37±0.29, p=0.041 for percentage of time), vertical (2.09±1.94 seconds vs. 0.83±1.19 seconds, p=0.003), and hypotenuse instantaneous accelerations (2.49±1.93 seconds vs. 0.81±1.24 seconds, p=0.004; 0.65±0.34 vs. 0.34±0.28, p=0.026 for percentage of time) were significantly prolonged in the aspiration group. After signal smoothing, the aspiration group exhibited delayed timing in reaching maximal horizontal instantaneous velocity (2.07±1.09 seconds vs. 0.74±1.10 seconds, p=0.004; 0.58±0.29 vs. 0.32±0.24, p=0.017 for percentage of time), as well as maximal horizontal (2.18±1.16 seconds vs. 1.12±1.46 seconds, p=0.008) and hypotenuse accelerations (2.21±2.50 seconds vs. 0.81±1.21 seconds, p=0.011). There were no significant between-group differences in other kinematic parameters, except for horizontal displacement (7.66±6.26 mm vs. 12.14±5.82 mm, p=0.042).

Conclusion: The timings of reaching maximal instantaneous velocities and accelerations of HBE, rather than the maximum values of these kinematic parameters, may be critical parameters related to aspiration in HNC patients.

Objective: To increase participation in cardiac rehabilitation among outpatients with heart disease in Thailand. Factors contributing to low participation are poorly understood. A scale is needed to identify barriers to participation in cardiac rehabilitation. This study aimed to evaluate the psychometric properties of the newly translated Cardiac Rehabilitation Barriers Scale Thai version to justify its use in the Thai population with cardiovascular diseases.

Methods: Psychometric testing was conducted using a cross-sectional survey of 200 outpatients at a Bangkok hospital eligible for the cardiac rehabilitation program from April 2023 to mid-April 2024. Construct validity was evaluated using principal axis factor analysis and first- and second-order confirmatory factor analysis. Cronbach's alpha assessed the scale's internal consistency.

Results: The average age of the total sample was 62.60±12.37 years. Principal axis factoring with Oblimin rotation and Kaiser normalization extracted four components (subscales) that explained 61.8% of the cumulative percentage of variance. These were labeled work and time conflicts, lack of perceived need factors, comorbidities, and logistical barriers. Values for the confirmatory factor analysis goodness of fit indices exceeded recommended minimum thresholds. The internal consistencies for the total scale and the four components were entirely acceptable.

Conclusion: The Cardiac Rehabilitation Barriers Scale Thai version has acceptable psychometric properties for Thai outpatients with cardiovascular diseases. It may be used to identify barriers to participating in cardiac rehabilitation, promote rehabilitation attendance, and improve patient care.

Objective: To investigate muscle tone changes over time in contralateral homonymous muscles when unilateral muscles are stimulated, using F-wave measurements, we examined whether vibratory stimulation on the contralateral homonymous muscle of the affected side may reduce spasticity, whose optimal duration remains unclear.

Methods: Vibratory stimulation was applied to the right hand of healthy adults, using parameters of 80 Hz frequency, 0.4 mm amplitude, 400 g load, and 195 seconds of duration on the abductor digiti minimi muscle. F-wave was measured in the left hand before stimulation, at seven intervals during stimulation, and immediately after.

Results: The F/M amplitude ratio decreased immediately at stimulation onset, at 30 seconds, and at 60 seconds compared to baseline. A least-squares analysis revealed a negative slope from baseline to 60 seconds (f(x)=-0.11x+1.12), while the slope became positive after 90 seconds, continuing after stimulation ended (f(x)=0.04x+0.82).

Conclusion: Unilateral vibratory stimulation may decrease excitability in the spinal anterior horn cells of the contralateral homonymous muscle for up to 75 seconds post-stimulation, suggesting a potential mechanism for spasticity management.

Wearable robotic exoskeletons have emerged as promising technologies for enhancing gait rehabilitation and providing mobility assistance in individuals with neurological and musculoskeletal disorders. This narrative review summarizes recent advances in wearable robots-including both rigid exoskeletons and soft exosuits-and evaluates their clinical application across diverse conditions such as stroke, spinal cord injury, cerebral palsy, and Parkinson's disease. For rehabilitation purposes, these devices enable repetitive, task-specific gait training that promotes motor learning, reduces therapist burden, and facilitates improvements in walking speed, balance, and endurance. Rigid exoskeletons provide substantial joint support and are particularly effective for patients with severe gait impairments, whereas soft exosuits offer lightweight assistance suited to individuals with milder deficits or fatigue, albeit with limited capacity to deliver high-torque support. Beyond rehabilitation, wearable robots are increasingly used as assistive devices to compensate for permanent gait limitations and restore mobility in daily life. However, widespread clinical adoption remains constrained by several challenges, including a lack of standardized protocols; limited evidence from large-scale, multicenter studies; and practical issues such as device weight, comfort, and ease of use in community settings. Recent developments-such as adaptive control algorithms, volition-adaptive assistance, and artificial intelligence integration-are addressing these barriers by enabling more personalized and responsive support. With continued research investment, user-centered design, and supportive policies, wearable exoskeletons hold considerable potential to improve independence, participation, and quality of life for individuals across a broad spectrum of mobility impairments.

Objective: To examine the short-term and long-term effects of computer-based cognitive training on postural stability, locomotion, and cognitive performance in Parkinson's disease (PD) patients.

Methods: Sixty-eight PD participated in this randomized-controlled trial, were randomly allocated into two groups; control group (GA) received a designed physiotherapy program for 60 minutes, and an experimental group (GB) got 30 minutes physiotherapy program as GA, along with 30 minutes of computerized cognitive training. Treatment sessions were three times/week for eight weeks. Primary outcomes were balance and spatiotemporal gait parameters; cognition was a secondary outcome. Primary and secondary measures were examined at baseline, immediately post-treatment, and three months post-treatment.

Results: From baseline to post-treatment, GB showed greater reductions in postural sway compared to GA. The mean differences in stability indices were 1.461±1.240, 0.982±1.185, and 1.006±0.982 in GB, vs. 0.581±1.503, 0.426±1.459, and 0.374±1.072 in GA. For gait parameters (gait velocity, stride length, and cadence), GB demonstrated larger improvements, with mean differences of -0.361±0.245, -0.242±0.158, and -11.606±12.628, compared to -0.155±0.254, -0.191±0.248, and -4.516±10.773 in GA. PD-Cognitive Rating Scale improved more substantially in GB (-16.091±6.978) than in GA (-1.129±4.552). These gains in postural stability, gait, and cognition were statistically significant (p<0.001) and sustained at the 3-month follow-up.

Conclusion: Computerized cognitive training as an add-on in the rehabilitation of PD is efficient in improving postural stability and locomotion, as well as the cognitive performance. The consistency of these findings for 3 months is an imperative point in the clinical course of PD patients.