Journal of Rehabilitation Medicine最新文献

Objective: The aim of the study was to investigate postural balance and functional muscle strength over 1 year following hospital discharge due to COVID-19 and identify possible differences depending on age, sex, and level of hospital care.

Design: A prospective longitudinal study.

Subjects: A total of 164 participants were included.

Methods: Postural balance, functional leg strength, and functional hand strength were evaluated. Change over time and differences between groups were investigated.

Results: At the 1-year follow-up postural balance was improved (p = 0.001), as well as strength in the hands (p = 0.001), and legs (p = 0.001). Participants treated at an intensive care unit (ICU) had impaired functional muscle strength in the hands but not in the legs 1 year after discharge. Functional muscle strength in dominant hand on discharge, age, and previous level of physical activity were associated with having more impaired functional muscle strength in the dominant hand 1 year after discharge.

Conclusion: Functional muscle strength and postural balance after COVID-19 improved significantly from discharge to the 1-year follow-up although nearly half of the patients still had impaired functional muscle strength 1 year after COVID-19 hospitalization.

Trial registration: FoU i Sverige (Research & Development in Sweden, Registration number: 274476, registered 2020-05-28).

Objective: The primary aim of this study is to compare the effectiveness of early active limb movement facilitated by virtual reality technologies with conventional exercise therapy in enhancing patient recovery in the Respiratory Intensive Care Unit. The follow-up period covers 1 week.

Methods: In this prospective randomized controlled trial, patients were allocated to either a control group, which received standard exercise therapy, or a virtual reality group, which utilized virtual reality software and equipment for active exercises. Patients were followed for 1 week. The study compared compliance, safety, and rehabilitative outcomes between these groups. Data were analysed using a linear mixed-effects model.

Results: Patients in the virtual reality-based exercise group exhibited significantly higher levels of average daily exercise time, out-of-bed exercise time, and overall exercise compliance compared with the control group (p < 0.05). There were no reports of adverse events related to exercise in either group. Notably, within the first week of intervention, the virtual reality-based exercise group showed significant improvements in various parameters, including muscle strength, grip strength, body mass index, and the Barthel Index, outperforming the control group in these areas (all p < 0.05).

Conclusion: Based on 1 week of follow-up data, the study confirms that virtual reality-based exercise modalities are more efficacious than traditional exercise approaches in enhancing exercise duration, compliance, and various health outcomes in Respiratory Intensive Care Unit patients. This approach also contributes to reducing Respiratory Intensive Care Unit stay duration. The system's effectiveness could be further increased by integrating more varied and engaging rehabilitation games and features tailored to the needs of ICU patients.

Trial registration: Chictr.org: ChiCTR1900021452.

Objective: This study aims to identify characteristic gait patterns in people with multiple sclerosis, to describe their key characteristics, and to identify their potential underlying causes.

Design: a 3-round Delphi study.

Participants: An international panel of 20 experts, including physiotherapists, a neurologist, rehabilitation physicians, biomechanical engineers, and movement scientists with expertise in multiple sclerosis or gait analysis.

Methods: A comprehensive list of gait characteristics and underlying impairments was compiled and analysed to identify common gait patterns and their primary features and potential causes. Consensus was defined as 67% agreement.

Results: Consensus was reached on 6 gait patterns in multiple sclerosis: (i) drop foot; (ii) insufficient push-off; (iii) stiff knee during swing; (iv) knee hyperextension during stance; (i) knee flexion in midstance; and (vi) enhanced gait variability. At least 69% agreement was achieved on the naming of the final gait patterns, their key characteristics, and the potential causes of each pattern.

Conclusion: Consensus was achieved on 6 gait patterns, their characteristics, and potential underlying causes. The identification of these gait patterns may support clinical decision-making regarding diagnostic and treatment measures, and deepen understanding of impairments that underlie walking problems in people with multiple sclerosis.

Objective: This study aimed to investigate the relationship between brain lesions and trunk function impairment in stroke patients.

Design: Retrospective cohort study.

Subjects/patients: One hundred fifty-six first-time stroke patients admitted for rehabilitation between August 2021 and October 2023.

Methods: Trunk function was assessed using the Trunk Control Test. Brain lesions were detected using magnetic resonance imaging scans. Support vector regression lesion-symptom mapping was used to identify brain lesions associated with trunk function on admission and discharge, adjusted for lesion volume, age, and lower limb motor impairment.

Results: After adjusting for age, admission trunk function was linked to lesions in the right corticospinal tract, superior longitudinal fasciculus, superior thalamic radiation, and putamen. Further adjustment for lower limb motor impairment revealed associations not only with all aforementioned regions, but also with lesions in the right supplementary motor area and premotor cortex. For trunk function on discharge, no suprathreshold regions were found.

Conclusion: Early post-stroke trunk control impairment was associated with lesions in the right hemisphere, which is involved in motor function, motor control, and sensory integration. These findings provide insights into trunk dysfunction mechanisms, and suggest that targeted rehabilitation could improve trunk control and independence in daily activities for stroke patients.

is missing (Corrigendum) This Corrigendum relates to the following article: https://doi.org/10.2340/jrm.v56.40055.

Objective: The feasibility, safety, and efficacy of automated multi-channel functional electrical stimulation-assisted gait training was assessed in individuals with chronic incomplete spinal cord injury, using an electrical stimulation suit with built-in surface electrodes and motion capture sensors (Teslasuit).

Design: 10-week functional electrical stimulation-assisted gait training, twice weekly for 30 min.

Subjects/patients: Five individuals with chronic incomplete spinal cord injury (≥ 12 months post-injury, ASIA C/D, minimal Walking Index Spinal Cord Injury II ≥ 9).

Methods: The quadriceps, gluteii, hamstrings, tibialis anterior, and gastrocnemius muscles were stimulated bilaterally during gait. Feasibility and safety were evaluated via questionnaires, session adherence, and adverse events. Gait function was assessed using a 10 m walk test, Walking Index Spinal Cord Injury II, and Hoffer classification at baseline, post-intervention, and follow-up. Surface electromyography and spatiotemporal parameters (walking speed, step length and width, cadence) were recorded during the 10 m walk test.

Results: All participants completed the training (91% adherence) with no serious adverse events. Temporary skin redness, muscle soreness, and fatigue were reported by participants. Post-intervention, 4 participants increased their walking speed, step length, and cadence, with 2 maintaining and 2 further improving at follow-up. No consistent changes were found in muscle activity post training.

Conclusion: Automated multi-channel functional electrical stimulation-assisted gait training was feasible, safe, and well received. Preliminary findings suggest that gait improved in most participants, though individual responses varied. The results highlight the potential of multi-channel functional electrical stimulation-assisted gait training as a valuable tool for enhancing gait recovery.

Objective: To determine the time course of longitudinal changes in the independence level of toileting-related subtasks in post-stroke patients.

Design: Single-institution, prospective cohort study.

Subjects/patients: A total of 101 consecutive patients with stroke admitted to subacute rehabilitation wards who urinated/defecated in bathrooms using wheelchairs upon admission.

Methods: Occupational therapists assessed the independence level of patients in each of the 24 toileting subtasks on a 3-level rating scale using the Toileting Tasks Assessment Form every 2-4 weeks from admission to the endpoint (achieving independent toileting or discharge). Patients were classified based on admission and endpoint assessment form scores using a two-step cluster analysis.

Results: Patients were classified into Cluster 1 (30 patients who exhibited a greater independence level in all subtasks upon admission [46.7-100% of patients performed each subtask independently] to the endpoint [73.3-100%]), Cluster 2 (41 patients who showed less independence upon admission [0-26.8%] but gained greater independence at the endpoint [34.1-73.2%]), and Cluster 3 (30 patients whose independence levels remained low in many subtasks from admission [0-26.7%] to the endpoint [3.3-26.7%]).

Conclusion: Changes in toileting independence levels could be classified into 3 time courses. Effective intervention strategies may differ between each group.

Objective: To assess the efficacy of anticipatory postural adjustments training on the ability to successfully step from freezing of gait, and to evaluate the contribution of attentional processes to potential benefits using an additional attentional-control training intervention.

Design: Crossover-design.

Subjects/patients: Nineteen people with Parkinson's and freezing (females: 10; age:75.5 ± 7.5 years) tested while ON medication.

Methods: Participants navigated a cluttered virtual domestic environment with freeze-provoking tasks. Assessments occurred in the laboratory at baseline, post-anticipatory postural adjustments training, and post-attentional-control training, with randomized training order. All training was video-based. Video annotation was used to identify freezing events. Participants' immediately recollected thoughts they had during the tasks were analysed with content analysis. Perceived safety and effectiveness of the strategies were reported in follow-up calls held 4 weeks post-assessment.

Results: Successful step initiations increased from 57% at baseline to 77% post-anticipatory postural adjustments training (p = 0.034). Participants rated the interventions as safe and effective, reporting increased balance confidence (70% to 90%), and reduced fear (p = 0.01), after the anticipatory postural training. Attentional-control training alone was perceived as less effective compared with more goal-directed anticipatory postural adjustments training.

Conclusion: Video-based anticipatory postural adjustments training significantly improved step initiation from freezing when used during challenging tasks and in complex environments. Anticipatory postural adjustments training shows promise as an effective "rescue strategy" that could be learned remotely/at home.

Objective: Because employees with low educational levels have the highest rates of sick leave, this study aimed to identify the self-perceived return-to-work barriers of employees with low educational levels on long-term sick leave.

Methods: Employees on long-term sick leave with primary/secondary educational attainment were included from the NOW WHAT large-scale interview study (n = 122). The World Health Organization's system of classifying functioning, disability, and health guided the deductive content analysis.

Results: 1,942 meaning units describing return-to-work barriers across all classifications were identified. The most frequent components were body functions (n = 552, 28%, mean = 4.5), with mental functions (e.g., sleep, tiredness, emotional and cognitive functioning) the most frequent barriers; environmental factors (n = 414, 21%, mean = 3.4), with services, systems ,and policies (e.g., social security, healthcare system) the most prevalent barriers; activity limitations (n = 352, 18%, mean = 2.9); and personal factors (n = 323, 17%, mean = 2.6).

Conclusion: Employees with low educational levels on long-term sick leave described a wide range of return-to-work barriers and combinations thereof. In addition to health-related functional barriers, identifying environmental, activity-limitation, and personal barriers is important to enhance understanding of this group's potential determinants of absence from work.

Background: Individuals with more education commonly have better outcome after brain injury, often attributed to cognitive reserve. However, evidence suggests that individuals with more education have better access to specialized care, potentially affecting outcomes.

Objective: To investigate differences in healthcare usage based on cognitive reserve and examine the relationship between healthcare usage and outcomes after stroke and traumatic brain injury.

Design: An observational cohort study with healthcare usage data from 3 years before to 4 years after injury, interviewing patients 5-15 years after injury.

Patients: A total of 83 participants suffering a stroke or traumatic brain injury.

Results: Healthcare usage over time varied based on educational level (repeated measures ANOVA, F(2, 227) = 4.17, p = 0.008). The differences in healthcare usage between educational levels was significant during the injury year (F(81) = -5.47, p = 0.022). Higher education implied more healthcare usage. Linear regression, controlling for possible confounders, confirmed the relationship between education and healthcare usage, (β = 4.3, p = 0.022). Healthcare usage was significantly related to long-term life satisfaction, but not to return to work.

Conclusion: Individuals with more education received more healthcare in the year after traumatic brain injury or stroke. However, this was not related to long-term outcome regarding return to work, but we found a relationship between healthcare usage and life satisfaction.