Frontiers in rehabilitation sciences最新文献

Stretching is a ubiquitous rehabilitation intervention for individuals with spinal cord injury (SCI), intended to reduce spasticity, maintain or improve joint range of motion, and prevent joint contractures. Although people with SCI report that stretching is their preferred approach to reduce spasticity, limited evidence supports the use of stretching for people with SCI, including short-term (< one hour) effects on spasticity. Further, the long-term effects and the effects of stretching on motor function have yet to be examined in humans with SCI. Evidence from pre-clinical studies in rats with SCI demonstrates that stretching impairs motor output, reduces spinal cord excitability, and abolishes walking function. This perspective paper discusses evidence of static stretching in humans and rats with SCI regarding the effects on range of motion, joint contractures, and effects on voluntary and involuntary (i.e., spasticity) motor output. Additionally, we aim to challenge assumptions regarding the use of stretching and encourage research to advance the understanding of this common rehabilitation approach. Research is needed to investigate underlying mechanisms of stretch-induced effects and to advance stretching protocols to optimize the potential beneficial effects of stretching for people with SCI.

[This corrects the article DOI: 10.3389/fresc.2024.1353077.].

Health-related quality of life (HRQoL) is a patient-perceived measure of physical, social, and emotional health. Acquired brain injury (ABI) occurs due to damage to the brain after birth. Individuals with an ABI typically present with reduced HRQoL and require additional support to maintain their HRQoL. Although structured exercise training has been shown to improve HRQoL in individuals with ABI, there is little research on habitual, real-world activity. Most activity research characterizes moderate-to-vigorous physical activity (MVPA) in absolute terms; however, relative physical activity levels have been promoted for research in clinical populations. We tested whether longer MVPA durations, measured in absolute/relative levels, are associated with higher HRQoL in outpatients with ABIs. In total, 26 adults (54 ± 13 years, 16 females) with ABI completed the Quality of Life After Brain Injury questionnaire, a 6-min walk test (a measure of aerobic fitness; 490 ± 105 m), and wore an activPAL device 24 h/day for 7 days. Participants had an average HRQoL score of 53.4 ± 15.0 (out of 100), with 20 of 26 showing impaired HRQoL (score <60). Absolute MVPA (74.6 ± 91.0 min/week, b = 0.09, p = 0.03) was associated with HRQoL, whereas total physical activity (565.7 ± 264.8 min/week, p = 0.47), light physical activity (LPA; 491.1 ± 224.3 min/week, p = 0.98), and step count (5,960 ± 3,037 steps/day, p = 0.24) were not. Neither relative LPA (521.4 ± 244.9) nor relative MVPA (33.5 ± 34.9 min/week) were associated with HRQoL (both p values > 0.14). Targeting more absolute MVPA, but not necessarily relative MVPA, may be an effective strategy for interventions aiming to improve HRQoL in individuals with ABI.

Objective: To analyze and study the causes and treatment approaches for lumbar disc herniation, focusing on office workers.

Methods: The concept of spinal internal balance disorder as a foundation for treating traumatic spinal diseases was introduced. Pathological changes occurring with single (or multiple) vertebral displacement were considered. For the first time, the "spinal (point) rotation repositioning method" from traditional Chinese bone setting was combined with NMES (neuromuscular electrical stimulation) technology to treat low back pain.

Results: The patient's symptoms of low back pain were cured within a short period, allowing a quick return to work and daily life, with no recurrence of the disease observed during long-term follow-up.

Conclusion: The combination of traditional Chinese bone setting and NMES provides a more effective and quicker resolution to low back pain in office workers with lumbar disc herniation. This integrated approach not only relieves pain but also restores lumbar function, ensuring long-term stability and reducing recurrence.

Background: The complex physical, cognitive, and psychological consequences of stroke can disrupt a survivor's sense of pre-stroke normality and identity. This can have a substantial impact on their individual and social lives. Individual reports about life after stroke have improved our understanding of this impact. However, stroke support systems, struggling with increased demands due to a growing stroke population and guideline requirements, require deeper insights based on synthesised narratives into what can enable stroke survivors to rebuild their lives and identities positively to provide person-centred care.

Methods: A qualitative study using Charmaz's Constructivist Grounded Theory (GT) method. Semi-structured interviews lasting 60-90 min were conducted. These interviews were held at least 12 months post-stroke.

Findings: Thirty participants were interviewed from across the UK (14 women, 16 men; aged 31-86; 1-25 years post-stroke). Participants reported the disruption stroke could cause to their sense of identity. The concept of liminality, that describes the ambiguous, transformative state between two distinct stages, where an individual or group exists "betwixt and between" stable conditions, explains the challenge to identity post-stroke. Participants reported developing an uncertain sense of identity as they struggled to structure identity in the same way they did before stroke. This is because the participants' characteristics, traits, hobbies, or future life plans, as well as social relationships and roles, were affected by stroke. Subsequently, participants began a process of reconfiguring their identity, an often-long-term process that involved coming to terms with, and integrating, the impact of stroke on their lives. As a result, participants could enter an indefinite period of sustained liminality as they contend with long-term change and continued uncertainty.

Conclusion: The concept of liminality, which emerged from individual stroke narratives for the first time, conveyed the adaptive and enduring nature of a stroke survivor's journey. Post-stroke liminality may continue indefinitely, sustained by a survivor's subjective individual and social situation. This new insight justifies the urgent call for long-term rehabilitation and support that is tailored towards the unique nature of a survivor's circumstances. Further work is required to understand how tailored, long-term and person-centred support can encourage survivors to positively reconfigure their identity.

This paper presents GARD, an upper limb end-effector rehabilitation device developed for stroke patients. GARD offers assistance force along or towards a 2D trajectory during physical therapy sessions. GARD employs a non-backdrivable mechanism with novel motor velocity-control-based algorithms, which offers superior control precision and stability. To our knowledge, this innovative technical route has not been previously explored in rehabilitation robotics. In alignment with the new design, GARD features two novel control algorithms: Implicit Euler Velocity Control (IEVC) algorithm and a generalized impedance control algorithm. These algorithms achieve $O\left(n\right)$ runtime complexity for any arbitrary trajectory. The system has demonstrated a mean absolute error of 0.023 mm in trajectory-following tasks and 0.14 mm in trajectory-restricted free moving tasks. The proposed upper limb rehabilitation device offers all the functionalities of existing commercial devices with superior performance. Additionally, GARD provides unique functionalities such as area-restricted free moving and dynamic Motion Restriction Map interaction. This device holds strong potential for widespread clinical use, potentially improving rehabilitation outcomes for stroke patients.

The International Classification of Functioning, Disability, and Health (ICF) is a widely used framework in rehabilitation that provides standardized measures to describe health and health-related states of people. The strength of the ICF lies in its provision of a common language for describing rehabilitation progress. However, personal factors are not classified within the ICF due to their significant variability across cultures, which may render it not adequately capturing the subjective and social dimensions of disability. Our objective in this research was to propose theoretical frameworks that could help identify relevant personal factors for inclusion in the ICF. We discuss the Personality Systems Interaction (PSI) Theory to identify personal variability in goal pursuit, highlighting the importance of emotions like negative and positive affect in handling adverse situations and managing habitual behaviors. Additionally, the theory helps to determine personality factors relevant to patients, facilitating the resolution of potential issues that may emerge during the goal achievement process. We also emphasize the role of goal setting in rehabilitation and suggest the Goal-Oriented Action Linking (GOAL) model as a useful tool for understanding how motivational values change over time, distance, and progress. Following from this, we discuss the importance of self-efficacy and its relationship to effort and goal achievement, while noting potential issues in its assessment. Finally, we propose viable assessment methods for measuring the potential components to be incorporated as personal factors.

Purpose: The Canadian province of Québec faces several issues regarding the accessibility and quality of diagnostic assessment and the efficiency and continuity of evaluation, support, and intervention services for children with neurodevelopmental conditions (NDCs). To address these issues, the Ministry of Health and Social Services mandated a research team to initiate the development of a reference trajectory, i.e., a proposed model pathway based on national and international best practices and research, for the diagnostic assessment of NDCs in children aged 0-7 years.

Methods: The present study focused on the development of a logic model to operationalize the diagnostic services trajectory using a community-based participatory research approach and informed by implementation science. This involved representatives from multiple stakeholder groups (e.g., parents, professionals, physicians, administrators, researchers). Project steps included an analysis of best practices from a literature review on diagnostic trajectories, focus groups and interviews with stakeholders, and a validation process to ensure the appropriateness of the final model.

Results: The integration of existing research and stakeholder input resulted in a logic model for a new diagnostic services trajectory for children aged 0-7 years suspected of NDCs and identified key ingredients that should be present in its future implementation.

Conclusion: The proposed model for a diagnostic services trajectory is expected to address several systemic issues identified previously. Its implementation will need to be evaluated to ensure its sustained focus on the needs of families and its ability to promote their quality of life, well-being, and involvement.