Frontiers in rehabilitation sciences最新文献

Clinical management of prandial aspiration remains heavily influenced by long-standing practices and may not align with current evidence. This editorial provides a broad overview of the articles in this edition of Frontiers in Rehabilitation Sciences and addresses three common misconceptions in dysphagia management: (a) that prandial aspiration always requires immediate restrictive intervention, (b) that coughing during meals indicates physiologic dysfunction, and (c) that thickened liquids universally reduce aspiration risk without consequence. We examine how these myths conflict with current evidence and highlight supportive perspectives from various disciplines. Rather than introducing new techniques, we encourage critical examination of current practices and provide guidance for implementing evidence-supported interventions. The goal is to move toward individualized care that considers multiple risk factors beyond the mere presence of aspiration, ultimately improving patient outcomes while maintaining quality of life.

Introduction: Focal vibration therapy (FVT) is increasingly used in the treatment of spastic paresis. In adults, it has been shown to reduce spasticity and to increase torque production from the vibrated muscles by restoring reciprocal inhibition of antagonists, thereby improving overall gait. In children with spastic cerebral palsy (CP), FVT has also been suggested to reduce spasticity, increase torque production and improve gait function, but evidence is limited.

Methods: We report the case of a child with unilateral spastic CP (USCP) and equinus gait (GFMCS II level) with (i) ankle dorsiflexor paresis, (ii) ankle plantar flexor overactivity, especially in gastrosoleus complex and peroneus longus, (iii) spastic myopathy, affecting gastrosoleus complex in particular, and (iv) calf pain seemingly related to muscle overactivity. The child was treated with a two-month program of alternating dorsiflexor and plantar flexor focal vibration therapy (FVT) and botulinum neurotoxin A (BoNT-A) injections into plantar flexors, alongside conventional physiotherapy.

Results and discussion: Clinical evaluations during the two-month program showed (i) improved walking speed (ii) decreased ankle dorsiflexor paresis and ankle plantar flexor overactivity, especially spastic co-contraction and spasticity, (iii) improved passive extensibility in plantar flexors, and (iv) reduced pain. This is the first report of the combination of FVT and BoNT-A injections having promising effects on equinus gait in USCP.

The potential of using prism adaptation for treating spatial neglect (SN) was questioned when recent meta-analyses found inconsistent evidence. However, analyses of clinical datasets support the use of prism adaptation treatment (PAT) in reducing SN and improving function. The main objective of this review is to evaluate the current state of the evidence of PAT therapeutic effects, identify knowledge gaps, and make suggestions to guide further research and support clinical decision-making. We used the framework of the National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development which provides guidance on best practices for developing effective behavioral interventions that can be implemented in real-world settings. This model emphasizes the interplay between mechanisms underlying therapeutic effects ("who" should receive the treatment and "how" best does it work?) and considerations of adaptability and feasibility in real-world settings. The present critical review led to the following conclusion: the use of the NIH Stage Model reveals the heterogeneity of PAT studies and challenges in advancing PAT as an effective intervention. The key mechanisms such as prism strength, treatment intensity, arm visibility and activities during treatment, and evaluation methods lack consensus. Therefore, clinical research teams must continue to collect evidence to determine critical mechanisms and the optimal protocol. Further research identifying the optimal PAT protocol is needed before another meta-analysis on PAT's clinical efficacy should be conducted again.

Giant meniscus cysts combined with mixed tears are relatively uncommon in clinical practice. The primary objective of rehabilitation is to restore knee joint function and prevent cyst recurrence. In this article, we discuss a series of rehabilitation strategies implemented for a patient who experienced both a giant meniscus cyst and a mixed tear.

Individuals with movement disorders often face challenges in writing independently due to factors such as spasticity, lack of precise motor control, muscle weakness, and tremors. This paper aims to develop a handwriting assistive device (HAD) for individuals with movement disorders, to stabilize the motion of user's hand, through initial needs assessment, iterative design, and a preliminary evaluation. The research is scoped to include only initial testing with a small user group, six potential users with movement disorders, providing foundational insights for future refinement. The findings from the initial needs assessment revealed that current assistive technologies do not fully meet handwriting challenges for individuals with motor impairments. The HAD prototype, developed with adjustable damping mechanism and customizable handles to suit different levels of motor control, enabled steadier handwriting in preliminary testing with six participants. Children drew shapes more accurately, and some traced letters they couldn't otherwise. The adult participant showed greater fluidity and legibility, completing tasks 4.81 times faster with the HAD. The qualitative feedback indicated the device's potential to enhance handwriting independence and usability across age groups. Future prospects for this study include developing an electronic version of the HAD, allowing real-time adjustable damping to better support users' voluntary movements while further stabilizing involuntary motions.

Objective: The study explores caregiver perceptions of home programs for clients with acquired brain injury based on current clinical care after transition to the community.

Design: A qualitative descriptive study.

Setting: Within the community, post inpatient rehabilitation.

Participants: A convenience sample of eight caregivers of clients with acquired brain injury from one clinical site. All participants spoke English, were between the ages of 18 and 85 years, had no neurodegenerative disorders, and self-identified as caregivers.

Procedures: Two nested semi-structured interviews were completed post-discharge from an inpatient rehabilitation facility. All interviews were audio recorded and transcribed. Qualitative data analysis was performed utilizing MAXQDA© software, consensus coding, and abstraction of themes.

Results: Two themes with subsequent subthemes were identified: (1) Systems, Roles, and Responsibilities Influenced Caregivers' Perceptions of Home Program and Recovery Outlook and (2) Caregivers' Home Program Experience. The first theme addresses topics of caregiver roles and responsibilities, system supports and barriers, and their general outlook on recovery. Within the second theme, results provide a chronological description of home program training, use, and modification.

Conclusions: A caregiver's outlook on the care receiver's recovery and home program implementation is influenced by the burden of responsibilities, and system-level supports and barriers. The home program experience of the caregivers was reported to involve limited but satisfactory training. Caregivers saw the value in home programs and advised others to engage in them. Future programs should encourage healthcare providers to provide explicit instruction to the caregiver about their intrinsic value to home program implementation and adherence.

Introduction: Total and sub-total lesions of the anterior cruciate ligament (ACL) are one of the most frequent and performance-limiting injuries to the knee joint within the active population. Early surgical management, often regarded as the primary management strategy, has recently been shown to have similar outcomes when compared with an initial rehabilitative approach followed by surgical ACL reconstruction if higher levels of functionality are needed. The primary objective of the study was to investigate the physiotherapists and orthopedic surgeons' "coper/non-coper" screening application in the clinical management of the patient after ACL injury. Second, the authors aimed to investigate the cooperation between physiotherapists and orthopedic surgeons when dealing with patients with ACL injuries.

Methods: An online survey consisting of 12 questions on the clinical practice of the surveyed physiotherapists (n = 803) and orthopedic surgeons (n = 201), and the relation between these healthcare professionals, was distributed. The answers were stratified depending on clinical experience in dealing with ACL injuries.

Results: Both physiotherapists and orthopedic surgeons showed a low degree of confidence and application of the "coper/non-coper" screening when managing ACL lesions. The sub-population of ACL experts reported a good level of interprofessional interaction. Nevertheless, an updated level of knowledge regarding the recent evidence on the non-surgical management of ACL lesions is still lacking.

Conclusions: The study findings indicate the need to improve the collaboration between Italian physiotherapists and orthopedic surgeons as well as their knowledge of the non-surgical approaches to ACL lesions.

Purpose: This study aimed to validate the accuracy of the Active Style Pro HJA-750C (ASP) in measuring metabolic equivalents (METs) during walking and reaching tasks in individuals with subacute stroke using a respiratory gas analyzer as a reference.

Methods: Twenty-three hospitalized patients with subacute stroke participated in this study. They performed sitting and standing reaching tasks, as well as walking while wearing a VO2 Master respiratory gas analyzer and ASP devices on both the paretic and non-paretic sides. The METs values recorded by the ASP were compared with those obtained using a VO2 Master respiratory gas analyzer. Pearson's correlation coefficients were calculated for each task, and Bland-Altman plots were used to assess the agreement between the two methods.

Results: The ASP demonstrated good concurrent validity, with correlation coefficients of 0.71 and 0.74 for the sitting reaching task, 0.75 and 0.79 for the standing reaching task, and 0.83 and 0.85 for walking when the ASP was placed on the paretic and non-paretic sides, respectively. Bland-Altman analysis indicated no significant fixed or proportional errors. The ASP accurately measures METs whether worn on the affected or unaffected side of the waist.

Conclusion: The ASP provides valid measurements of physical activity during walking and reaching tasks in patients with subacute stroke. These findings suggest that ASP is a valuable tool for monitoring physical activity in clinical rehabilitation settings.