American Journal of Physical Medicine & Rehabilitation最新文献

Objective: This study aimed to compare the effects of ipsilateral electroacupuncture (IEA) at the site of exercise-induced pain and those of contralateral electroacupuncture (CEA) on delayed-onset muscle soreness (DOMS), muscle injury markers, and oxidative stress following eccentric exercise.

Design: Nineteen young men were randomly assigned to receive either CEA or IEA. All participants performed eccentric exercise using the biceps brachii muscle of the nondominant arm to induce muscle damage. Six sets of five repetitions were completed at 70% of maximal muscle strength. Electroacupuncture stimulation was applied to the dominant arm in the CEA group and the nondominant arm in the IEA group. Electroacupuncture stimulation was applied in both groups from 7 days before exercise to 4 days after exercise.

Results: Palpation pain was significantly lower in the IEA group than the CEA group at 72 and 96 hours after exercise. The muscle injury markers increased following exercise, but these changes were not significantly influenced by IEA stimulation. IEA suppressed exercise-induced oxidative stress at 72 hours after exercise.

Conclusions: This study suggests that the direct electroacupuncture on the damaged muscle before and after eccentric exercise effectively reduces DOMS. Electroacupuncture might suppress increases in oxidative stress elicited by eccentric exercise.

Objective: This study was conducted to evaluate the diagnostic performance and to establish cutoff values of median nerve cross-sectional area for classifying the severity of carpal tunnel syndrome.

Design: The study dataset included 1069 wrists from 1034 patients with carpal tunnel syndrome (May 2017 to December 2022). A machine learning algorithm was used to predict carpal tunnel syndrome severity based on median nerve cross-sectional area, adjusting for sex, age, body mass index, and disease duration.

Results: The multivariable model showed a multi-class AUC of 0.753, and single-class AUCs of 0.733, 0.635, and 0.780 for mild, moderate, and severe syndrome, respectively. Optimal cross-sectional area cutoffs were identified as <14 mm2 for mild and > 16 mm2 for severe syndrome, with AUC values of 0.773 and 0.794, respectively. The model showed high sensitivity for mild and high specificity for severe syndrome but had a low performance for moderate carpal tunnel syndrome (AUC = 0.568).

Conclusion: Median nerve cross-sectional area is a valuable tool for diagnosing mild and severe carpal tunnel syndrome. While cross-sectional area provides limited accuracy for moderate carpal tunnel syndrome, it remains a useful adjunct to other diagnostic methods, potentially reducing the need for more invasive procedures.

Objective: This study aimed to investigate the feasibility of a neurorehabilitation pipeline and develop an algorithm to automatically select the appropriate treatment for individuals with upper extremity motor paralysis after stroke in the chronic phase.

Design: In experiment 1, eight post-stroke participants in the chronic phase who underwent treatment sustaining two to three phases were assessed before and after treatment. In experiment 2, a decision tree analysis was performed in which the dependent variable was set as the treatment option determined by a board-certified physiatrist for 95 poststroke participants; the independent variables were only motor function scores or both motor function scores and electromyogram variables.

Results: In experiment 1, the clinical assessment scores were improved significantly after treatment. Experiment 2 showed that the agreements of the model with only motor function scores as the independent variable and with motor function scores and electromyogram variables as the independent variables were 75.8% and 82.1%, respectively.

Conclusions: This novel treatment package is feasible for improvement of motor function in poststroke individuals with severe motor paralysis. The study also established an automated algorithm for selecting appropriate treatments for upper extremity motor paralysis after stroke, identifying standard values of key variables, including electromyography variables.

Objective: This study investigated whether the origin (acquired or congenital) and type of impairment affect the participation and likelihood of winning a medal in different sports at the Paralympic Games.

Design: We analyzed competition data and athlete biographies web scraped from the International Paralympic Committee's website ( www.Paralympic.org ).

Results: In some sports, athletes with one origin or type of impairment were overrepresented. For example, 76% of Para-snowboarders had an acquired impairment. Furthermore, mixed effects logistic regression analyses showed that the origin of impairment had no effect on the likelihood of winning a medal in most sports. However, athletes with a congenital impairment had a significantly higher likelihood of winning a medal compared to those with an acquired impairment in Para-athletics, Para-alpine skiing, and Para-biathlon (odds ratio: 1.71, P < 0.01, odds ratio: 3.69, P = 0.002, and odds ratio: 3.70, P = 0.016, respectively). Athletes with a given origin-type of impairment combination also may have an advantage or disadvantage in some sports. For example, athletes with an acquired spinal cord injury win proportionally fewer medals in Para-powerlifting.

Conclusions: Understanding potential effects of the origin and type of impairment on participation and medaling chances in Paralympic sports can help shape the development of Para-sports and support talent identification.

Objective: The aim of the study is to review the literature regarding the current state and clinical applicability of machine learning models in prognosticating the outcomes of patients with mild traumatic brain injury in the early clinical presentation.

Design: Databases were searched for studies including machine learning and mild traumatic brain injury from inception to March 10, 2023. Included studies had a primary outcome of predicting post-mild traumatic brain injury prognosis or sequelae. The Prediction model study Risk of Bias for Predictive Models assessment tool was used for assessing the risk of bias and applicability of included studies.

Results: Out of 1235 articles, 10 met the inclusion criteria, including data from 127,929 patients. The most frequently used modeling techniques were support vector machine and artificial neural network and area under the curve ranged from 0.66 to 0.889. Despite promise, several limitations to studies exist such as low sample sizes, database restrictions, inconsistencies in patient presentation definitions, and lack of comparison to traditional clinical judgment or tools.

Conclusions: Machine learning models show potential in early stage mild traumatic brain injury prognostication, but to achieve widespread adoption, future clinical studies prognosticating mild traumatic brain injury using machine learning need to reduce bias, provide clarity and consistency in defining patient populations targeted and validate against established benchmarks.

Introduction: Intubated, ventilator unweanable patients with ventilatory pump failure can be extubated to continuous noninvasive positive pressure ventilatory support; however, delays may result in untoward effects on speech and swallowing.

Methods: This is a retrospective chart review of ventilatory pump failure patients to determine need for postextubation gastrostomy tubes and consequences on speech for intubations less than (short) versus greater than (long) 3 wks.

Results: One hundred sixty-five patients were intubated for a mean 20.7 ± 23.5 (range = 1-240) days. All recovered prehospitalization speech status within 2 hrs to 3 days. One hundred four of the short group were intubated 1.6 ± 1.3 (range = 1-9) times for 9.9 ± 5.1 (range = 1-20) days versus 61 of the long group intubated 2.4 ± 3.3 (range = 1-26) times for 39.0 ± 30.5 (range = 21-210) days, 10.6% vs. 8.2%, respectively, required postextubation gastrostomy tubes indefinitely.

Discussion: There was no difference in untoward effects on speech or swallowing from short- versus long-term intubation. Had the patients undergone tracheotomies, the majority would have had gastrostomy tubes placed permanently and suffer morbidity and mortality from the tubes. Thus, an option is to permit patients to remain intubated and, even if unweanable, extubate them to continuous noninvasive positive pressure ventilatory support rather than tracheotomy.

Objective: The aim of the study is to investigate the effectiveness of an 8-wk cardiopulmonary rehabilitation program on cardiorespiratory fitness (VO 2 peak) and key cardiopulmonary exercise test measures, quality of life, and symptom burden in individuals with long COVID.

Design: Forty individuals with long COVID (mean age 53 ± 11 yrs), were randomized into two groups: (1) rehabilitation group: center-based individualized clinical rehabilitation program (8 wks, 3 sessions per week of aerobic and resistance exercises, and daily inspiratory muscle training) and (2) control group: individuals maintained their daily habits during an 8-wk period.

Results: There was a significant difference between groups in mean VO 2 peak improvement ( P = 0.003). VO 2 peak improved significantly in the rehab group (+2.7 mL.kg.min; 95% CI = +1.6 to +3.8; P < 0.001) compared to the control group (+0.3 mL.kg.min; 95% CI = -0.8 to +1.3 P = 0.596), along with VE/VCO 2 slope ( P = 0.032) (-2.4; 95% CI = -4.8 to +0.01; P = 0.049 and +1.3; 95% CI = -1.0 to +3.6; P = 0.272, respectively) and VO 2 at first ventilatory threshold ( P = 0.045). Furthermore, all symptom impact scales improved significantly in the rehabilitation group compared to the control group ( P < 0.05).

Conclusions: An individualized and supervised cardiopulmonary rehabilitation program was effective in improving cardiorespiratory fitness, ventilatory efficiency, and symptom burden in individuals with long COVID. Careful monitoring of symptoms is important to appropriately tailor and adjust rehabilitation sessions.