Journal of rehabilitation medicine. Clinical communications最新文献

Objective: Long-term mobility impairment is a sequel of stroke victims which requires intensive medical and physiotherapeutic care. Detailed assessment of therapeutic success is relevant to achieving efficacy, but requires expert knowledge, since mobility disorders are complex. Increasing shortage of qualified staff and larger numbers of patients are thus major problems in this field. To meet these challenges, we show that machine learning algorithms can reproduce expert mobility assessment from gait data with acceptable accuracy, supporting poststroke evaluation while giving intelligible feedback into how the assessments were generated.

Methods: A total of 100 hemiparetic stroke patients received clinical examinations followed by instrumented gait analysis and were assigned a Stroke Mobility Score by an interdisciplinary expert board. From each measured stride pair, 680 features were extracted. After removing non-discriminating features, two regression models were trained: a decision tree and a multilayer perceptron artificial neural network.

Results: The models yielded good to very good (Cohen) coefficients of determination. The interpretable decision-trees and the explanations obtained from the neural network unveiled key features supporting the mobility assessments.

Conclusion: The automated assessments agree well with those of the experts. Synergistic interactions between system, and experts via the computed key features may improve quality in diagnosis and objectify therapeutic targets.

Aim of the study: To improve the effectiveness of neurorehabilitation in patients with severe combat spinal cord injury by combining spinal cord repetitive transvertebral magnetic stimulation (rTvMS) and non-invasive transcutaneous electrical stimulation (TcES) of peripheral nerves.

Clinical rationale for study: For the best recovery from severe combat spinal cord injury, neurorehabilitation must start in the acute phase. Only technologies targeting sensorimotor conduction and functional improvement can confirm the potential of the time factor. Non-invasive neuromodulation has been shown to work for combat spinal cord injury of varying severity.

Material and methods: We have analysed 154 cases of severe combat spinal cord injury, followed continuously for at least 12 months from the start of neurorehabilitation. A unified «end-to-end» protocol combined rTvMS of the spinal cord with simultaneous TcES of peripheral nerves in different modes was developed for non-invasive spinal cord neuromodulation.

Results: The combination of these parameters produced the most positive results in post-traumatic sensory-motor disorders: (i). rTvMS, level ThX-LI: 2000 pulses per set, 100 pulse packages, 5-10 Hz, intensity "+ 30--40%" of the threshold of the evoked motor potential; TcES n. tibialis or n. peroneus: 5-10 Hz, pulse intensity corresponded to the threshold of the motor response, functional electrical stimulation (FES) mode. (ii). rTvMS, level C_II-Th_II: 2000 pulses per set, 50 pulse packages, 5-7 Hz, intensity + 20-30% of the threshold of the evoked motor potential; TcES n. medianus or n. ulnaris; n. tibialis or n. peroneus: 5-10 Hz, pulse intensity corresponded to the threshold of the motor response, FES mode. Approximately 28% of patients in group A (FRANKEL/ASIA) moved to a higher level of function after 3 courses of neurorehabilitation intervention (90 working days).

Conclusions and clinical implications: Electro-magnetic stimulation of the spinal cord excitatory cell conduction system according to the principle of "end-to-end: as in Hebb's theory," combined with physical movement, led to an increase in spinal cord conduction in the acute phase of combat spinal cord injury. This was manifested by neurological and functional improvement.

Objective: We aimed to translate, culturally adapt and test the Prosthetic Upper Extremity Functional Index-2 for a Swedish context.

Subjects: Ten children with congenital upper limb deficiency with an upper limb prosthesis and their parents.

Methods: The translation and cultural adaptation of the Prosthetic Upper Extremity Functional Index-2 was conducted according to the International Society for Pharmacoeconomics and Outcomes Research Principles of Good Practice for cross-cultural adaptation of patient-reported outcome measures; this comprises 10 steps, including Preparation, Forward Translation, Reconciliation, Back Translation, Back Translation Review, Harmonization, Cognitive Debriefing, Review of Cognitive Debriefing Results and Finalization, Proofreading and Final Report.

Result: The new translated version, tested on 10 children, 4 boys and 6 girls, 3-14 years showed good relevance for the Swedish context, the questions were easy to understand, and response options were easy to interpret. It was also easily accessible on computers and mobile devices.

Conclusion: The Swedish version of the Prosthetic Upper Extremity Functional Index-2 is user-friendly and provide information of the child's self-reported prosthesis use in a Swedish context. Children's right to express their opinions, is crucial, and using the questionnaire prior to their clinic visits gives children the opportunity to participate in goal setting and treatment planning.

Objective: To descriptively evaluate Orthopaedic Manual Physical Therapy - a novel intervention for post-stroke shoulder pain - by use of clinical assessments and the participants' experiences.

Design: Two case reports.

Methods: Two individuals with mild to moderate upper extremity impairments and persistent post-stroke shoulder pain, underwent Orthopaedic Manual Physical Therapy for 12 weeks. The intervention comprised a thorough clinical examination, joint mobilization, stretching, and exercises targeting the affected structures and incorrect movement patterns. Participants were clinically assessed pre- and post-intervention and followed up 4-5 months later. They also answered interviews about their experiences of the intervention and perceived effects.

Results: After Orthopaedic Manual Physical Therapy, both participants showed decreased pain intensity during movements and increased range of motion. One of the participants also experienced decreased resistance to passive movements, improved motor function, grip strength, and upper extremity daily activities after the intervention and at follow-up. Interviews revealed that the participants tolerated the therapy well and were satisfied with the intervention and long-lasting results.

Conclusion: Orthopaedic Manual Physical Therapy may be a useful method to reduce post-stroke shoulder pain in persons with mild to moderate upper extremity paresis after stroke. To confirm the results, further studies are warranted.

Objective: To evaluate the long-term efficacy of spasticity-corrective surgery and botulinum toxin treatment in patients with upper limb spasticity.

Design: Pretest-posttest quasi-experimental study.

Patients: Thirty-four patients with disabling spasticity.

Methods: Patients were divided into 2 groups based on their treatment preference: the surgery group, which underwent tendon lengthening/release (n = 17), and the botulinum toxin injection group (n = 17). The primary outcome measure was the Modified Ashworth Scale. Secondary outcomes included range of motion, grip strength, and activity performance. Assessments were conducted at baseline for both groups, at 3 months following botulinum toxin injection, and at 6 months following surgery, with an additional peak-effect evaluation for botulinum toxin at week 5.

Results: The surgery group demonstrated significantly greater reductions in composite Modified Ashworth Scale scores, with a mean change of 2.7 (SD 0.8), compared to the botulinum toxin group (1.1, SD 0.6 at peak; 0.3, SD 0.5 at long-term; p < 0.001). Surgery also led to significantly larger improvements in range of motion, grip strength, task performance, and patient satisfaction. While botulinum toxin effects were transient, surgery provided sustained benefits.

Conclusion: Spasticity-corrective surgery achieves superior and longer-lasting benefits compared to botulinum toxin treatment in patients with disabling upper limb spasticity.

Background: Prediction of functional recovery in older adults recovering from stroke is typically based on observational scales, such as the Utrecht Scale for Evaluation of Rehabilitation (USER). Objectively measuring postural sway using inertial measurement devices (IMU) may complement or improve conventional approaches. The aim of this study was to evaluate whether integrating an IMU with USER data enhances the accuracy of predicting functional recovery at discharge.

Methods: This prospective cohort study included older adults (≥ 65 years) recovering from stroke. Postural sway was assessed using an IMU during 2 different balance conditions and analysed using principal component analysis (PCA). Using 3 different regression models, percentage explained variance was compared to assess predictive performance on functional recovery of USER vs an IMU.

Results: The 71 patients included had a mean age of 78 (SD 7.6) and a median time since stroke of 16 days (IQR 19-60). Of the 71 patients, 12 (16.9%) were unable to perform balance condition 2 due to insufficient balance. Of 35 postural sway features displaying reliability for both balance conditions, 12 were selected for PCA. Incorporation of principal components for both balance conditions in the final model increased the explained variance compared to a model in which only USER-mobility at admission was used to predict delta-USER at discharge (R ² = 0.61 vs 0.30).

Conclusions: Sitting and standing balance as measured by an IMU improves the prediction of functional recovery at discharge compared to USER alone.

Objective: To report an in-hospital cardiac rehabilitation strategy after exercise-induced implantable cardioverter defibrillator shock.

Case report: A 72-year-old man with heart failure, peripheral artery disease, a history of percutaneous coronary intervention and coronary artery bypass surgery, exercise-induced ventricular fibrillation, and an implantable cardioverter defibrillator was hospitalised after experiencing recurrent ventricular fibrillation while walking, which triggered implantable cardioverter defibrillator shock. While hospitalised, his medication regimen was adjusted. After passing the 200-m walking test, he started in-hospital cardiac rehabilitation. During cardiopulmonary exercise testing, he experienced non-sustained ventricular tachycardia. Percutaneous coronary intervention was performed to relieve ischaemia; however, ventricular tachycardia recurred during walking, causing another implantable cardioverter defibrillator shock. After further medication adjustments and setting heart rate limits, he gradually resumed cycling and low-intensity resistance exercises, followed by walking, and was subsequently discharged without ventricular tachycardia recurrence.

Discussion: Peripheral artery disease-associated pain and increased heart rate may have contributed to ventricular tachycardia. A stepwise exercise programme involving heart rate monitoring and medication therapy adjustments enabled safe exercise resumption after implantable cardioverter defibrillator shock in a patient with multiple comorbidities.

Conclusion: This case emphasises the importance of personalised exercise strategies that consider both arrhythmic risk and comorbidities for patients at high risk of exercise-induced arrhythmias.

Objective: The current aftertreatment for surgically treated patients with displaced intra-articular calcaneal fractures (DIACFs) consists of restricted weight bearing (RWB) for 8-12 weeks. This study aimed to assess whether permissive weight bearing (PWB) results in improved patient-reported outcomes (PROMs) after a minimum of 2 years follow-up, compared to RWB.

Design: Multicentre, retrospective cohort study.

Patients: Surgically treated patients with isolated unilateral DIACFs.

Methods: Foot and ankle function was measured using the American Orthopaedic Foot and Ankle Society (AOFAS) Score and the Maryland Foot Score (MFS). Health-related quality of life was assessed using the Short Form-12 (SF-12) and the EuroQoL EQ-5D-5L (EQ-5D). Additionally, radiographic parameters and complications were recorded.

Results: Fourteen patients followed the PWB and 18 followed the RWB protocol (n = 32). The PWB group had similar outcome scores on the AOFAS Score (83.4 vs. 71.1, p = 0.13) and MFS (86.3 vs. 77.6, p = 0.20) compared to the RWB group. PWB showed similar outcomes on the EQ-5D (0.86 vs. 0.80, p = 0.26) scores. Radiographic parameters and complication rates were comparable for both groups.

Conclusion: This study suggests that PWB and RWB yield comparable PROMs in foot and ankle function without radiographic failures and similar complication rates in surgically treated patients with isolated, unilateral DIACFs.

Introduction: Traumatic brain injury (TBI) with diffuse axonal injury (DAI) necessitates significant medical and rehabilitation interventions. The late long-term outcome is variable with potential for neurodegenerative development and deterioration. This study evaluates the late long-term outcomes of moderate to severe TBI with DAI.

Methods: Patients aged 16-65 with moderate to severe TBI and DAI were included. From 2006 to 2018, 30 patients (mean age 34; 21 males, 9 females) were enrolled. Outcomes were assessed using the Glasgow Outcome Scale Extended (GOSE) at 6 months and ≥ 1-year post-injury.

Results: At 6 months, 10 patients had a favourable outcome (GOSE 6-8), increasing to 12 at ≥ 1-year post-injury. Patients with unfavourable outcomes were older (mean 40) than those with favourable outcomes (mean 24, p < 0.001). DAI stage correlated with outcomes (p = 0.003). GOSE remained unchanged in 15 patients, improved in 9 and deteriorated in 6 between the 6 months and the ≥ 1-year follow-up.

Discussion: Approximately one-third of TBI patients with DAI achieved favourable long-term outcomes, and the outcome changed in half of the patients between 6 months and ≥ 1 year follow-up. Age and DAI stage were significant predictors of outcome. Further studies are required to enhance prognostic accuracy and explore rehabilitation's impact.

Objective: To examine incidence and associations for unplanned Acute Care Unit Readmissions (ACURs) in Asian primary brain tumour patients.

Design: A retrospective single-centre cohort study.

Patients: A total of 173 Asian primary brain tumour patients undergoing inpatient rehabilitation in a tertiary rehabilitation centre.

Methods: Primary outcome was unplanned ACUR. Logistic regression analysis was used to determine associations with patients who had an unplanned ACUR.

Results: Altogether, the majority of patients had low-grade (World Health Organization Class I and II) tumours (76.9%), whilst 32 (18.5%) patients had glioblastoma multiforme tumours. Unplanned ACUR occurred in 27 (15.9%) patients, with the 2 most common causes being neurosurgical complications (37.0%) and non-neurosurgical infections (25.9%). Significant risk factors for ACUR patients were a longer acute hospitalization stay (odds ratio = 1.024; 95% confidence interval [CI] = 1.01-1.04; p = 0.007), whereas a higher admission motor Functional Independence Measure was protective against unplanned ACUR (odds ratio = 0.945; 95% CI = 0.915-0.977; p = 0.001).

Conclusions: Despite rehabilitation goals of prevention of complications, patients with primary brain tumours undergoing inpatient rehabilitation continue to demonstrate significant unplanned ACUR rates (15.9%) with neurosurgical complications being common. These findings underscore the importance of continued vigilance, access to and coordination of neurosurgical care and management beyond the acute surgical phase, in order to ensure optimal outcomes.