American Journal of Physical Medicine & Rehabilitation最新文献

Objective: The current classification system in para-cycling needs to be investigated in order to comply with requirements of the International Paralympic Committee of providing evidence-based classification in all Paralympic sports. The aim was to investigate consensus on issues within the current para-cycling classification system and identify future research priorities within para-cycling classification.

Design: Three rounds of online questionnaires were sent to an international expert-panel (n=51, representing six continents) consisting of para-cyclists (n=27, 52.9%), para-cycling coaches and team managers (n=5, 9.8%), classifiers (n=8, 15.7%), para-sport researchers (n=5, 9.8%), and other roles in para-cycling (n=6, 11.7%). Each new round was based on the responses of the previous round.

Results: Consensus was reached on the following main issues: adjust current muscle strength assessment in classification (76%), redefine the minimum impairment criteria for the lower (97%) and upper (76%) body, athletes cycling with one leg should compete separately from athletes cycling with two legs (81%), athletes with musculoskeletal impairments should compete separately from athletes with coordination impairments (77%).

Conclusions: The panel's views revealed directions to revise the para-cycling classification system, and that future para-cycling research should focus on leg muscle strength assessments, upper-body impairments, and the cut-off between bicycling and tricycling (C and T-divisions).

Objective: To compare evidence on Virtual Reality (VR) and Body Weight-Supported Treadmill Training (BWSTT) for gait rehabilitation in Parkinson's disease (PD) using a narrative review. Design: A systematic search was conducted in PubMed, PEDro, SciELO, Cochrane, and LILACS through March 2024, following PRISMA guidelines. Randomized controlled trials of VR or BWSTT in PD were included. Systematic reviews were used solely for context. Methodological quality was assessed with PEDro and AMSTAR-2 tools.

Results: Fourteen primary studies (nine VR, five BWSTT) with 416 participants with mild-to-moderate PD met eligibility criteria. VR protocols (5-12 weeks) often improved balance, gait speed, and dual-task performance, but differences in immersion, platform, sensory feedback, and task complexity limited direct comparison. BWSTT interventions (4-8 weeks, 20-40% unloading) showed moderate improvements in step length, walking endurance, and balance. No major adverse events were reported.

Conclusion: Both VR and BWSTT improve gait and balance in PD through complementary mechanisms. VR offers sensory-cognitive engagement, while BWSTT provides biomechanical support and repetitive practice. Due to protocol heterogeneity, small sample sizes, and the absence of meta-analysis, findings should be interpreted narratively. Combined approaches may be promising, but current evidence is limited.

Objectives: Spinal muscular atrophy (SMA) is a rare neuromuscular disorder caused by SMN1 mutations, leading to progressive muscle weakness. Although nusinersen improves motor function, its broader impact on daily life remains insufficiently understood. This study explored caregivers' perceptions of nusinersen treatment and identified themes reflecting its influence on everyday functioning.

Methods: An observational study included 23 children with SMA (10 type 2, 7 type 3, 6 type 1) treated with nusinersen for up to 36 months. The mean age at interview was 6.3 years (SD 2.3). Caregivers completed a semi-structured questionnaire with closed and open-ended items. Narrative responses were analyzed using natural language processing (NLP) and topic modeling to identify recurring patterns.

Results: Caregivers reported consistent positive effects. NLP identified three thematic clusters: Functional and Daily Progress (34.9%), Global Improvement and Quality of Life (33.6%), and Hospitalization and Physical Recovery (31.5%). Reported benefits included improved swallowing, easier breathing, fewer hospitalizations, increased independence, and enhanced mood. Families emphasized reduced stress and improved family dynamics.

Conclusions: Caregivers perceive nusinersen as providing meaningful improvements in daily functioning beyond motor outcomes. Incorporating caregiver-reported insights through NLP may enrich treatment evaluation and support holistic, patient- and family-centered care in SMA.

Objective: To investigate the longitudinal relationship between spatial-temporal gait asymmetries and locomotor capacity in ambulatory children with unilateral cerebral palsy (UCP).

Design: A prospective longitudinal study with assessments at baseline, 6, 12, 18, and 24 months. Twenty-seven children with UCP (GMFCS levels I-II, aged 8-15 years) were evaluated for spatial (SAI) and temporal (TAI) gait asymmetry indices and locomotor capacity measures (community balance & mobility: CB&M, functional walking test: FWT, 10-meter Shuttle Run Test: 10m-SRT, and 6-Minute Walk Test: 6mWT).

Results: Mixed-effects models analyses indicated that higher SAI was significantly associated with lower CB&M scores (β=-124.73, P<0.001), reduced FWT performance (β=-48.79, P<0.001), increased 10m-SRT times (β=32.14, P<0.001), and shorter 6mWT distances (β=-774.86, P<0.001). Similar associations were found with TAI (β=-118.47, β=-43.93, β=35.18, β=-719.46, respectively; all P<0.001). Trajectory analysis revealed gradual improvements in asymmetry indices over 24 months. Children with lower baseline asymmetry demonstrated faster rates of locomotor improvement compared to those with higher baseline asymmetry.

Conclusion: Longitudinal data establish that spatial-temporal gait asymmetries are significantly associated with locomotor capacity in children with UCP, with these relationships persisting over time. This supports the value of gait asymmetry metrics as clinical biomarkers for monitoring heterogeneous functional mobility trajectories within this specific population.

Objective: To investigate if completion of a Veterans Health Administration (VHA) Career Development Award (CDA) influenced subsequent Merit Review Award funding success in rehabilitation scientist applying for funding in the Rehabilitation Research, Development, and Translation Broad Portfolio from fiscal year 2020 to 2025.

Design: Retrospective cohort study.

Results: Early-career investigators with prior VHA CDAs (n=14) submitted 32 new/revised applications for VHA Merit Review award funding. While early investigators with prior VHA CDAs had a numerically higher percentage of funding across the three application submission cycles (34.4% vs 25.0%), this factor was not statistically significant. Mid-career/senior investigators with prior VHA CDAs (n=78) submitted 180 new/revised applications and demonstrated an overall 30.0% funding success across the three-application submission cycle. Mid-career/senior investigators with prior VHA CDAs had a statistically significant increased odds of funding across the three-application submission cycle (30.0% vs 26.4%; ORunadj:1.62; ORadj: 1.54).

Conclusion: Based on the potential benefits of the mentored research experience observed in the current study and in preceding studies, early-career scientists interested in working with Veterans are encouraged to apply for these awards following completion of the terminal degree or post-doctoral fellowship.

Objective: We aimed to evaluate the effectiveness of combining Low-Frequency (1 Hz) rTMS (LF-rTMS) over the unaffected hemisphere or Intermittent Theta Burst Stimulation (iTBS) over the affected hemisphere with conventional rehabilitation (CR) on lower extremity motor function, balance and gait.

Design: This single-center, randomized, sham-controlled study included patients with chronic stroke (>6 mo) and unilateral hemiplegia (Brunnstrom stages 3-5), who were assigned to LF-rTMS+CR (n=21), iTBS+CR (n=21), or sham rTMS+CR (n=21) for 10 sessions using a figure-of-eight coil. All active participants completed treatment, and 18 sham participants were analyzed. The Fugl-Meyer Assessment, Berg Balance Scale (BBS), Timed-Up and Go (TUG) test, Functional Independence Measure, and 36-item Short Form Health Survey (SF-36) were performed during pretreatment, posttreatment, and 6-week follow-up, alongside assessments of the Hmax/Mmax amplitude at baseline and 6-week follow-up.

Results: Both real rTMS groups showed greater improvements in balance and mobility (BBS and TUG) versus sham group. Additionally, intragroup evaluation revealed that improvements in mental function and general health (SF-36) were more pronounced in the real rTMS groups.

Conclusion: The combination of rTMS, including LF-rTMS or iTBS, with CR may serve as an effective neurorehabilitation strategy to improve balance and mobility in individuals with chronic stroke.

Objective: The aim of the study was to study the effect of transcranial direct current stimulation on the left dorsolateral prefrontal cortex plus exercise on pain, function, and quality of life in chronic knee osteoarthritis.

Design: Thirty-two participants with chronic knee osteoarthritis were randomly assigned to real transcranial direct current stimulation (anode: left dorsolateral prefrontal cortex, cathode: right supraorbital, 2 mA for 20 mins) or sham treatment, with quadriceps exercises three times weekly for 4 wks. Visual analog scale, pressure pain threshold, and the Western Ontario and McMaster University Osteoarthritis Index, and Short Form Health Survey-36, were assessed at baseline, posttreatment, and 4 wks later.

Results: No significant differences were found between groups in any outcome after completing 12 sessions (mean difference [95% CI]: visual analog scale -0.30 [-9.49, 8.89]; pressure pain threshold 0.033 [-0.039, 0.105]; Western Ontario and McMaster University Osteoarthritis Index 4.22 [-3.35, 11.79]; Short Form Health Survey-36 -0.44 [-6.23, 5.35]) or at follow-up (visual analog scale 0.01 [-15.69, 15.71]; pressure pain threshold 0.008 [-0.113, 0.130]; Western Ontario and McMaster University Osteoarthritis Index 4.91 [-7.56, 17.37]; Short Form Health Survey-36 -2.96 [-12.11, 6.20]).

Conclusions: The findings showed that transcranial direct current stimulation over the left dorsolateral prefrontal cortex provided no significant additional benefit to quadriceps exercise compared to sham stimulation in improving pain, function, or quality of life in individuals with chronic knee osteoarthritis.

Abstract: Interventional Spine and Musculoskeletal Medicine is an innovative and expanding fellowship supported by the North American Spine Society that uses minimally invasive techniques to diagnose and manage spine and musculoskeletal pain. This study surveys interventional spine and musculoskeletal medicine fellowship program directors to provide greater awareness to applicants about interventional spine and musculoskeletal medicine, their career motivations, important trainee characteristics, and interventional spine and musculoskeletal medicine's distinct role within physical medicine and rehabilitation. An anonymous survey was distributed to interventional spine and musculoskeletal medicine program directors and current fellows. It assessed participant demographics, career motivations, trainee characteristics, and differentiation of interventional spine and musculoskeletal medicine versus pain medicine and sports medicine. qualitative thematic analysis was performed using the free-text response. Twelve (40%) of 30 interventional spine and musculoskeletal medicine program directors and eight fellows completed the survey. Common motivations included strong job security, competitive salary, procedural focus, and obtaining advanced skills. Most did not consider research a major factor but emphasized the importance of research due to the rapidly expanding innovation in spine care. All respondents agreed that earlier exposure and mentorship are crucial in shaping career paths. Additionally, program directors noted key differences between interventional spine and musculoskeletal medicine and pain medicine, emphasizing the need for awareness of interventional spine and musculoskeletal medicine as a career path. These findings highlight the importance of early exposure, mentorship, passion, and a clear understanding of interventional spine and musculoskeletal medicine for interested applicants.