Archives of rehabilitation research and clinical translation最新文献_第2页

Integrating Fitness Training in Oncologic Care: Lessons Learned from a Large Telemedicine Trial 在肿瘤治疗中整合健身训练：从大型远程医疗试验中获得的经验教训。

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation

Pub Date : 2024-12-01 DOI: 10.1016/j.arrct.2024.100367

Karen S. Schaepe PhD , Jeffrey R. Basford MD, PhD , Andrea L. Cheville MD, MSCE

Objective

To provide insights from patients and clinicians regarding the benefits and barriers of the introduction of a telerehabilitation fitness program into the oncologic care of people with late-stage cancer.

Design

This study is a qualitative assessment of the COllaborative Care to Preserve PErformance in Cancer trial, which involved the insertion of a telerehabilitation fitness program into the oncologic care of patients with late-stage cancer.

Setting

A large midwestern medical center.

Participants

Thirty-one patients who matched the overall demographics of the study participants as well as 3 oncologists, 2 physical therapist fitness care managers (FCMs), nurse pain care manager, and 2 supervisory physicians involved in the study.

Interventions

Five hundred sixteen patients with late-stage (IIIC or IV) cancer were randomly assigned to 1 of 3 arms: a control group that received usual oncologic care and 2 intervention groups. The members of the latter continued with their usual care but also received either 6 months of a fitness program, with or without the addition of pain management assistance. All components were delivered via telemedicine with the fitness program consisting of progressive resistance and walking components.

Main Outcome Measures

Perceived benefits and shortcomings of the intervention were obtained via written narratives from the patients and as well as through interviews with the oncologists, FCMs, nurse pain care manager, and supervisory physicians involved in the study.

Results

Thematic analysis revealed 87% (27/31) of the participants found the program helpful. Regular contact with someone who understood their situation, helped improve their function, and encouraged active engagement in their care was perceived as particularly beneficial. The FCMs who worked remotely with participants to coordinate their exercise programs agreed that regular interactions with the patient facilitated engagement, education, and meaningful goal setting. The oncologists were supportive of the intervention but had concerns about patient suitability. The supervisory physicians noted a number of institutional barriers such as oncology workflows and the need for better sharing of information across disciplines.

Conclusions

A fitness program delivered via telemedicine was perceived as beneficial by the patients, the FCMs, and the supervising physicians. Success hinged on the quality of the interaction between patients and the FCMs. Institutional barriers to implementation seem similar to those encountered by many new programs that need to be inserted into the workflows of busy clinics and practices.

目的：为患者和临床医生提供关于将远程康复健身计划引入晚期癌症患者肿瘤护理的益处和障碍的见解。设计：本研究是对协作护理以保持癌症患者表现试验的定性评估，该试验涉及将远程康复健身计划纳入晚期癌症患者的肿瘤护理。环境：中西部一个大型医疗中心。参与者：31名符合研究参与者总体人口统计数据的患者，以及3名肿瘤学家，2名物理治疗师健身护理经理（fcm），护士疼痛护理经理和2名监督医生参与了研究。干预：516名晚期（IIIC或IV）癌症患者被随机分配到3组中的1组：接受常规肿瘤治疗的对照组和2个干预组。后者的成员继续他们的常规护理，但也接受了6个月的健身计划，有或没有额外的疼痛管理协助。所有组件都通过远程医疗提供，健身计划包括渐进式阻力和步行组件。主要结果测量：通过患者的书面叙述以及对参与研究的肿瘤学家、fcm、护士疼痛护理经理和监督医生的访谈，获得干预措施的感知益处和缺点。结果：专题分析显示87%（27/31）的参与者认为该计划有帮助。定期与了解他们情况的人接触，帮助改善他们的功能，并鼓励积极参与他们的护理，被认为是特别有益的。与参与者远程合作协调锻炼计划的fcm一致认为，与患者的定期互动促进了参与、教育和有意义的目标设定。肿瘤学家支持干预，但担心患者是否适合。督导医师注意到一些制度障碍，如肿瘤学工作流程和跨学科更好地共享信息的需要。结论：通过远程医疗提供的健身计划被患者、fcm和监督医生认为是有益的。成功与否取决于患者与fcm之间的互动质量。实施的制度障碍似乎与许多需要插入繁忙诊所和实践工作流程的新项目所遇到的障碍相似。

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引用次数: 0

Neurovisual Training With Acoustic Feedback: An Innovative Approach for Nystagmus Rehabilitation 听觉反馈神经视觉训练：眼球震颤康复的一种创新方法。

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation

Pub Date : 2024-12-01 DOI: 10.1016/j.arrct.2024.100371

Damiano Antognetti MD , Luca Maggiani DPT , Elena Gabbrielli DPT , Luca Allegrini MD , Stefania Dalise MD , Carmelo Chisari MD

Nystagmus has various clinical manifestations, including downbeat, upbeat, and torsional types, each associated with distinct neurologic features. Current rehabilitative interventions focusing on fixation training and optical correction often fail to achieve complete resolution. When nystagmus coexists with fragile X-associated tremor/ataxia syndrome (FXTAS), functional impairments worsen, particularly affecting balance. Recognizing these limitations, the authors propose an innovative approach using audiovisual stimulation to complement visual pursuit training and optical compensation, potentially improving rehabilitation outcomes. This study describes the case of a 60-year-old woman with worsening nystagmus and cerebellar ataxia suggestive of FXTAS who underwent a customized rehabilitation program. The program included 30 sessions involving audiovisual training and physical exercises. Visual performance assessments were conducted using AV-Desk and Nidek MP-1 microperimeters, with functional assessments including the Barthel Modified Index, 10-meter walking test, timed Up and Go, and Berg Balance Scale. After treatment, visual performance improved with reduced response times and higher success rates, especially without drugs. Fixation stability improved consistently using the bivariate contour ellipse area method. Functional assessments showed enhanced mobility and balance, with benefits sustained at the 6-month follow-up. The combined approach of audiovisual training, proprioceptive training, and targeted muscle strengthening has proven effective. Notable improvements in overall physical performance, especially in balance and gait, and a reduction in nystagmus severity were observed. Integrating audiovisual stimulation into rehabilitation protocols shows promising results in managing nystagmus and ataxia, significantly enhancing patients' quality of life. Further studies are needed to validate these findings and expand upon this approach.

眼球震颤有多种临床表现，包括低拍型、高拍型和扭转型，每一种都有不同的神经特征。目前的康复干预侧重于固定训练和光学矫正往往不能达到完全解决。当眼球震颤与脆性x相关震颤/共济失调综合征（FXTAS）共存时，功能损害加重，特别是影响平衡。认识到这些局限性，作者提出了一种创新的方法，使用视听刺激来补充视觉追求训练和光学补偿，可能改善康复结果。本研究描述了一名60岁的女性，患有严重的眼球震颤和小脑共济失调，提示FXTAS，她接受了定制的康复计划。该计划包括30个课程，包括视听训练和体育锻炼。使用AV-Desk和Nidek MP-1微周长进行视觉性能评估，功能评估包括Barthel修正指数、10米步行测试、计时Up and Go和Berg平衡量表。治疗后，视觉表现改善，反应时间缩短，成功率提高，特别是在没有药物的情况下。采用双变量轮廓椭圆面积法，固定稳定性持续提高。功能评估显示活动能力和平衡能力增强，在6个月的随访中获益持续。视听训练、本体感觉训练和有针对性的肌肉强化相结合的方法已被证明是有效的。观察到整体身体表现的显著改善，特别是平衡和步态，以及眼球震颤严重程度的降低。将视听刺激纳入康复治疗方案在治疗眼球震颤和共济失调方面显示出良好的效果，显著提高了患者的生活质量。需要进一步的研究来验证这些发现并扩展这种方法。

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引用次数: 0

Psychometrics of Wearable Devices Measuring Physical Activity in Ambulant Children With Gait Abnormalities: A Systematic Review and Meta-analysis 可穿戴设备测量步态异常患儿身体活动的心理测量学：系统回顾和荟萃分析。

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation

Pub Date : 2024-12-01 DOI: 10.1016/j.arrct.2024.100384

Huib van Moorsel MSc , Barbara Engels MSc , Jacek Buczny PhD , Jan Willem Gorter MD , Kelly Arbour-Nicitopoulos PhD , Tim Takken PhD , Raoul H.H. Engelbert PhD , Manon A.T. Bloemen PhD

Objective

To evaluate psychometrics of wearable devices measuring physical activity (PA) in ambulant children with gait abnormalities due to neuromuscular conditions.

Data Sources

We searched PubMed, Embase, PsycINFO, CINAHL, and SPORTDiscus in March 2023.

Study Selection

We included studies if (1) participants were ambulatory children (2-19y) with gait abnormalities, (2) reliability and validity were analyzed, and (3) peer-reviewed studies in the English language and full-text were available. We excluded studies of children with primarily visual conditions, behavioral diagnoses, or primarily cognitive disability. We performed independent screening and inclusion, data extraction, assessment of the data, and grading of results with 2 researchers.

Data Extraction

Our report follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed methodological quality with Consensus-based Standards for the selection of health measurement instruments. We extracted data on reported reliability, measurement error, and validity. We performed meta-analyses for reliability and validity coefficient values.

Data Synthesis

Of 6911 studies, we included 26 with 1064 participants for meta-analysis. Results showed that wearables measuring PA in children with abnormal gait have high to very high reliability (intraclass correlation coefficient [ICC]_{+, test-retest reliability}=0.81; 95% confidence interval [CI], 0.74-0.89; I²=88.57%; ICC_{+, interdevice reliability}=0.99; 95% CI, 0.98-0.99; I²=71.01%) and moderate to high validity in a standardized setting (r_{+, construct validity}=0.63; 95% CI, 0.36-0.89; I²=99.97%; r_{+, criterion validity}=0.68; 95% CI, 0.57-0.79; I²=98.70%; r_{+, criterion validity cutoff} _{point based}=0.69; 95% CI, 0.58-0.80; I²=87.02%). The methodological quality of all studies included in the meta-analysis was moderate.

Conclusions

There was high to very high reliability and moderate to high validity for wearables measuring PA in children with abnormal gait, primarily due to neurological conditions. Clinicians should be aware that several moderating factors can influence an assessment.

目的：评价可穿戴设备对因神经肌肉疾病引起的步态异常患儿身体活动（PA）的心理测量学。数据来源：检索PubMed， Embase, PsycINFO， CINAHL, SPORTDiscus，检索时间为2023年3月。研究选择：我们纳入了以下研究：(1)参与者是步态异常的2-19岁的可走动儿童，(2)进行了信度和效度分析，(3)有英文和全文的同行评议研究。我们排除了主要有视觉问题、行为诊断或主要有认知障碍的儿童的研究。我们与2名研究人员进行了独立筛选和纳入、数据提取、数据评估和结果分级。数据提取：我们的报告遵循系统评价和荟萃分析指南的首选报告项目。我们用基于共识的健康测量工具选择标准来评估方法学质量。我们提取了报告的信度、测量误差和效度的数据。我们对信度和效度系数值进行了meta分析。数据综合：在6911项研究中，我们纳入了26项1064名参与者进行meta分析。结果显示，可穿戴设备测量步态异常儿童PA具有高至极高的信度(类内相关系数[ICC]+，重测信度=0.81；95%置信区间[CI]， 0.74-0.89；我2 = 88.57%;ICC+，设备间可靠性=0.99；95% ci, 0.98-0.99；I 2=71.01%)和中至高效度(r +，结构效度=0.63；95% ci, 0.36-0.89；我2 = 99.97%;R +，标准效度=0.68；95% ci, 0.57-0.79；我2 = 98.70%;R +，基于标准效度截止点=0.69；95% ci, 0.58-0.80；我2 = 87.02%)。纳入meta分析的所有研究的方法学质量均为中等。结论：可穿戴设备测量主要由神经系统疾病引起的步态异常儿童的PA具有高至极高的信度和中至高的效度。临床医生应该意识到有几个缓和因素会影响评估。

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引用次数: 0

Adaptive Approaches to Exercise Rehabilitation for Postural Tachycardia Syndrome and Related Autonomic Disorders 体位性心动过速综合征及相关自主神经疾病的适应性运动康复方法。

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation

Pub Date : 2024-12-01 DOI: 10.1016/j.arrct.2024.100366

Lauren Ziaks PT, DPT, ATC , Kathryn Johnson PT, DPT , Kelsi Schiltz PT, DPT , Ryan Pelo PT, DPT, PhD , Guillaume Lamotte MD, MSc , Claudia Dal Molin DO, RMSK , Tae Chung MD , Melissa M. Cortez DO

Exercise is a well-documented, nonpharmacologic treatment for individuals with autonomic dysfunction and associated orthostatic intolerance, such as postural tachycardia syndrome and related disorders. Exercise has been shown to increase blood volume, reverse cardiovascular deconditioning, and improve quality of life. Current first-line standard of care treatment for autonomic dysfunction combines graded approaches to exercise with medications and lifestyle modifications. However, current exercise rehabilitation protocols for postural orthostatic tachycardia syndrome contain rigid timelines and progression paradigms that often threaten tolerability and adherence. In addition, they fail to account for clinical variables potentially critical to care and lack guidance for individualization, limiting accessibility to patients with co-morbidities that affect exercise appropriateness and safety. Therefore, we introduce an adaptive approach to exercise prescription for orthostatic intolerance that allows patient-specific modifications to meet functional goals for a wider spectrum of patients, thus improving adherence. The proposed approach integrates iterative physiological and symptomatic assessments to provide flexible, yet structured, exposure to aerobic exercise and strength training to improve functional capacity and tolerance of daily activities for patients with postural tachycardia syndrome and related autonomic disorders.

对于自主神经功能障碍和相关的直立性不耐受，如体位性心动过速综合征和相关疾病，运动是一种有充分证据的非药物治疗方法。运动已被证明可以增加血容量，逆转心血管疾病，提高生活质量。目前自主神经功能障碍的一线标准护理治疗结合了分级方法的运动与药物和生活方式的改变。然而，目前针对体位性心动过速综合征的运动康复方案包含严格的时间表和进展模式，这往往会威胁到耐受性和依从性。此外，它们没有考虑到可能对护理至关重要的临床变量，缺乏个体化指导，限制了患有影响运动适宜性和安全性的合并症患者的可及性。因此，我们引入了一种适应性方法来治疗直立性不耐受的运动处方，允许患者进行特定的修改，以满足更广泛患者的功能目标，从而提高依从性。该方法整合了反复的生理和症状评估，为体位性心动过速综合征和相关自主神经疾病患者提供灵活而有组织的有氧运动和力量训练，以提高其日常活动的功能能力和耐受性。

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引用次数: 0

Association of Step Count with Cardiorespiratory Fitness: Results from the Virtual 2-Minute Step Test 步数与心肺健康的关系：虚拟2分钟步数测试的结果。

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation

Pub Date : 2024-12-01 DOI: 10.1016/j.arrct.2024.100369

Krisann K. Oursler MD , Brandon C. Briggs PhD , Alicia J. Lozano MS , Nadine M. Harris MD , Vincent C. Marconi MD , Alice S. Ryan PhD , FIT VET Project Team

Objective

To test the hypothesis that step count based on a virtual 2-minute step test (2MST) predicts cardiorespiratory fitness (CRF).

Design

Cross-sectional study.

Setting

Veteran Affairs Medical Centers participating in a randomized trial of functional exercise training delivered by videoconferencing.

Participants

People with human immunodeficiency virus (HIV) (PWH) who were aged ≥50 years and clinically stable on antiretroviral therapy were eligible for the trial. Consecutive male participants who were enrolled prior to November 9, 2023 and completed a baseline 2MST and cardiopulmonary exercise test (CPET) were included in the cross-sectional study (N=74).

Intervention

None.

Main Outcome Measures

Step count was measured by a 2MST performed by live videoconferencing using the Rikli and Jones protocol. CRF was measured by peak oxygen utilization (VO₂peak) during a modified Bruce cardiopulmonary exercise testing.

Results

Most participants (62.2%) were ≥60 years of age. The mean (SD) VO₂peak was 23.6 (5.7) mL/kg/min, which represented 72.4% (SD, 14.1) of expected VO₂peak. Step count correlated with VO₂peak (r=0.47, P<.001). Multivariable linear regression showed that step count was significantly associated with VO₂peak independently of age and body mass index. Based on this model, the prediction of VO₂peak based on step count explained 60% of the variance in VO₂peak. A Bland-Altman plot showed good agreement between predicated and measured VO₂peak without heteroscedasticity.

Conclusions

The virtual 2MST predicted VO₂peak independently of age and body mass index in men with well-controlled HIV. In ambulatory populations with known impaired cardiorespiratory fitness, the virtual 2MST may be a feasible and valid estimate of VO₂peak that can be used in the telerehabilitation setting. Future work is required in more demographically diverse individuals with various chronic conditions.

目的：验证基于虚拟2分钟步数测试（2MST）的步数预测心肺适能（CRF）的假设。设计：横断面研究。背景：退伍军人事务医疗中心参与了一项通过视频会议提供的功能运动训练的随机试验。受试者：年龄≥50岁且经抗逆转录病毒治疗临床稳定的人类免疫缺陷病毒（HIV）（PWH）患者符合试验条件。在2023年11月9日之前连续入组并完成基线2MST和心肺运动测试（CPET）的男性参与者被纳入横断面研究（N=74）。干预:没有。主要结果测量：步数通过使用Rikli和Jones协议的实时视频会议进行的2MST测量。在改进的布鲁斯心肺运动试验中，通过峰值氧利用率（vo2峰值）来测量CRF。结果：大多数参与者（62.2%）年龄≥60岁。平均（SD） VO2peak为23.6 (5.7)mL/kg/min，占预期VO2peak的72.4% （SD, 14.1）。步数与VO2peak相关（r=0.47）， P2peak与年龄和体重指数无关。基于该模型，基于步数的VO2peak预测解释了VO2peak方差的60%。Bland-Altman图显示，预测的vo2峰与实测的vo2峰吻合良好，无异方差。结论：虚拟2MST预测vo2峰值独立于年龄和体重指数控制良好的男性HIV。在已知心肺功能受损的门诊人群中，虚拟2MST可能是一个可行和有效的vo2峰值估计，可用于远程康复设置。未来的工作需要更多的人口统计学不同的个体与各种慢性疾病。

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引用次数: 0

Perceived Barriers to Leisure-Time Physical Activity Among Physically Active Individuals With Spinal Cord Injury 脊髓损伤的体力活动个体在休闲时间体力活动中的感知障碍。

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation

Pub Date : 2024-12-01 DOI: 10.1016/j.arrct.2024.100380

Paul K. Watson BAppSci , Laura Stendell MPhysio , Camila Quel De Oliveira PhD , James W. Middleton MBBS, PhD , Mohit Arora PhD , Glen M. Davis PhD

Objective

To investigate barriers to leisure-time physical activity (LTPA) for physically active people with spinal cord injury (SCI).

Design

Prospective cross-sectional.

Setting

General community.

Participants

One hundred and five physically active individuals with SCI.

Interventions

Semi-structured interviews and surveys.

Main Outcome Measure

Participants were surveyed and interviewed to determine barriers and determinants of LTPA participation. SCI-specific physical activity (PA) guideline adherence was documented. Barriers were categorized using the capability, opportunity, motivation, and behavior model, and regression statistics were used to determine relationships between LTPA volume and barriers.

Results

Health problems, costs of equipment and programs, pain, and a lack of energy were the most common capability barriers, and a lack of accessible facilities, confidence in the knowledge and skill of a health professional, and a lack of time were common opportunity barriers. Motivation barriers pertained to self-consciousness in a fitness center and a lack of interest. Believing LTPA to be too difficult, uninteresting, and unable to improve health emerged as significant barriers to SCI-specific PA guideline adherence.

Conclusion

SCI-specific PA guideline adherence was below 50% in physically active individuals. There are still numerous capability and opportunity barriers that physically active people with SCI must overcome when engaging in LTPA. Motivational barriers such as feeling self-conscious in a fitness center significantly influence PA guideline compliance in this population. Service providers should emphasize the benefit of LTPA to people with SCI while providing LTPA options that facilitate enjoyment, interest, and inclusivity, particularly for those who do not meet PA guideline recommendations.

目的：探讨体力活动者脊髓损伤（SCI）休闲时间体力活动（LTPA）障碍。设计：前瞻性横断面。设置：普通社区。参与者：105名体力活动的SCI患者。干预措施：半结构化访谈和调查。主要结果测量：对参与者进行调查和访谈，以确定LTPA参与的障碍和决定因素。记录了sci特异性身体活动（PA）指南的遵守情况。使用能力、机会、动机和行为模型对障碍进行分类，并使用回归统计来确定LTPA量与障碍之间的关系。结果：健康问题、设备和方案的成本、疼痛和缺乏精力是最常见的能力障碍，而缺乏无障碍设施、对卫生专业人员的知识和技能的信心以及缺乏时间是常见的机会障碍。动机障碍与健身中心的自我意识和缺乏兴趣有关。认为LTPA太困难、无趣、不能改善健康成为sci特异性PA指南依从性的重大障碍。结论：运动个体的sci特异性PA指南依从性低于50%。肢体活跃的脊髓损伤患者在进行LTPA时仍然需要克服许多能力和机会障碍。动机障碍，如在健身中心感到自我意识显著影响该人群的PA指南依从性。服务提供者应强调LTPA对脊髓损伤患者的益处，同时提供LTPA选项，以促进享受、兴趣和包容性，特别是对那些不符合PA指南建议的患者。

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引用次数: 0

Assessing the Effect of Fatigue on Swallowing Function in Adults with Acute Stroke. A Pilot Study 评估疲劳对急性脑卒中患者吞咽功能的影响。试点研究。

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation

Pub Date : 2024-12-01 DOI: 10.1016/j.arrct.2024.100381

Hope E. Baylow DA

Objective

To determine if fatigue systematically effects the timing of swallowing events and to discuss underlying causes of fatigue other than peripheral neuromuscular fatigue.

Design

Pre-post within-subject repeated-measures design.

Setting

General acute care hospital and designated stroke center.

Participants

Thirteen patients (10 males and 3 females) aged 52-80 years (mean 64.84±9.58 y) with acute stroke and clinically suspected dysphagia.

Interventions

Under videofluoroscopy, each participant swallowed a pre- and post-study 1-mL liquid barium bolus and, in an attempt to fatigue the system, 30-45 additional bolus trials of varying amounts (ie, 5 mL, 10 mL, and bite-sized) and consistencies (ie, International Dysphagia Diet Standardisation Initiative Level 0-7).

Main Outcome Measures

Six temporal sequences (ie, oral, pharyngeal, and pharyngeal delay transit times and durations of laryngeal vestibule closure, cricopharyngeal opening, and laryngeal elevation) for 1-mL liquid boluses were measured pre- and postvideofluoroscopic swallowing study and compared.

Results

Findings indicated that only 2 of the 6 temporal factors yielded significant differences pre- to post fatigue. The postvideofluoroscopic 1-mL liquid swallow took longer than the pre-videofluoroscopic 1-mL liquid swallow in terms of pharyngeal transit (_1,11=5.362, P=.046) and pharyngeal delay time (F_1,11=5.228, P=.048).

Conclusions

These findings indicate that peripheral neuromuscular fatigue is unlikely to be the primary cause of the observed changes, as only 2 of the 6 temporal measures—pharyngeal transit time and pharyngeal delay time—were affected. In cases of peripheral neuromuscular fatigue, one would expect increases across all 6 timing measures due to the integrated nature of the swallowing process. Instead, the results suggest that the inconsistencies may stem from a delayed excitatory response of neurons or a delay in synaptic transmission within the nucleus tractus solitarius, potentially associated with stroke. This delay likely contributes to the prolongation of both pharyngeal transit and pharyngeal delay times. Thus, a model focused solely on peripheral neuromuscular fatigue does not fully account for the findings, highlighting the importance of considering central neural mechanisms in the clinical evaluation of swallowing disorders.

目的：确定疲劳是否系统性地影响吞咽事件的时间，并讨论疲劳的潜在原因，而不是周围神经肌肉疲劳。设计：主题前后重复测量设计。环境：普通急症护理医院和指定中风中心。参与者：急性脑卒中合并临床怀疑吞咽困难患者13例（男10例，女3例），年龄52 ~ 80岁（平均64.84±9.58岁）。干预措施：在视频透视下，每个参与者在研究前和研究后分别吞下1ml液体钡丸，并尝试使系统疲劳，进行30-45次不同剂量（即5ml， 10ml和一口大小）和浓度（即国际吞咽困难饮食标准化倡议0-7级）的额外丸试验。主要观察指标：测量1 ml液体丸在透视吞咽研究前后的6个时间序列（即口服、咽部和咽部延迟传递时间和喉前庭关闭、环咽打开和喉抬高的持续时间）并进行比较。结果：6个时间因素中只有2个在疲劳前后产生显著差异。在咽部过境时间（1,11=5.362，P= 0.046）和咽部延迟时间（f1,11 =5.228， P= 0.048）方面，透视后1 ml吞咽液比透视前1 ml吞咽液花费的时间更长。结论：这些发现表明，周围神经肌肉疲劳不太可能是观察到的变化的主要原因，因为6项时间测量中只有2项-咽传递时间和咽延迟时间受到影响。在周围神经肌肉疲劳的情况下，由于吞咽过程的整体性，人们会期望所有6个计时措施都增加。相反，结果表明，这种不一致可能源于神经元兴奋反应的延迟或孤立束核内突触传递的延迟，这可能与中风有关。这种延迟可能导致咽传递和咽延迟时间的延长。因此，仅关注周围神经肌肉疲劳的模型并不能完全解释这些发现，强调了在吞咽障碍的临床评估中考虑中枢神经机制的重要性。

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引用次数: 0

The Impact of Executive Function on Retention and Compliance in Physical Therapy in Veterans 执行功能对退伍军人物理治疗保留性和依从性的影响。

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation

Pub Date : 2024-12-01 DOI: 10.1016/j.arrct.2024.100383

Elisa F. Ogawa PhD , Rebekah Harris PT, DPT, PhD , Rachel E. Ward PhD , Mary-Kate Palleschi BA , William Milberg PhD , David R. Gagnon MD, PhD , Ildiko Halasz MD , Jonathan F. Bean MD, MPH

Objective

To examine retention and compliance to a novel physical therapy (PT) treatment among Veterans with and without executive function deficits (EFD+/EFD−).

Design

This study was a preplanned secondary analysis of an ongoing randomized controlled trial.

Setting

Outpatient PT at VA Boston Healthcare System.

Participants

Seventy-two community-dwelling middle-aged and older Veterans (mean age, 72 years [range 51-91]; 87% male) with gait speed between 0.5 and 1.0 m/second were recruited from primary care practices.

Interventions

Eight-week moderate-to-vigorous intensity PT program.

Main outcome measure

Veterans’ baseline mobility, retention (dropouts), and treatment compliance and posttreatment exercise compliance to 8-week PT treatment were evaluated based on their baseline EFD status.

Results

Of the 72 participants, 22% (n=16) were EFD+. Veterans with EFD+ at baseline had worse mobility performance (Short Physical Performance Battery [SPPB], 7.7 vs 9.5, P<.001) and patient-reported mobility (Activity Measure for Post-Acute Care [AM-PAC], 57.6 vs 62.2, P<.01) after adjusting for age, gender, number of comorbidities, depressive symptoms, and pain interference. Dropout rates for EFD+ and EFD− were 44% and 25%, respectively (P>.05). In multivariable logistic regression modeling, pain interference, depressive symptoms, mobility, and living alone but not EFD status were associated with dropping out. Among study completers, there was no evidence of significant differences in treatment compliance or posttreatment exercise compliance, measured by the number of attended sessions and the number of posttreatment exercise days by EFD status.

Conclusion

EFD+ was associated with poor baseline mobility. Although the dropout rate was higher among Veterans with EFD+, we were unable to conclude whether EFD status impacts retention or compliance due to the small sample size. Further investigation is needed to determine whether EFD status may identify individuals who need additional support during and/or after rehabilitation treatment.

目的：研究有或无执行功能缺陷（EFD+/EFD-）的退伍军人对一种新型物理疗法（PT）的保留和依从性。设计：本研究是一项正在进行的随机对照试验的预先计划的二次分析。背景：VA波士顿医疗保健系统门诊PT。参与者：72名居住在社区的中老年退伍军人(平均年龄72岁[范围51-91]；87%为男性)，步态速度在0.5至1.0 m/秒之间，从初级保健诊所招募。干预措施：8周中等至高强度的体育锻炼计划。主要结果测量：退伍军人的基线活动能力，保留（退出），治疗依从性和治疗后8周PT治疗的运动依从性基于他们的基线EFD状态进行评估。结果：72名参与者中，22% （n=16）为EFD+。基线时EFD+的退伍军人的活动能力较差（短物理性能电池[SPPB]， 7.7 vs 9.5， PPP>.05）。在多变量logistic回归模型中，疼痛干扰、抑郁症状、活动能力和独居与辍学有关，但与EFD状态无关。在研究完成者中，没有证据表明治疗依从性或治疗后运动依从性有显著差异，这是通过参加会议的次数和治疗后运动天数的EFD状态来衡量的。结论：EFD+与基线活动能力差有关。虽然EFD+退伍军人的辍学率较高，但由于样本量小，我们无法得出EFD状态是否影响保留或依从性的结论。需要进一步的调查来确定EFD状态是否可以识别在康复治疗期间和/或之后需要额外支持的个体。

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引用次数: 0

Overview of Effects of Motor Learning Strategies in Neurologic and Geriatric Populations: A Systematic Mapping Review 运动学习策略在神经病学和老年人群中的作用综述：一个系统的地图回顾。

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation

Pub Date : 2024-12-01 DOI: 10.1016/j.arrct.2024.100379

Li-Juan Jie PhD , Melanie Kleynen PhD , Guus Rothuizen MSc , Elmar Kal PhD , Andreas Rothgangel PhD , Susy Braun PhD

Objective

To provide a broad overview of the current state of research regarding the effects of 7 commonly used motor learning strategies to improve functional tasks within older neurologic and geriatric populations.

Data Sources

PubMed, CINAHL, and Embase were searched.

Study Selection

A systematic mapping review of randomized controlled trials was conducted regarding the effectiveness of 7 motor learning strategies—errorless learning, analogy learning, observational learning, trial-and-error learning, dual-task learning, discovery learning, and movement imagery—within the geriatric and neurologic population.

Data Extraction

Two thousand and ninety-nine articles were identified. After screening, 87 articles were included for further analysis. Two reviewers extracted descriptive data regarding the population, type of motor learning strategy/intervention, frequency and total duration intervention, task trained, movement performance measures, assessment time points, and between-group effects of the included studies. The risk of bias 2 tool was used to assess bias; additionally, papers underwent screening for sample size justification.

Data Synthesis

Identified articles regarding the effects of the targeted motor learning strategies started around the year 2000 and mainly emerged in 2010. Eight populations were included, for example, Parkinson's and stroke. Included studies were not equally balanced: analogy learning (n=2), errorless learning and trial-and-error learning (n=5), mental practice (n=19), observational learning (n=11), discovery learning (n=0), and dual-tasking (n=50). Overall studies showed a moderate-to-high risk of bias. Four studies were deemed sufficiently reliable to interpret effects. Positive trends regarding the effects were observed for dual-tasking, observational learning, and movement imagery.

Conclusions

Findings show a skewed distribution of studies across motor learning interventions, especially toward dual-tasking. Methodological shortcomings make it difficult to draw firm conclusions regarding the effectiveness of motor learning strategies to improve functional studies. Future researchers are strongly advised to follow guidelines that aid in maintaining methodological quality. Moreover, alternative designs fitting the complex practice situation should be considered.

目的：对7种常用的运动学习策略在老年神经系统和老年人群中改善功能任务的影响的研究现状进行综述。数据来源：检索PubMed， CINAHL, Embase。研究选择：在老年和神经学人群中，对7种运动学习策略（无错误学习、类比学习、观察学习、试错学习、双任务学习、发现学习和运动图像）的有效性进行了随机对照试验的系统回顾。数据提取：确定了2999篇文章。筛选后纳入87篇文献进行进一步分析。两名评论者提取了关于纳入研究的人群、运动学习策略/干预类型、干预频率和总持续时间、训练任务、运动表现测量、评估时间点和组间效应的描述性数据。偏倚风险2工具用于评估偏倚；此外，对论文进行了样本量的筛选。数据综合：关于目标运动学习策略的影响的确定文章大约始于2000年，主要出现在2010年。其中包括8个人群，比如帕金森氏症和中风患者。纳入的研究并不均衡：类比学习（n=2）、无错误学习和试错学习（n=5）、心理练习（n=19）、观察学习（n=11）、发现学习（n=0）和双重任务（n=50）。总体研究显示有中等到高度的偏倚风险。四项研究被认为足够可靠来解释效果。在双重任务、观察性学习和运动意象方面观察到积极的趋势。结论：研究结果显示运动学习干预的研究分布不均匀，特别是对双任务的研究。方法上的缺陷使得很难得出关于运动学习策略对改善功能研究的有效性的确切结论。强烈建议未来的研究人员遵循有助于保持方法质量的指导方针。此外，还应考虑适合复杂实际情况的替代设计。

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引用次数: 0

Cryoneurolysis and Quadriplegia: A Case Report on Pain and Severe Spasticity Management 冷冻神经溶解和四肢瘫痪：疼痛和严重痉挛处理一例报告。

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation

Pub Date : 2024-12-01 DOI: 10.1016/j.arrct.2024.100374

Laura Schatz BSc , Samuel Herzog , Mahdis Hashemi MD , Paul Winston MD

Spasticity, a common symptom after spinal cord injury, often leads to pain, muscle contracture, and compromised daily activities. Cryoneurolysis, a minimally invasive, drug-free procedure for the treatment of pain, is now gaining recognition for treating spasticity. It involves using an ultrasound-guided probe to freeze and destroy overactive target nerves. The objective of this case study was to assess the effect of cryoneurolysis on joint range of motion (ROM) by reducing spasticity and pain in a person with quadriparesis spinal cord injury. A 52-year-old male with C4 incomplete quadriplegia presented with severe right hip osteoarthritis, causing a severe hip flexion deformity with hip flexor spasms, as well as spasticity in the upper limbs. Previous attempts with exceeding maximum-dose botulinum toxin injections for the lower limb proved insufficient to improve ROM. Percutaneous cryoneurolysis was performed on multiple nerves, contributing to spasticity in the upper and lower limbs. Immediately after each procedure, the patient experienced an increased ROM in the upper and lower limb targeted regions. During the patient's follow-up, he also reported improvements in performing daily activities, such as independent showering, no falls, and a significant decrease in muscle tone. Results were primarily maintained up to 9 months postprocedure when cryoneurolysis was repeated for the lower limbs only. On repeat cryoneurolysis, results were re-established. Cryoneurolysis is a nonsurgical, percutaneous procedure that could be considered for pain and spasticity management in patients with quadriplegia. It can provide an option for improved quality of life and independence for patients.

痉挛是脊髓损伤后的常见症状，常导致疼痛、肌肉挛缩和日常活动受损。冷冻神经溶解是一种微创、无药物治疗疼痛的方法，目前在治疗痉挛方面得到了认可。它包括使用超声波引导探针来冻结和破坏过度活跃的目标神经。本病例研究的目的是通过减少四肢瘫脊髓损伤患者的痉挛和疼痛来评估冷冻神经溶解对关节活动范围（ROM）的影响。52岁男性C4不完全性四肢瘫痪患者表现为严重的右髋关节骨关节炎，导致严重的髋关节屈曲畸形伴髋屈肌痉挛，以及上肢痉挛。先前对下肢注射超过最大剂量肉毒杆菌毒素的尝试证明不足以改善ROM。对多条神经进行经皮冷冻神经溶解，导致上肢和下肢痉挛。每次手术后，患者在上肢和下肢目标区域的ROM立即增加。在随访期间，他还报告了日常活动的改善，如独立淋浴，没有摔倒，肌肉张力明显下降。结果主要维持到术后9个月，此时仅对下肢重复冷冻神经溶解。重复冷冻解液，结果重新确定。冷冻神经溶解术是一种非手术、经皮手术，可用于四肢瘫痪患者的疼痛和痉挛管理。它可以为改善患者的生活质量和独立性提供一种选择。

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引用次数: 0