Journal of Neurologic Physical Therapy最新文献

Background and purpose: To evaluate the effect of intensity and frequency of vestibular rehabilitation exercises over time on dizziness handicap and secondary outcomes in adults with vestibular impairments following mild traumatic brain injuries (mTBI).

Methods: The Targeted Rehabilitation Exercises for Vestibular (T-REV) impaiments randomized clinical trial was conducted from February 2020 to May 2024. Adult (18-50 years) civilian and military service members within 8 days to 1 year of mTBI with vestibular impairments participated. The sample size target was 252 participants. Exercises prescribed by a physical therapist were performed at home for 4 weeks at an intensity of 30% or 70%, and a frequency of once or twice daily. The Dizziness Handicap Inventory (DHI) and secondary outcomes were assessed at baseline, 2 and 4 weeks, and DHI at 12 weeks. Least square mean differences and 95% confidence intervals were calculated from a linear mixed model to examine the effects of intensity, frequency, time, and their interactions.

Results: A total of 120 participants completed baseline assessment (69 F, 51 M; 73 civilians, 47 military service members; mean (SD) age: 29 (9) years). Group differences in DHI and secondary outcomes over time due to intensity or frequency were equivocal. For all participants, mean improvement in DHI from baseline to 4 weeks was 16 points (95% CI: 13-19 points, P < .0001), and most secondary outcomes significantly improved across 4 weeks. Adverse events occurred in 20% of the participants.

Discussion and conclusions: The dose of vestibular rehabilitation for individuals with mTBI-related vestibular impairments can be individualized based on patient goals and symptom burden.

Background and purpose: To determine the feasibility of low-load resistance blood flow restriction training (BFRT) in people with Parkinson disease (PD).

Methods: This prospective cohort, convergent parallel mixed-methods design investigated the feasibility of 8 weeks of low-load resistance BFRT in people with PD. Feasibility was determined by enrolling 20 participants, ≥80% retention and adherence, and no serious intervention-related adverse events. Semistructured interviews and questionnaires evaluated acceptability and satisfaction. Changes in muscle strength and thickness, mobility, physical activity, and patient-reported outcomes were also assessed.

Results: Sixteen of 20 participants (80%) were retained at the postintervention assessment (68.1 ± 8.6 years old, 44% Female), completing 88% of visits with no serious adverse events. Qualitative analysis identified 3 themes: satisfaction and acceptability, functional capacity changes, and program feedback. Most participants were satisfied (88%), and lack of satisfaction was primarily related to pressure intolerance and exercise specificity. There were improvements in knee extension and ankle plantarflexion strength (18-22%), 30-Second Sit to Stand (+2.2 reps), Timed Up and Go (-2.1 seconds), and 10-Meter Walk Test (0.12 m/s). The average daily step count decreased (-476 steps/day) and sedentary time increased (21 minutes/day). There were minimal changes in elbow extension strength, rectus femoris muscle thickness, Parkinson's Fatigue Scale, and Patient-Specific Functional Scale.

Discussion and conclusions: BFRT was feasible and safe in people with PD, with promising improvements in muscle strength and mobility, warranting a future efficacy study. Clinicians considering BFRT should carefully evaluate tolerance and make sure BFRT aligns with patient goals.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A539 ).

Background and purpose: No clear consensus exists regarding the expected proficiency of entry-level physical therapists (PTs) when practicing vestibular physical therapy (VPT). The aims of this research were to: 1) ascertain clinicians' and administrators' expectations of entry-level PTs' knowledge, skills, and abilities (KSA) for practicing VPT, and 2) explore correlations between clinician characteristics and their expectations for VPT KSA and performance level for entry-level PTs.

Methods: PTs and PT managers in the United States were invited to complete a survey consisting of 3 parts: 1) clinician/entity demographics, 2) importance of knowledge in foundational sciences, diagnostic groups, examination and intervention skills, and clinical decision-making, and 3) level of expected clinical performance. Rating frequencies and Spearman correlation coefficients between respondent characteristics and survey responses were calculated. Clinical expertise was dichotomized and differences between ratings were compared with the Mann-Whitney U test.

Results: Four hundred fifty-eight respondents completed the survey, prioritizing KSAs of benign paroxysmal positional vertigo (70.0%), postconcussion dizziness (45.1%), and vestibular hypofunction (43.4%) as most important. Eighty-three percent of respondents expected competence for VPT at graduation as advanced beginner (26.7%), intermediate (33.6%), or advanced intermediate (22.4%). Relationships between respondent characteristics and survey responses were fair to poor. Experienced clinicians rated item importance higher than novices, but their expected competence levels did not differ.

Discussion and conclusion: Differences were found between expert and novice clinicians regarding the importance of VPT KSA, but certain items were deemed important for entry-level practice. The findings lay the groundwork for the development of recommendations for entry-level VPT curriculum.

Background and purpose: Individuals with multiple sclerosis (MS) experience mobility declines and an increased risk of falls. Studies in MS have suggested backward walking (BW) as a promising intervention to improve mobility, yet the impact of BW on reactive balance, physical activity, prospective falls, and brain structure has not been explored. The purpose of this case series was to examine feasibility, acceptability, and impact of 8 weeks of BW training (BWT) on gait speed, static and reactive balance, fall incidence, physical activity, and white matter microstructure. A secondary aim was to explore concurrent changes in structure and function with BWT.

Case description: Eight ambulatory individuals with relapsing-remitting MS performed forward walking (FW) and BW, static and reactive balance tests, and underwent myelin water imaging (MWI) pre- (baseline) and post-intervention. MWI metrics were extracted from the body of the corpus callosum, superior cerebellar peduncle, and corticospinal tract. Physical activity was measured for 1 week before and after the intervention, and falls were monitored prospectively for 6 months.

Intervention: Eight weeks of laboratory (1×/week) and home-based (2×/week) BWT; in the laboratory, individuals performed treadmill and overground BW followed by functional exercises incorporating backward stepping. At home, participants performed overground BW and the same functional exercises.

Outcomes: BWT was feasible (100%) and acceptable (96.9%). All participants exhibited increased microstructural changes on the MWI metrics in at least 1 region of interest. Participants demonstrated decreases in sway area during static balance tasks (7/8), decreases in postural latency during reactive stepping (7/8), increases in BW velocity (6/8), and increases in FW velocity (4/8). There was a decrease in fall rate from baseline to 6 months post-intervention (4/7).

Discussion: Eight weeks of BWT resulted in structural and functional changes; however, a larger sample size is needed to determine the clinical significance and generalizability of these findings.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A564 .

Background and purpose: Stroke clinicians need access to cost-effective, accurate, and time-efficient tools that can assist with cardiorespiratory fitness (V̇O 2 peak) screening. The associations and diagnostic metrics between physical activity as measured by the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) and V̇O 2 peak 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, V̇O 2 peak, and PASIPD were included in adjusted logistic regression analyses. The association between the PASIPD (MET-hours/day) and V̇O 2 peak at 15, 12, and 18 mL/kg/min was evaluated to reflect the average, lower, and upper limits of V̇O 2 peak 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 V̇O 2 peak ≥ 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 V̇O 2 peak ≥ 12 mL/kg/min (aOR = 1.15; 95% CI 1.01, 1.14; P = .046) but not for V̇O 2 peak ≥ 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 V̇O 2 peak ≥ 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 V̇O 2 peak impairments post-stroke.

Background and purpose: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a well-established tool for assessing disability. However, diverse factor structures complicate its interpretation, necessitating further validation. This study examined the factorial validity of the 32-item WHODAS 2.0 in persons with stroke using 1-factor, 6-factor, and 2-level hierarchical structures.

Methods: A cross-sectional design was used with data from 1343 persons with stroke in the Taiwan Databank of Persons with Disabilities. Confirmatory factor analysis (CFA) was used to determine the valid structure of the 32-item WHODAS 2.0.

Results: The 1-factor structure exhibited poor model fits, while the 6-factor and the overall 2-level hierarchical structure had acceptable model fits. However, the relationships between domains and overall score of the 2-level structure yielded poor fits. Excellent internal consistencies (Cronbach's α ≥ 0.90) were obtained for the 6 domain scores and the overall score.

Discussion and conclusions: Our results revealed poor model fit for the 1-factor model, whereas the 6-factor structure and the overall 2-level hierarchical structure were both acceptable. However, the relationships between domains and the overall score within the 2-level structure were poor. The 6-factor model is preferable due to its better fit and alignment with WHODAS 2.0's design to assess multiple life perspectives. The 6-domain structure appears the most robust for persons with stroke. Thus, the 6 domain scores of the 32-item WHODAS 2.0 are recommended.

Purpose: Moderate-to-high intensity locomotor training (M-HIT) is strongly recommended in stroke rehabilitation, but outcomes are variable. This study aimed to identify baseline clinical characteristics that predict changes in walking capacity following M-HIT in chronic stroke.

Methods: This analysis used data from the HIT-Stroke Trial ( N = 55), which involved up to 36 sessions of either moderate- or high-intensity locomotor training. A prespecified model assessed how well baseline motor impairment (Fugl-Meyer lower limb motor scale [FM-LL]), comfortable gait speed (CGS), and balance confidence (Activities-specific balance confidence scale [ABC]) independently explain changes in 6-minute walk distance (∆6MWD), while controlling for the treatment group. Exploratory analysis tested additional baseline covariates using the all-possible regressions procedure. The predictive value of each potential covariate was assessed by its average contribution to the explained variance in ∆6MWD (∆pseudo- R2 ).

Results: With the prespecified model, 8-week ∆6MWD was significantly associated with baseline FM-LL (β = 5.0 [95% CI: 1.4, 8.6]) and ABC (β = 0.7 [0.0, 1.4]), but not CGS (β = - 44.6 [-104.7, 15.6]). The exploratory analysis revealed that the top 7 covariates with the highest mean ∆pseudo- R2 were FM-LL, pain-limited walking duration, ABC, the use of an assistive device, fatigue, depression, and recent walking exercise history >2 days per week.

Discussion and conclusions: On average, participants with less motor impairment and higher balance confidence exhibit greater walking capacity improvements after M-HIT in chronic stroke. Additional negative predictive factors may include pain-limited walking duration, use of an assistive device, fatigue, depression, and recent walking exercise; however, these exploratory findings need to be confirmed in future studies.

Video abstract: Supplemental Digital Content available at [ http://links.lww.com/JNPT/A533 ].