American Journal of Physical Medicine & Rehabilitation最新文献

Objective: To evaluate the historical trends of sex differences in athletic performance and participation among male and female wheelchair marathon athletes.

Design: This retrospective, observational study utilized secondary, publicly available data of the Boston, Chicago, and New York City marathons within the Wheelchair Division from 1984 to 2023. Athletic performance and participation were evaluated across all marathon events and over time using univariate analysis of variance and Pearson correlations.

Results: Sex differences in athletic performance were observed with males outperforming females in all marathon events over time (p < 0.001). The sex difference among first place finishers was 20% and increased to 33% for tenth place finishers. Though sex differences decreased over time (p < 0.001), large sex differences in performance remain. Female athlete participation in wheelchair marathon events significantly increased over time (p < 0.001) and the ratio of male athletes to female athletes in these events significantly decreased over time (p < 0.001). Overall participation and male athlete participation also generally increased over time.

Conclusion: Significant sex differences were observed in wheelchair marathon performance and participation. These findings highlight the importance of sex as a key biological variable related to human health and performance, especially among wheelchair athletes.

Objectives: Transfers between wheelchairs and beds pose injury risks to users and caregivers, with conventional devices often inefficient and unsafe. The Powered Personal Transfer System (PPTS)-a no-lift solution integrating an Electric Powered Wheelchair (EPW) and hospital bed-aims to improve safety and efficiency. This study evaluated (1) the usability of the PPTS compared with current transfer methods, (2) whether design refinements, including a docking station for EPW positioning, reduced workload, and (3) whether EPW modifications affected indoor mobility functionality.

Design: Cross-sectional usability study.

Setting: Simulated bedroom laboratory.

Intervention: Participants viewed a short instructional video, performed transfers using the PPTS, and completed validated usability measures comparing the PPTS with their usual transfer methods.

Main outcome measures: System Usability Scale (SUS), Usability Scale for Assistive Technology (USAT), NASA Task Load Index (NASA-TLX), and Visual Analog Scale (VAS) for mobility ease.

Results: The PPTS achieved excellent usability. SUS scores were higher than current methods (users: 90 vs 63.4, p < .01; caregivers: 82.5 vs 62.5, p = .013). The docking station reduced mental workload (p < .001). Mobility tasks were rated easy (median VAS >8.5).

Conclusion: PPTS demonstrated excellent usability, and outperformed existing transfer methods, offering a promising, safe, and efficient no-lift transfer solution.

Abstract: Early recovery of arm and trunk function after high cervical spinal cord injury (SCI) is challenging. We report a case of a 42-year-old woman with subacute C3 AIS B SCI treated with cervical and thoracic transcutaneous spinal cord stimulation (tSCS) during acute inpatient rehabilitation. Initiated six weeks post-injury alongside physical therapy, tSCS was associated with improved motor scores (0 to 10), sensory gains, and AIS conversion to C. Functional gains included better trunk control and voluntary upper extremity movement. Treatment was well tolerated without adverse effects. This case supports the feasibility and potential efficacy of early tSCS integration in acute cervical SCI rehabilitation and warrants further study.

Magnetic resonance imaging is the current "gold standard" for measuring cervical muscle volume, but the associated time and cost may be prohibitive in numerous environments. This study sought to develop a novel and accessible model for estimating cervical muscle volume in adolescent athletes. It was hypothesized that cervical muscle volume could be accurately predicted using a combination of clinically-accessible variables. This secondary analysis of clinical trial data utilized 78 sets of biomechanics lab measurements and neck magnetic resonance imaging scans collected in a total of 42 adolescent athletes to develop a multiple linear regression model for predicting total cervical muscle volume. The final regression model was significant (R2 = 0.7644, F = 78.94, p < 0.001) and successfully predicted total cervical muscle volume using body weight, sex, and neck circumference as model inputs. These variables can be easily obtained using simple measurement tools that are available across most clinical and research environments. This model may be used by medical professionals and researchers to estimate total cervical muscle volume when magnetic resonance imaging measurements are unavailable.

Objective: Primary aim was to investigate the effects of upper extremity (UE) robot-assisted training (RAT), applied in addition to conventional rehabilitation program, on cognitive functions after stroke. Secondary aim was to investigate its effects on UE motor functions and activities, hand dexterity, and daily living activities.

Design: 40 post-acute stroke patients were randomized into robotic (n = 20) and control (n = 20) groups. All patients received a conventional rehabilitation program for 6 weeks, total 30 sessions. The robotic group received additional RAT to the affected UE by exoskeleton robotic system at each session. Cognitive functions (Montreal Cognitive Assessment), UE motor functions (Fugl-Meyer Assessment of Upper Extremity), UE activities (Motor Activity Log-28), hand dexterity (Box and Block Test), and daily living activities (Functional Independence Measure) were assessed before and after the treatment, and at 3-month follow-up.

Results: Both groups showed significant improvements regarding primary and secondary outcomes (p < 0,05). However, improvements in all outcome measures did not differ significantly between the groups (p > 0,0167).

Conclusions: UE RAT applied in addition to conventional rehabilitation program in post-acute stroke provided no extra benefit in terms of improvements in cognitive functions, as well as UE extremity motor functions and activities, hand dexterity, and daily living activities.

Purpose: The aim of this umbrella review is to assess the effectiveness of exercise interventions in preventing and managing cancer-related cognitive impairment among cancer survivors, providing an evidence-based foundation for clinical practice.

Methods: The umbrella review was preregistered on PROSPERO. It included systematic reviews that assessed any exercise interventions aimed at improving cognition in cancer patients. The overview adhered to gold standard guidelines and recommendations. We utilized AMSTAR 2 to evaluate the quality of the literature and to synthesize the consistency of the evidence in order to formulate recommendations.

Results: Based on 28 systematic reviews, four subtypes of exercise interventions were identified. High-quality evidence consistently demonstrates that aerobic exercise significantly improves performance on specific neuropsychological tests. The Hopkins Verbal Learning Test shows a score improvement (standardized mean difference (SMD) = 0.65, 95% confidence interval (CI) = 0.42, 0.88); The Trail Making Test Part A shows a reduction (SMD = -0.61, 95% CI = -0.92, -0.30). Mind-body exercises also have notable effects on alleviating subjective cognitive complaints, indicated by an improvement in the Functional Assessment of Cancer Therapy-Cognitive Function score (SMD = 0.82, 95% CI = 0.49, 1.15). However, the evidence for objective cognitive improvement is limited and inconsistent. Combined training presents preliminary evidence of synergistic effects in enhancing global cognitive function, with an average effect across multiple cognitive domains (SMD = 0.45, 95% CI = 0.20, 0.70). Currently, resistance training lacks robust, high-quality evidence, and more studies are needed to determine its effects on specific objective cognitive domains.

Conclusions: This review highlights exercise intervention as a key nonpharmacological approach for managing Cancer-Related Cognitive Impairment. Urgent priorities for future research include the following: (1) conducting high-quality randomized controlled trials to validate exercise tolerability in patients undergoing active treatment; (2) developing multimodal assessment frameworks that integrate neuroimaging and blood-based biomarkers; and (3) establishing personalized exercise guidelines tailored to specific cancer types and treatment phases. Additionally, future studies should focus on clarifying the biological mechanisms that underpin the cognitive improvements associated with exercise. This will help create a stronger evidence base for precision exercise prescription.

Objective: A Paralympic sport classification system aims to minimize the impact of the athlete's impairment on performance, thus contributing to a fair competition. The aim of this study was to investigate consensus among an expert panel regarding statements on recent scientific findings and their implications for handcycling classification.

Design: Three rounds of online questionnaires were sent to an international panel ( N = 53) consisting of para-cyclists, para-cycling coaches and team managers, classifiers, and researchers within para-sport or Paralympic classification. The second and third questionnaire rounds were based on insights gathered from the previous round.

Results: Consensus was reached on the inclusion of upper-limb function, shoulder function, and lower-limb function in the classification assessment of athletes competing in recumbent handcycling positions. In contrast, topics related to the role of trunk function, hand function, and equipment settings did not achieve consensus within the panel.

Conclusions: The future of handcycling classification requires consideration of these recent findings and consensus. Nevertheless, to continuously develop its system toward an evidence-based classification, the handcycling sport should further research the remaining questions and controversial topics to rely less on subjective decisions.

Abstract: As endorsed by leading endocrine societies, a fragility fracture of the hip or spine warrants a diagnosis of osteoporosis, irrespective of bone mineral density. A fragility fracture occurs from a force equal to or less than a fall from standing height, an event unlikely to cause a fracture in healthy bone. Physiatrists often manage patients with such fractures, including fractures stabilized by surgery. However, many patients are not diagnosed with osteoporosis during their acute hospitalization or rehabilitation admission, leading to suboptimal care and an increased risk of repeat fractures. This project involves a 6-mo retrospective review of 77 patients with fragility fractures at an acute inpatient rehabilitation facility, which found that none of the 77 patients were diagnosed with osteoporosis either at the time of admission or during their stay. To address this, the authors developed an educational flowchart for admitting providers and a "smart-phrase" shortcut within the electronic health record that automatically entered a diagnosis of osteoporosis into the patient's record. After intervention, 93% of patients (56/60) admitted with fragility fractures over 6 mos had osteoporosis documented in their rehabilitation medical record. Additionally, 66% of patients discussed or received osteoporosis management during outpatient primary follow-up appointments.

Objective: Lee Silverman Voice Treatment is an exercise program developed for patients with Parkinson's disease. This systematic review and meta-analysis evaluate the benefits of Lee Silverman Voice Treatment on motor function in these patients.

Design: A comprehensive search was conducted in Embase, PubMed, Cochrane Library, Scopus, MEDLINE, ScienceDirect, and PEDro up to October 2024. Two investigators reviewed studies comparing Lee Silverman Voice Treatment with other interventions on motor function outcomes. Study quality was assessed using the Cochrane Risk of Bias tool, and certainty of the evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation methodology.

Results: The search identified 827 studies, with 6 included in the systematic review and 5 in the meta-analysis. Lee Silverman Voice Treatment significantly improved walking speed, as measured by the 10-Meter Walk Test mean difference (MD) -0.60, (95% confidence interval (CI) = -1.17, -0.02, P = 0.04). No significant improvement was found in quality of life (Parkinson's Disease Questionnaire-39 items, MD -2.79, 95% CI = -7.38, 1.80, P = 0.23). Sensitivity analysis revealed significant improvement in motor function (Unified Parkinson's Disease Rating Scale Part III, MD -5.52, 95% CI = -7.72, -3.32, P < 0.05). The certainty of evidence ranged from moderate to low.

Conclusions: Lee Silverman Voice Treatment could be more effective than general exercise in improving gait speed and motor function in patients with mild to moderate Parkinson's disease. However, because of the variability in study quality and the limited number of participants, these findings should be interpreted with caution.