ADL Function Research Articles

여성노인의 노쇠정도에 따른 기능체력 및 일상생활수행능력과의 관계

Purpose: The purpose of this study is to identify the effects of frailty on functional fitness and ADL in the elderly.BR Method: The study was conducted on 59 elderly women at senior welfare centers in Seoul and Gyeonggi Province. The collected data were derived using the SPSS 23 program through technical statistical analysis, one-way analysis, correlation analysis, and multiple regression analysis.BR Results: As a result of the analysis, the higher the level of senility, the lower the functional stamina, and the higher the level of senility, the lower the ability to perform daily life. The degree of senility was found to have an effect on lower extremity muscle strength and cardiorespiratory endurance among functional physical strength. Therefore, to prevent aging, it was considered that it was necessary to prevent it from middle age and to maintain and improve physical strength.BR Conclusion: This study could be used as basic data when developing a preventive exercise program as well as predicting and evaluating old age. However, since the study was conducted only by elderly women living in the community, it is necessary to expand the size of the sample in the future as the findings are limited to the overall elderly population.

A comparison of test–retest reliability and random measurement error of the Barthel Index and modified Barthel Index in patients with chronic stroke

Objective To compare the test–retest reliability and random measurement errors of the Barthel Index (BI) and modified Barthel Index (MBI) in patients with chronic stroke. Method The intraclass correlation coefficient (ICC) and the minimal detectable change (MDC) were applied respectively to examine the test–retest reliability (about 2 weeks apart) and the random measurement errors. The MDC% was used to adjust the cut-off score for determining whether a real change had been achieved, if heteroscedasticity existed. Results A total of 60 patients participated. The BI and MBI both had high ICCs (0.94 and 0.94, respectively) with small MDCs (16.2 and 15.4, respectively) and MDC%s (21.2% and 19.0%, respectively), indicating that both measures have comparable reliability in repeated assessments. However, moderate associations (r = −0.47 for the BI and −0.59 for the MBI) were found between the means of tests and retests and the absolute values of change scores, indicating heteroscedasticity. These findings suggest that a fixed MDC value is not appropriate for determining the real change in both measures because the amount of random measurement error varies with the patients’ ADL function. Conclusion The MBI, which showed excellent test–retest reliability and relatively lower random measurement error than the BI, appears to be a better ADL measure. The MDC% adjusted value is recommended to determine whether the change scores are beyond random measurement error. IMPLICATIONS FOR REHABILITATION The MBI is recommended for clinical and research applications because it has better test–retest reliability and relatively lower random measurement error than those of the original BI. The MDC% adjusted value is recommended to determine whether the change scores are beyond random measurement error when the MBI or the BI is used.

Effects of Exoskeletal Lower Limb Robot Training on the Activities of Daily Living in Stroke Patients: Retrospective Pre-Post Comparison Using Propensity Score Matched Analysis

PurposeThere is limited evidence of gait training using newly developed exoskeletal lower limb robot called Hybrid Assistive Limb (HAL) on the function and ability to perform ADL in stroke patients. In clinical settings, we frequently find it challenging to conduct a randomized controlled trial; thus, a large-scale observational study using propensity score analysis methods is a feasible alternative. The present study aimed to determine whether exoskeletal lower limb robot training improved the ability to perform ADL in stroke patients. Materials and methodsAcute stroke patients who were admitted to our facility from April 2016 to March 2017 were evaluated in the conventional rehabilitation period (CRP) and those admitted from April 2017 to June 2019 were evaluated in the HAL rehabilitation period (HRP). We started a new gait rehabilitation program using HAL at the midpoint of these two periods. The functional outcomes or ADL ability outcomes of the patients in the CRP and the subsequent HRP were compared using propensity score matched analyses. ResultsPropensity score matching analysis was performed for 108 stroke patients (63 from the CRP and 45 from the HRP), and 36 pairs were matched. The ADL ability, defined by the FIM scores and FIM score change, was significantly higher in patients admitted during the HRP. In addition, more stroke patients obtained practical walking ability during hospitalization in the HRP. ConclusionGait training using HAL affects the ADL ability and obtaining of practical walking ability of stroke patients.

The longitudinal association between depressive symptoms and functional abilities in older patients

ObjectivesTo investigate the course of depressive symptoms, and basic and instrumental activities of daily living (collectively described as, (I)ADL functioning) from acute admission until one year post-discharge, the longitudinal association between depressive symptoms and (I)ADL functioning, and to disaggregate between- and within-person effects to examine whether changes in depressive symptoms are associated with changes in (I)ADL functioning. MethodsProspective multicenter cohort of acutely hospitalized patients aged ≥70. Data gathered over a one-year period were assessed using validated measures of depressive symptoms (GDS-15) and physical functioning (Katz-ADL index). A Poisson mixed model analysis was used to examine the association between the courses and a hybrid model was used to disentangle between- and within-subject effects. ResultsThe analytic sample included 398 patients (mean age = 79.6 years, SD = 6.6). Results showed an improvement in depressive symptoms and physical functions over time, whereby changes in depressive symptoms were significantly associated with the course of ADL function (rate ratio (RR) = 0.91, p < .001) and IADL function (RR = 0.94, p < .001), even after adjustment for confounding variables. Finally, both between- and within-person effects of depressive symptoms were significantly associated with the course of ADL function (between-person: RR = 0.85, p < .001; within-person: RR = 0.94, p < .001) and IADL function (between-person: RR = 0.87, p < .001; within-person: RR = 0.97, p < .001). ConclusionThe course of depressive symptoms and physical functions improved over time, whereby changes in depressive symptoms were significantly associated with changes in physical functions, both at group and individual level. These changes in (I)ADL functioning lie mostly above the estimated minimally important change for both scales, implying clinically relevant changes.

Effect of patellofemoral joint targeted education, and exercise guidelines on outcomes of patients with patellofemoral osteoarthritis

Background and objective: Patellofemoral joint osteoarthritis (PFJOA) is an under recognized category of arthritis, evident in almost 70% of adults with knee pain. Objective was to evaluate the effect of patellofemoral joint targeted education, and exercise guidelines on outcomes of patients with patellofemoral osteoarthritis.Methods: A quasi experimental (pre/post) design was used. Setting: The study was conducted in the physiotherapy department of a large University Hospital in Egypt. Sample: A randomized 30 adult patients with symptomatic and diagnosed PFJOA. Researchers and Physiotherapists delivered the PFJ-targeted education, and exercise program in 3 sessions over 9 month period.Results: The PFJ-targeted education, and exercise guidelines resulted in a highly statistically significant difference in the Knee Injury and Osteoarthritis Outcome Score (KOOS) pre/posttest in the whole five domains of the questionnaire; Pain (nine items); Symptoms (seven items); ADL Function (17 items); Sport and Recreation Function (five items); and Quality of Life (four items) p &lt; .001**.Conclusions: PFJ-targeted education, and exercise guidelines were more effective in reducing pain, improving physical function, and activities of daily living. Recommendation: Replication of the study using a larger probability sample from different geographical areas to help for generalization of the results.

Spontaneous subarachnoid hemorrhage. Prognostic factors for social readjustment

Sixty-seven patients surviving spontaneous subarachnoid haemorrhage (SAH) have been followed up for 2-12 years (mean: 7 years) in order to determine prognostic factors concerning the long-term disability in familial and social functioning. A correlation was found between the severity of the neurological deficit at the time of admission and the degree of familial and social disability at the end of the observation period. In addition, the Barthel-Index on discharge was shown to be of prognostic value for readjustment for social--but not for familial--functioning. Other clinical variables in the acute stage, however, including source of bleeding, sex, age, interval between SAH and admission, level of consciousness, cognitive functions, as well as initial Hunt and Hess grading and Glasgow Coma Scale scoring, did not influence the long-term social prognosis. Furthermore, residual neurological signs, cognitive dysfunctions, and the Glasgow Outcome score on discharge were not related to the extent of social handicap in the long-term outcome. At the end of the observation period, significant correlations were found between the presence of persisting neurological and cognitive deficits but also disability in ADL functions and occupational capacity and the decline in familial and social functioning.

Percentile curves for the knee injury and osteoarthritis outcome score in the middle-aged Dutch population

To improve the interpretation of the Knee injury and Osteoarthritis Outcome Score (KOOS) in individual patients, we explored associations with age, sex, BMI, history of knee injury and presence of clinical knee osteoarthritis, and developed percentile curves. We used cross-sectional data of middle-aged individuals from the population-based Netherlands Epidemiology of Obesity (NEO) study. Clinical knee osteoarthritis was defined using the ACR classification criteria. KOOS scores were handled according to the manual (zero=extreme problems, 100=no problems). Patient characteristics associated with KOOS were explored using ordered logistic regression, and sex and body mass index (BMI)-specific percentile curves were developed using quantile regression with fractional polynomials. The curves were applied as a benchmark for comparison of KOOS scores of participants with knee osteoarthritis and comorbidities. The population consisted of 6,643 participants (56% women, mean (SD) age 56(6) years). Population-based KOOS subscale scores (median; interquartile range) near optimum: pain (100;94-100), symptoms (96;86-100), ADL function (100;96-100), sport/recreation function (100;80-100), quality of life (100;75-100). Worse KOOS scores were observed in women and in participants with higher BMI. Clinical knee osteoarthritis was defined in 15% of participants, and was, in comparison to other patient characteristics, associated with the highest odds of worse KOOS scores. Furthermore, presence of any comorbidity and cardiovascular disease specifically, was associated with worse KOOS scores, particularly in women. In the middle-aged Dutch population KOOS scores were generally good, but worse in women and with higher BMI. These percentile curves may be used as benchmarks in research and clinical practice.

Individual Responsiveness to Physical Exercise Intervention in Acutely Hospitalized Older Adults.

We analyzed inter-individual variability in response to exercise among acutely hospitalized oldest-old adults. In this ancillary analysis of a randomized controlled trial, 268 patients (mean age 88 years) were assigned to a control (n = 125, usual care) or intervention group (n = 143, supervised exercise, i.e., walking and rising from a chair [1–3 sessions/day]). Intervention group patients were categorized as responders, non-responders, or adverse responders (improved, no change, or impaired function in activities of daily living [ADL, Katz index] from hospital admission to discharge, respectively). We analyzed the association between responsiveness to exercise and variables assessed at baseline (2 weeks pre-admission), admission, during hospitalization, at discharge, and during a subsequent 3-month follow-up. An impaired ADL function and worse nutritional status at admission were associated to a greater responsiveness, whereas a better ADL function at admission, longer hospitalization and lower comorbidity index were associated with a poorer response (p < 0.05). Adverse responders had worse outcomes at discharge and during the follow-up (e.g., impaired physical performance and greater fall number) (p < 0.05). Although exercise intervention helps to prevent ADL function decline in hospitalized oldest-old people, a number of them—particularly those with a better functional/health status at admission and longer hospitalization—are at higher risk of being adverse responders, which can have negative short/middle-term consequences.

Effects of Virtual Reality-Based Rehabilitation on Burned Hands: A Prospective, Randomized, Single-Blind Study.

Hands are the most frequent burn injury sites. Appropriate rehabilitation is essential to ensure good functional recovery. Virtual reality (VR)-based rehabilitation has proven to be beneficial for the functional recovery of the upper extremities. We investigated and compared VR-based rehabilitation with conventional rehabilitation (CON) in patients with burned hands. Fifty-seven patients were randomized into a VR or CON group. Each intervention was applied to the affected hand for four weeks, and clinical and functional variables were evaluated. Hand function was evaluated before intervention and four weeks after intervention using the Jebsen-Taylor hand function test (JTT), Grasp and Pinch Power Test, Purdue Pegboard test (PPT), and Michigan Hand Outcomes Questionnaire (MHQ). The JTT scores for picking up small objects and the MHQ scores for hand function, functional ADL, work, pain, aesthetics, and patient satisfaction were significantly higher in the VR group than in the CON group (p < 0.05). The results suggested that VR-based rehabilitation is likely to be as effective as conventional rehabilitation for recovering function in a burned hand. VR-based rehabilitation may be considered as a treatment option for patients with burned hands.

Effect of electric stimulation combined with Ai salt bag on shoulder-hand syndrome after cerebral infarction

Objective To study the effect of electric stimulation combined with Ai salt bag on shoulder-hand syndrome after cerebral infarction. Methods A total of 188 patients with shoulder-hand syndrome after cerebral infarction admitted to Taizhou Central Hospital from September 2015 to August 2018 were enrolled in the study, they were randomly divided into study group (n=94) and control group (n=94) according to the random number table method.The control group was given uplink electrical stimulation treatment based on the conventional treatment for cerebral infarction and rehabilitation training, the study group was given Ai salt bag treatment on the basis of the control group.The clinical treatment effect, pain and edema VAS score, Fugl-Meyer motor function score and ADL score were observed and compared between the two groups. Results After 28 days of treatment, the total effective rate was 88.30%(83/94) in the study group and 76.60%(72/94) in the control group, the difference between the two groups was statistically significant (χ2=4.447, P<0.05). The VAS score of edema degree and pain degree in the study group decreased from (4.13±1.40) points, (3.43±2.20)points to (1.70±1.36) points, (1.52±1.22)points, which in the control group decreased from (4.10±1.46) points, (3.40±2.17) points to (2.79±1.58) points, (2.52±1.18)points, there were statistically significant differences between the two groups after treatment(t1=5.712, t2=5.069, all P<0.05). The Fugl-Meyer motor function score and ADL score of the study group increased from (19.91±13.32) points, (42.34±15.57)points to (54.21±11.71) points, (86.02±16.62)points, which in the control group increased from (20.74±11.30) points, (45.84±14.44) points to (45.44±12.61) points, (78.84±17.79)points, there were statistically significant differences between the two groups after treatment (t1=4.941, t2=2.859, all P<0.05). Conclusion Electrical stimulation combined with Ai salt bag in the treatment of shoulder-hand syndrome after cerebral infarction has significant clinical effect, which can effectively alleviate the pain symptoms and swelling of the affected limb, promote the activities of daily living and improve the function of the affected limb, and is worthy of clinical application. Key words: Infarction, middle cerebral artery; Reflex sympathetic dystrophy; Pain; Edema; Electric stimulation therapy; Artemisia; Moxibustion

Early Return Of Activity Of Daily Living After Surgery Of Pfna Li Fixation In Elderly Osteoporotic Intertrochanteric

Background: Hip fractures are common, morbid, and costly health events that threaten independence and function of older patients . Early functional recovery is extremely important for elderly patients with femoral intertrochanteric fractures to shorten their hospital stay, omit the necessity of the further nursing and care services, and reduce associated medical expenditures . Assessment of (ADL) is an important predictor of outcomes Of orthopedic surgery in very early postoperative period at two weeks and a month postoperatively using Japanese orthopedic score get a quick recovery of ADL &amp; return the patient to his or her premorbid level function reducing the morbidity and mortality.&#x0D; Objectives: We evaluate in our study the Return of ADL function in 27 cases of elderly with intertrochanteric hip fractures treated with closed reduction and surgical fixation with proximal femoral nail anti rotation in very early postoperative period at two weeks and a month postoperatively.&#x0D; Type of the study : Prospective observational stud&#x0D; Methods: Prospective observational study of 27 consecutively patients with an intertrochanteric fracture Stable and unstable fractures treated between December 2015 and Augest 2016 were enrolled in study.&#x0D; Results: Regain in a walking ability and daily living activities which indicate a fast recovery in early days and weeks after surgery in contrary the regular fellow up a month up to 3 month revealed a slower recovery from that achieved in early weeks&#x0D; Conclusions: Use of proximal femoral nailing in intertrochanteric elderly osteoporostic fracture has a significant impact on early functional recovery

Evaluation of Clinical Efficacy of Combination of Surgery and Rehabilitation for Treatment of Scar Contracture after Hand Burn

Objective: To evaluate the clinical efficacy of combination of surgery and rehabilitation for patients with scar contracture after hand burn. METHODS: Subjects of data calculation in this study were 66 patients with scar contracture after hand burn who were admitted from May 2018 to May 2019. The subjects were divided into regular group and combined group according to random number table method. The regular group (n=33) received surgical treatment alone. The combined group (n=33) patients were given surgery combined with rehabilitation. Recovery of hand function, efficacy of clinical treatment, hand function recovery and ADL score were calculated and compared between the two groups of patients with scare contracture after hand burn. RESULTS: Efficacy, recovery of hand function (finger, finger flexion and extension, palm and finger adduction or abduction, daily activity, wrist rotation, wrist flexion and extension, appearance and sensory function) and ADL score were more superior in combined group when compared with regular group patients with scar contracture after hand burn. P &lt;0.05, the indicator data showed statistical significance. Conclusion: Surgery combined with rehabilitation therapy shown significant value for patients with scar contracture after hand burn.

Validation of the LOCOMO-25 and its minimum clinically important differences in domain scores for Chinese patients with low back pain and neck pain

BackgroundThe 25-question Geriatric Locomotive Function Scale (LOCOMO-25) was developed to assess any decline in mobility functions. This study aims to validate the LOCOMO-25 in Chinese patients with chronic low back pain and/or neck pain. MethodsAdult patients with chronic low back pain and/or neck pain completed the LOCOMO-25, SF-36, EQ-5D-5L, ODI, VAS and/or NDI. Internal consistency was assessed by Cronbach's alpha coefficient (α). Test-retest reliability was assessed by intra-class correlation coefficients. Construct validity was assessed by Spearman correlation tests against other outcome measures. Sensitivity to detect differences between groups was assessed by Mann–Whitney U or Kruskal–Wallis H test, where appropriate. Intergroup comparison was performed further in terms of domain scores and their changes at test-retest. ResultsA total of 111 patients were consecutively recruited. LOCOMO-25 demonstrated excellent internal consistency (α = 0.915) and test-retest reliability (Intraclass correlation: 0.705 to 0.826). LOCOMO-25 was significantly correlated with all domains of SF-36, EQ-5D, ODI, NDI, and VAS (p < 0.01). It was found to be sensitive in differentiating between patients with neural compression (32.8 ± 16.9) and without (21.2 ± 12.7), with history of fall(s) within the previous one year (30.8 ± 16.0) and without (24.2 ± 15.1), requires assistive devices for ambulation (40.6 ± 21.6) or independent (23.6 ± 13.1) and various pain levels (mild: 17.2 ± 10.6; moderate: 23.5 ± 11.7; severe: 38.5 ± 16.5). Patients with neural compression scored significantly higher in the domain of pain and patients requiring assistive devices for ambulation scored significantly higher in the domains of ADL and social functions. The minimum detectable differences for various domains of the LOCOMO-25 score included pain (2.76), activities of daily living (6.07), social function (1.59), and mental health status (2.06). ConclusionsLOCOMO-25 has been validated in Chinese patients with chronic low back and neck pain with satisfactory psychometric properties, and with individual domain minimum clinically important differences. There is adequate internal consistency, test-retest reliability, construct validity and sensitivity to detect differences between patients with/without neural compression, different ambulatory statuses and pain severity.

Association Between Home Layout and Physical, Psychosocial, and Cognitive Functions in Community-Dwelling Older Adults: A Preliminary Study

Abstract Date Presented 04/04/19 This study investigated the relationships of home layout and the ADL, physical, cognitive, and psychosocial functions in community-dwelling older adults. The findings support the idea that the spatial layout of a home affects the ability to live in one's own home independently. Primary Author and Speaker: Yoonjeong Lim Additional Authors and Speakers: Kinsuk Maitra, Sang-Heon Lee, Sonit Bafna Contributing Authors: Audrey Reiner, Veronica Betancourt, Ben Allen, Marianna Thomas, Eric Minter, Wei Wang, Amanda Pitts, Hayat Akmel, Jonathan Cam, Mary Alvarez

The Surprise Question and Self-Rated Health Are Useful Screens for Frailty and Disability in Older Adults with Chronic Kidney Disease.

Background: Self-rated health (SRH) and the surprise question (SQ) capture perceptions of health and are independent risk factors for poor outcomes. Little is known about their association with physiologic and functional decline. Objective: Determine the association of SRH and SQ with frailty and functional status in older adults with chronic kidney disease (CKD) and their utility as screening tools. Design: Prospective cohort study. Setting/Subjects: Two hundred seventy-two adults, age ≥60 years, with advanced CKD seen in nephrology clinic. Measurements: Patients completed SRH and were evaluated for frailty (Fried criteria and Clinical Frailty Scale [CFS]) and functional status (Katz and Lawton indices of activities of daily living [ADLs] and instrumental ADLs [iADLs]). Providers completed the SQ. Correlations were evaluated using Spearman's rho. Results: Fifteen percent of patients were frail, 8% had ≥1 ADL deficit, and 29% had ≥1 iADL deficit. SRH and SQ were moderately correlated with frailty and iADLs. A SRH of excellent, very good, or good was predictive of nonfrail status (Fried negative predictive value [NPV]: 0.92; CFS NPV: 0.92) and preserved ADL function (NPV for ≥1 deficit: 0.96). A SQ response of 5, 4, or 3 (i.e., surprised) was predictive of nonfrail status and preserved ADL function (CFS NPV: 0.90; ADL ≥1 deficit NPV: 0.95). A SQ response of 1 or 2 had a positive predictive value of 0.64 for ≥1 iADL deficit. Conclusions: Subjective health measures may be useful screening tools for frailty and functional status.

Clinical application study of acupotomy-injection technique with targeted three-point in the treatment of frozen shoulder

To observe the clinical efficacy of minimally invasive acupotomy-injection technique with targeted three-point in the treatment of frozen shoulder. From March 2017 to November 2018, a total of 140 patients with frozen shoulder were randomly divided into observation group and control group. The observation group was made up of 70 patients, including 30 males and 40 females; the mean age was (59.2±11.5) years old; the mean duration of disease was (6.76±4.14) months; the observed patients were treated with acupotomy-injection technique with targeted three-point. There were also 70 patients in the control group, made up of 29 males and 41 females; the mean age was (58.9±11.8) years old; the mean duration of disease was (6.65±3.98) months; the control group was treated with the small needle knife therapy. Before treatment and one month after the treatment, the pain levels of both groups were assessed using the short-form McGill pain questionnaire, and the shoulder function was evaluated using the Constant-Murley Shoulder Outcome Scoring. The clinical efficacy of between groups was compared after treatment, and finally, the improvement rate of pain degree was used to evaluate the therapeutic effect of the patients. The PRI, VAS, PPI and total pain scores of frozen shoulder patients in both groups decreased significantly one month after the treatment compared with those before treatment (P<0.01). Compared with the control group, the observation group exhibited a more significant decrease in pain scores (P<0.01). Furthermore, the shoulder pain, muscle strength, ADL, ROM and total function scores of frozen shoulder patients in the two groups were significantly improved one month after the treatment compared with those before treatment(P<0.01). The inter-group comparison indicated that the pain, ADL, ROM and total function scores were improved obviously in the observation group when compared to those in the control group(P<0.01), but no remarkable difference was found between muscle strength score and the control group(P>0.05). In addition, the markedly effective rate of pain improvement was 70.0% and 45.7% in the observation group and the control group, respectively, meanwhile, the corresponding total effective rate was 97.1% and 84.3%, respectively. The application of acupotomy-injection technique with targeted three-point in the treatment of frozen shoulder shows definite efficacy, easy operation, little pain and high safety. Therefore, it is an ideal method for minimally invasive treatment.

Intensive Rehabilitation Therapy Following Brain Tumor Surgery: A Pilot Study of Effectiveness and Long-Term Satisfaction

ObjectiveTo evaluate the effectiveness of intensive rehabilitation to support recovery of neurological function after brain tumor surgery and assess long-term satisfaction.MethodsThis retrospective study included patients with neurological impairment after brain tumor surgery who underwent intensive rehabilitation therapy between December 2013 and May 2017. To assess effectiveness of rehabilitation, functional outcomes (motor, cognition, and activities of daily living [ADL]) were compared between brain tumor group and a control group enrolling stroke patients who received equivalent rehabilitation during the study period. Long-term satisfaction with rehabilitation was evaluated by surveying family caregivers.ResultsThis study included 21 patients with benign brain tumor, 14 with malignant brain tumor, and 108 with stroke. Significant and similar improvement in motor, cognition, and ADL function were noted in both the brain tumor group and the stroke group. Malignancy status did not influence the extent of functional improvement. According to medical records and surveys, 9 (69.2%) patients with malignant tumor and 2 (11.8%) with benign tumor had expired by the time of the survey. Most family caregivers confirmed that rehabilitation was effective for functional improvement (>60%), expressing overall satisfaction and stating they would recommend such therapy to patients with similar conditions (approximately 70%).ConclusionIntensive rehabilitation may help promote functional improvement following brain tumor surgery regardless of malignancy compared with stroke patients. Family caregivers expressed overall satisfaction with rehabilitation at long-term follow-up. These findings support the provision of intensive rehabilitation therapy for neurologic function recovery following brain tumor surgery.

Effects of a New Sensory Re-Education Training Tool on Hand Sensibility, Manual Dexterity and Functional Activities of Daily Living in People with Traumatic Brachial Plexus Injury (Pilot Study)

The protocols of sensory re-education programs have not changed in recent decades even with the advancement in Neuroscience and cognitive science. Based on the current knowledge and developments in neuro physiology to enhance cortical mapping, this study describe and evaluate the effects of a modified clinical-based sensory re-education training tool not only on hand sensibility and manual dexterity but also functional ADL as well. The study was conducted on ten participants (N=10) with Traumatic brachial Plexus injury (TBPI) with upper extremity sensory deficits participate in the study. Participants were divided equally into control group (n=5) and experimental group (n=5). The experimental group were assigned to 8-week of 12-session intervention phase of sensory re-education program. Measurements used were the Semmes Weinstein monofilaments test, nine-hole peg test, turning fork test, Nottingham Extended activities of daily living and the Michigan Hand Outcome questionnaire. Measurements were collected at baseline, following the control phase and at the end of the intervention. Outcome of this study shows that, Compared to control group, experimental group demonstrated significant improvement in both Nottingham extended ADL scale and Michigan Hand Outcomes Questionnaire (MHQ) in functional Activities of Daily Living (fADL) with (p<0.05). However, No significant differences were observed as to the nine hole peg test and the monofilament tests. In conclusion, sensory re-education training not necessarily affects the level of sensory impairment in the hand but may lead to improvement in functional ADL measures.

Cold acclimation via the KQT-2 potassium channel is modulated by oxygen in Caenorhabditis elegans.

Adaptive responses to external temperatures are essential for survival in changing environments. We show here that environmental oxygen concentration affects cold acclimation in Caenorhabditis elegans and that this response is regulated by a KCNQ-type potassium channel, KQT-2. Depending on culture conditions, kqt-2 mutants showed supranormal cold acclimation, caused by abnormal thermosensation in ADL chemosensory neurons. ADL neurons are responsive to temperature via transient receptor potential channels-OSM-9, OCR-2, and OCR-1-with OCR-1 negatively regulating ADL function. Similarly, KQT-2 and KQT-3 regulate ADL activity, with KQT-2 positively regulating ADL function. Abnormal cold acclimation and acute temperature responses of ADL neurons in kqt-2 mutants were suppressed by an oxygen-receptor mutation in URX coelomic sensory neurons, which are electrically connected to ADL via RMG interneurons. Likewise, low oxygen suppressed supranormal kqt-2 cold acclimation. These data thus demonstrate a simple neuronal circuit integrating two different sensory modalities, temperature and oxygen, that determines cold acclimation.

Pre- and post-comprehensive geriatric assessment in older patients with hematological malignancy before allogeneic stem cell transplantation.

212 Background: Comprehensive geriatric assessment (CGA) is a multi-dimensional evaluation which influences medical decisions and predicts toxicity in older cancer patients. CGA pre-allogeneic stem cell transplant patients (ASCT) and repeated post-transplant provides information about treatment and helps to determine which parameters may predict ASCT outcomes. Methods: This was a prospective observational study evaluating 17 older patients with hematologic malignancy with CGA between December 9, 2016 and April 3, 2018 within the Levine Cancer Institute Senior Oncology Clinic. Included were validated measures across domains of cognition, disability, frailty, function and psychologic status. Repeat CGA was performed on surviving patients at least 99 days after ASCT (avg 122 days). Results: Median age was 66 (range 60-75) and the most common diagnosis was AML. There was no notable difference in pre and post-CGA physical and neurocognitive parameters for ASCT survivors (n=8). Within the deceased group (n=9) there was a longer TUG, lower patient-reported KPS, poorer psychological status, grip strength, and social support. Conclusions: There was no notable difference in the physical and neurocognitive CGA parameters before and after ASCT. Although the sample is small, there were notable trends toward lower patient-rated KPS compared to physician-rated KPS, poorer ADL function, slower TUG, and weaker grip strength in those patients who did not survive. CGA may identify older patients with hematologic malignancy who are at risk for worse outcomes post-ASCT.[Table: see text]