Archives of physical medicine and rehabilitation最新文献

Objective: To investigate the effects of an action observation (AO) and motor imagery (MI) training compared with the standard care pathway on motor and functional recovery in patients with surgical fixation after distal radial fractures (DRF).

Design: Two-armed single-blind randomized controlled trial.

Setting: Outpatient hand rehabilitation unit.

Participants: Forty right-handed participants (N=40) who underwent surgical fixation for right DRF.

Interventions: Participants allocated to AOMI group performed an AO and MI training during immobilization period, whereas participants allocated to control group followed a routinary care pathway. Both groups performed a 5-week rehabilitation program after immobilization end.

Main outcome and measures: Primary outcome was hand dexterity (Purdue Pegboard Test). Secondary outcomes were active range of motion, pinch and grip strength, and hand function (Patient-Rated Wrist/Hand Evaluation [PRWHE]). Outcomes were assessed at the end of immobilization, after a 5-week rehabilitation program, and at 6-month follow-up.

Results: AOMI group revealed better R-task score of the PPT (mean difference: 1.9; 95% CI, 0.8-3.0), PRWHE-pain (median difference: -6.0; 95% CI, -11.0 to -1.0), and PRWHE-specific-activity (median difference: -10.0; 95% CI, -18.0 to -2.0) subscores and total PRWHE score (median difference: -12.8; 95% CI, -23.8 to -4.0) compared with control group at physiotherapy program end. Moreover, AOMI group revealed higher pinch and grip strength than control group at immobilization end (median difference: grip 4.6, 95% CI_, 2.0-7.7; pinch 1.9, 95% CI, 0.3-3.2).

Conclusions: AO and MI during the immobilization period accelerated the recovery of hand dexterity and function in patients with surgical fixation for DRF. These findings suggested the incorporation of AO and MI in the care pathway of patients undergoing immobilization after surgery for DRF.

Objective: To identify the effects of bilateral plantar kinesio taping (BP-KT) combined with conventional therapy (CT) on plantar tactile sensation (PTS) and gait ability in patients with subacute stroke by comparing BP-KT with tibialis anterior KT (TA-KT).

Design: A single-center, participant-blinded, randomized controlled trial.

Setting: Rehabilitation center.

Participants: Fifty-two subacute stroke survivors (N=52) were randomly assigned to one of 2 groups.

Interventions: All participants performed 30 minutes of CT, and each group additionally received either BP-KT or TA-KT. Both interventions were performed 5 times a week for a 4-week period.

Main outcome measures: The primary outcome was PTS. The secondary outcomes included spatiotemporal gait parameters (step length, stance phase, swing phase, step width, cadence, and velocity) and the variability of these parameters.

Results: The BP-KT group showed statistically significant improvements in PTS at the first metatarsal head (P=.003; η²=0.159), fifth metatarsal head (P=.025; η²=0.096), and lateral longitudinal area (P=.015; η²=0.114). Statistically significant improvements were observed in the BP-KT group compared with those in the TA-KT group in step length (P=.005; η²=0.679), single stance (P=.037; η²=0.084), and velocity (P=.018; η²=0.180). There was a statistically significant decrease in the coefficient of variation for step length (P=.042; η²=0.080) and step width (P=.018; η²=0.107).

Conclusions: BP-KT combined with CT effectively enhanced PTS and gait ability in patients with subacute stroke, and it proved to be more effective than TA-KT combined with CT. These findings suggest that BP-KT may be a useful adjunctive method for gait rehabilitation in patients with stroke..

Objective: To develop and validate a wearable sensor-based, fine-grained assessment framework for quantitative evaluation and prediction of upper extremity motor function in poststroke patients.

Design: Validation cohort study with modeling of clinical predictions.

Setting: Hospital-based rehabilitation clinic.

Participants: A total of 80 poststroke patients (N=80) with upper extremity motor dysfunction were recruited and underwent routine Fugl-Meyer Assessment for Upper Extremity (FMA-UE) evaluation. Upper extremity kinematic data and corresponding clinical labels were collected using a wearable motion acquisition system.

Interventions: This study was observational in nature and involved no therapeutic intervention. We confirm the intervention is not applicable.

Main outcome measures: Agreement between clinician-rated FMA-UE scores and system-predicted FMA-UE scores.

Results: Wearable kinematic data and corresponding clinician-rated FMA-UE scores were collected during standardized assessment procedures. Guided by clinical labels, 8 critical items were selected from the original 33-item FMA-UE. Fine-grained, action-level scoring models were constructed for the selected items using feature engineering and machine learning techniques, enabling more discriminative and fine-grained item-level scoring. A regression model based on the fine-grained item scores was subsequently developed to predict the FMA-UE total score. The predicted scores showed strong agreement with clinician-rated scores, with an R² of 0.950 and a Spearman correlation coefficient of 0.972.

Conclusions: A wearable sensor-based fine-grained assessment framework can provide objective, high-resolution evaluation and accurate prediction of upper extremity motor function after stroke. By relying on a minimal set of key assessment items, the framework reduces assessment burden while maintaining clinical consistency with standard FMA-UE scoring.

Objective: To describe functional mobility among children, adolescents, and young adults with arthrogryposis multiplex congenita (AMC) and identify factors associated with mobility outcomes.

Design: Multisite cross-sectional study.

Setting: Eight orthopedic hospitals for children.

Participants: A total of 256 individuals (N=256) aged 5-21 years with a confirmed clinical diagnosis of AMC were recruited between October 2019 and December 2022. AMC subtypes included amyoplasia (n=122), distal arthrogryposis (n=62), and Central Nervous System (CNS)/syndromic AMC (n=39).

Interventions: Not applicable.

Main outcome measures: Functional mobility was assessed using the mobility domain of the Functional Independence Measure for Children (WeeFIM) and the Gillette Functional Assessment Questionnaire (FAQ). Multivariable models were used to examine associations with perinatal and current clinical and environmental factors.

Results: Children with CNS/syndromic and amyoplasia subtypes demonstrated significantly lower WeeFIM scores (coefficients [Exp(B)]=0.74 and 0.85, respectively; both P<.05) and reduced odds of higher FAQ levels (adjusted odds ratio [AOR]=0.16 and 0.18, respectively; both P<.001) compared with those with distal arthrogryposis. Greater joint involvement, particularly at the knees, was a strong negative factor. Each additional perinatal joint contracture was associated with a 3.1% reduction in WeeFIM scores (Exp(B)=0.97, P<.001) and an 8.2% decrease in the odds of higher FAQ levels (AOR=0.92, P<.05). Current knee involvement was associated with a 27.7% reduction in WeeFIM scores (Exp(B)=0.72, P<.001) and nearly 90% lower odds of higher FAQ levels (AOR=0.10, P<.001). Parental unemployment (AOR=0.44, P<.05) and higher musculoskeletal surgical burden (AOR=0.24, P<.001) were significantly associated with poorer mobility.

Conclusions: This is the largest cohort to date examining functional mobility in AMC. Clinical and socioeconomic factors identified may guide tailored rehabilitation strategies to promote positive outcomes in children with AMC.