Frontiers in rehabilitation sciences最新文献

Gerstmann-Sträussler-Scheinker syndrome (GSS) is a genetic, autosomal dominant prion brain disease that causes ataxia and slow cognitive decline. Herein, we describe a 34-year-old woman (S.C.B.) diagnosed with GSS (variant Pro102Leu). In 2018, she presented with gait instability without falls, early fatigue, and dizziness; after 3 years, urinary incontinence, initial insomnia and rapid-eye movement sleep behavior disorder, writing difficulties, and occasional dysphagia had appeared. S.C.B. was admitted to the Neurorehabilitation Unit due to the progressive worsening of her balance and walking ability [Timed Up and Go (TUG): not evaluated; Berg Balance Scale (BERG): 5/56]. At admission, neurological, neuropsychological, physiotherapeutic, occupational, and speech assessments were performed. She was completely dependent in basic (ADL) and instrumental activities of daily living (iADL) (ADL: 5/6; iADL: 4/8; Barthel Index: 60); furthermore, moderate cognitive decline and depressive symptoms were observed. After 4 weeks of intensive motor-cognitive rehabilitation treatment, an improvement was observed in all the intervention areas, leading to a global gain in autonomy (TUG: 1 min 50 s; BERG: 10/56; Barthel Index: 70). This case report highlights the importance of tailored motor-cognitive rehabilitation and how these interventions can enhance patients' quality of life and their ability to cope with their symptoms. In conclusion, this case contributes to a broader understanding of treatment options that clinicians can propose to patients.

Objective: The aim of this study was to examine the effects of an intensive, multidisciplinary, inpatient rehabilitation program on the functional outcomes of patients with Parkinson's disease (PD), admitted directly from home.

Design: Retrospective cohort study.

Setting: Suburban academic medical center with an inpatient rehabilitation facility.

Methods: The study included 37 patients with PD who participated in a two-week acute inpatient multidisciplinary rehabilitation program. Functional assessments utilizing the Activity Measure for Post-Acute Care (AM-PAC), Section GG of the Inpatient Rehabilitation Facility-Patient Assessment Inventory (Section GG scores), and Voice Handicap Index (VHI) were collected and compared upon admission and discharge from the program.

Results: Significant improvements were observed in the AM-PAC domains of Basic Mobility and Daily Activity between admission and discharge (p < 0.0001), as well as in Section GG scores for self-care and mobility (p < 0.001). Importantly, VHI scores demonstrated statistically significant improvements in vocal functioning (p = 0.028). No significant changes were observed in the Applied Cognitive domain of the AM-PAC (p = 0.871).

Conclusions: Intensive inpatient rehabilitation programs have the potential to enhance both physical functioning and speech and vocal abilities in patients with PD. This study is the first of its kind in the United States, demonstrating the safety and efficacy of a multidisciplinary acute inpatient rehabilitation program designed to enhance the functional outcomes of individuals with PD living at home.

Introduction: Employment is one of the most important means of meeting an individual's psychological, social, and economic needs. Severe mental health illness (SMI) poses a significant challenge to managing psychological resources, which can further impede one's employability. The purpose of this research is to investigate the contextual factors associated with employment for individuals suffering from SMI, for the benefit of both their well-being, as well as the wider economic and social context they live in.

Methods: This umbrella review evaluates the available literature from PubMed and PsycINFO. It included systematic reviews, meta-analyses, and scoping reviews, for which a quality appraisal was conducted using the AMSTAR 2 Checklist and the Scoping Review Checklist.

Results: Our search identified 40 reviews, from which we pulled seven evidence-based factors associated with employment, four facilitators, and three barriers. Receiving individual placement and support represents the facilitator that was most extensively researched, with reported employment rates up to 61%, while negative symptoms represent the most robustly identified barrier.

Discussion: Overall, the synthesis of evidence highlights underlying factors that might shape employment for individuals with SMI and identifies interventions that hold potential for further development. It also underscores the necessity for conceptual consistency and reveals significant heterogeneity in the literature, which diminishes the generalizability of the results.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023460410, PROSPERO CRD42023460410.

Background: Research on the combined effects of Naldemedine and targeted rehabilitation for managing opioid-induced constipation (OIC) is limited. This retrospective study aims to explore their use in chronic pain patients with OIC.

Methods: The study examined 53 patients with OIC, comparing outcomes between those receiving Naldemedine with targeted physical exercise (28 in Naldemedine + Rehabilitation group) and those receiving Naldemedine alone (25 in Naldemedine alone group). Assessments at baseline (T0), 14 ± 2 days (T1), and three months (T2) included Numerical Rating Scale (NRS), Patient Assessment of Constipation Quality of Life (PAC-QoL) and Bowel Function Index (BFI).

Results: Combining Naldemedine with rehabilitation led to higher patient satisfaction at three months compared to Naldemedine alone, while no significant between-group differences were observed in abdominal pain relief or bowel function. After 14 days of treatment, both groups demonstrated improvements in NRS, BFI, PAC-QoL total score, and PAC-QoL subscale for satisfaction (p = 0.716, p = 0.886, p = 0.585, p = 0.431). After three-month, Naldemedine + Rehabilitation group showed significantly higher satisfaction levels compared to those on Naldemedine alone, as indicated by PAC-QoL total score and sub-score for satisfaction (p = 0.031, p = 0.0163).

Conclusions: The implementation of a combined approach involving targeted physical exercise alongside Naldemedine treatment showed promising results in enhancing patients' satisfaction.

Background: Stroke survivors often experience impaired balance, increased fall risk, and dependency in activities of daily living (ADLs). Dual-task exercises, combining motor and cognitive challenges, may improve these outcomes. This study was conducted to evaluate the effects of dual-task exercise intervention on balance, fall risk, and ADLs dependency in stroke patients.

Methods: A quasi-experimental single-group pretest-posttest design was used with 54 stroke patients recruited from Ain Shams University Hospitals, Cairo. Participants underwent 16- sessions of individualized dual-task exercises over 8 weeks. Follow-up assessments were conducted immediately post-intervention (two months). Balance was measured at follow-up using the Postural Assessment Scale for Stroke (PASS); fall risk was assessed at follow-up using the Timed Up and Go Test (TUGT); and ADLs dependency was evaluated at follow-up using the Barthel Index (BI). Data were analyzed using SPSS version 27.

Results: Before intervention, 75.9% of participants had low ability to maintain posture, which improved post-intervention to 61.1% with high ability (p < 0.05). Similarly, the ability to change posture improved significantly (81.5% low to 63.0% high; p < 0.05). Pre-intervention 68.5% of patients were at high risk of falling, which decreased post-intervention, with 40.7% classified as low risk and 46.3% as no risk (p < 0.001). Severe ADLs dependency reduced markedly from 75.9% to 9.3% (p < 0.001). Across time points, higher PASS scores (better balance) were negatively associated with fall risk (TUGT) and ADL dependence, while higher BI scores (better ADL independence) were negatively correlated with fall risk and positively correlated with PASS (p = 0.001 for all).

Conclusion: Dual-task exercise training significantly improves balance, reduces fall risk, and enhances independence in ADLs among stroke patients. These findings support integrating dual-task interventions into stroke rehabilitation protocols, especially in resource-limited settings.

In recent years, shifting paradigms in cerebral palsy (CP) rehabilitation have highlighted approaches that promote autonomous movement through active participation, including goal-directed training, task-specific training, context-focused therapy, and constraint-induced movement therapy. Dance has increasingly been recognized in neurorehabilitation as a promising intervention capable of supporting physical, cognitive, and social functioning. Among various dance practices, this mini review focuses on the conceptual framework of creative dance. Creative dance centers on the process of generating movement, which aligns with contemporary paradigms in cerebral palsy rehabilitation. Additionally, because creative dance values the discovery and development of new and unique movements, it provides a setting in which movements, whether with or without disabilities, are respected and accepted as having equal value. These values play a crucial role in fostering a sense of achievement, interest, motivation, and sustained engagement, all of which are emphasized in rehabilitation for individuals with cerebral palsy. However, despite its potential, creative dance remains in the early stages of development as a rehabilitation modality. Establishing a solid evidence base will require a clearer understanding of the movement methodology underlying creative dance. In this mini review, I examine the movement methodology embedded in creative dance-based practice (CBP) and propose a conceptual framework to support its implementation within rehabilitation contexts for individuals with CP.

Background: Children treated for brain tumor (CTBT) experience lasting physical and cognitive impairments that impact quality of life. Given the pervasive impact of brain tumor treatments on cognition, we designed a group exercise program with the specific goal of improving cognition in CTBT. A feasibility study evaluating the program demonstrated improved cognitive and physical outcomes. However, the exercises varied across sessions to maximize participant engagement throughout the 12-week program, which made it difficult to describe the program contents and identify how each element contributed to the observed improvements.

Objective: As a precursor to identifying the effective elements within the group exercise program for CTBT, this study characterized the content of our program according to the exercise categories observed in the exercise sessions, the physical fitness components within the exercises, and the cognitive demand of the exercises.

Methods: This retrospective descriptive analysis coded the content of 50 videos from the exercise program sessions by exercise category (warm-up, aerobic training, games, sports, cool-down), physical fitness components (cardiovascular, coordination, speed, agility, object control, strength, balance, flexibility), and cognitive demand (low, medium, high). Data were descriptively summarized.

Results: Most of the exercise session was spent on games, followed closely by sports. 33% of the exercise session involved exercises with high amounts of cardiovascular content and 46% of the exercise session involved exercises with moderate amounts of cardiovascular content. Exercises with high cognitive demand had the most coordination and object control content. Exercises with medium cognitive demand had the most cardiovascular content.

Conclusion: The presence of exercises with either high cardiovascular content or high coordination was the hallmark of our group exercise program for CTBT. These features should be manipulated in future exercise program evaluations to determine their impact on cognitive and physical outcomes in CTBT.

Introduction: In children with Neuromuscular diseases (NMDs), gait monitoring is essential for evaluating motor function over time. The 10-meter walk test (10 mWT) and the 6 Minute Walking test (6 MWT) are commonly used timed tests. Wearable inertial measurement units (IMUs) have recently gained increasing interest and use for gait assessment. The primary objective of the study is to verify the technical feasibility and clinical usability of IMUs in children with NMDs during standard 10 and 6 MWT. Secondly, the authors aimed to investigate the agreement between the results of manual and device-based tests and the device's measurements of the 95th percentile of stride speed (SV95C) and its correlation with the 6 MWT.

Methods: Ambulatory children aged 6-18 with NMDs were enrolled. The IMU used for the study was the mTest³® device. The 10 mWT and 6-MWT were performed both in the standard method and with the device. Feasibility was assessed through the completion rates of tests with the device, the thematic analysis of clinicians' feedback, timing for the device's use and the percentage of usable recordings. Usability was evaluated using the System Usability Scale (SUS) questionnaire and a pediatric-adapted semi-structured patient interview. Agreement between the results of manual and device-based tests and the device's measurements of the 95th percentile of stride speed (SV95C) and its correlation with the 6 MWT were also evaluated.

Results: Twelve patients with NMDs and a mean age of 12 years and 9 months (range: 8-17 years) were enrolled. All patients completed the assessment protocol using the device. Feedback from clinicians was positive, with few outlier recordings identified. Results from the SUS questionnaire and patient interview showed predominance of positive judgments. The study showed good agreement between the measurements, particularly for the 6 MWT. High correlation between SV95C and 6 MWT was also demonstrated.

Conclusion: This study confirmed the feasibility and usability of IMUs for gait assessment in children with NMDs. In addition, agreement between device-based and manual-based measurements and high correlation between SV95C and 6 MWT was also demonstrated. IMUs can serve both as clinical outcome assessment tools and as devices for gait monitoring across various contexts, supporting their integration into pediatric rehabilitation protocols.

We report a rare and uncommon case of ideational apraxia (IA) and conceptual apraxia (CA) in a 70-year-old woman after concurrent cerebral infarctions of the left basal ganglia (BG) extending to the corona radiata and the right pons. The patient abruptly developed difficulty operating devices such as the car's gear shift and smartphone. The brain MRI on admission disclosed infarction in the area involving the left BG and right pons. During rehabilitation therapy, she exhibited features of IA and CA, including sequencing failures when using technological devices and a profound loss of functional knowledge, exemplified by an inability to recall the purpose and functions of an automated teller machine (ATM) despite prior proficiency. A testing error involved using the keyboard rather than the mouse to open a file. Behaviorally, she impulsively initiated actions and sometimes scheduled conflicting appointments. Neuropsychological testing showed preserved scores on the Mini-Mental State Examination (MMSE) and the Hasegawa Dementia Scale-Revised (HDS-R), but memory impairment was evident on the Rivermead Behavioural Memory Test (RBMT) and the Standard Verbal Paired Associates Learning Test (S-PA). The Behavioural Assessment of the Dysexecutive Syndrome (BADS) revealed marked dysexecutive symptoms, and the Clinical Assessment for Attention (CAT) indicated reduced auditory selective attention and diminished inhibitory control. Notably, the Standard Performance Test for Apraxia (SPTA) yielded normal results. Treated with antiplatelets then antihypertensives, she was discharged home four months later. Attention deficits and driving cessation persisted, but daily life was minimally affected. Although IA and CA are typically linked to left-hemisphere damage, particularly to the BG, the right pontine lesion may have contributed to the deficits, possibly through network disruption. This infarct pattern suggests a complex interplay in apraxia development and warrants further mechanistic study.

Introduction: Virtual reality (VR) is proposed as a support (and potential alternative) to traditional rehabilitation after breast cancer surgery, with expected effects on pain, anxiety, fatigue, and recovery of shoulder ROM (range of movement). The study aims to test a VR system that integrates body illusion, gamification, and distraction, evaluating its usability, user experience, and comfort for clinical use.

Methods: The study was conducted on 31 healthy subjects (28 physiotherapy students, 3 physiotherapists). The software includes a shoulder ROM calibration phase and a training phase involving a VR tennis game, with adjustable parameters and automatic performance recording. SSQ, SUS, UEQ, CRS, and a question on the adequacy of playing speed were administered. A descriptive analysis (mean, standard deviation) and a qualitative analysis of the open-ended responses were conducted.

Results: SSQ: very low average symptoms (minimal discomfort). SUS: good perceived usability (easy, integrated, safe). UEQ: Overall positive experience (clarity, modernity, pleasantness); concerns regarding predictability/slowness. CRS: High tolerability and low anxiety/harm; higher "attachment." Regarding speed: 15 "Yes" votes to making it faster, 16 "No" votes (divided opinions).

Discussion: The VR system is well tolerated, usable, and has a favorable user experience in healthy subjects, indicating promising clinical transferability for shoulder rehabilitation after breast surgery. Dynamics and predictability (adaptive speed/levels) remain to be optimized, and the software needs to be validated on patients and experienced physiotherapists in dedicated studies.