American Journal of Physical Medicine & Rehabilitation最新文献

Abstract: Neuromuscular ultrasound has emerged as a beneficial, complementary tool to electromyography (EMG) in the diagnosis of neuromuscular diseases as it provides high-resolution anatomic imaging of peripheral nerves and muscles. It has been used previously as an adjunct to EMG to diagnose Charcot-Marie-Tooth disease. Here, we present a case of a 64-yr-old man with bilateral sensorineural hearing loss of 14 yrs who presented to an outpatient neuromuscular clinic at a tertiary medical center with very slow progressive paresthesias. This case highlights the application of neuromuscular ultrasound to help confirm the presence of a likely Charcot-Marie-Tooth disease type 4C despite indeterminate genetic testing results and challenging EMG results. He had genetic testing which revealed a normal PMP22 gene; however, he had a variant of uncertain significance in the SH3TC2 gene which has shown associations with autosomal recessive CMT4C. Neuromuscular ultrasound revealed mild median and significant tibial nerve uniform enlargement throughout their course. There may also be utility in performing neuromuscular ultrasound on similarly affected family members if the same variant of uncertain significance returns for SH3TC2 , with consideration of both peripheral nerve and nerve root assessment.

Abstract: Pediatric acquired and congenital conditions leading to shoulder pain and dysfunction are common. Objective, quantitative musculoskeletal imaging-based measures of shoulder health in children lag recent developments in adults. We review promising applications of quantitative imaging that tend to be available for common pediatric shoulder pathologies, especially brachial plexus birth palsy and recurrent shoulder instability, and imaging-related considerations of musculoskeletal growth and development of the shoulder. We highlight the status of quantitative imaging practices for the pediatric shoulder and highlight gaps where better care may be provided with advances in imaging technique and/or technology.

Objective: The aim of the study is to evaluate how gait kinematics and muscle activity during robot-assisted gait training are affected by different combinations of parameter settings and a number of instruction types, ranging from no instructions to goal-specific instructions.

Design: Robots for gait therapy provide a haptic guidance, but too much guidance can limit the active participation. Therapists can stimulate this active participation either with instructions or by adapting device parameters. How these two factors interact is still unknown. In the present study, we test the interaction of three different parameter settings and four instruction types in a cross-sectional study with 20 children and adolescents without impairment. Gait kinematics and surface electromyography were measured to evaluate the immediate effects.

Results: We found that only goal-specific instructions in combination with a low guidance led to a moderate but significant change in gait kinematics. The muscle activity was altered by all instructions, but the biggest effect was found for goal-specific instructions with a 2.5 times higher surface electromyography amplitude compared to no instruction.

Conclusions: Goal-specific instructions are a key element of robot-assisted gait therapy interventions and device parameter adjustments may be used to modulate their effects. Therapists should pay close attention to how they instruct patients.

Objective: This systematic review and meta-analysis aimed to evaluate the influence of core muscle training on throwing ball velocity among overhead throwing athletes.

Design: A literature search was performed from inception to July 2023 for randomized controlled trials investigating the effects of core muscle training on overhead throwing ball velocity. The primary outcome was the change in standing throwing ball velocity. The secondary outcome focused on the enhancement of step/jump throwing ball velocity.

Results: Ten randomized controlled trials were included, revealing a significant improvement in standing throwing ball velocity in the group undergoing core muscle training (Hedges' g = 0.701, 95% confidence interval = 0.339 to 1.063, P < 0.001). Longer treatment duration and a higher frequency of core muscle training sessions per week contributed to improved standing throwing ball velocity. However, core muscle training did not show significant benefits for step (Hedge's g = 0.463, 95% confidence interval = -0.058 to 0.985, P = 0.082) and jump throwing ball velocity (Hedges' g = 0.550, 95% confidence interval = -0.051 to 1.152, P = 0.073).

Conclusions: Core muscle training significantly enhanced standing ball throwing velocity. However, its effect on step/jump throwing ball velocity was less certain. Further research is needed to explore the impact of core muscle training (especially its long-term effects) on throwing ball velocity.

Abstract: The aim of this systematic review was to evaluate eye illnesses in para athletes in the winter and summer settings. A search was conducted using PubMed-Medline, EbscoHost, and Web of Science for full-text original research articles published anytime until November 2022. Studies that reported quantitative data on eye illness in highly active individuals and para athletes, at any level of performance (elite/nonelite/recreational), aged 15-75 yrs were included. Of the eight studies included, two reported eye pathologies in athletes with visual impairment only, and six studies reported specific factors associated with eye illnesses in various impairments. Illnesses in the eye and adnexa were more prevalent in winter (incidence: 1.6-2.2/1000 athlete days) compared to summer (incidence: 0.3-0.5/1000 athlete days) settings. Eye illnesses were reported in athletes with limb deficiency (33.5%), spinal cord injury (29.4%), visual impairment (10.6%), and central neurologic impairment (15.2%). The findings of this review indicate that: (1) eye illness in para athletes is an understudied area; and (2) eye illnesses are present in athletes with impairments other than visual impairment. There is a need for further research on eye illness, particularly in winter sports settings to understand the types and nature of eye illness affecting para athletes during competition and training settings.

Objective: This study aimed to assess the impact of combining transcranial direct current stimulation with end-effector robot-assisted treatment on upper limb function, spasticity, and hand dexterity in chronic stroke patients.

Design: This was a prospective, double-blind randomized trial with 20 equally allocated stroke patients. The experimental group received dual transcranial direct current stimulation (anode over affected M1, cathode over contralateral M1) alongside robot-assisted treatment, while the control group received sham transcranial direct current stimulation with the same electrode placement + robot-assisted treatment. Each patient underwent 20 combined transcranial direct current stimulation and robot-assisted treatment sessions. The primary outcome measure was the Fugl-Meyer Upper Limb motor score, with secondary outcomes including AMADEO kinematic measures, Action Research Arm Test, and Functional Independence Measure. Assessments were conducted at baseline, after rehabilitation, and 3 mos later.

Results: Combining bilateral transcranial direct current stimulation with robot-assisted treatment did not yield additional improvements in Fugl-Meyer Upper Limb motor score, Functional Independence Measure, or Action Research Arm Test scores among stroke patients. However, the real transcranial direct current stimulation group showed enhanced finger flexion in the affected hand based on AMADEO kinematic measures.

Conclusions: The addition of transcranial direct current stimulation to robot-assisted treatment did not result in significant overall functional improvements in chronic stroke patients. However, a benefit was observed in finger flexion of the affected hand.

Objective: The main objective of this study was to investigate the effect of a self-regulated dual task on muscle endurance within a single rehabilitation session in patients recovering from an elbow fracture.

Design: This is a cross-sectional study of individuals recovering from elbow fractures ( N = 20). Muscle endurance was tested using elastic bands at Borg's CR10 intensity 3-during four conditions: single-task and dual-task for elbow flexion and extension.

Results: The cognitive condition significantly influenced muscle endurance ( P < 0.001), while the type of elbow exercise (flexion or extension) did not show significant differences ( P = 0.592). The perceived difficulty of the tasks showed a significant interaction effect ( P = 0.032). The dual-task condition showed an average increase of about 15 repetitions. A moderate negative correlation was found between the differences in repetitions and the perceived difficulty of the flexion exercise ( r = 0.677, P = 0.001).

Conclusions: Dual-task with self-regulation enhances muscle endurance among patients recovering from an elbow fracture. However, the improvements seem to depend on the perceived difficulty of the cognitive task. Future randomized controlled trials are required to understand the therapeutic implications of dual-tasking.

Abstract: Nerve conduction studies are a commonly performed procedure and a core competency for physical medicine and rehabilitation residents. Nerve conduction studies are complex to learn and no standardized training protocols exist across physical medicine and rehabilitation programs. The aims of this study are to standardize training and assessment of resident proficiency in nerve conduction studies skills and to evaluate the impact of an educational intervention on skills development. This was a repeated measures design wherein 36 physical medicine and rehabilitation residents underwent a pretest, followed by a mastery learning-based intervention, including deliberate practice. Residents were then expected to meet or exceed a minimum passing score at posttest. Performance improved from a median score of 4.5/66 on the pretest to a median score of 63/66 on the posttest. Thirty-three of 36 residents achieved the minimum passing score on the first attempt; three residents required additional deliberate practice and met the minimum passing score on the second attempt. A curriculum featuring deliberate practice dramatically increased checklist scores of residents performing nerve conduction studies. This mastery learning program shows a reliable and reproducible method to achieve procedural competency within a physical medicine and rehabilitation residency program and can shift the curve to allow residents to immediately start performing nerve conduction studies at the start of their clinical experience.