To identify predictors of functional improvement and home discharge across a wide age spectrum in a real-world inpatient neurorehabilitation cohort, and to assess whether age independently influences rehabilitation outcomes.
Design
Retrospective observational cohort study.
Setting
Two inpatient neurorehabilitation units within a university hospital: a high-intensity program (Neurorehabilitation Unit A) and a geriatric-adapted, less intensive program (Neurorehabilitation Unit B).
Participants
A total of 694 patients (N=694) admitted for neurorehabilitation between January 2018 and April 2020. Mean age was 66.6±17.5 years; 47.1% were women, and 60.1% were admitted poststroke.
Interventions
Not applicable.
Main Outcome Measures
Home discharge; functional improvement defined as ΔFIM≥10 and Montebello Rehabilitation Factor Score (MRFS)≥0.5.
Results
At discharge, 74.9% of patients returned home. Functional improvement was achieved in 32.5% (ΔFIM≥10) and 18.3% (MRFS≥0.5). In multivariable models, age was not independently associated with any outcome. Positive predictors of home discharge included higher FIM score at discharge (odds ratio, 1.05; 95% CI, 1.03-1.07), lower FIM score at admission, and greater therapy intensity. Functional improvement was associated with longer length of stay and lower comorbidity burden. Use of antipsychotics (home discharge) and antidepressants (MRFS) were negatively associated with outcomes. Hospitalization in the geriatric unit (Neurorehabilitation Unit B) was associated with lower odds of recovery and discharge home, likely reflecting increased frailty and complexity.
Conclusions
Chronological age was not an independent predictor of home discharge or functional improvement in this mixed-age cohort; generalization to the oldest-old and markedly frail populations should be cautious. Functional status, comorbidities, and therapy factors were more relevant for prognosis. These findings support individualized, age-inclusive rehabilitation strategies that focus on clinical complexity rather than age alone.
{"title":"Age Is Not the Limit—Functional Outcomes and Discharge Predictors in a Neurorehabilitation Cohort of Mixed Ages","authors":"Mauro Silva MD , Armin Schnider MD, PhD , François Herrmann MD, PhD , Christophe Graf MD","doi":"10.1016/j.arrct.2025.100545","DOIUrl":"10.1016/j.arrct.2025.100545","url":null,"abstract":"<div><h3>Objective</h3><div>To identify predictors of functional improvement and home discharge across a wide age spectrum in a real-world inpatient neurorehabilitation cohort, and to assess whether age independently influences rehabilitation outcomes.</div></div><div><h3>Design</h3><div>Retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>Two inpatient neurorehabilitation units within a university hospital: a high-intensity program (Neurorehabilitation Unit A) and a geriatric-adapted, less intensive program (Neurorehabilitation Unit B).</div></div><div><h3>Participants</h3><div>A total of 694 patients (N=694) admitted for neurorehabilitation between January 2018 and April 2020. Mean age was 66.6±17.5 years; 47.1% were women, and 60.1% were admitted poststroke.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Home discharge; functional improvement defined as ΔFIM≥10 and Montebello Rehabilitation Factor Score (MRFS)≥0.5.</div></div><div><h3>Results</h3><div>At discharge, 74.9% of patients returned home. Functional improvement was achieved in 32.5% (ΔFIM≥10) and 18.3% (MRFS≥0.5). In multivariable models, age was not independently associated with any outcome. Positive predictors of home discharge included higher FIM score at discharge (odds ratio, 1.05; 95% CI, 1.03-1.07), lower FIM score at admission, and greater therapy intensity. Functional improvement was associated with longer length of stay and lower comorbidity burden. Use of antipsychotics (home discharge) and antidepressants (MRFS) were negatively associated with outcomes. Hospitalization in the geriatric unit (Neurorehabilitation Unit B) was associated with lower odds of recovery and discharge home, likely reflecting increased frailty and complexity.</div></div><div><h3>Conclusions</h3><div>Chronological age was not an independent predictor of home discharge or functional improvement in this mixed-age cohort; generalization to the oldest-old and markedly frail populations should be cautious. Functional status, comorbidities, and therapy factors were more relevant for prognosis. These findings support individualized, age-inclusive rehabilitation strategies that focus on clinical complexity rather than age alone.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100545"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arrct.2025.100540
Affan Smani , Seonjoo Lee PhD , Michael Spinner MS , Scott Barbuto MD, PhD
Objective
To investigate gait changes for individuals who performed either home aerobic or balance training.
Design
Single-blind randomized clinical trial.
Setting
Home training and outcome assessments at large, tertiary, urban hospital.
Participants
Individuals with cerebellar ataxia (N=52).
Interventions
Individuals in the aerobic group trained 30 minutes per session, 5 times per week at up to 85% predicted maximum heart rate. Individuals in the balance group (control) performed 30 minutes of balance exercises of varying difficulty 5 times per week. Participants in both groups were expected to train for 1 year.
Main Outcome Measures
Gait parameters (step length, step variability, stride width, gait velocity) were determined at 0, 6, and 12 months.
Results
Of the 52 individuals who agreed to participate, 24 individuals in each group had gait analysis performed. At 12 months, 20 and 19 participants had gait analysis performed in the balance and aerobic groups, respectively. Linear mixed effect model analysis was used to determine difference between individuals in the balance versus the aerobic group. Step length was the only parameter that showed statistically significant improvement with aerobic training over balance training (6mo: , 4.1 cm; 95% CI, 0.76-7.42; P=.03; 12mo: , 4.1 cm; 95% CI, 0.33-7.82; P=.04). We also found that individuals who hit training goals (either balance or aerobic) had statistically significant improvements in step length (6mo: , 7.15 cm; 95% CI, 3.87-10.42; P<.001; 12mo: , 7.16 cm; 95% CI, 4.20-10.13; P<.001), stride width (6mo: , −2.72 cm; 95% CI, −4.33 to −1.11; P=.001; 12mo: , −2.29 cm; 95% CI, −3.72 to −0.86; P=.002), and gait speed (6mo: , 15.26 cm/s; 95% CI, 5.16-25.36; P=.004; 12mo: , 16.85 cm/s; 95% CI, 7.89-25.80; P<.001) compared to those who did not hit training goals. Step variability was not improved with either training.
Conclusions
There was a minor improvement of increased step length in individuals with ataxia who performed home aerobic training compared to home balance training. However, individuals with ataxia who regularly performed either type of home training had statistically significant improvements in multiple gait parameters compared to those who did not train regularly.
{"title":"Changes in Gait After Training for Individuals With Cerebellar Ataxia","authors":"Affan Smani , Seonjoo Lee PhD , Michael Spinner MS , Scott Barbuto MD, PhD","doi":"10.1016/j.arrct.2025.100540","DOIUrl":"10.1016/j.arrct.2025.100540","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate gait changes for individuals who performed either home aerobic or balance training.</div></div><div><h3>Design</h3><div>Single-blind randomized clinical trial.</div></div><div><h3>Setting</h3><div>Home training and outcome assessments at large, tertiary, urban hospital.</div></div><div><h3>Participants</h3><div>Individuals with cerebellar ataxia (N=52).</div></div><div><h3>Interventions</h3><div>Individuals in the aerobic group trained 30 minutes per session, 5 times per week at up to 85% predicted maximum heart rate. Individuals in the balance group (control) performed 30 minutes of balance exercises of varying difficulty 5 times per week. Participants in both groups were expected to train for 1 year.</div></div><div><h3>Main Outcome Measures</h3><div>Gait parameters (step length, step variability, stride width, gait velocity) were determined at 0, 6, and 12 months.</div></div><div><h3>Results</h3><div>Of the 52 individuals who agreed to participate, 24 individuals in each group had gait analysis performed. At 12 months, 20 and 19 participants had gait analysis performed in the balance and aerobic groups, respectively. Linear mixed effect model analysis was used to determine difference between individuals in the balance versus the aerobic group. Step length was the only parameter that showed statistically significant improvement with aerobic training over balance training (6mo: <span><math><mi>β</mi></math></span>, 4.1 cm; 95% CI, 0.76-7.42; <em>P</em>=.03; 12mo: <span><math><mi>β</mi></math></span>, 4.1 cm; 95% CI, 0.33-7.82; <em>P</em>=.04). We also found that individuals who hit training goals (either balance or aerobic) had statistically significant improvements in step length (6mo: <span><math><mi>β</mi></math></span>, 7.15 cm; 95% CI, 3.87-10.42; <em>P</em><.001; 12mo: <span><math><mi>β</mi></math></span>, 7.16 cm; 95% CI, 4.20-10.13; <em>P</em><.001), stride width (6mo: <span><math><mi>β</mi></math></span>, −2.72 cm; 95% CI, −4.33 to −1.11; <em>P</em>=.001; 12mo: <span><math><mi>β</mi></math></span>, −2.29 cm; 95% CI, −3.72 to −0.86; <em>P</em>=.002), and gait speed (6mo: <span><math><mi>β</mi></math></span>, 15.26 cm/s; 95% CI, 5.16-25.36; <em>P</em>=.004; 12mo: <span><math><mi>β</mi></math></span>, 16.85 cm/s; 95% CI, 7.89-25.80; <em>P</em><.001) compared to those who did not hit training goals. Step variability was not improved with either training.</div></div><div><h3>Conclusions</h3><div>There was a minor improvement of increased step length in individuals with ataxia who performed home aerobic training compared to home balance training. However, individuals with ataxia who regularly performed either type of home training had statistically significant improvements in multiple gait parameters compared to those who did not train regularly.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100540"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arrct.2025.100535
Mariana M. Bahia PhD, CCC-SLP , Julia Carpenter MA, CCC-SLP , Kelly Rogers MA, CCC-SLP , Leora R. Cherney PhD, CCC-SLP
<div><h3>Objective</h3><div>To develop a skill-based swallowing training program for poststroke survivors with dysphagia, to examine the acceptability, appropriateness, and feasibility of the program from the perspective of clinicians and researchers, and to investigate the early efficacy of the program.</div></div><div><h3>Design</h3><div>The Plan-Do-Study-Act framework was used to conduct a clinician survey and to measure within-subject changes pre and posttreatment.</div></div><div><h3>Setting</h3><div>Inpatient rehabilitation hospital.</div></div><div><h3>Participants</h3><div>Fifteen swallowing clinicians and 7 researchers with a background in speech-language pathology responded to a survey about the intervention’s acceptability, appropriateness, and feasibility (n = 22). Two patients (a 56y woman and a 33y man) with moderate-severe dysphagia secondary to poststroke received the swallowing intervention during inpatient rehabilitation (n = 2).</div></div><div><h3>Interventions</h3><div>The Effort Accuracy Timing-Skill Training Applied to Rehabilitation in Swallowing (EAT-STARS) program is a novel, systematic, and progressive skill-based training program designed to improve swallowing function in poststroke dysphagia. The program consists of up to 8 treatment sessions, spanning 2 weeks, and incorporates principles of motor learning and neuroplasticity to enhance participants’ ability to recognize correct/incorrect motor patterns, thereby promoting skill acquisition and mastery. It requires patients to generate different levels of swallowing effort (ie, regular swallow, effortful swallow) and control the timing of swallowing (ie, prompt swallow, swallow with bolus hold) using real-time surface electromyography visual biofeedback.</div></div><div><h3>Main Outcome Measures</h3><div>Clinicians and researchers answered a survey that included the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measurequestionnaires. The early efficacy of the EAT-STARS program was assessed through standardized pre- and postswallowing measurements, including the Mann Assessment of Swallowing Ability, the Modified Barium Swallowing Impairment Profile, the Eating Assessment Tool, and a visual analog scale to indicate patient-perceived swallowing difficulty.</div></div><div><h3>Results</h3><div>The EAT-STARS program met preestablished cutoff scores for the Acceptability of Intervention Measure (90%), Intervention Appropriateness Measure (87.5%), and Feasibility of Intervention Measure (83.4%) measures, indicating excellent acceptability, appropriateness, and feasibility, respectively. The early efficacy measures indicated that patients demonstrated improvements in both clinical swallowing ability and swallowing physiologyposttreatment. Moreover, patients reported perceived improvements in swallowing (visual analog scale and Eating Assessment Tool).</div></div><div><h3>Conclusions</h3><div>The novel EAT-STARS pr
{"title":"Early Feasibility and Efficacy of a Novel Skill-Based Training Program for Poststroke Dysphagia","authors":"Mariana M. Bahia PhD, CCC-SLP , Julia Carpenter MA, CCC-SLP , Kelly Rogers MA, CCC-SLP , Leora R. Cherney PhD, CCC-SLP","doi":"10.1016/j.arrct.2025.100535","DOIUrl":"10.1016/j.arrct.2025.100535","url":null,"abstract":"<div><h3>Objective</h3><div>To develop a skill-based swallowing training program for poststroke survivors with dysphagia, to examine the acceptability, appropriateness, and feasibility of the program from the perspective of clinicians and researchers, and to investigate the early efficacy of the program.</div></div><div><h3>Design</h3><div>The Plan-Do-Study-Act framework was used to conduct a clinician survey and to measure within-subject changes pre and posttreatment.</div></div><div><h3>Setting</h3><div>Inpatient rehabilitation hospital.</div></div><div><h3>Participants</h3><div>Fifteen swallowing clinicians and 7 researchers with a background in speech-language pathology responded to a survey about the intervention’s acceptability, appropriateness, and feasibility (n = 22). Two patients (a 56y woman and a 33y man) with moderate-severe dysphagia secondary to poststroke received the swallowing intervention during inpatient rehabilitation (n = 2).</div></div><div><h3>Interventions</h3><div>The Effort Accuracy Timing-Skill Training Applied to Rehabilitation in Swallowing (EAT-STARS) program is a novel, systematic, and progressive skill-based training program designed to improve swallowing function in poststroke dysphagia. The program consists of up to 8 treatment sessions, spanning 2 weeks, and incorporates principles of motor learning and neuroplasticity to enhance participants’ ability to recognize correct/incorrect motor patterns, thereby promoting skill acquisition and mastery. It requires patients to generate different levels of swallowing effort (ie, regular swallow, effortful swallow) and control the timing of swallowing (ie, prompt swallow, swallow with bolus hold) using real-time surface electromyography visual biofeedback.</div></div><div><h3>Main Outcome Measures</h3><div>Clinicians and researchers answered a survey that included the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measurequestionnaires. The early efficacy of the EAT-STARS program was assessed through standardized pre- and postswallowing measurements, including the Mann Assessment of Swallowing Ability, the Modified Barium Swallowing Impairment Profile, the Eating Assessment Tool, and a visual analog scale to indicate patient-perceived swallowing difficulty.</div></div><div><h3>Results</h3><div>The EAT-STARS program met preestablished cutoff scores for the Acceptability of Intervention Measure (90%), Intervention Appropriateness Measure (87.5%), and Feasibility of Intervention Measure (83.4%) measures, indicating excellent acceptability, appropriateness, and feasibility, respectively. The early efficacy measures indicated that patients demonstrated improvements in both clinical swallowing ability and swallowing physiologyposttreatment. Moreover, patients reported perceived improvements in swallowing (visual analog scale and Eating Assessment Tool).</div></div><div><h3>Conclusions</h3><div>The novel EAT-STARS pr","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100535"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arrct.2025.100530
Run Peng MSc , Huiming Gong MD , Xiaoxin Wang MD , Liang Zhang MD , Zitong Liu MSc , Yongqi Xie MSc , Shuang Guo MSc , Xinqi Cao MSc , Xinyue Pang MSc , Mingliang Yang MD
In the treatment of respiratory impairment because of cervical spinal cord injury, bilateral implantation of a diaphragmatic pacemaker is considered to be the most effective way to enable patients to achieve independent breathing. However, in patients who can only use unilateral diaphragmatic pacemakers, especially adolescent children, the use of unilateral diaphragmatic pacemakers may have an effect on the productive development of such patients, which can lead to thoracic deformities and a decrease in the efficiency of pacing. This study presents a case of a pediatric patient with high cervical spinal cord injury who underwent unilateral implanted diaphragm pacing (IDP) combined with bilateral percutaneous intercostal nerve stimulation. The results demonstrated that intercostal nerve stimulation led to an increase in tidal volume. After 14 days of treatment and follow-up, a further increase in tidal volume was observed. These findings suggest that percutaneous intercostal nerve stimulation may serve as a viable adjunctive therapy for respiratory rehabilitation in patients with cervical spinal cord injury.
{"title":"Impact of Percutaneous Intercostal Nerve Stimulation Combined With Diaphragm Pacing on Respiratory Function in Cervical Spinal Cord Injury: A Case Report","authors":"Run Peng MSc , Huiming Gong MD , Xiaoxin Wang MD , Liang Zhang MD , Zitong Liu MSc , Yongqi Xie MSc , Shuang Guo MSc , Xinqi Cao MSc , Xinyue Pang MSc , Mingliang Yang MD","doi":"10.1016/j.arrct.2025.100530","DOIUrl":"10.1016/j.arrct.2025.100530","url":null,"abstract":"<div><div>In the treatment of respiratory impairment because of cervical spinal cord injury, bilateral implantation of a diaphragmatic pacemaker is considered to be the most effective way to enable patients to achieve independent breathing. However, in patients who can only use unilateral diaphragmatic pacemakers, especially adolescent children, the use of unilateral diaphragmatic pacemakers may have an effect on the productive development of such patients, which can lead to thoracic deformities and a decrease in the efficiency of pacing. This study presents a case of a pediatric patient with high cervical spinal cord injury who underwent unilateral implanted diaphragm pacing (IDP) combined with bilateral percutaneous intercostal nerve stimulation. The results demonstrated that intercostal nerve stimulation led to an increase in tidal volume. After 14 days of treatment and follow-up, a further increase in tidal volume was observed. These findings suggest that percutaneous intercostal nerve stimulation may serve as a viable adjunctive therapy for respiratory rehabilitation in patients with cervical spinal cord injury.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100530"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arrct.2025.100534
Joon Sin Ser MBBS, MMed, MRCP , Kee Jin Loh MBBS, MRCP , Sing Mei Chung MBBS , Mei Xian Tan BSc , Evangeline Jia Yun How BASc , San San Tay MBBS, MMed, MRCP
Opsoclonus-Myoclonus-Ataxia Syndrome (OMAS) is a rare inflammatory neurologic condition predominantly described in pediatric populations. Adult-onset OMAS presents significant rehabilitation challenges because of limited literature and established treatment protocols. We report a middle-aged man with postinflammatory OMAS who underwent intensive inpatient rehabilitation using both conventional therapy and adjunct interventions, including robot-assisted gait training and hydrotherapy. The patient presented with characteristic opsoclonus, truncal ataxia, and bilateral dysmetria after an upper respiratory tract infection. After 22 days of intensive rehabilitation, the patient demonstrated remarkable functional improvement with a FIM efficiency of 1.77 and effectiveness of 0.84. Berg Balance Scale scores improved from 25 of 56 to 53 of 56, and the patient achieved modified independence in activities of daily living. While recovery occurred during rehabilitation, causality cannot be established, as improvement may also reflect the natural disease trajectory. Nevertheless, this case demonstrates the potential efficacy of combining conventional rehabilitation with targeted adjunct therapies for adult-onset OMAS, providing a rationale for a treatment strategy in rare neurologic conditions.
{"title":"A Dual Approach to Rehabilitation of an autoimmune ataxia : A case study involving the Adult-Onset Opsoclonus-Myoclonus-Ataxia Syndrome","authors":"Joon Sin Ser MBBS, MMed, MRCP , Kee Jin Loh MBBS, MRCP , Sing Mei Chung MBBS , Mei Xian Tan BSc , Evangeline Jia Yun How BASc , San San Tay MBBS, MMed, MRCP","doi":"10.1016/j.arrct.2025.100534","DOIUrl":"10.1016/j.arrct.2025.100534","url":null,"abstract":"<div><div>Opsoclonus-Myoclonus-Ataxia Syndrome (OMAS) is a rare inflammatory neurologic condition predominantly described in pediatric populations. Adult-onset OMAS presents significant rehabilitation challenges because of limited literature and established treatment protocols. We report a middle-aged man with postinflammatory OMAS who underwent intensive inpatient rehabilitation using both conventional therapy and adjunct interventions, including robot-assisted gait training and hydrotherapy. The patient presented with characteristic opsoclonus, truncal ataxia, and bilateral dysmetria after an upper respiratory tract infection. After 22 days of intensive rehabilitation, the patient demonstrated remarkable functional improvement with a FIM efficiency of 1.77 and effectiveness of 0.84. Berg Balance Scale scores improved from 25 of 56 to 53 of 56, and the patient achieved modified independence in activities of daily living. While recovery occurred during rehabilitation, causality cannot be established, as improvement may also reflect the natural disease trajectory. Nevertheless, this case demonstrates the potential efficacy of combining conventional rehabilitation with targeted adjunct therapies for adult-onset OMAS, providing a rationale for a treatment strategy in rare neurologic conditions.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100534"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arrct.2025.100499
Stacy Schantz Wilkins PhD , Jin J. Zhou PhD , Rebecca J. Melrose PhD , Mia Delgadillo PhD , Elisa F. Ogawa PhD , Steven C. Castle MD , Megan Pearson MA , Rebekah Harris PT, DPT, PhD , Jonathan Wanagat MD, PhD , Jamie Giffuni MA , Neil Alexander MD , Adam D. Gepner MD , Lauren M. Abbate MD, PhD , Daniel E. Forman MD , Odessa Addison DPT, PhD , Monica C. Serra PhD , Katherine S. Hall PhD , Cathy C. Lee MD
Objective
To evaluate cognition at entry into the Gerofit program and its association with physical function.
Gerofit outpatient clinical exercise programs at multiple Veterans Affairs Medical Centers from 2021 to 2023.
Participants
New enrollees (N=1172) completed measures of lower and upper extremity strength, balance, cardiovascular endurance, and measures of global cognition (telephone Montreal Cognitive Assessment, tMoCA) and cognitive set shifting (Oral Trail Making Test B). Dementia diagnosis in the medical record was exclusionary.
Interventions
Not applicable.
Main Outcome Measures
Relationship between physical and cognitive function, self-rated memory change, and demographics were evaluated by linear regression.
Results
Mean age was 75 years. 78% of participants were White and 20% Black; 88% were men. Mean tMoCA score was 17.39. tMoCA and Oral Trail Making Test B scores were significantly associated with lower extremity strength (P<.001), and tMoCA score was significantly associated with endurance. tMoCA score was significantly associated with self-rated memory.
Conclusions
Global cognitive functioning was below the cutoff for normal cognition in 61% of participants, suggesting mild cognitive impairment is common in older exercise program enrollees. Lower cognitive scores were related to both reduced strength and endurance.
{"title":"Cognitive Impairment Highly Prevalent and Associated With Reduced Physical Function in Older Veteran Clinical Exercise Program","authors":"Stacy Schantz Wilkins PhD , Jin J. Zhou PhD , Rebecca J. Melrose PhD , Mia Delgadillo PhD , Elisa F. Ogawa PhD , Steven C. Castle MD , Megan Pearson MA , Rebekah Harris PT, DPT, PhD , Jonathan Wanagat MD, PhD , Jamie Giffuni MA , Neil Alexander MD , Adam D. Gepner MD , Lauren M. Abbate MD, PhD , Daniel E. Forman MD , Odessa Addison DPT, PhD , Monica C. Serra PhD , Katherine S. Hall PhD , Cathy C. Lee MD","doi":"10.1016/j.arrct.2025.100499","DOIUrl":"10.1016/j.arrct.2025.100499","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate cognition at entry into the Gerofit program and its association with physical function.</div></div><div><h3>Design</h3><div>Retrospective observational cross-sectional design.</div></div><div><h3>Setting</h3><div>Gerofit outpatient clinical exercise programs at multiple Veterans Affairs Medical Centers from 2021 to 2023.</div></div><div><h3>Participants</h3><div>New enrollees (N=1172) completed measures of lower and upper extremity strength, balance, cardiovascular endurance, and measures of global cognition (telephone Montreal Cognitive Assessment, tMoCA) and cognitive set shifting (Oral Trail Making Test B). Dementia diagnosis in the medical record was exclusionary.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Relationship between physical and cognitive function, self-rated memory change, and demographics were evaluated by linear regression.</div></div><div><h3>Results</h3><div>Mean age was 75 years. 78% of participants were White and 20% Black; 88% were men. Mean tMoCA score was 17.39. tMoCA and Oral Trail Making Test B scores were significantly associated with lower extremity strength (<em>P</em><.001), and tMoCA score was significantly associated with endurance. tMoCA score was significantly associated with self-rated memory.</div></div><div><h3>Conclusions</h3><div>Global cognitive functioning was below the cutoff for normal cognition in 61% of participants, suggesting mild cognitive impairment is common in older exercise program enrollees. Lower cognitive scores were related to both reduced strength and endurance.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100499"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arrct.2025.100506
Na Yoon Yoo MD , Hyoung Seop Kim MD, PhD
Objective
To analyze ultrasonographic findings associated with subacromial impingement syndrome and adhesive capsulitis in patients with unrestricted shoulder joint motion and positive impingement signs during physical examinations, and assess pain improvement after intraarticular steroid injections to verify the potential presence of early-stage adhesive capsulitis.
Outpatient clinic of the Department of Physical Medicine and Rehabilitation at a single general hospital.
Participants
Twenty-seven patients (N=27) presenting with unilateral shoulder pain and no limitation in joint motion.
Interventions
Not applicable.
Main Outcome Measures
At the initial visit, ultrasonography was performed to measure supraspinatus tendon thickness and evaluate for bicipital groove fluid collection and subacromial bursitis. All patients received sonography-guided intraarticular steroid injections. Pain and functional status were assessed using the Visual Analog Scale (VAS) and the Korean version of the Shoulder Pain and Disability Index (SPADI) at baseline and at a 2-week follow-up. Positive impingement signs were confirmed via the painful arc, Neer, Hawkins–Kennedy, Paxinos, and horizontal adduction tests.
Results
There was no significant difference in supraspinatus tendon thickness between the painful and nonpainful shoulders. However, VAS scores showed a significant decrease at follow-up. Both SPADI total disability scores and total SPADI scores demonstrated statistically significant improvement.
Conclusions
Patients with preserved shoulder range of motion but positive impingement signs, often diagnosed as subacromial impingement syndrome, may in fact represent early-stage adhesive capsulitis. Ultrasonography and steroid injection response may help differentiate these conditions in clinical practice.
{"title":"Ultrasonographic Validity of Clinical Shoulder Impingement Signs in Patients Without Limitation of Motion","authors":"Na Yoon Yoo MD , Hyoung Seop Kim MD, PhD","doi":"10.1016/j.arrct.2025.100506","DOIUrl":"10.1016/j.arrct.2025.100506","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze ultrasonographic findings associated with subacromial impingement syndrome and adhesive capsulitis in patients with unrestricted shoulder joint motion and positive impingement signs during physical examinations, and assess pain improvement after intraarticular steroid injections to verify the potential presence of early-stage adhesive capsulitis.</div></div><div><h3>Design</h3><div>Prospective, noninterventional, observational study.</div></div><div><h3>Setting</h3><div>Outpatient clinic of the Department of Physical Medicine and Rehabilitation at a single general hospital.</div></div><div><h3>Participants</h3><div>Twenty-seven patients (N=27) presenting with unilateral shoulder pain and no limitation in joint motion.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>At the initial visit, ultrasonography was performed to measure supraspinatus tendon thickness and evaluate for bicipital groove fluid collection and subacromial bursitis. All patients received sonography-guided intraarticular steroid injections. Pain and functional status were assessed using the Visual Analog Scale (VAS) and the Korean version of the Shoulder Pain and Disability Index (SPADI) at baseline and at a 2-week follow-up. Positive impingement signs were confirmed via the painful arc, Neer, Hawkins–Kennedy, Paxinos, and horizontal adduction tests.</div></div><div><h3>Results</h3><div>There was no significant difference in supraspinatus tendon thickness between the painful and nonpainful shoulders. However, VAS scores showed a significant decrease at follow-up. Both SPADI total disability scores and total SPADI scores demonstrated statistically significant improvement.</div></div><div><h3>Conclusions</h3><div>Patients with preserved shoulder range of motion but positive impingement signs, often diagnosed as subacromial impingement syndrome, may in fact represent early-stage adhesive capsulitis. Ultrasonography and steroid injection response may help differentiate these conditions in clinical practice.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100506"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vitamin B12 deficiency is a well-established cause of spinal cord dysfunction, often manifesting as subacute combined degeneration. However, in young adults, especially those with a history of substance use, this diagnosis can be delayed or misattributed to other causes. We present the case of a 26-year-old woman with a history of nitrous oxide and ketamine use who developed significant functional decline and was ultimately diagnosed with B12 deficiency-related spinal cord injury. Despite normal spinal magnetic resonance imaging, she exhibited profound bilateral lower extremity weakness and neuropathic pain. Intensive inpatient rehabilitation resulted in significant functional improvement. This case underscores the importance of early recognition and a multidisciplinary approach to recovery, even in radiographically silent presentations.
{"title":"Functional Recovery in a Young Adult With Spinal Cord Injury Secondary to Vitamin B12 Deficiency and Substance Use: A Case Report","authors":"Fereshteh Kargar Bafrani MD , Nozima Akbarova MD , Paul Rutkowski MD","doi":"10.1016/j.arrct.2025.100531","DOIUrl":"10.1016/j.arrct.2025.100531","url":null,"abstract":"<div><div>Vitamin B12 deficiency is a well-established cause of spinal cord dysfunction, often manifesting as subacute combined degeneration. However, in young adults, especially those with a history of substance use, this diagnosis can be delayed or misattributed to other causes. We present the case of a 26-year-old woman with a history of nitrous oxide and ketamine use who developed significant functional decline and was ultimately diagnosed with B12 deficiency-related spinal cord injury. Despite normal spinal magnetic resonance imaging, she exhibited profound bilateral lower extremity weakness and neuropathic pain. Intensive inpatient rehabilitation resulted in significant functional improvement. This case underscores the importance of early recognition and a multidisciplinary approach to recovery, even in radiographically silent presentations.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100531"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 46-year-old man received a course of quinolone-family antibiotics for puncture wound-related cellulitis. Cerebellar symptoms developed within 3 weeks of treatment, progressed over 6 months, and then became static. Seven years later, he received an individualized 12-week-long course of physical therapy to challenge his balance with high-level fall-inducing but safe dynamic activities. Outcome measures included the International Cooperative Ataxia Rating Scale, modified Dynamic Gait Index, instrumented gait analysis, and posturography. The total modified dynamic gait index score improved 4 points. Gait velocity increased and reached a meaningful clinically important difference threshold. Step length increased, and step width and toeing out decreased. Reaction times, movement velocities, and center of gravity excursions improved on the limits of stability test. He increased frontal and sagittal speed on the rhythmic weight shift test and became able to jump vertically and run with hand support on a treadmill. The results highlight the benefits of an individualized physical therapy program for a patient with chronic nonprogressive cerebellar deficits years after the original insult. Factors that may have contributed to the success of this case are the nonprogressive nature of the disorder, a harness system that allowed for sufficiently challenging repetitions, and the patient’s physically fit and disciplined characteristics.
{"title":"Rehabilitation of High-Level Dynamic Balance Skills in an Individual With Significant Nonprogressive Cerebellar Atrophy: Case Report","authors":"Earllaine Croarkin PT, MPT , Joseph A. Shrader PT , Pashtun Shahim MD, PhD , Simge Yonter MD , Camilo Toro MD , Cris Zampieri PT, PhD","doi":"10.1016/j.arrct.2025.100500","DOIUrl":"10.1016/j.arrct.2025.100500","url":null,"abstract":"<div><div>A 46-year-old man received a course of quinolone-family antibiotics for puncture wound-related cellulitis. Cerebellar symptoms developed within 3 weeks of treatment, progressed over 6 months, and then became static. Seven years later, he received an individualized 12-week-long course of physical therapy to challenge his balance with high-level fall-inducing but safe dynamic activities. Outcome measures included the International Cooperative Ataxia Rating Scale, modified Dynamic Gait Index, instrumented gait analysis, and posturography. The total modified dynamic gait index score improved 4 points. Gait velocity increased and reached a meaningful clinically important difference threshold. Step length increased, and step width and toeing out decreased. Reaction times, movement velocities, and center of gravity excursions improved on the limits of stability test. He increased frontal and sagittal speed on the rhythmic weight shift test and became able to jump vertically and run with hand support on a treadmill. The results highlight the benefits of an individualized physical therapy program for a patient with chronic nonprogressive cerebellar deficits years after the original insult. Factors that may have contributed to the success of this case are the nonprogressive nature of the disorder, a harness system that allowed for sufficiently challenging repetitions, and the patient’s physically fit and disciplined characteristics.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100500"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arrct.2025.100542
Angela Benfield PhD, OTR , Mark V. Johnston PhD , Cheryl Miller DrOT, OTR/L , Alexandra E. Harper PhD, OTR/L, CPHQ , Minmei Shih PhD, OTR/L , Elizabeth R. Skidmore PhD, OTR/L
Objective
To explore relationships between therapists’ recurrent, self-regulated evidence-related activities and antecedent factors that may influence these habits.
Design
Secondary analysis of survey data using multivariate regression/correlations analyses.
Setting
Representative sample of 30 inpatient rehabilitation clinics across the United States.
Participants
163 rehabilitation therapists (N=163), specifically physical and occupational therapists and speech-language pathologists.
Interventions
Not applicable.
Main Outcome Measures
Evidence-informed professional thinking, which is comprised of measures of recurrent, self-regulated evidence-informed practice (EIP) and reflective critical clinical reasoning (CCR) activities by therapists.
Results
Scores indicate infrequent engagement in EIP activities (mean=4.22, SD=0.93), with somewhat greater engagement in CCR (mean=5.00, SD=0.920). Therapists generally had positive attitudes toward evidence-based practice (EBP) on the Evidence-Based Practice Attitude Scale-36. The EIP and CCR were highly related (r=.651, P=.001). Even after linear controls for other possible predictors, beliefs that EBPs lead to greater Job Security predicted greater engagement in both EIP and CCR (P<.001). Openness was also independently related to engagement in EIP (P<.001) and to CCR (P<.011), apparently mediated by Feedback, Professional Education, and awareness of Limitations (of EBP). Specialty certification was clearly related to EIP (P<.016), but many common educational and experience background variables had weak or nonsignificant relationships with therapists’ EIP or CCR habits.
Conclusions
Self-regulated engagement in EIP and CCR are predicted by identifiable but somewhat complex antecedents. CCR was more strongly related to EIP than any other variable. Results suggest that implementation strategies that engage therapists’ reflective critical clinical reasoning will be more successful at increasing therapists’ engagement in self-regulated EBP habits than in strategies that do not.
{"title":"Engagement in Evidence-Based Practice Activities and Thinking by Rehabilitation Therapists: Predictive Factors","authors":"Angela Benfield PhD, OTR , Mark V. Johnston PhD , Cheryl Miller DrOT, OTR/L , Alexandra E. Harper PhD, OTR/L, CPHQ , Minmei Shih PhD, OTR/L , Elizabeth R. Skidmore PhD, OTR/L","doi":"10.1016/j.arrct.2025.100542","DOIUrl":"10.1016/j.arrct.2025.100542","url":null,"abstract":"<div><h3>Objective</h3><div>To explore relationships between therapists’ recurrent, self-regulated evidence-related activities and antecedent factors that may influence these habits.</div></div><div><h3>Design</h3><div>Secondary analysis of survey data using multivariate regression/correlations analyses.</div></div><div><h3>Setting</h3><div>Representative sample of 30 inpatient rehabilitation clinics across the United States.</div></div><div><h3>Participants</h3><div>163 rehabilitation therapists (N=163), specifically physical and occupational therapists and speech-language pathologists.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Evidence-informed professional thinking, which is comprised of measures of recurrent, self-regulated evidence-informed practice (EIP) and reflective critical clinical reasoning (CCR) activities by therapists.</div></div><div><h3>Results</h3><div>Scores indicate infrequent engagement in EIP activities (mean=4.22, SD=0.93), with somewhat greater engagement in CCR (mean=5.00, SD=0.920). Therapists generally had positive attitudes toward evidence-based practice (EBP) on the Evidence-Based Practice Attitude Scale-36. The EIP and CCR were highly related (<em>r</em>=.651, <em>P</em>=.001). Even after linear controls for other possible predictors, beliefs that EBPs lead to greater Job Security predicted greater engagement in both EIP and CCR (<em>P</em><.001). Openness was also independently related to engagement in EIP (<em>P</em><.001) and to CCR (<em>P</em><.011), apparently mediated by Feedback, Professional Education, and awareness of Limitations (of EBP). Specialty certification was clearly related to EIP (<em>P</em><.016), but many common educational and experience background variables had weak or nonsignificant relationships with therapists’ EIP or CCR habits.</div></div><div><h3>Conclusions</h3><div>Self-regulated engagement in EIP and CCR are predicted by identifiable but somewhat complex antecedents. CCR was more strongly related to EIP than any other variable. Results suggest that implementation strategies that engage therapists’ reflective critical clinical reasoning will be more successful at increasing therapists’ engagement in self-regulated EBP habits than in strategies that do not.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 4","pages":"Article 100542"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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