American Journal of Physical Medicine & Rehabilitation最新文献

Objective: The aim of the study is to determine whether virtual reality-based dynamic standing balance training improves three elements of sensory integration and investigate whether virtual reality-based dynamic standing balance training results in improved outcomes, especially regarding balance and gait, compared with the standard training method.

Design: This single-blinded, randomized, controlled trial involved 30 patients with hemiplegia. The experimental ( n = 15) and control ( n = 15) groups received virtual reality augmented-standing balance training or standard standing balance training, respectively, for 20 mins, 5 days a week, for 3 wks. The patients were assessed for primary (Sensory Organization Test and the Berg Balance Scale) and secondary (the functional reaching test and timed up-and-go test) outcomes before and after training.

Results: From preintervention to postintervention, the Berg Balance Scale score (F = 26.295, P < 0.05), timed up-and-go test score (F = 18.12, P < 0.05), mean score of conditions 2 (F = 4.36, P < 0.05) and 6 (F = 5.61, P < 0.05), and composite score of the Sensory Organization Test (F = 5.385, P < 0.05) in both groups were significantly improved. However, there was no significant difference between experimental group and control group (time*group P > 0.05).

Conclusions: Virtual reality combined with standing balance training improved sensory integration, postural control, balance, and gait ability in patients with hemiplegia, reducing fall risk. However, outcomes were comparable with general balance training regarding balance and gait.

Abstract: Reverse total shoulder arthroplasty is an effective procedure to improve shoulder pain, range of motion, and function for a variety of conditions, including glenohumeral osteoarthritis and rotator cuff arthropathy. However, up to 22% of patients have persistent shoulder pain 12-24 mos after reverse total shoulder arthroplasty, even in the absence of surgical complications. Currently, there are no widely accepted nonpharmacological treatments for persistent postoperative pain after reverse total shoulder arthroplasty. This case report details the successful management of a 64-yr-old woman with chronic postoperative shoulder pain after reverse total shoulder arthroplasty. She was treated with single-lead percutaneous peripheral nerve stimulation to the right axillary nerve for 8 wks with 12 Hz motor-level stimulation. She demonstrated improvement in shoulder flexion active range of motion, shoulder flexion strength, and shoulder abduction strength. Her Shoulder Pain and Disability Index total score improved from 26.93% to 8.46% 1 yr after treatment. She reported an overall Global Rating of Change of +7 one year after treatment. This case's success demonstrates that short term peripheral nerve stimulation may provide long-term improvement of persistent postoperative pain and dysfunction in patients with painful reverse total shoulder arthroplasty.

Objective: This study aimed to assess the effects of aquatic therapy in individuals with hemiplegia compared with those of a conventional land-based exercise program.

Design: This was a blinded, randomized controlled study of chronic stroke patients with hemiplegia. The participants were randomized in to aquatic therapy (experimental) or conventional therapy (control) groups. The aquatic therapy group conducted the exercise program in a swimming pool, and the conventional therapy group performed to an exercise on the land environment three times per week for 6 wks. Both interventions focused on posture, balance, and weight-bearing exercises. Outcomes included the Berg Balance Scale, Brunnstrom Scale, Motricity Index, muscle strength tests, Modified Ashworth Scale, Postural Assessment Scale for Stroke, Trunk Control Test, and Functional Independence Measure. In addition, postural sway was evaluated by using the variables of center of pressure displacements in the mediolateral and anteroposterior directions.

Results: The findings of the present study show that the experimental group (26 patients) exhibited significant improvements in spasticity compared with the control group (25 patients) ( P = 0.01). The conventional therapy group also achieved significant improvements ( P < 0.05) in anteroposterior deviation, mediolateral velocity, and total velocity of center of pressure in a sitting position with eyes closed.

Conclusions: Land-based exercises were more beneficial in the spasticity of chronic stroke patients.

Abstract: Advocacy for diversity, inclusion, and equity within healthcare continues to be an issue of importance and attention nationally. However, definitions of diversity often do not include people with disability. This commentary describes barriers to healthcare utilization experienced by people with disabilities in the United States and presents a rationale to refocus disability through this lens of diversity, equity, and inclusion within the US systems of care. Bringing light to the ongoing challenges and inequities faced by our patients with disability is an essential first step toward improved inclusivity, leading to improved welfare of persons with disability as a whole.

Objective: The objective of this study was to assess the effect of repetitive transcranial magnetic stimulation on the supplementary motor area in motor function in Parkinson's disease patients.

Method: Databases searched included five databases from October 7, 2022, to January 4, 2023. The Cochrane Bias Risk Assessment Tool was used for quality assessment. Standardized mean differences were calculated using a random-effects model. Outcome measure is the motor function examination of the motor part of Unified Parkinson's Disease Rating Scale.

Results: Seven studies totaling 374 patients were included. Meta-analysis showed that stimulation of supplementary motor area significantly improved motor function in Parkinson's disease patients compared with sham stimulation (standardized mean differences = -1.24; 95% CI, -2.24 to -0.24; P = 0.02; I2 = 93%). Stimulation of the same target (supplementary motor area) subgroup analysis showed that high-frequency repetitive transcranial magnetic stimulation is more effective than low-frequency repetitive transcranial magnetic stimulation in improving motor function in Parkinson's disease (standardized mean differences = -1.39; 95% CI, -2.21 to -0.57; P = 0.04; I2 = 77.2%).

Conclusions: Overall, repetitive transcranial magnetic stimulation over supplementary motor area had a statistically significant improvement in motor function in Parkinson's disease patients, and high-frequency repetitive transcranial magnetic stimulation is statistically significantly more effective than low-frequency repetitive transcranial magnetic stimulation.

Objective: Intra-articular injection therapy for hand osteoarthritis has inconclusive evidence regarding the effectiveness of different regimens. A systematic review and network meta-analysis of randomized controlled trials was conducted to examine the effectiveness of different injectants.

Design: The PubMed, Cochrane Library, Embase, ClinicalKey, and Scopus databases were searched for studies from inception to July 15, 2023. Randomized controlled trials that applied intra-articular injection to hand osteoarthritis patients were included, and the outcomes of pain scores and functional scales were assessed.

Results: Fourteen randomized controlled trials with 674 patients met the inclusion criteria; 11 randomized controlled trials were included in the network meta-analysis. Intra-articular injected platelet-rich plasma and dextrose significantly improved pain scores (mean difference = -4.03, 95% confidence interval = -6.51 to -1.56 for platelet-rich plasma; mean difference = -1.06, 95% confidence interval = -2.1 to -0.02 for dextrose) and hand function (standard mean difference = -0.93, 95% confidence interval = -1.81 to -0.05 for platelet-rich plasma; standard mean difference = -0.84, 95% confidence interval = -1.58 to -0.09 for dextrose) in the long-term (≥6 mos after treatment completion). The ranking probabilities revealed the highest effectiveness of platelet-rich plasma, followed by dextrose. No major adverse effects were reported.

Conclusions: Intra-articular injected platelet-rich plasma and dextrose can be recommended for treating hand osteoarthritis.

Objective: This cross-sectional study examined associations between wheelchair sprint and anaerobic power (measured in the lab) and wheelchair mobility performance (measured in the field) among two groups of wheelchair tennis players. Additionally, construct validity was assessed for both lab and field tests.

Design: Nine amateur and nine elite wheelchair tennis players performed a Sprint and Wingate test on a wheelchair ergometer in the lab and a Sprint, Illinois, and Spider test in the field, with inertial measurement units on their wheelchairs. Associations were assessed using regression analyses, and construct validity was assessed with an independent t test (elite vs. amateur).

Results: The strongest associations were observed between lab outcomes and field sprint power (R 2 > 90%), followed by peak linear velocity and test duration (R 2 = 77%-85%), while peak rotational velocity showed the lowest associations with lab outcomes (R 2 = 69%-80%). The elite group outperformed the amateur group on all test outcomes.

Conclusions: Despite differences in lab- and field-testing methodologies (e.g., trunk influence, linear/rotational components), the strong associations indicate overlap in measured constructs. Field testing offers valuable insight into practical performance, whereas lab testing enables in-depth biomechanical and physiological analyses. All tests effectively discriminate between elite and amateur wheelchair tennis players.