Covering a graph with independent walks

Few studies have investigated the factors associated with ambulation and survival over one year. Therefore, this study aimed to examine the factors that influence ambulation and survival rates in elderly patients who have undergone conservative management for hip fractures. This retrospective study included 74 ambulatory individuals aged 65 years or older prior to their injuries. One-year mortality and ambulatory status were assessed. Statistical comparisons of background and medical characteristics between groups of independent and non-independent walkers, as well as between survivors and mortalities, were performed using the Pearson chi-squared, Fisher exact, and Mann-Whitney U tests. The numbers of older patients able to walk independently, those not able to walk independently, and those with mortality at one-year post-injury after conservative management of hip fractures were 13 (18.3%), 35 (49.3%), and 23 (32.4%), respectively. Independent walkers one year after conservative treatment for hip fracture were younger (p=0.04) and less likely to have cognitive impairment (p=0.04) than non-independent walkers. The proportion of individuals with cognitive impairment was found to be lower among survivors than among mortalities (p=0.0098). Cognitive decline may contribute to difficulties in walking independently and mortality at one year post-injury in this population.

A consecutive series of 106 children and adolescents (mean age 10 years, 6 months; SD 4 years, 8 months) with recent traumatic brain injury admitted to a regional hospital-based rehabilitation program was assessed to determine the rate of walking recovery, and characteristics that distinguish between independent walkers, non-walkers, and device-assisted walkers at hospital discharge. Data were collected through a retrospective medical record review of patients admitted between 1994 and 2001. Mean hospital stays were 66.7 days (SD 88.5, range 7 to 140 days). All children (72 male, 34 female) had recent injuries (from 1 to 8 weeks after onset of traumatic brain injury) and were independent walkers before injury. Sixty-four children (60.4%) were discharged as independent walkers, 13 (12.3%) walked with the assistance of a device, and 29 (27.3%) were non-walkers. Non-walkers had a higher proportion of prolonged loss of consciousness, lower-extremity injury, impaired responsiveness, and lower-extremity spasticity than independent walkers. In addition, non-walkers had poorer discharge mobility and social function scores, longer average hospital stays, and a greater proportion of non-community discharges. Device-only walkers were older, more likely to be male, and had a higher proportion of lower-extremity injuries than independent walkers. Results highlight several demographic, clinical, and outcome variables that distinguish independent walkers from device-assisted walkers and non-walkers. These variables might help to determine the prognosis for ambulation, resource needs, and discharge plans for children and adolescents with traumatic brain injury after episodes of inpatient rehabilitation.

Gait Function in Adults Aged 50 Years and Older With Spina Bifida

A consecutive series of 106 children and adolescents (mean age 10 years, 6 months; SD 4 years, 8 months) with recent traumatic brain injury admitted to a regional hospital‐based rehabilitation program was assessed to determine the rate of walking recovery, and characteristics that distinguish between independent walkers, non‐walkers, and device‐assisted walkers at hospital discharge. Data were collected through a retrospective medical record review of patients admitted between 1994 and 2001. Mean hospital stays were 66.7 days (SD 88.5, range 7 to 140 days). All children (72 male, 34 female) had recent injuries (from 1 to 8 weeks after onset of traumatic brain injury) and were independent walkers before injury. Sixty‐four children (60.4%) were discharged as independent walkers, 13 (12.3%) walked with the assistance of a device, and 29 (27.3%) were non‐walkers. Non‐walkers had a higher proportion of prolonged loss of consciousness, lower‐extremity injury, impaired responsiveness, and lower‐extremity spasticity than independent walkers. In addition, non‐walkers had poorer discharge mobility and social function scores, longer average hospital stays, and a greater proportion of non‐community discharges. Device‐only walkers were older, more likely to be male, and had a higher proportion of lower‐extremity injuries than independent walkers. Results highlight several demographic, clinical, and outcome variables that distinguish independent walkers from device‐assisted walkers and non‐walkers. These variables might help to determine the prognosis for ambulation, resource needs, and discharge plans for children and adolescents with traumatic brain injury after episodes of inpatient rehabilitation.

Twenty percent of patients with Guillain-Barré syndrome (GBS) have poor outcomes despite proper management. The aim of the study was to characterize electrophysiological factors related to poor outcome in patients with GBS. We conducted an observational study from a prospective cohort of 91 patients with GBS in a tertiary healthcare center in Mexico, from 2017 to 2019. Demographics and nerve conduction studies were performed on admission, and a 3-month follow-up for GBS disability score was ensued, allocating patients in good (GBS disability score ≤ 2) and poor outcome (GBS disability score ≥ 3) groups. A logistic regression analysis for independent walk at 3months was performed. Kaplan-Meier estimator curves for independent walk in very low (< 20% LLN) and low-normal ( ≥20% LLN) peroneal nerve CMAPs are presented. From the 91 GBS patients included, 37 (40.6%) did not regain independent walk at 3months. Axonal variants were more common in the poor outcome group (31.4% vs 59.4%, p = 0.01) as well as AIDP variants with motor conduction block (6.6% vs 42.4%, p = 0.018). Univariable analysis was statistically significant for very low median, ulnar, tibial, and peroneal CMAP amplitudes in poor outcome patients; however, multivariable analysis was only significant for very low peroneal nerve CMAP amplitude (OR 3.6 [1.1-11.5, p = 0.024]). Conversely, a greater proportion of GBS patients with low-normal CMAPs recovered independent walk at 90days (75% vs 30%, p < 0.001). Severe axonal injury of the peroneal nerve, axonal, and AIDP with motor conduction block variants predicts worse functional outcome regarding independent walk at 3months.

Purpose Physical functioning after discharge from specialized rehabilitation is a concern. The purpose of this study was to investigate functioning and health after a long period of community living in participants with severe disability after stroke. Materials and methods An observational, longitudinal follow-up design was used to investigate 60 participants from a randomized controlled trial. Assessment tools: Short Form 36 health-survey, Functional Ambulation Categories, EU Walking, 10 Meter Walk Test, and questions concerning health and walking ability. Results Forty-seven participants (78%) responded, mean age 51.2 years. Non-respondents demonstrated poorer function at hospital discharge. At follow-up, median 11.9 months after discharge, all but three respondents lived in their own home, and 85% received physiotherapy. Twenty-nine (64%) perceived their health as good to excellent, while four (9%) reported poor health. Activities requiring substantial strength and endurance were typically restricted. Most participants (83%) were independent walkers, and fewer (a 27% reduction) used a wheelchair. Among independent walkers, mean walking speed improved by 0.14 m/s. Time elapsed since hospital discharge was not found to correlate with change in walking speed. Conclusions This study demonstrates maintenance or progress in important aspects of functioning and health in most participants at long-term follow-up, but not in all. Implications for rehabilitation Patients with severe disability after stroke may maintain or improve their physical functioning and health after a long period of community living, when they receive continuous individualized rehabilitation including physiotherapy. Patients who maintain or improve walking ability and walking speed after living for a long time in the community, may still need assistance with daily activities, especially if they require substantial muscle strength and endurance. Expectations to long-term functional outcomes after institutional followed by community rehabilitation for patients after stroke, should be considered in light of functional status at hospital discharge.

High-intensity interval training (HIT) is superior compared to moderate-intensity continuous training for improving anaerobic fitness, agility and aerobic fitness. However, for children and adolescents with a chronic disease or condition the effects of HIT as a training modality is relatively unknown. PURPOSE: To investigate the effect of eight weeks of HIT on physical fitness in children and adolescents with a chronic disease or condition who 1) are able to run, 2) walk independently but are not able to run, and 3) propel a manual wheelchair. METHODS: A total of 68 children and adolescents were recruited from schools for special education in the Netherlands (mean age 13.5±2.8, range 8-19 years, 56% boys). They had various chronic diseases; cerebral palsy (41%), spina bifida (8%), other neuromuscular diseases (34%), musculoskeletal (4%), cardiovascular (4%) and metabolic diseases (9%). The sample consisted of 35 runners, 24 independent walkers, and 9 wheelchair users. All subjects performed HIT twice a week for 45 minutes. Every session consisted of 8-12 intervals containing a 30 seconds all-out exercise followed by 90 or 120 seconds of active recovery. Anaerobic fitness was measured by the Muscle Power Sprint Test (MPST), agility with the 10x5 meter sprint test and a shuttle run/ride test (SRT) was performed to determine aerobic performance (shuttles) and aerobic capacity (VO2peak). RESULTS: Exercise attendance was 85%. A significant improvement in respectively mean and peak power on the MPST was only found for children and adolescents who are able to run (p=.043; p=.028). Both agility and aerobic performance on the SRT showed a significant training effect in all groups; runners (p=.001; p<.001), independent walkers (p=.024; p=.006) and wheelchair users (p=.024; p=.012). However, VO2peak (ml/kg/min) did not change significantly in all groups of functional mobility. CONCLUSION: HIT is feasible in children and adolescents independent of mode of mobility. Agility and aerobic performance, both parameters containing motor-skills, improved. However, since anaerobic fitness improved only in children and adolescents who are able to run, the 30s all-out HIT principle is probably not applicable for independent walkers and wheelchair users. Future studies about HIT protocols to improve VO2peak as well are warranted.

Daily step-count is important post-insult in the subacute phase to influence neuroplasticity, functional recovery and as a predictive factor for activity level one-year post event. Measure daily step-count in subacute patients follow-ing brain injury in an inpatient neurorehabilitation setting and compare these to evi-dence-based recommendations. 30 participants measured of daily step-count over a seven-day period, throughout the day to assess when and how activity varied. Step-counts were analyzed in sub-groups based on walking ability using the Functional Ambulation Categories (FAC). Correlations between steps-count and FAC level, walking speed, light touch, joint position sense, cognition, and fear of falling were calculated. Median (IQR) daily steps for all patients was 2512 (568.5,4070.5). Not independently walkers took 336 (5-705), the value is below the recommendation. Participants walking with assistance took 700 (31-3080), significantly below recommended value (p = 0.002), independent walkers took 4093 (2327-5868) daily steps, significantly below recommended value (p = < 0.001). Step-count showed moderate to high and statistically-significant correlations: positive for walking speed, joint position sense, negative for fear of falling, and number of medications. Only 10% of all participants reached the recommended daily steps. Interdisciplinary team-work and strategies to increase daily activity between therapies may be crucial to achieve recommended step-levels in subacute inpatient settings.

OBJectIVe: The aim of this study is to evaluate the influence of the ambulatory status of children with MMC on renal functions, clinical and radiological findings. MAteRIAl and MetHODS: The records of 83 children with MMC between 2005-2010 were reviewed retrospectively. The ambulatory status of the patients was classified as independent walkers (walks without assistive appliances), assisted walkers (requires walking aid), and non-ambulatory (wheelchair bound) and the patient characteristics were evaluated according to the ambulatory status. resUlTs: The mean age was 7.1±0.61 years and median follow-up was 58 (32-97) months. Thirtyseven patients (44.6%) had been operated in the first three days of life. The patients with earlier initiation of follow-up earlier had less hydronephrosis and trabeculated bladder. Sixty-one children (73.5%) were non-ambulatory, 14 (16.9%) were assisted walkers and eight (9.6%) were independent walkers. GFR was less than 80 ml/minute/1.73m2 in six patients. There were no relation between ambulatory status and patients’ renal functions, radiological and clinical findings. cOncluSIOn: Ambulatory status does not influence renal functions, clinical and radiological findings of children with MMC. Beginning follow-up earlier may lead to fewer complications such as hydronephrosis and deformed and trabeculated bladder. Besides, patients operated in the first three days of life were more compliant with regular follow-ups. key wORDS: Meningomyelocele, Renal function, Ambulatory status doi: 10.5262/tndt.2012.1003.10 Yazisma Adresi: Meryem Benzer Marmara Universitesi, Pediatrik Nefroloji Bilim Dali, Istanbul, Turkiye Gsm : 0 505 914 02 69 E-posta : mbenzer1@hotmail.com Gelis Tarihi : 20.02.2011 Kabul Tarihi : 17.08.2011

ABSTRACTThis article contributes to the discussion of how people with limited communication means become active participants in the assessment of welfare technologies. The article combines ethnomethodology with insights from Science and Technology Studies and emphasises the situated and multimodal practices that constitute the trial as a joint activity in which the impaired person becomes a competent participant and independent walker. The analysis is based on video recordings from a case study in which a person with brain injury is trying out a new type of walking help. The trial is understood as a situated learning process in which the participants prepare, enact and assess the performance of the technology-supported walking. The article distinguishes two iterative phases in which the impaired person is constituted as an independent walker: the adjustment and assessment of a body–device relation and, further, the performance and assessment of the activity the user can perform.

Cemented hip hemiarthroplasty is a routine surgical option for elderly neck of femur (NOF) fractures. It is uncertain if quality of cementing has any effect on functional outcomes. The aim of this study was to determine if the quality of cementing would affect short term functional outcomes in elderly neck of femur fractures. Retrospective analysis of 637 single-centre cemented hip hemiarthroplasties from 2014 to 2021 was performed. Each post-operative radiograph was double-read by 2 authors (1 resident and 1 fellowship trained surgeon) to determine quality of cementing via the Barrack grading. Disagreements were reviewed by a third reader. Cement grades were grouped as Optimal (Barrack grade A-B), or Suboptimal (Barrack grade C-D). Functional outcomes were compared using mobility (community- or home-ambulant), assistance required for mobility, and Modified Barthel Index (MBI). Surgical parameters were compared between the groups. There were 429 Optimal and 208 Suboptimal cases of cementing performed. There was no difference in age, American Society of Anesthesiologists score, mobility, assistance required, and MBI score pre-operatively (p > 0.05). Patients in the "Suboptimal" cementing group had a higher Charlson Comorbidity Index (CCI) score (p < 0.001). At 1year post-operation, there was no significant difference between "Optimal" and "Suboptimal" cementing with regards to the proportion of community ambulators (30.2% vs. 25.7%, p = 0.252), walking independence (independent walkers (19.8% vs.17.3%), independent walkers with aids (41.3%vs.42.1%), walker with caregiver assistance (29.2%vs.33.7%), wheelchair-bound (9.6%vs.6.9%), p = 0.478), and distribution of MBI score (81.1%vs.82.2% achieving MBI > 60, p = 0.767). There was no significant difference in the proportion of patients with postoperative delirium (7.9% vs. 5.8, p = 0.324) or 1-year mortality rates (3.5% vs. 2.9%, p = 0.685). Except for stem design (12.2% tapered vs 20.1% collared; p = 0.011), no other surgical parameters were significantly different. The kappa value for inter-reader agreement was "substantial" at 0.727 (95% CI 0.682-0.772) (p < 0.001). Quality of cementing in cemented hip hemiarthroplasty for elderly NOF fractures does not affect the short-term functional outcomes. In low demand patients and patients at risk of BCIS, optimal cementing may not be necessary to achieve similar short-term functional outcomes. Further studies should be conducted to determine the effect of sub-optimal cementing on long-term functional outcomes.

“that night she was like a little tottering, stumbling, clutching child, who of a sudden realizes its power and walks for the first time alone...She could have shouted for joy. She did shout for joy, as...she lifted her body to the surface of the water. / A feeling of exultation overtook her, as if some power of significant import had been given her to control the working of her body and her soul. She grew daring and reckless, overestimating her strength. She wanted to swim far out, where no woman had swum before.” (908) / Edna Pontellier's euphoria at learning to swim pinpoints the conceptual, and feminist, dimensions of Chopin's complex metaphor of a turn-of-the-century woman's 'awakening' to her ability to 'control the working of her body and soul'. Compared as it is to a toddler's first independent walk - a first step in the development towards adulthood - Edna's midnight swim is much more than a victory of physical coordination. It establishes her sense of self-ownership, physical, mental and spiritual, which in turn triggers two fundamental insights that determine her progression from disengaged wife to autonomous subject: in control of her body, she becomes aware of its potential for pleasure and learns to claim her right to self-determination. The novel begins with Mr Pontellier's assertion of his ownership rights: his act of 'looking at his wife as one looks at a valuable piece of personal property' poignantly reminds her of the wedding ring she gave into his safe-keeping when she went for her seabath (882). It ends with the newly born New Woman Edna's declaration of economic and sexual independence: 'I am no longer one of Mr. Pontellier's possessions to dispose of or not. I give myself where I choose' (992). Edna's proclamation of rights is the equivalent of Chopin's claim to independence in her choice of subject matter, as is the desire to venture 'where no woman had swum before'.

Sampling the content of an Online Social Network (OSN) is a major application area due to the growing interest in collecting social information e.g., email, location, age and number of friends. Large-scale social networks such as Facebook can be difficult to sample due to the amount of data and the privacy settings imposed by this company. Sampling techniques require the development of reliable algorithms able to cope with an unknown environment. Our main purpose in this manuscript is to examine whether it is possible to switch the normal distribution of the Metropolis–Hasting random walk (MHRW) by using a spiral approach as an alternative and reliable distribution. We propose a sampling algorithm, the Alternative Metropolis–Hasting random walk AMHRW, to study the effect of collecting digital profiles on two different datasets. We examine the soundness and robustness of the proposed algorithm through independent walks on two different representative samples of Facebook. We observe that normal distribution performance can be approximated by means of the use of an Illusion spiral. Similarly, we provide a formal convergence analysis to evaluate the performance of our independent walks and to evaluate whether the sample of draws has attained an equilibrium state. Finally, our preliminary results provide experimental evidence that collecting data with the AMHRW algorithm can be equally effective as the MHRW algorithm on large-scale networks.

The Standing and Walking Assessment Tool (SWAT) standardizes the timing and content of walking assessments during inpatient rehabilitation by combining 12 stages ranging from lowest to highest function (0, 0.5, 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B, 3C, and 4) with 5 standard measures: the Berg Balance Scale, the modified Timed "Up & Go" test, the Activities-specific Balance Confidence Scale, the modified 6-Minute Walk Test, and the 10-Meter Walk Test (10MWT). This study aimed to determine if the SWAT at rehabilitation discharge could predict outdoor walking capacity 1-year after discharge in people with traumatic spinal cord injury. This retrospective study used data obtained from the Rick Hansen Spinal Cord Injury Registry from 2014 to 2020. Community outdoor walking capacity was measured using the Spinal Cord Independence Measure III (SCIM III) outdoor mobility score obtained 12 (±4) months after discharge. Of 206 study participants, 90 were community nonwalkers (ie, SCIM III score 0-3), 41 were community walkers with aids (ie, SCIM III score 4-6), and 75 were independent community walkers (ie, SCIM III score 7-8). Bivariate, multivariable regression, and an area under the receiver operating characteristic curve analyses were performed. At rehabilitation discharge, 3 significant SWAT associations were confirmed: 0-3A with community nonwalkers, 3B/higher with community walkers with and without an aid, and 4 with independent community walkers. Moreover, at discharge, a higher (Berg Balance Scale, Activities-specific Balance Confidence Scale), faster (modified Timed "Up & Go," 10MWT), or further (10MWT) SWAT measure was significantly associated with independent community walking. Multivariable analysis indicated that all SWAT measures, except the 10MWT were significant predictors of independent community walking. Furthermore, the Activities-Specific Balance Confidence Scale had the highest area under the receiver operating characteristic score (0.91), demonstrating an excellent ability to distinguish community walkers with aids from independent community walkers. The SWAT stage and measures at discharge can predict community outdoor walking capacity in persons with traumatic spinal cord injury. Notably, a patient's confidence in performing activities plays an important part in achieving walking ability in the community. The discharge SWAT is useful to optimize discharge planning.

Decomposing correlated random walks on common and counter movements