Physical medicine and rehabilitation international最新文献

Background: MicroRNAs; miRs are used as biomarkers in the diagnosis of several diseases. Cerebral palsy; CP, resulting from perinatal brain injury, cannot be diagnosed until 18-24 months old. Biomarkers to predict CP and assess response to investigational therapies are needed. We hypothesized that miRs expressed in neonates with the CP risk factors of abnormal tone and/or intraventricular hemorrhage; IVH differ from those without risk factors.

Methods: This was a cohort study of neonates at risk for CP. Subjects <32 weeks gestation and <1500 grams were recruited from neonatal intensive care units at a large urban delivery hospital and an adjacent children's hospital. Thirty-one plasma samples were evaluated. An unbiased examination was performed by locked nucleic acid quantitative real time - polymerase chain reaction; qRT-PCR. Results were evaluated in the context of IVH and abnormal tone.

Results: Plasma miR profiles in neonates at risk for CP differ when comparing those with and without IVH, and with and without abnormal tone. Restricted profiles were found in each condition with greater differences in the tone comparison than the IVH comparison.

Conclusion: Plasma miR profiles show potential in predicting CP. This study also suggests biologically plausible candidates for future studies.

Purpose: To quantify the effects of an articulated ankle foot orthosis on genu recurvatum gait in adolescents with traumatic brain injury (TBI).

Methods: Gait analysis was conducted in 2 individuals with TBI during over ground ambulation with (braced condition) and without (barefoot condition) the AAFO. For each participant, stride-by-stride gait data were compared to assess differences between barefoot and braced walking conditions.

Results: During the braced versus barefoot condition, both participants demonstrated reduced plantar flexion at initial contact, increased knee flexion at initial contact, reduced peak knee extension during stance, and reduced peak and integral of internal knee flexor moment during stance.

Conclusions: The data suggest that the AAFO reduced plantar flexion during stance, therefore attenuating the anterior displacement of the ground reaction force vector (GRFV) relative to the ankle and knee joint axes, and leading to a reduction in knee hyperextension and the internal knee flexor moment during stance. We posit that the reduction in internal knee flexor moment may lead to a more sustainable gait pattern with less potential for mechanical stress on the posterior knee joint capsule.

The success of locomotion training with robotic exoskeletons requires identifying control algorithms that effectively retrain gait patterns in neurologically impaired individuals. Here we report how the two training paradigms, performance-based error-augmentation versus error-reduction, modified walking patterns in four chronic post-stroke individuals as a proof-of-concept for future locomotion training following stroke. Stroke subjects were instructed to match a prescribed walking pattern template derived from neurologically intact individuals. Target templates based on the spatial paths of lateral ankle malleolus positions during walking were created for each subject. Robotic forces were applied that either decreased (error-reduction) or increased (error-augmentation) the deviation between subjects' instantaneous malleolus positions and their target template. Subjects' performance was quantified by the amount of deviation between their actual and target malleolus paths. After the error-reduction training, S1 showed a malleolus path with reduced deviation from the target template by 16%. In contrast, S4 had a malleolus path further away from the template with increased deviation by 12%. After the error-augmentation training, S2 had a malleolus path greatly approximating the template with reduced deviation by 58% whereas S3 walked with higher steps than his baseline with increased deviation by 37%. These findings suggest that an error-reduction force field has minimal effects on modifying subject's gait patterns whereas an error-augmentation force field may promote a malleolus path either approximating or exceeding the target walking template. Future investigation will need to evaluate the long-term training effects on over-ground walking and functional capacity.

There is little information in peer-reviewed literature to specifically guide the choice of exercise for persons with balance and vestibular disorders. The purpose of this study is to provide a rationale for the establishment of a progression framework and propose a logical sequence in progressing balance exercises for persons with vestibular disorders. Our preliminary conceptual framework was developed by a multidisciplinary team of physical therapists and engineers with extensive experience with people with vestibular disorders. Balance exercises are grouped into six different categories: static standing, compliant surface, weight shifting, modified center of gravity, gait, and vestibulo-ocular reflex (VOR). Through a systematized literature review, interviews and focus group discussions with physical therapists and postural control experts, and pilot studies involving repeated trials of each exercise, exercise progressions for each category were developed and ranked in order of degree of difficulty. Clinical expertise and experience guided decision making for the exercise progressions. Hundreds of exercise combinations were discussed and research is ongoing to validate the hypothesized rankings. The six exercise categories can be incorporated into a balance training program and the framework for exercise progression can be used to guide less experienced practitioners in the development of a balance program. It may also assist clinicians and researchers to design, develop, and progress interventions within a treatment plan of care, or within clinical trials. A structured exercise framework has the potential to maximize postural control, decrease symptoms of dizziness/visual vertigo, and provide "rules" for exercise progression for persons with vestibular disorders. The conceptual framework may also be applicable to persons with other balance-related issues.

Background: While cooled radiofrequency ablation (C-RFA) appears to be a promising technology for joint denervation, outcomes of this technique for the treatment of lumbar facet syndrome have not been described. We report clinical outcomes in a case series of patients treated with C-RFA for lumbar facet syndrome.

Methods: Consecutive patients aged 18-60 years diagnosed with lumbar facet syndrome, confirmed by ≥75% symptom relief with at least one set of diagnostic medial branch nerve blocks, who underwent C-RFA between January 2007 and December 2013 in an urban academic pain center were included. The respective proportions of participants who reported ≥50% improvement in pain and in function were calculated. Change in median NRS score, daily morphine equivalent consumption (DME), and medication quantification scale III (MQS III) score were measured.

Results: Twelve patients underwent C-RFA; three were lost to follow-up. The median and 25%-75% interquartile range (IQR) for age was 44 years (35, 54). The median duration of follow-up was 34 months, IQR (21, 55). The percentage and 95% confidence interval (CI) of patients who reported ≥50% improvement in pain was 33% CI (12%, 64%) and in function was 78%, CI (41%, 96%). There was no significant change in DME or MSQ III score. Approximately 50% of patients sought additional healthcare by long-term follow-up. No complications were reported.

Conclusions: This case series suggests that C-RFA may improve function and to a lesser degree pain at long-term follow-up. A randomized, controlled trial is warranted.