Journal of Neurologic Physical Therapy最新文献

Background and purpose: Few studies have examined the long-term effects of lung volume recruitment (LVR) in amyotrophic lateral sclerosis (ALS). This study aimed to clarify the impact of LVR on respiratory function (Aim 1) and survival (Aim 2).

Methods: This retrospective cohort included hospitalized patients with ALS who underwent LVR from 2015 to 2020. For Aim 1, longitudinal changes in forced vital capacity (%FVC) were assessed every 3 months before and after LVR. For Aim 2, the survival study, data on sex, onset age, delay in diagnosis, duration of LVR, and subtype were also collected.

Results: A total of 79 patients underwent LVR (Aim 2), 48 patients had %FVC data before and after LVR (Aim 1). Regarding long-term effects on respiratory function (Aim 1), %FVC declined at approximately 2% per month before LVR, with significant decreases observed at 12, 9, and 6 months relative to baseline (P < .001). After LVR, the decline slowed to less than 1% per month, and no significant decreases were observed at 3, 6, 9, or 12 months. In Aim 2, patients continuing LVR ≥6 months had longer survival than those with shorter use. Multivariate Cox regression identified LVR ≥6 months as a prognostic factor (hazard ratio [95% CI] = 0.42 [0.19-0.96], P = .04).

Discussion and conclusions: These findings suggest a potential association between continued LVR and both a slower decline in %FVC and longer survival in patients with ALS. Further prospective studies are warranted to confirm these findings.

Video abstract available: For more insights from the author (see the Video, Supplemental Digital Content Video, available at http://links.lww.com/JNPT/A552.

Background and purpose: Pain is a frequent symptom of multiple sclerosis (MS). Algometry as a method to measure pressure pain threshold (PPT) has not yet been validated for test-retest reliability and construct validity in persons with MS (pwMS). This research aims to investigate the test-retest reliability and construct validity of the pressure algometry for pain in MS.

Methods: Sixty pwMS with pain were included (mean age: 51.08 ± 11.61, Expanded Disability Status Scale [IQR]: 3.75 [3.3]). The reliability (test-retest, measurement error) and construct validity (hypothesis testing) were analyzed. A digital algometer (Somedic Sales AB, Hörby, Sweden) was applied perpendicularly and bilaterally on the trapezius muscle, thumbnails, low back, and quadriceps muscle to assess local PPTs. Three trials were performed on each body site, and the mean of the trials was used for statistical analysis. To investigate test-retest reliability, participants repeated the testing at 3- to 8-day intervals.

Results: PPTs obtained by algometry showed good to excellent test-retest reliability (ICC [95% CI]: 0.82 [0.70-0.89]-0.91 [0.85-0.95]) in 4 different body parts. PPT measures had significant negative moderate correlations with pain outcome measures (the Neuropathic Pain Scale, Neuropathic Pain Symptom Inventory, Brief Pain Inventory-Short Form, Douleur Neuropathique en 4, and painDETECT) (Spearman's rho = -0.265 to -0.456) and the Modified Fatigue Impact Scale (Spearman's r = -0.281 to -0.392). Weak nonsignificant correlations were found between PPT measures and clinical variables (Spearman's r = -0.201 to 0.227).

Discussion and conclusions: PPT measurement can reliably assess pain in MS with weak to moderate validity in the neck, thumbnails, lower back, and legs.

Background and purpose: The American Physical Therapy Association's (APTA) vision of transforming society by optimizing movement to improve the human experience must include a reduction in the unwarranted variation in physical therapist practice. The APTA proposed that the profession adopt the movement system as a basis for developing diagnoses to classify movement dysfunction so that treatment is more consistent and specific. In 2021, the Academy of Neurologic Physical Therapy Movement System Diagnosis Task Force developed 10 movement system diagnoses for balance dysfunction, a diagnostic process, and recommended intervention strategies. The purpose of this special interest paper is to report on the ongoing refinement of the balance diagnoses and the diagnostic process based on a pilot survey of practicing clinicians and colleagues' informal feedback.

Summary of key points: Pilot survey participants largely agreed on the clarity of the definitions, the accuracy of the key movement observations, and appropriateness of the key findings from tests and measures, but not the mutual exclusivity of the balance diagnoses. Using an iterative process, the authors considered the feedback to arrive at a consensus to address these concerns. The result is an updated set of 12 balance diagnoses, revision of some key definitions, a refined diagnostic process, and an updated summary of the evidence for task-specific balance-related interventions. These updated diagnoses and diagnostic processes must be examined for mutual exclusivity, validity, and reliability prior to clinical adoption.

Recommendations for clinical practice: Until the balance diagnoses are shown to be mutually exclusive, valid, and reliable, we recommend that clinicians conceptualize balance control dysfunction using the well-established postural control strategies and apply well-supported principles of task-specific interventions when managing individuals with balance dysfunction.(JNPT 2025;24: 1-13).

Background and purpose: Stroke clinicians need access to cost-effective, accurate, and time-efficient tools that can assist with cardiorespiratory fitness (V̇O2peak) screening. The associations and diagnostic metrics between physical activity as measured by the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) and V̇O2peak among individuals ≥6 months post-stroke were evaluated.

Methods: This is a secondary analysis of an randomized controlled trial (RCT). Participants' baseline age, sex, gait speed, V̇O2peak, and PASIPD were included in adjusted logistic regression analyses. The association between the PASIPD (MET-hours/day) and V̇O2peak at 15, 12, and 18 mL/kg/min was evaluated to reflect the average, lower, and upper limits of V̇O2peak post-stroke, respectively. Predicted classifications and the Youden index identified cut points of the PASIPD.

Results: Eighty-five participants (n =53 males, aged 65.1 ± 9.5 years, 1.8 ± 1.2 years post-stroke) were included. A 1-unit increase in the PASIPD (MET-hours/day) was significantly associated with 21% increased odds of identifying an individual with a V̇O2peak ≥ 15 mL/kg/min (adjusted OR [aOR] = 1.21; 95% CI 1.07, 1.36; P = .002) with excellent area under the curve (AUC = 0.91; 95% CI 0.85, 0.97). Consistent associations were found for a V̇O2peak ≥ 12 mL/kg/min (aOR = 1.15; 95% CI 1.01, 1.14; P = .046) but not for V̇O2peak ≥ 18 mL/kg/min (aOR = 1.04; 95% CI 0.99, 1.10; P = .15). Unadjusted Youden PASIPD cut point of 8.9 MET-hours/day may identify individuals with a V̇O2peak ≥ 15 mL/kg/min post-stroke (AUC = 0.69; 95% CI 0.59, 0.79).

Discussion and conclusions: Clinicians may use the PASIPD to screen V̇O2peak impairments post-stroke.

Background: Sustainable utilization of neurology and allied health professions' services is pivotal for effective management of Parkinson disease (PD) and is correlated with positive health-related outcomes.

Objectives: (1) To describe the utilization of neurology and allied health services by people with PD (PwP); (2) to explore the associations between demographic and structural variables and utilization; and (3) to test associations between utilization and unplanned hospitalizations.

Methods: A retrospective observational cohort study of 1761 PwP in the years 2014-2019 was conducted. Utilization of neurology and allied health services was mapped. Regression models were examined to test associations between demographic and structural variables, utilization of neurology and physical therapy (PT), and unplanned hospitalizations.

Results: Approximately 50% of the study population utilized neurology services. Utilization rate of allied health services ranged between 0% and 19%. The likelihood of utilizing neurology services increased for people with extended health insurance and people with more years since diagnosis and decreased for women and for people living at a great distance from a neurology service. The likelihood of utilizing PT increased for Jews and people with extended health insurance and decreased for people with more years since diagnosis and for people living at a great distance from a PT service. Among patients with fewer years since diagnosis (<5 years), those who utilized PT had a higher likelihood of unplanned hospitalization.

Conclusions: Neurology and allied health services are underutilized by PwP, particularly by minorities and women. Policymakers should take proactive steps to increase utilization.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A496 ).

Background and purpose: Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats some of the motor manifestations of Parkinson disease (PD). However, previous work suggests STN-DBS may lead to worsening of balance and gait in some people with PD. Physical therapy (PT) is often used to improve balance and gait in PD, but its safety, feasibility, and efficacy have not been tested in people with STN-DBS. The purpose of this study was to test the safety, feasibility, and preliminary efficacy of PT for improving gait and balance in persons with PD and STN-DBS.

Methods: This randomized pilot study compared the effects of an 8-week PT intervention ( n = 15) on balance and gait to a usual care control group ( n = 14) among people with PD with STN-DBS. Individuals were evaluated in the on medication/on stimulation state as well as off medication/off stimulation state.

Results: PT was safe as there were no serious adverse events during treatment. PT was feasible as the average percentage of session attendance was 93%. PT significantly improved balance as measured by the Balance Evaluation Systems Test (BESTest) in the on medication/on stimulation state but did not significantly improve gait. No significant differences between groups were found in the off medication/off stimulation state.

Discussion and conclusions: PT was safe, feasible, and may improve balance for individuals with PD with STN-DBS. Further work is needed to understand how modifying the frequency and intensity of PT interventions may impact balance and gait in individuals with STN-DBS.

Background and purpose: This cross-sectional study aimed to (1) establish the safety and tolerability of head-mounted display (HMD) assessment of sensory integration for postural control in participants with chronic traumatic brain injury (TBI); (2) investigate whether responses to visual and auditory cues differ between persons with TBI and healthy controls; and (3) evaluate the relationship between postural responses, postural visual dependence, and self-reported perception of disability.

Methods: 20 healthy adults and 19 participants with TBI completed an HMD assessment of with visual and auditory perturbations. Head sway was quantified as a directional path in the anteroposterior and mediolateral directions. Participants also completed the Simulator Sickness Questionnaire (SSQ) and the Dizziness Handicap Inventory (DHI).

Results: All participants completed testing. The average change in SSQ scores from pre to post postural control assessment was 0.8 points for healthy controls and 3.2 points for participants with TBI. Head sway in the TBI group was consistently higher in both directions, especially with dynamic visuals. In addition, a significant sound by visual by group interaction in the mediolateral direction indicates that participants with TBI responded more to the visual perturbations when sounds were present. Under the most challenging conditions, people with mild-to-moderate dizziness handicap showed little head sway, while those with severe symptoms were more variable.

Discussion and conclusions: HMD assessment of participants with TBI is feasible and provides a clinic-based assessment of postural visual dependence in this population. This assessment carries the potential to evaluate postural control and monitor progress of participants with TBI.

Background and purpose: Muscle strength is important for functional independence after a stroke. Given the rise in telerehabilitation, there is a need to study the measurement properties of virtually administered performance-based measures. The purpose of this study was to assess the validity and responsiveness of a virtually administered 30-second chair stand test (30sCST-Virtual) in people with stroke.

Methods: Thirty-two hypotheses were generated about construct validity and responsiveness using several outcome measures (Stroke Impact Scale, strength domain [SIS-S], Timed Up and Go [TUG], Activities-Specific Balance Confidence Scale, Fugl-Meyer Lower Extremity Assessment, Functional Reach Test, and SIS cognition domain). Hypotheses were tested using Spearman's correlations. Scores on the 30sCST-Virtual were compared between higher- and lower-functioning participants using the modified Rankin Scale (mRS) and NIH Stroke Scale (NIHSS) with Wilcoxon rank-sum tests to assess known-groups validity.

Results: Sixty-seven participants ( n = 19 female, 9.3 months post-stroke) with mild to moderate stroke were included. The 30sCST-Virtual demonstrated acceptable construct validity and responsiveness, as 14 (82%) and 12 (80%) hypotheses were confirmed, respectively. Its baseline scores were most highly correlated with the TUG ( r = - 0.64) and change scores with the SIS-S ( r = 0.35). The 30sCST-Virtual scores were also lower in those with lower function using the mRS (median difference [MD] = 4.0 repetitions, P < 0.001) and NIHSS (MD = 3.5 repetitions, P = 0.003), meeting our hypotheses for known-groups validity.

Discussion and conclusions: The 30sCST-Virtual demonstrated acceptable construct validity and responsiveness, as well as adequate known-groups validity. It was also moderately correlated with other measures of physical function, indicating that the 30sCST-Virtual may measure the construct of functional strength.

Video abstract available: For more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A526 ).