American Journal of Physical Medicine & Rehabilitation最新文献

Objective: Osteoarthritis is a major cause of impairment. Research has shown that individuals with unilateral lower limb amputation are 17 times more likely to develop osteoarthritis on their sound side limb. Therefore, this review aimed to describe similarities and differences in the biomechanical loading variables of individuals with osteoarthritis and those with unilateral lower limb amputation.

Design: Researchers systematically searched PubMed-Medline, EBSCOhost, and Web of Science for articles published between January 1990 and February 2022. Included studies investigated the biomechanical profiles (peak external knee adduction moment; peak external knee flexion moment; ground reaction force; external knee adduction moment loading rate; external knee adduction moment impulse) of both population groups.

Results: A total of 31 articles were included in this review. Only knee adduction moment and knee flexion moment presented similar profiles in both groups, while all other variables were dissimilar. The use of advanced prostheses reduced the loading on the sound side of individuals with unilateral lower limb amputation.

Conclusions: As both knee adduction moment and knee flexion moment are surrogate measures for knee contact forces, interventions need to target these variables to help manage and prevent the development of osteoarthritis. Interventions, particularly for addressing these variables in individuals with unilateral lower limb amputation, should be further investigated in future research.

Abstract: This feasibility study tested the capability of high-frequency stimulation to block muscle contractions elicited by electrical stimulation of the same nerve proximally. During a tendon lengthening surgery in the forearm, the anterior interosseous nerve was exposed. A specialized nerve cuff electrode was placed around the nerve, and a stimulating probe held on the nerve 1 cm proximal to the cuff electrode delivered pulses of current causing the pronator quadratus muscle to contract. Through the cuff electrode, 20-kHz high-frequency stimulation was delivered to the nerve for 10 secs during proximal stimulation. High-frequency stimulation amplitudes between 5 and 10 mA peak-to-peak were tested to determine which produced complete and partial block of the electrically induced contractions. The minimum high-frequency stimulation amplitude that produced complete block was 8 mA, with lower amplitudes producing partial block. In all trials, muscle contractions resumed immediately after high-frequency stimulation was turned off. This demonstration of high-frequency electrical nerve block is a milestone in the road to clinical implementation of high-frequency stimulation mediated motor block for spasticity.

Objective: The aim of the study is to assess the effects on spasticity reduction of the association between focal extracorporeal shock wave therapy and botulinum toxin type A, versus the toxin only in brain injury patients.

Design: Eighteen patients were included. The study had two phases: the first phase was observational, and botulinum toxin type A was used. The second was a prospective, deliberate intervention phase in which the toxin was injected and focal extracorporeal shock wave treatment was added (1 sessions/week, for 3 wks). The patients were followed up in the 1st, 4th, and 6th month, the Ashworth Scale criterion was applied, and for those with lower limb involvement and changes in walking, the 10-meter walk test was used.

Results: Patients treated with toxin only showed a statistically significant improvement in spasticity, with 1 point on the Ashworth Scale from week 5, which disappeared at week 17. However, the combined therapy reduced spasticity by 2 points from week 1 to week 25 ( P < 0.001), with a faster result in the 10-meter gait test ( P = 0.004).

Conclusions: Combined and simultaneous treatment with botulinum toxin and focal extracorporeal shock wave reduced spasticity in a more effective and prolonged way than treatment with botulinum toxin only.

Objective: The aim of the study is to evaluate the effectiveness of pulmonary rehabilitation programs and other rehabilitation interventions in adults with asthma.

Design: This is a systematic review and meta-analysis.

Results: MEDLINE (PubMed), Embase, Cumulative Index to Nursing & Allied Health Literature, and CENTRAL were searched from inception to 31 May 2023. PROSPERO registration number: CRD42022331440. Thirty-six randomized controlled trials were analyzed, and only 26 were pooled in the meta-analysis because of the heterogeneity of comparisons and outcomes across the studies. Pulmonary rehabilitation, compared with education associated with breathing exercises, may result in little to no difference in the Asthma Quality of Life Questionnaire (mean difference 0.01 score, 95% confidence interval = -0.48 to 0.50, 163 participants, three studies, low certainty).

Conclusions: Our findings show that pulmonary rehabilitation, compared with education associated with breathing exercises, may result in little to no difference in the impact of asthma on health-related quality of life. Overall, the certainty of evidence was low or very low preventing any firm conclusion on the effects of single or combined rehabilitation interventions.

Abstract: With increasing use of golf carts and low speed vehicles for recreational, work-related, and commuting purposes, the number of related injuries is also on the rise. The body of literature describing these injuries is informative but limited. From this scoping review, we found that low speed vehicle-related injuries preferentially affect children, older adults, and males. Common mechanisms of injury include ejection and collision. Associated alcohol consumption is common and typically related to increasing severity of injury. Various injuries may result from low speed vehicles as described in the review, including soft tissue injuries, orthopedic injuries, and traumatic brain injury. Description of trends and classifications of injury will hopefully improve reporting and ability to make recommendations on safe use and regulation.

Objective: Chronic low back pain affects nociceptive responses in the cerebellum, which leads to increased pain perception and sensorimotor control dysfunction. This study aimed to investigate altered functional connectivity in the anterior and posterior lobes of the cerebellum during chronic low back pain.

Design: Twenty patients with chronic low back pain and 18 healthy participants underwent 3.0 T resting-state functional magnetic resonance imaging. The bilateral lobule V of the anterior cerebellum and Crus I of the posterior cerebellum were selected as the region of interest for identifying the corresponding networks.

Results: The left lobule V had a greater intrinsic connectivity with the left insular cortex, left orbitofrontal cortex, and bilateral medial prefrontal cortex in patients with chronic low back pain. In contrast, the right lobule V and bilateral Crus I had a significantly decreased connectivity with the contralateral multimodal cerebral networks, including the default mode network, salience network, and emotional network.

Conclusions: The cerebellum had mechanistic implications in pain-related changes, which are involved in motor control, cognition, and emotion processing. These findings provide a novel perspective on the role of functional subregions in chronic low back pain, which add to the growing body of evidence that the cerebellum can be a potential target for noninvasive brain stimulation for chronic pain treatment.

Objective: The network meta-analysis was to compare and rank the effectiveness of different exercises on cardiorespiratory function or exercise efficiency in poststroke patients.

Design: A network meta-analysis of randomized controlled trials was conducted. PubMed, Embase, Cochrane Library, and Web of Science were searched. The impact of exercises including individual and combination of aerobic exercise, resistance exercise, task-oriented training, gait training, breathing exercise, and regular rehabilitation training on 6-min walk test, peak oxygen consumption, maximum oxygen consumption, resting heart rate, resting systolic blood pressure, and resting diastolic blood pressure were assessed.

Results: In total, 36 studies were included in the meta-analysis. Aerobic exercise + GT (63.06%) had the highest likelihood of improving 6-min walk test performance in poststroke patients. Regular rehabilitation training + resistance exercise was the most favorable exercise in terms of 6-min walk test performance assessing by minimum clinically significant difference. Aerobic exercise + resistance exercise had the highest likelihood of improving peak oxygen consumption and reducing resting heart rate in poststroke patients.

Conclusion: Different types of exercise demonstrated the benefits of improving cardiorespiratory function in stroke patients. Further research is needed to determine the best exercise regimen to maximize the benefits of rehabilitation interventions for poststroke patients.

Objective: The aim of this study was to determine whether patients treated with platelet-poor plasma after an acute thigh muscle injury would have a faster return to activity compared with patients treated with platelet-rich plasma.

Design: This quasi-experimental study included 100 patients (ages 16-45) with an acute thigh muscle injury diagnosed by sports ultrasound and treated with either platelet-rich plasma or platelet-poor plasma followed by a course of structured rehabilitation. The primary outcome was the number of days until unrestricted participation in sport, while the secondary outcome was the rate of recurrent injury within 12 mos.

Result: The time until full, unrestricted participation in sport was significantly lower in the platelet-poor plasma group compared with the platelet-rich plasma group for all injury grades, with patients in the platelet-poor plasma group on average returning to unrestricted participation in sport 22.89 days more quickly than the platelet-rich plasma group ( P < 0.001). In addition, no significant difference in recurrent injury up to 12 mos after procedure was seen between groups ( P = 0.967).

Conclusions: Platelet-poor plasma resulted in faster return to sport than platelet-rich plasma for acute thigh muscle injuries with a noninferior injury recurrence rate. These findings suggest that future high level studies comparing platelet-poor plasma and platelet-rich plasma for the treatment of thigh muscle injuries should be considered.