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Are specific, measurable, action-oriented, realistic, and time-bound (SMART) goals associated with improved walking outcomes for stroke survivors undergoing outpatient stroke rehabilitation? An observational cross-sectional retrospective cohort study 具体的、可测量的、以行动为导向的、现实的、有时限的(SMART)目标是否与接受门诊卒中康复治疗的卒中幸存者步行效果的改善有关?一项观察性横断面回顾性队列研究
Pub Date : 2024-09-06 DOI: 10.1101/2024.09.05.24313054
Helia Mohammadi-Ghayeghchi, Nidhi Bhagat, Mackenzie Campbell, Madi Mayhew, Rheall Dufresne, Levi Ewald, Augustine J. Devasahayam, Avril Mansfield
Background Goal-setting is a core principle used in clinical practice to guide treatment. Setting goals improves adherence to rehabilitation treatments and may lead to better outcomes in people with neurological disorders. However, there is a lack of research into the prevalence of goals using a Specific, Measurable, Action-Oriented, Realistic, and Time-Bound (SMART) framework. Additionally, it is currently unclear if the SMART framework improves ambulatory outcomes in outpatient stroke rehabilitation.
背景设定目标是临床实践中用于指导治疗的核心原则。设定目标可提高康复治疗的依从性,并可为神经系统疾病患者带来更好的治疗效果。然而,目前还缺乏对使用 "具体、可衡量、以行动为导向、现实、有时限"(SMART)框架设定目标的普遍性的研究。此外,目前还不清楚 SMART 框架是否能改善中风康复门诊的非卧床治疗效果。
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引用次数: 0
Research report CERITER Clinical study - Stride One 研究报告 CERITER 临床研究 - Stride One
Pub Date : 2024-09-04 DOI: 10.1101/2024.09.04.24312478
Sarah Meyer, Jan Limet, Piet Stevens, Marc Michielsen
Objective This study investigates the short-term impact of the use of Ceriter Stride One on the quality of gait in patients rehabilitating after a cerebrovascular accident (CVA). Stride One is a smart insole that provides real-time audio feedback (cues) to the patient when performing a certain exercise. The goal of Stride One is to allow patients to practice walking more intensively and with higher quality during rehabilitation.
本研究调查了使用 Ceriter Stride One 对脑血管意外(CVA)后康复患者步态质量的短期影响。Stride One 是一种智能鞋垫,可在患者进行某种运动时向其提供实时音频反馈(提示)。Stride One 的目标是让患者在康复期间进行更密集、更高质量的步行练习。
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引用次数: 0
Understanding Bilateral Motor Coordination in Stroke Using the Towel Folding Task: An Exploratory Biomechanical Study 通过折叠毛巾任务了解脑卒中患者的双侧运动协调能力:一项探索性生物力学研究
Pub Date : 2024-09-04 DOI: 10.1101/2024.09.03.24313027
Jingyi Wu, Patrick Wai-Hang Kwong, Ananda Sidarta, Jack Jiaqi Zhang, Jingwen Zhuang, Yining Li, Kenneth NK Fong
Objectives Coordination deficits in bilateral upper limbs make daily activities more difficult for stroke survivors. Previous studies showed worse kinematics during unilateral tasks compared to healthy individuals, but this was unclear for bimanual tasks. We aim to assess the potential of the towel folding task from the Wolf Motor Function Assessment as a measure of bimanual control by examining kinematic differences between stroke survivors and healthy individuals and correlating these differences with clinical parameters in the stroke group.
目的 双侧上肢的协调障碍使中风幸存者的日常活动更加困难。以前的研究表明,与健康人相比,单侧任务中的运动学表现较差,但双臂任务的情况尚不清楚。我们旨在通过研究中风幸存者与健康人之间的运动学差异,并将这些差异与中风组的临床参数相关联,来评估沃尔夫运动功能评估中的毛巾折叠任务作为双臂控制测量的潜力。
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引用次数: 0
Red flags useful to screen for suspect cancer in patients with low back pain: a scoping review protocol 有助于筛查腰背痛患者疑似癌症的红旗:范围界定审查方案
Pub Date : 2024-09-01 DOI: 10.1101/2024.09.01.24311072
Gianluca Notarangelo, Giuseppe Giovannico, Francesco Bruno, Claudia Milella, Firas Mourad, Filippo Maselli
Low back pain (LBP) is defined as pain and discomfort occurring under the costal arch and above the inferior gluteal folds, with or without leg pain. The most common type of low back pain is “non-specific low back pain”. It is defined as such because there is no specific pathology that can be the cause. Instead, “specific low back pain” is caused by diseases such as infections, tumors, osteoporosis, ankylosing spondylitis, fractures, inflammatory processes, radicular syndromes, cauda equina syndrome, etc. It is the most common musculoskeletal disorder in the world and the most cause of disability.
腰背痛(LBP)是指发生在肋弓下方和臀下皱襞上方的疼痛和不适,伴有或不伴有腿部疼痛。最常见的腰痛类型是 "非特异性腰痛"。之所以定义为 "非特异性腰痛",是因为没有特定的病理原因。相反,"特异性腰背痛 "是由感染、肿瘤、骨质疏松症、强直性脊柱炎、骨折、炎症过程、根性综合征、马尾综合征等疾病引起的。它是世界上最常见的肌肉骨骼疾病,也是导致残疾的最主要原因。
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引用次数: 0
Priority Setting for Multicenter Research Among Adults with Cerebral Palsy: A Qualitative Study 确定脑瘫成人多中心研究的优先事项:定性研究
Pub Date : 2024-08-29 DOI: 10.1101/2024.08.28.24312747
Cristina A. Sarmiento, Mary Gannotti, Jocelyn Cohen, Edward Hurvitz
Purpose Identify priorities for adult cerebral palsy (CP) research by engaging individuals with lived experience, clinical investigators, and community leaders.
目的 通过让有生活经验的个人、临床研究人员和社区领袖参与进来,确定成人脑瘫 (CP) 研究的优先事项。
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引用次数: 0
Effects of maximal speed locomotor training on spatiotemporal gait changes in individuals with chronic stroke: A secondary analysis of a randomized controlled trial 最大速度运动训练对慢性中风患者步态时空变化的影响:随机对照试验的二次分析
Pub Date : 2024-08-28 DOI: 10.1101/2024.08.27.24312508
Daria Pressler, Sarah M. Schwab-Farrell, Darcy S. Reisman, Sandra A. Billinger, Pierce Boyne
Objective To investigate longitudinal changes in spatiotemporal gait parameters after maximal versus moderate speed locomotor training in chronic stroke, by comparing short-burst high-intensity interval training (HIIT) versus moderate-intensity aerobic training (MAT). Compared to MAT, short-burst HIIT was hypothesized to exhibit greater improvement in non-paretic step length.
目的 通过比较短脉冲高强度间歇训练(HIIT)与中等强度有氧训练(MAT),研究慢性中风患者在接受最大速度与中等速度运动训练后,步态时空参数的纵向变化。与中等强度有氧训练相比,短促高强度间歇训练被认为能更有效地改善非运动步长。
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引用次数: 0
Gait Adaptations to Walking Speeds in Individuals with Myotonic Dystrophy Type 1 1 型肌张力营养不良症患者步态对步行速度的适应性
Pub Date : 2024-08-28 DOI: 10.1101/2024.08.28.24312607
Hoerter Barthelemy, Laurent Ballaz, Yosra Cherni
BackgroundMyotonic dystrophy type 1 (DM1) is a prevalent inherited muscular dystrophy in adults, affecting distal muscles such as the gastrocnemius, soleus, and tibialis anterior. This leads to significant gait deviations and reduced walking speed, impacting overall well-being and increasing fall risk.ObjectiveThis study aimed to assess how walking speed affects gait kinematics in individuals with DM1. MethodsEighteen individuals with genetically confirmed DM1 (4 women, age: 41.0 [35.5; 47.8] years, mass: 76.8 [67.1; 94.6] kg, height: 166.0 [156.7; 173.3] cm) participated in this study. Each participant walked barefoot along a 13-meter walkway at comfortable and fast speeds. Subsequently, spatiotemporal parameters and joint kinematics were assessed. ResultsThe step length (p < 0.001), cycle speed (p < 0.001), and cadence (p < 0.001) increased significantly, leading to a higher walking speed. Moreover, the vertical amplitude of the center of mass (CoM) increased significantly (p = 0.015), while the mediolateral amplitude decreased (p = 0.001) at fast walking condition. In addition, significant kinematic changes included increased trunk tilt (p < 0.001), greater anterior pelvic tilt (p < 0.001), increased hip flexion at initial contact, and enhanced knee flexion during both stance and swing phases. Ankle dorsiflexion showed a trend towards increase during stance phase (p = 0.055) at fast walking condition.ConclusionsFast walking speed in individuals with DM1 lead to significant gait adaptations. These adaptations reflect compensatory mechanisms to manage muscle weakness. The present study revealed significant changes in spatiotemporal parameters related to walking speed. Fast walking also highlighted kinematic adaptations in trunk, pelvis and lower limb joints. These findings enhance our understanding of gait deviation in individuals with DM1 and suggest the potential benefits of targeted fast walking training in this population.
背景1型肌营养不良症(DM1)是成人中常见的遗传性肌肉营养不良症,影响腓肠肌、比目鱼肌和胫前肌等远端肌肉。本研究旨在评估步行速度如何影响 DM1 患者的步态运动学。方法18名经基因确认的DM1患者(4名女性,年龄:41.0 [35.5; 47.8]岁,体重:76.8 [67.1; 94.6]公斤,身高:166.0 [156.7; 173.3]厘米)参加了本研究。每位参与者都赤脚在 13 米长的人行道上以舒适和快速的速度行走。随后,对时空参数和关节运动学进行了评估。结果步长(p <0.001)、循环速度(p <0.001)和步频(p <0.001)显著增加,从而提高了步行速度。此外,在快走状态下,质量中心(CoM)的垂直振幅明显增加(p = 0.015),而内外侧振幅则下降(p = 0.001)。此外,明显的运动学变化包括躯干倾斜度增加(p = 0.001)、骨盆前倾幅度增大(p = 0.001)、初始接触时髋关节屈曲度增加,以及在站立和摆动阶段膝关节屈曲度增加。在快步行走条件下,踝关节背屈在站立阶段有增加趋势(p = 0.055)。这些适应反映了控制肌无力的代偿机制。本研究揭示了与步行速度相关的时空参数的显著变化。快速行走还突显了躯干、骨盆和下肢关节的运动适应性。这些发现加深了我们对DM1患者步态偏差的理解,并表明在这一人群中进行有针对性的快走训练可能会带来益处。
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引用次数: 0
Predicting Walking Capacity Outcomes After Moderate to High Intensity Locomotor Training in Chronic Stroke 预测慢性中风患者接受中高强度运动训练后的行走能力结果
Pub Date : 2024-08-26 DOI: 10.1101/2024.08.24.24312537
Christina Garrity, Darcy S Reisman, Sandra A Billinger, Katie A Butera, Pierce Boyne
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 change 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 Balance Confidence scale [ABC]), independently explain changes in 6-minute walk distance (Δ6MWD), while controlling for treatment group. Exploratory analysis tested additional baseline covariates using the all-possible regressions procedure. The prognostic value of each potential covariate was assessed by its average contribution to the explained variance in Δ6MWD (Δ pseudo-R2). Results: With the prespecified model, 8-week Δ6MWD 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 the top 7 covariates with the highest mean Δ 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.Conclusions: On average, participants with less motor impairment and higher balance confidence have greater walking capacity improvements after M-HIT in chronic stroke. Additional negative prognostic factors may include pain-limited walking duration, use of an assistive device, fatigue, depression, and recent walking exercise but these exploratory findings need to be confirmed in future studies.
目的:中风康复强烈建议进行中高强度运动训练(M-HIT),但结果却不尽相同。本研究旨在确定可预测慢性中风患者接受 M-HIT 后行走能力变化的基线临床特征:本分析使用了 HIT-Stroke 试验(N=55)的数据,该试验涉及多达 36 个疗程的中等强度或高强度运动训练。预设模型评估了基线运动障碍(Fugl-Meyer下肢运动量表[FM-LL])、舒适步态速度(CGS)和平衡信心(活动平衡信心量表[ABC])在控制治疗组的同时,对6分钟步行距离(Δ6MWD)变化的独立解释能力。探索性分析使用全可能回归程序测试了其他基线协变量。每个潜在协变量的预后价值根据其对Δ6MWD解释方差的平均贡献率(Δ伪R2)进行评估。结果:在预设模型中,8 周 Δ6MWD 与基线 FM-LL (β=5.0 [95% CI: 1.4, 8.6])和 ABC (β=0.7 [0.0, 1.4])显著相关,但与 CGS (β=-44.6 [-104.7, 15.6])无关。探索性分析显示,平均 Δ 伪 R2 最高的前 7 个协变量是FM-LL、疼痛限制行走时间、ABC、使用辅助设备、疲劳、抑郁和最近每周2天的行走锻炼史:平均而言,运动障碍程度较轻、平衡信心较高的慢性中风患者在接受 M-HIT 治疗后,步行能力会有更大的改善。其他不良预后因素可能包括疼痛限制步行时间、使用辅助设备、疲劳、抑郁和最近的步行锻炼,但这些探索性发现还需要在未来的研究中得到证实。
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引用次数: 0
A low-cost virtual reality stroke rehabilitation system: breaking down barriers to treatment 低成本虚拟现实中风康复系统:打破治疗障碍
Pub Date : 2024-08-26 DOI: 10.1101/2024.08.23.24312233
Aidan Fisk, Summer Fox, Jenna Floyd, Daniel H Blustein
Stroke is a leading cause of disability worldwide. Following a stroke, high doses of intensive motor rehabilitation provide maximal benefit. Barriers to realizing recommended levels of rehabilitation therapy include cost, physical access, and clinical resource availability. Virtual Reality (VR) offers a potential solution to overcome these challenges and enable home-based, self-directed therapy. Here we present a low-cost system utilizing the off-the-shelf Meta Quest 2 headset running custom software to deliver immersive rehabilitation exercises. The system employs movement amplification to partially reduce motor deficits and enable more engaging task completion. It leverages recent advances in VR technology, including hand tracking, voice recognition, and an AI-driven virtual coach, to create a more accessible environment for users with no prior VR experience. We tested the system in 60 able-bodied participants to assess feasibility for eventual clinical use. Participants completed three VR tasks with 30 participants receiving motor amplification. We measured motion sickness levels and attitudes towards the technology, while generating a set of normative motor performance data. Results showed no significant effect of amplification on motor performance, indicating that the small amplification factors applied in this healthy sample did not markedly impact task outcomes. User attitudes towards VR improved after the experience and minimal motion sickness was reported. This study suggests that low-cost VR systems may serve as a feasible option to increase post-stroke motor rehabilitation. Further study is needed to test the system in older adults and in stroke patients to determine feasibility in a more representative clinical setting.
中风是全球致残的主要原因。中风后,大剂量的强化运动康复治疗可带来最大益处。实现推荐康复治疗水平的障碍包括成本、物理访问和临床资源可用性。虚拟现实(VR)为克服这些挑战提供了一个潜在的解决方案,并实现了基于家庭的自主治疗。在这里,我们介绍一种低成本系统,它利用现成的 Meta Quest 2 头戴式设备,运行定制软件,提供身临其境的康复训练。该系统采用运动放大技术,可部分减少运动障碍,使任务的完成更具吸引力。它充分利用了 VR 技术的最新进展,包括手部跟踪、语音识别和人工智能驱动的虚拟教练,为没有 VR 经验的用户创造了一个更容易使用的环境。我们在 60 名健全参与者中测试了该系统,以评估最终用于临床的可行性。参与者完成了三项 VR 任务,其中 30 人接受了运动放大。我们测量了晕动症水平和对该技术的态度,同时生成了一组标准运动表现数据。结果显示,放大对运动表现没有明显影响,这表明在这个健康样本中应用的小放大系数不会对任务结果产生明显影响。体验后,用户对 VR 的态度有所改善,晕动症的报告也极少。这项研究表明,低成本的 VR 系统可以作为增加中风后运动康复的可行选择。还需要进一步研究,在老年人和中风患者中测试该系统,以确定在更具代表性的临床环境中的可行性。
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引用次数: 0
Comparison of Peripheral Nerve Injury Outcomes Between COVID-19 Survivors and Non-COVID Rehabilitation Inpatients: A Retrospective Study COVID-19 存活者与非 COVID 康复住院患者的周围神经损伤结果比较:回顾性研究
Pub Date : 2024-08-22 DOI: 10.1101/2024.08.22.24312439
Antonio Mondriguez-Gonzalez, Brian M Rothemich, Manasi N Sheth, Kevin N Swong, Colin K. Franz
Introduction: Peripheral nerve injury (PNI) is associated with severe Coronavirus disease 2019 (COVID-19) survivorship. The diagnosis of PNI is often made by a physiatrist during a detailed functional assessment during an inpatient rehabilitation stay. COVID-19 patients have elevated rates of medical comorbidities, including risk factors for acquired PNI, such as diabetes mellitus and obesity. It is not known if the functional prognosis from PNI in COVID-19 survivors differs substantially from PNI in other inpatient rehabilitation populations.Objective: To determine the prognosis of PNI associated with severe COVID-19 survivorship and compare it to PNI associated with other inpatient rehabilitation populations.Design: Retrospective chart review study.Setting: Single-center inpatient rehabilitation hospital in a large urban city. Patients: Adult patients admitted to an inpatient rehabilitation hospital with PNI(s).Interventions: Not applicable.Main Outcome Measures: The primary outcome was the change in manual muscle testing (MMT) over time. Secondary outcomes included the rate of peripheral nerve surgery and the number of distinct PNI sites per patient. Results: The analysis consisted of 60 subjects with PNI. We identified 30 subjects who had PNI associated with COVID-19 and were matched with 30 subjects with PNI not associated with COVID-19 who were diagnosed during their inpatient rehabilitation admission. The data collected included basic demographics, COVID-19 status immediately before inpatient rehabilitation admission, medical comorbidities, acute rehabilitation inpatient diagnosis, nerve injury location and mechanism of injury, muscles affected, and change in serial MMT, plus documentation of any surgical intervention. No significant difference was found between the improvement of MMT, surgery rate, or number of nerve injuries and COVID-19 status.Conclusion: PNIs associated with severe COVID-19 survivorship have similar recovery patterns as those of other etiologies. This data is reassuring that PNI associated with COVID-19 may be managed similarly to other types of PNI.
导言:周围神经损伤(PNI)与严重的冠状病毒病 2019(COVID-19)存活率有关。PNI的诊断通常是由物理治疗师在住院康复期间进行详细功能评估时做出的。COVID-19 患者的合并症发病率较高,其中包括糖尿病和肥胖等后天性 PNI 的风险因素。目前尚不清楚 COVID-19 存活者的 PNI 功能预后是否与其他住院康复人群的 PNI 有很大不同:确定与 COVID-19 严重幸存者相关的 PNI 的预后,并将其与其他住院康复人群的 PNI 进行比较:设计:回顾性病历研究:地点:大城市的单中心住院康复医院。患者干预措施:不适用:主要结果测量主要结果是徒手肌肉测试(MMT)随时间的变化。次要结果包括外周神经手术率和每位患者不同 PNI 位点的数量。分析结果分析包括 60 名患有 PNI 的受试者。我们确定了 30 名患有与 COVID-19 相关的 PNI 的受试者,并与 30 名患有与 COVID-19 无关的 PNI 的受试者进行了配对,这些受试者是在住院康复期间确诊的。收集的数据包括基本人口统计学特征、入院康复治疗前的 COVID-19 状态、合并症、急性康复住院诊断、神经损伤位置和损伤机制、受影响的肌肉、序列 MMT 的变化,以及任何手术干预的记录。结果发现,MMT、手术率或神经损伤数量的改善与 COVID-19 状态之间没有明显差异:结论:与严重 COVID-19 存活率相关的 PNI 与其他病因的恢复模式相似。这一数据令人欣慰,与 COVID-19 相关的 PNI 可按照与其他类型 PNI 相似的方式进行处理。
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引用次数: 0
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medRxiv - Rehabilitation Medicine and Physical Therapy
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