Journal of rehabilitation medicine. Clinical communications最新文献

Objective: Toe walking due to progressive shortening of the calf muscles is common in people with hereditary spastic paraplegia. Achilles tendon lengthening is a treatment option, but clinicians are often hesitant to use this procedure, as it may result in weakening of the calf muscles and, subsequently, in reduced ankle power and knee instability during the stance phase of gait. We report here a case report supporting that these negative side-effects can be avoided in well-selected people with hereditary spastic paraplegia.

Method: Bilateral Achilles tendon lengthening, combined with bilateral tenotomy of the tibialis posterior and toe flexors, was performed in a 29-year-old woman with uncomplicated hereditary spastic paraplegia who experienced progressive gait instability due to shortening of the soleus and gastrocnemius muscles (resulting in irreducible pes equinus).

Results: Bilateral Achilles tendon lengthening resulted in improvement in both subjective and objective outcomes. Self-selected gait speed improved from 0.75 m/s before surgery to 1.07 m/s after surgery (p < 0.001). Knee instability during the stance phase did not occur post-surgery. The ankle moment trajectories normalized after surgery, while peak ankle powers increased.

Conclusion: Correction of bilateral irreducible pes equinus by Achilles tendon lengthening may improve gait capacity in well-selected subjects with hereditary spastic paraplegia.

For special populations such as people with a mental health issue or learning disability, a disconnect between the ability to accurately monitor and regulate exercise behaviour can lead to reduced levels of physical activity, which, in turn, is associated with additional physical or mental health problems. Activity pacing is a strategy used in clinical settings to address issues of pain amelioration, while self-pacing research is now well addressed in sport and exercise science literature. It has been proposed recently that these overlapping areas of investigation collectively support the development of self-regulatory, lifestyle exercise skills across broad population groups. Activity pacing appears to have substantial application in numerous development and rehabilitation settings and, therefore, the purpose of this short communication is to articulate how an activity pacing approach could be utilized among population groups in whom self-regulatory skills may require development. This paper provides specific examples of exercise practice across 2 discrete populations: children, and people with mental health and learning difficulties. In these cases, homeostatic regulatory processes may either be altered, or the individual may require extrinsic support to appropriately self-regulate exercise performance. A support-based exercise environment or approach such as programmatic activity (lifestyle) pacing would be beneficial to facilitate supervised and education-based self-regulation until such time as fully self-regulated exercise is feasible.

Objective: To assess satisfaction of prosthesis users with their prostheses, and the problems they experience with the residual limb, using a checklist, in order to evaluate potential benefits of checklist use and to summarize issues and problems with the prosthesis and/or residual limb presented by prosthesis users.

Design: Cross-sectional study.

Subjects: Participants were adult trans-tibial prosthesis users (n = 82) and certified prosthetist orthotist (n = 19) experienced in fitting lower-limb prostheses.

Methods: Prosthesis users reported their reasons for consultation and factors concerning prosthesis (dis)satisfaction and residual limb problems, using a checklist. Checklist use was evaluated by certified prosthetist orthotists and prosthesis users and the significance of evaluation scores was determined.

Results: Checklist use identified 126 issues/problems, most of which concerned prosthesis fit (33%) and pressure points on the residual limb skin (26%). Evaluation scores were significantly higher than neutral regarding the checklist helping the certified prosthetist orthotist to gather more information and to make clear with which issues the prosthesis user was dissatisfied. Prosthesis users reported that checklist use made them feel more understood by the certified prosthetist orthotist.

Conclusion: Checklist use in the assessment of trans-tibial prostheses is beneficial in identifying factors related to dissatisfaction, and improves the quality of certified prosthetist orthotists' consultation. The implementation of checklist use is, however, challenging.

Despite increasing evidence for, and heightened awareness of, the importance of exercise in Parkinson's disease, many patients remain sedentary. This tendency to lead an inactive lifestyle has various underlying reasons, including the presence of gait and balance impairments that complicate the patients' ability to perform sports activities. This case report illustrates that a personally tailored approach may be required in these patients, supported, if needed, by the use of compensation strategies or novel technological advances.

Objective: Low back pain caused by osteoporosisinduced thoracolumbar vertebral compression fractures is a common debilitating disorder. The aims of this study were to determine the accuracy and efficacy of spinal dorsal ramus injection and radiofrequency neurolysis for pain reduction in patients with this condition.

Methods: This study was a retrospective chart review of 46 patients with low back pain caused by osteoporosis-induced thoracolumbar vertebral compression fractures. All patients had been treated with spinal dorsal ramus injection with mixed Sensorcaine (Fresenius Kabi, USA) and Depo-Medrol (Pfizer, USA). In some patients further treatment with radiofrequency neurolysis had been required after the initial injection wore off.

Results: Out of a total of 46 patients, 45 (97.7%) had ≥ 50% reduction in low back pain immediately after injection. After the initial injection wore off, 18 patients remained pain free and 27 required radiofrequency neurolysis. The follow-up period ranged from 60 to 1,440 days (mean 335 days). The intensity of low back pain decreased from 7.09 ± 0.84 (numerical pain scale of 0-10) before treatment to 1.39 ± 1.51 immediately after the injection, and to 0.96 ± 1.36 at the last office visit.

Conclusion: Spinal dorsal ramus injection and radiofrequency neurolysis are effective and accurate therapies for low back pain caused by osteoporosis-induced thoracolumbar vertebral compression fractures.

Objective: To describe the sociodemographic features, impairments, and functional changes of COVID-19-positive individuals who underwent inpatient rehabilitation at three rehabilitation hospitals in Toronto, Canada.

Design: Retrospective chart review of patients admitted to three COVID-19 rehabilitation units between 20 April 2020 and 3 June 2020. Sociodemographic factors, impairments, length of stay, and Functional Independence Measure data were reported.

Results: A total of 41 patients were included in this study, including 22 males and 19 females. The median age was 75 years. Thirty-six percent of patients were admitted to the intensive care unit during their acute stay. The most commonly affected body functions were: neuromusculoskeletal (73.2%); combined cardiovascular, haematological, immunological, and respiratory (65.9%); and mental functions (29.3%). Median total Functional Independence Measure score was 85 at admission and 108.5 at discharge.

Conclusion: This study represents some of the first data on the characteristics and outcomes of COVID-19-positive individuals admitted to inpatient rehabilitation in Toronto, Canada early in the COVID-19 pandemic.

Background: Intrathecal baclofen is considered an adjuvant therapy for patients with intractable spasms due to stiff-person syndrome. There is increasing evidence to support the use of intrathecal baclofen in the management of symptomatic stiffperson syndrome, with improvement in function.

Case report: A 38-year-old woman with stiff- person syndrome initially presented to inpatient rehabilitation for intractable muscle spasms. The symptoms made her non-ambulatory and limited her tolerance to wheelchair use for mobility. The patient underwent up-titration of oral baclofen and diazepam, with concurrent intravenous immunoglobulin cycles, leading to transient symptom relief. She agreed to explore intrathecal baclofen therapy. An initial trial of a single bolus of 50 μg intrathecal baclofen resulted in a significant decrease in spontaneous spasms, enabling modified independence in transfers and ambulation. The patient was subsequently implanted with a permanent intrathecal delivery system. To date, the intrathecal baclofen had been titrated to 186 μg per day with simple continuous delivery. The patient was weaned off oral baclofen. She attained complete functional independence with ambulation without the need for assistive devices, and has had no lasting post-procedural complications to date.

Conclusion: This case report adds to the increasing evidence of cases of refractory stiff-person syndrome managed successfully using intrathecal baclofen therapy.

Objective: Periods of lockdown due to coronavirus disease 2019 (COVID-19) have a negative effect on individuals' physical health and quality of life, and may result in a weakened immune response, leading to enhanced risk of infection. Due to lack of access to public resources during periods of lockdown many individuals cannot perform their usual daily physical activities. The aim of this short report is to discuss the use of mobile-based health applications and virtual reality systems for promoting physical activity at home through an interactive and motivating digital environment.

Methods and results: Information on tele-health, available from the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), and data on physical activity during lockdowns were reviewed. A list of mobile-based health applications suitable for use in promoting physical activity at home was compiled.

Conclusion: This report makes recommendations for mobile-based health applications to promote physical health, which can be used at home during periods of lockdown.

Objective: Alien hand syndrome is a rare neurological disorder in which the patient makes seemingly purposeful movements of one hand, which are dissociated from any conscious intent. These abnormal movements are very annoying, and can be disabling, for the patient. There is no established effective treatment for alien hand syndrome.

Methods: Report of a case of a 61-year old man with frontal variant of alien hand syndrome following ischaemic stroke.

Results: During therapy, the patient unwittingly grabbed objects with his right hand and could not voluntarily release his grip. Multidisciplinary rehabilitation was started, with learning of compensation strategies and a focus on bimanual tasks. Follow-up after 5 months showed a major improvement in the Functional Index Measure (FIM) score, an improvement from 36 to 79 on 126 scored items.

Conclusion: It is important to recognize this rare syndrome because of its disabling character. Evidence about the best treatment for alien hand syndrome is scarce. There is an important role for specific exercises and patient education. During rehabilitation of the patient, most improvement occurred with bimanual tasks and different colours (black, white and other bright colours) to navigate the subject's attention more to one side. Another exercise strategy was letting the alien hand catch a cube, after which the patient was able to perform more exercises with the other hand during one - handed training. In the current case, the alien hand syndrome resolved following specific and multidisciplinary rehabilitation.