Level Of Ambulation Research Articles

Predictive discriminative accuracy of walking abilities at discharge for community ambulation levels at 6 months post-discharge among inpatients with subacute stroke.

[Purpose] This study aimed to compare the predictive accuracy of walking ability at discharge among subacute stroke inpatients at 6 months post-discharge in terms of community ambulation level and establish optimal cut-off values. [Participants and Methods] This prospective observational study included 78 patients who completed follow-up assessments. Patients were classified into three groups based on the Modified Functional Walking Category (household/most limited community walkers, least limited community walkers, and unlimited community walkers) obtained by telephone survey at 6 months post-discharge. Predictive accuracy and cut-off values for discriminating among groups were calculated from 6-minute walking distance and comfortable walking speed measured at the time of discharge using receiver operating characteristic curves. [Results] Between household/most limited and least limited community walkers, 6-minute walking distance and comfortable walking speed offered similar predictive accuracy (area under the curve, 0.6-0.7), with cut-off values of 195 m and 0.56 m/s, respectively. Between least limited and unlimited community walkers, the areas under the curve were 0.896 for 6-minute walking distance and 0.844 for comfortable walking speed, with cut-off values of 299 m and 0.94 m/s, respectively. [Conclusion] Walking endurance and walking speed among inpatients with subacute stroke provided superior predictive accuracy for unlimited community walkers at 6 months post-discharge.

AMPREDICT PROsthetics—Predicting Prosthesis Mobility to Aid in Prosthetic Prescription and Rehabilitation Planning

ObjectiveTo develop and validate a patient-specific multivariable prediction model that uses variables readily available in the electronic medical record to predict 12-month mobility at the time of initial post-amputation prosthetic prescription. The prediction model is designed for patients who have undergone their initial transtibial (TT) or transfemoral (TF) amputation because of complications of diabetes and/or peripheral artery disease. DesignMulti-methodology cohort study that identified patients retrospectively through a large Veteran's Affairs (VA) dataset then prospectively collected their patient-reported mobility. SettingThe VA Corporate Data Warehouse, the National Prosthetics Patient Database, participant mailings, and phone calls. ParticipantsThree-hundred fifty-seven veterans who underwent an incident dysvascular TT or TF amputation and received a qualifying lower limb prosthesis between March 1, 2018, and November 30, 2020 (N=357). InterventionsNot applicable. Main Outcome MeasureThe Amputee Single Item Mobility Measure (AMPSIMM) was divided into a 4-category outcome to predict wheelchair mobility (0-2), and household (3), basic community (4), or advanced community ambulation (5-6). ResultsMultinomial logistic lasso regression, a machine learning methodology designed to select variables that most contribute to prediction while controlling for overfitting, led to a final model including 23 predictors of the 4-category AMPSIMM outcome that effectively discriminates household ambulation from basic community ambulation and from advanced community ambulation—levels of key clinical importance when estimating future prosthetic demands. The overall model performance was modest as it did not discriminate wheelchair from household mobility as effectively. ConclusionsThe AMPREDICT PROsthetics model can assist providers in estimating individual patients’ future mobility at the time of prosthetic prescription, thereby aiding in the formulation of appropriate mobility goals, as well as facilitating the prescription of a prosthetic device that is most appropriate for anticipated functional goals.

Weight Status of Children Participating in the National Spina Bifida Patient Registry.

Describe the distribution of weight status categories and determine factors associated with overweight and obesity (OW/OB) in children and adolescents with spina bifida (SB) using the National Spina Bifida Patient Registry. Demographic, anthropometric, and clinical data collected from 2009 through 2018 was used to describe the prevalence of OW/OB. The generalized estimating equation model (GEE) identified factors associated with OW/OB among individuals with SB. Participants (n = 7215) were aged 2 to 19 years (mean = 11.1; standard error, 0.06) and 51.4% female. The majority were non-Hispanic white (57.2%) followed by Hispanic or Latino (25.1%) and non-Hispanic Black (7.5%). The myelomeningocele (MMC) subgroup accounted for 76.3%. Most (60.2%) were community ambulators. The overall percentage of OW/OB was 45.2%, with 49.2% of MMC and 32.0% of nonmyelomeningocele OW/OB. Following the Centers for Disease Control Obesity Severity Classification System, 19.7% of MMC were in class 1, 6.6% in class 2, and 3.5% in class 3. Univariate analysis of MMC participants demonstrated demographic (age, sex, race/ethnicity, and clinic region) and clinical variables (functional level of lesion, ambulation, and number of shunt surgeries) were associated with OW/OB. The GEE model showed that OW/OB was independently, and significantly, associated with age, sex, race/ethnicity, lesion levels, and geographic location of the clinics. The demographic and clinical factors associated with OW/OB in children and adolescents with SB further our understanding of factors contributing to the higher prevalence of OW/OB in this population and may inform OW/OB prevention and treatment strategies.

White Plaques on the Tongue of a Patient with Advanced CKD.

<h3>Introduction</h3> Falls among people with multiple sclerosis (PwMS) are common and associated with injuries, fear of falling and low health-related quality of life. Considerations of behavioural, environmental, psychological and physical influences (including ambulation status) are needed to meet fall prevention needs for PwMS. Thus, using a codesign process involving key stakeholders a novel online self-management fall prevention intervention was created specifically for ambulatory and non-ambulatory PwMS. The feasibility, acceptability, fidelity and outcome of this complex intervention will be explored. Findings will inform a future full-scale randomised controlled trial. <h3>Methods and analysis</h3> A mixed-method design will be used. Forty-eight PwMS, stratified for ambulation level, will be randomised to control (n=24) or intervention (n=24). Both groups will receive a brochure about fall risk factors and fall prevention. The intervention is group-based (eight PwMS in each group); will be delivered online; and involve six, 2-hour weekly sessions and a booster session 8 weeks after the sixth session. Each intervention group will be led by a trained facilitator. Data collection will be performed at baseline, and after seven and 18 weeks. Outcome measures will capture data on fall prevention behaviours, fear of falling, falls self-efficacy, social and everyday activities, perceived impact of MS and number of falls. Feasibility of recruitment process, data collection procedures, outcome measures, and delivery, and intervention acceptability, fidelity and outcomes will be evaluated. Both quantitative and qualitative methods will be used. <h3>Ethics and dissemination</h3> Ethical approval has been obtained from the Swedish Ethical Review Authority (registration number 2021-04817). Results will be disseminated in peer-review journals, at conferences, research meetings, in social media and through the patient organisation Neuro Sweden. <h3>Trial registration number</h3> NCT04317716.

Active and Passive Immunization with an Anti-Methamphetamine Vaccine Attenuates the Behavioral and Cardiovascular Effects of Methamphetamine.

Background: Methamphetamine use disorder (MUD) is a growing health concern with no FDA-approved treatment. The present series of studies build upon our previous work developing an anti-methamphetamine (MA) vaccine for MUD. We determined the effects of a formulation that included tetanus-toxoid (TT) conjugated to succinyl-methamphetamine (TT-SMA) adsorbed onto aluminum hydroxide (alum) in combination with the novel Toll-Like Receptor-5 agonist, entolimod. Methods: Mice were vaccinated (0, 3, 6 weeks) with TT-SMA+alum and various doses of entolimod to determine an optimal dose for enhancing immunogenicity against MA. Functional effects were then assessed using MA-induced locomotor activation in mice. Experiments using passive immunization of antibodies generated by the vaccine tested its ability to attenuate MA-induced cardiovascular effects and alter the reinforcing effects of MA in an MA-induced reinstatement of a drug seeking model of relapse in male and female rats. Results: Antibody levels peaked at 10 weeks following vaccination with TT-SMA+alum combined with entolimod (1, 3 and 10 µg). MA-induced locomotor activation was significantly attenuated in vaccinated vs. unvaccinated mice and antibody levels significantly correlated with ambulation levels. Passive immunization decreased mean arterial pressure following MA dosing in rats of both sexes but did not alter heart rate. Passive immunization also attenuated the ability of MA to reinstate extinguished drug-seeking behavior in male and female rats. Results support further development of this vaccine for relapse prevention for individuals with MUD.

Outcomes of Partial Calcanectomy in an Academic Limb Salvage Center: A Multicenter Review

Chronic nonhealing heel ulcerations have been established as an independent risk factor for major amputation, with poor rates of limb salvage success. Partial calcanectomy is a controversial limb salvage procedure reserved for patients with these heel ulcerations. We conducted a retrospective cohort study reviewing 39 limbs that underwent a partial calcanectomy from 2012 to 2018 to evaluate the proportion of patients healed, time to healing, ulcer recurrence, and postoperative functional level compared to the preoperative state. In addition, age, gender, body mass index, smoking status, coronary artery disease, diabetes mellitus, renal insufficiency, dialysis, peripheral arterial disease, method of closure, and percent of calcaneus resected were evaluated. Mean follow-up for our cohort was 2.3 years. We had a 1 year mortality rate of 11%, and a major amputation rate of 18%. Our results demonstrated a 77% healing rate with a median time to healing of 162 days. We found that patients who were closed primarily had a faster time to healing compared to patients who underwent closure by secondary intention. Our data showed that ulcer recurrence developed in 57% of healed limbs. We found that 76% of our patients were ambulatory postoperatively. These results suggest that partial calcanectomy is a viable limb salvage procedure with a predictable level of ambulation and function in a high-risk patient population.

An investigation of the psychometric properties of the Turkish adaptation of the activity limitations in cerebral palsy questionnaire

Purpose To translate the ACTIVLIM-CP questionnaire, developed to assess global activity performance in children with Cerebral Palsy (CP), into Turkish and to investigate its psychometric properties. Methods Eighty-nine children with CP, aged between 2 and 18 years (mean age: 10.08 ± 4.94 years), were included in the study. Internal consistency was measured by Cronbach’s alpha and test-retest reliability was assessed using intraclass correlation coefficient (ICC). Convergent validity was evaluated through the pattern of correlations between the ACTIVLIM-CP with PEDI, ABILOCO-Kids, ABILHAND-Kids, and Wee-FIM scores. Known-group comparisons were made according to epilepsy existence and ambulation level measured by Gross Motor Function Classification System (GMFCS). Results Internal consistency was excellent (Cronbach's α = 0.990), and the ICC for the test-retest reliability was 0.990. There was a very strong correlation between ACTIVLIM-CP and ABILHAND-Kids (r = 0.946), WeeFIM (r = 0.900), PEDI Functional Skills and Caregiver Assistance scores (r = 0.954, r = 0.937, respectively), and ABILOCO-Kids (r = 0.817) (p < 0.001) score. ACTIVLIM-CP score was lower in children with epilepsy (p = 0.001) and in the high-level group according to GMFCS (p < 0.001). Conclusion The Turkish adaptation of ACTIVLIM-CP is a valid and reliable scale for measuring activity limitations in children with CP and is compatible with other scales evaluating activity limitations. Clinical Trial Number NCT05184244 IMPLICATIONS FOR REHABILITATION Activity limitation measurements are crucial and necessary to determine the global activity performance of children with CP. ACTIVLIM-CP was translated and culturally adapted to Turkish and showed good psychometric properties. ACTIVLIM-CP is a valid and reliable tool to evaluate activity performance in children with CP.

Online self-management fall prevention intervention for people with multiple sclerosis: a feasibility study protocol of a parallel group randomised trial

IntroductionFalls among people with multiple sclerosis (PwMS) are common and associated with injuries, fear of falling and low health-related quality of life. Considerations of behavioural, environmental, psychological and physical influences...

Factors associated with the health-related quality of life among people with Duchenne muscular dystrophy: a study using the Health Utilities Index (HUI)

BackgroundData on health state utility in Duchenne muscular dystrophy (DMD) are few. This study estimated mean utility values by age, ambulatory status and over time, and investigated which aspects of health-related quality-of-life (HRQoL) are most strongly associated with utility in DMD.MethodsData from placebo-treated ambulant boys with DMD with exon 51 skip amenable mutations, (NCT01254019), were included. Ambulatory function assessments were conducted at baseline and every 12 weeks for the trial duration. Family member proxies completed the Health Utility Index (HUI) at baseline, 24 and 48 weeks; and HUI3 and HUI2 utility values were summarized. Changes in HUI attribute level over time, and predictors of changes in utility, were explored.ResultsSixty-one boys (mean [range] age of 8.0 [5–16] years) were included in the analysis. Mean baseline utilities were 0.82 (HUI3) and 0.87 (HUI2); and utilities were 0.35 (HUI3) and 0.55 (HUI2) after loss of ambulation (LOA, where applicable). Over the follow-up period mean utility declined more among the older versus younger boys. Pain accounted for the highest proportion of variability (42%) in change in HUI3 utility from baseline to week 48, while for HUI2, self-care (39%) did. After LOA, change in ambulation levels explained 88% of the decline in mean HUI3 utility and change in mobility levels explained 66% of the decline in mean HUI2 utility.ConclusionsUtility values among this sample were higher than previously published estimates. In younger boys utility remained relatively stable, but older boys and those losing ambulation experienced important declines over follow-up.

Factors Associated With Walking Adaptability and Its Relationship With Falling in Polio Survivors

ObjectiveTo explore factors associated with walking adaptability and associations between walking adaptability and falling in polio survivors. DesignCross-sectional study. SettingOutpatient expert polio clinic. ParticipantsPolio survivors (N=46) who fell in the previous year and/or reported fear of falling. InterventionsNot applicable. Main Outcome MeasuresWalking adaptability was assessed on an interactive treadmill and operationalized as variable target-stepping and reactive obstacle avoidance performance. Further, we collected walking speed and assessed leg muscle strength, balance performance (Berg Balance Scale and Timed-Up-and-Go Test), balance confidence (Activities-specific Balance Confidence scale), ambulation level, orthosis use, fear of falling, and number of falls in the previous year. ResultsWith walking speed included as a covariate, muscle weakness of the most affected leg and balance confidence explained 54% of the variance in variable target-stepping performance. For reactive obstacle avoidance performance, muscle weakness of the most affected leg and knee extensor strength of the least affected leg explained 32% of the variance. Only target-stepping performance was significantly related to the number of falls reported in the previous year (R2=0.277, P<.001) and mediated the relation between leg muscle weakness and balance confidence with falling. ConclusionOur exploratory study suggests that leg muscle weakness and reduced balance confidence limit walking adaptability in polio survivors. Because poorer target stepping rather than obstacle avoidance performance was associated with falling, our results indicate that a limited ability to ensure safe foot placement may be a fall risk factor in this group. These findings should be confirmed in a larger sample.

A functional approach towards the design, development, and test of an affordable dynamic prosthetic foot.

Humanitarian actors involved in physical rehabilitation, such as the International Committee of the Red Cross (ICRC), usually provide their beneficiaries with lower-limb prostheses comprising Solid Ankle Cushion Heel (SACH) feet as these are considered appropriate (price, durability, low profile to fit a majority of patients, appearance) and reliable for all ambulation levels. However, individuals in low-resource settings having higher ambulation abilities would greatly benefit from dynamic prosthetic feet with improved biomechanics and energy storage and release. Some attempts tried to address this increasing need (e.g. Niagara Foot) but most products proposed by large manufacturers often remain unaffordable and unsuitable to the context of low-resource settings. The design requirements and a price target were defined in partnership with the ICRC according to their initial assessment and used as a starting point for the development process and related technological choices. Numerical simulation and modeling were used to work on the design and to determine the required materials properties (mechanical, chemical, wear), and a cost modeling tool was used to select suitable materials and relevant processing routes (price vs. performance). A prosthetic foot comprising an internal keel made of composite materials, a filling foam, and a cosmetic shell with a foot shape was developed. Manufacturing processes meeting the cost criteria were identified and prototype feet were produced accordingly. These were successfully tested using a compression testing system before gait analyses were performed in the laboratory with non-amputees wearing testing boots. After validation in laboratory conditions, the prototype foot was tested in the field (Vietnam) with 11 trans-tibial unilateral amputees, who showed an increased mobility compared with the SACH foot. The collaboration of different research fields led to the development of a prosthetic foot which met the technical requirements determined by the ICRC's specific needs in its field of operation. The materials and selected production processes led to a manufacturing cost of less than 100 USD per part.

The impact of frailty and its associations among a sample of community-dwelling older adults

Frailty, sarcopenia and fragility fractures are powerful correlated and all of them are predictors of clinical adverse outcomes. Elderly individuals with have a fragility fracture should be assessed for frailty and sarcopenia to better develop a care plan. For these reason interventions are necessary to determinate and treat frailty. The present study investigates the prevalence of frailty and associated factors among the older adults who were assessed within the scope of a geriatric study in the Fatih District of the Istanbul Province. The study included community-dwelling older adults aged 61-101 years who were living in the Fatih District of the Istanbul Province between November 2014 and May 2015. The number of drugs regularly used by the participants and the number of diseases were recorded. It was evaluated whether the participants experienced falling / risk of falling / fear of falling in the last 1 year. Visual analog scale (VAS) was used in the assessment of chronic pain. The other instruments used for assessment included the FRAIL scale for frailty screening; the 6-item KATZ Activities of Daily Living (ADL) scale; the 8-item LAWTON-BRODY Instrumental Activities of Daily Living Scale (IADL) for the measurement of functional capacity; the European Quality 5 Dimensions (EQ-5D) questionnaire for the assessment of quality of life; the Mini-Cog test for cognitive screening; the Geriatric Depression Scale-Short Form (GDS-SF) for depression screening; the Mini Malnutrition Assessment-Short Form (MNA-SF) for malnutrition screening; and the Romberg test and postural instability test for walking. Hand grip strength (HGS) was measured using a Jamar hydraulic hand dynamometer and the thresholds for hand grip strength were evaluated < 27 kg < 16 kg in men and women, respectively, based on the European Working Group on Sarcopenia in Older People (EWGSOP2) definition. Muscle mass was measured through a bioimpedance analysis (TANITA-BC532). Low muscle mass (young adult mean-2SD) and the thresholds for muscle mass were evaluated as < 9.2 kg/m2 vs 7.4 kg/m2 in men and women, respectively, based on national data. Sarcopenia was defined as a reduction in muscle mass and muscle function [usual gait speed (UGS) or muscle strength] based on the European Working Group on Sarcopenia in Older People (EWGSOP2) definition. The study included 204 older adults (94 men and 110 women), with a mean age of 75.4±7.3 years. Of the cases, 30.4% were robust, 42.6% were pre-frail and 27% were frail. Significant differences were recorded in number of diseases (p=0.006), frail score (p=0.002), malnutrition (p=0.004) and the results of a clock-drawing test (CDT)(p=0.040), number of drugs, chronic pain(p=0.001), as well as in the fear of falling, IADL, GDS-SF, -EQ-5D scores, BIA fat, BIA muscle and hand grip strength (p< 0.001) between the groups. The frailty groups differed significantly in terms of the presence of malnutrition, fear of falling, urinary incontinence (UI), chronic pain, Romberg sign, postural instability, level of ambulation, presence of depression, dementia, falls within the last one year (p< 0.001) and gender (p=0.004). A regression analysis evaluating independent frailty-associated factors [dependent variable: frailty (robust vs. prefrail +frail)], revealed an association with the number of drugs (OR=1.24, p=0.036), cognitive disorder (OR=0.30, p=0.016) and EQ-5D (OR=1.53, p=0.017). The present study established the prevalence of frailty in the Fatih district community, in which the most prominent associated factors were cognitive dysfunction, low quality of life, and multiple drug usage. Nationwide population studies involving multiple centers are required.

Does the Use of an Intra-Articular Local Anesthetic Injection During Total Hip Arthroplasty Reduce Patient Reported Pain Scores or Patient Opioid Consumption?

During primary total hip arthroplasty (THA), some surgeons use an intra-articular injection (IAI) containing 200 mg ropivacaine to target postoperative pain. There is no clear consensus on the efficacy of an IAI alone. The purpose of this study is to evaluate the effect of a 200 mg ropivacaine IAI on pain scores, opioid consumption, and mobility for primary THA patients. We retrospectively reviewed 571 patients who underwent primary THA at a single institution. Patients were grouped according to those who received a 200 mg ropivacaine IAI and those who did not. Primary outcome measures for this study included pain scores, morphine milligram equivalents (MMEs) dosed, distance of ambulation achieved, and time to ambulation. The intervention group reported higher average pain scores with activity than the control group (P= .024). The intervention group also required higher MMEs. When striated by hour, a statistically significant uptick in pain started at 16hours (P= .0009) and persisted to 28hours (P= .032) in patients receiving a 200 mg ropivacaine IAI. This correlated with an increase in MMEs seen at hour 24 through 32 (P= .003 to P= .012). Level of ambulation, time to ambulation, and distance ambulated did not differ between groups. An IAI of 200 mg ropivacaine also appeared to lead to higher pain scores and higher opioid doses in males. The IAI does not appear to reduce postoperative pain scores or MMEs dosed for THA patients. More research is needed to look at the utilization and efficacy of intra-articular ropivacaine, especially focusing on functional outcomes and gender differences.

REHABILITATION RESULTS OF PATIENTS WITH COVID-19 RELATED STROKE

The aim of the study is to examine the patients with COVID-19 associated stroke who were admitted to the inpatient rehabilitation program in terms of clinical features, ambulation level and functional status, and to reveal the improvements achieved as a result of rehabilitation. 29 COVID-19-related stroke patients (group 1) and 29 non-COVID-19 stroke patients (group 2) were included in this study. The groups were compared in terms of demographic and clinical characteristics, risk factors, post-stroke disorders and complications of stroke. Motor function was evaluated with the Brunnstrom Motor Recovery Staging (BMRS), ambulation status was evaluated with the Functional Ambulation Scale (FAS), and functional disability was evaluated with the Functional Independence Scale (FIM). Both groups of patients were compared in terms of pretreatment and posttreatment values of BMRS, FIM and FAS stages. In addition, the changes in BMRS, FIM and FAS values within the group were evaluated. Pulmonary involvement (mild/moderate-severe) and the use of anticoagulants after COVID-19 infection were investigated in patients with COVID 19 stroke. In patients with COVID-19-associated stroke, the mean age was statistically significantly lower (p=0.045), the risk factor hypertension was significantly less (p=0.016), pre-stroke anticoagulant use was significantly higher (p=0.004), and deep vein thrombosis was significantly higher (p=0.022). All patients with COVID-19 had pulmonary involvement. No statistically significant difference was observed between the two groups in the comparison of post-stroke disorders. There was no statistically significant difference between the two groups in terms of BMRS, FIM and FAS values before and after treatment (p&gt;0.05). The change in BMRS, FIM and FAS values within both groups was found statistically significant. According to the results of this study, COVID-19-related stroke is seen at younger ages and deep vein thrombosis is more common. Significant improvements are observed in motor and functional status after rehabilitation. Rehabilitation should be given importance in patients with COVID-19-related stroke, and care should be taken in terms of deep vein thrombosis during rehabilitation.

Structural FEA-Based Design and Functionality Verification Methodology of Energy-Storing-and-Releasing Prosthetic Feet

The prosthetic feet that are most often prescribed to individuals with K3/K4 levels of ambulation are the ESR feet. ESR stands for energy-storing and -releasing. The elastic energy is stored by the elastic elements in composite materials (carbon fiber or glass fiber). ESR feet must be developed and optimized in terms of stiffness, taking into account the loads that a healthy human foot undergoes and its kinematics while walking. So far, state-of-the-art analyses show that the literature approaches for prosthetic foot design are not based on a systematic methodology. With the aim of optimizing the stiffness of ESR feet following a methodological procedure, a methodology based on finite element structural analysis, standard static testing (ISO 10328) and functional verification was optimized and it is presented in this paper. During the path of optimization of the foot prototypes, this methodology was validated experimentally. It includes the following: (i) geometry optimization through two-dimensional finite element analysis; (ii) material properties optimization through three-dimensional finite element analysis; (iii) validation test on physical prototypes; (iv) functionality verification through dynamic finite element analysis. The design and functional verification of MyFlex-γ, a three-blade ESR foot prosthesis, is presented to describe the methodology and demonstrate its usability.

Early identification of patients at risk for delayed recovery of ambulation after elective abdominal surgery.

Recovery of preoperative ambulation levels 1 month after surgery represents an important patient-centered outcome. The objective of this study is to identify clinical factors associated with the inability to regain baseline preoperative ambulation levels 28 days postoperatively. This is a prospective cohort study enrolling patients scheduled for elective inpatient abdominal operations. Daily ambulation (steps/day) was measured with a wristband accelerometer. Preoperative steps were recorded for at least 3 full calendar days before surgery. Postoperatively, daily steps were recorded for at least 28 days. The primary outcome was delayed recovery of ambulation, defined as inability to achieve 50% of preoperative baseline steps at 28 days postoperatively. A total of 108 patients were included. Delayed recovery (< 50% of baseline preoperative steps/day) occurred in 32 (30%) patients. Clinical factors associated with delayed recovery after multivariable logistic regression included longer operative time (OR 1.37, 95% CI 1.05-1.79), open operative approach (OR 4.87, 95% CI 1.64-14.48) and percent recovery on POD3 (OR 0.73, 95% CI 0.56-0.96). In addition, patients with delayed ambulation recovery had increased rates of postoperative complications (16% vs 1%, p < 0.01) and readmission (28% vs 5%, p < 0.01). After elective inpatient abdominal operations, nearly one in three patients do not recover 50% of their baseline preoperative steps 28 days postoperatively. Factors that can be used to identify these patients include longer operations, open operations and low ambulation levels on postoperative day #3. These data can be used to target rehabilitation efforts aimed at patients at greatest risk for poor ambulatory recovery.

Evaluating Completeness of Discrete Data on Physical Functioning for Children With Cerebral Palsy in a Pediatric Rehabilitation Learning Health System.

The purpose of this study was to determine the extent that physical function discrete data elements (DDE) documented in electronic health records (EHR) are complete within pediatric rehabilitation settings. A descriptive analysis on completeness of EHR-based DDEs detailing physical functioning for children with cerebral palsy was conducted. Data from an existing pediatric rehabilitation research learning health system data network, consisting of EHR data from 20 care sites in a pediatric specialty health care system, were leveraged. Completeness was calculated for unique data elements, unique outpatient visits, and unique outpatient records. Completeness of physical function DDEs was low across 5766 outpatient records (10.5%, approximately 2 DDEs documented). The DDE for Gross Motor Function Classification System level was available for 21% (n = 3746) outpatient visits and 38% of patient records. Ambulation level was the most frequently documented DDE. Intercept only mixed effects models demonstrated that 21.4% and 45% of the variance in completeness for DDEs and the Gross Motor Function Classification System, respectively, across unique patient records could be attributed to factors at the individual care site level. Values of physical function DDEs are missing in designated fields of the EHR infrastructure for pediatric rehabilitation providers. Although completeness appears limited for these DDEs, our observations indicate that data are not missing at random and may be influenced by system-level standards in clinical documentation practices between providers and factors specific to individual care sites. The extent of missing data has significant implications for pediatric rehabilitation quality measurement. More research is needed to understand why discrete data are missing in EHRs and to further elucidate the professional and system-level factors that influence completeness and missingness. Completeness of DDEs reported in this study is limited and presents a significant opportunity to improve documentation and standards to optimize EHR data for learning health system research and quality measurement in pediatric rehabilitation settings.

Neurological behaviour of albino rats treated separately and in combination with Cannabis sativa L. and Cannabis indica L.

There has been an increasing rate of cannabis consumption globally, especially among the youths. This study therefore evaluated the neurological behaviours and some brain marker hormones and enzymes of cannabis administered rats. Twenty six albino rats were divided into four groups based on oral cannabis administration (control, Cannabis sativa, Cannabis indica and the combination of the two). At the end of seven days, open field test was conducted on the rats. Also, brain neuro-chemicals, activities of antioxidant enzymes and lipid peroxidation were evaluated using spectrophotometry. The results of the Open-Field Test showed an appreciable increase in the level of ambulation (line crossing), grooming, urination and stretched attend posture in the rats administered with Cannabis indica, Cannabis sativa and the combination when compared with the control. Norepinephrine was significantly lower (p &lt; 0.05) in the rat groups administered with the combination of Cannabis indica and Cannabis sativa. The control group however had the lowest dopamine level. Superoxide dismutase (SOD) was significantly lower (p &lt; 0.05) in the rats administered the combination of both Cannabis indica and Cannabis sativa. The brain level of reduced glutathione (GSH) was significantly higher in the rats administered with Cannabis indica. Malondialdehyde (MDA) was significantly higher in the rats administered with Cannabis sativa than the other rat groups. Histopathological evaluation of the brain also revealed various damages in the brain cells of rats administered with cannabis compared to the normal brain structure of the control rats. It is thus said that consumption of C. sativa or C. indica alone produced mild effect on the brain cells and physiology in rats. However, combination of C. sativa and C. indica produced a severe synergistic effect on the neurological function of the exposed rat.

Selective Dorsal Rhizotomy for Treatment of Hereditary Spastic Paraplegia-Associated Spasticity in 37 Patients.

BackgroundA limited number of publications have described a reduction of spasticity associated with hereditary spastic paraplegia (HSP) after selective dorsal rhizotomy (SDR). Typically, the SDR procedure is performed on patients with spastic cerebral palsy to remove spasticity and to help these patients with ambulatory function. Whether SDR has similar effects on HSP patients, requires further investigation. Thus, we are providing a personal experience of the effects of SDR on this specific cohort of patients.ObjectivesTo examine the safety of SDR, changes in spasticity, and ambulatory function after SDR on patients with HSP.MethodsThe Institutional Review Board of Washington University School of Medicine approved this study (#201704003). A total of 37 children and adults received SDR for the treatment of HSP-associated spasticity between 1988 and 2021. SDR was performed through an L1 laminectomy, as we previously described in an earlier publication. The patients took part in the follow-up examination either in-person or by email. The follow-up focused on the patients’ motor functions (primarily ambulation), adverse effects of SDR, and orthopedic treatments after SDR.ResultsOf the total 37 patients who participated in this study, 46% were female and 54% were male. The age range of when HSP was diagnosed was one month to 34 years. Six of the patients’ diagnoses were made, based on the family history of HSP in six patients and the remaining 31 patients’ diagnoses were confirmed by genetic tests. The most common genetic mutations were SPG4 and SPG3A. Of the patients with positive genetic tests, 40% had no family history of HSP. SDR was performed at the age of 2 to 45 years (mean: 14.7 years). The follow-up period ranged from 0 to 33 years (mean: 3.8 years). One patient developed a spinal fluid leak requiring surgical repair. Two patients reported mild numbness in parts of the lower limbs. Spasticity was removed in 33 patients (89%). Four patients (11%) experienced a return in spasticity. Regarding ambulatory function, 11% of patients reported a decline in function. Two patients walked independently before surgery but declined, requiring a wheelchair eight years and seven years, respectively, after surgery for each patient. In contrast, 16% saw an improvement in ambulatory function, improving from walking with a walker to walking independently. The remaining 73% of patients maintained their level of ambulation. These two groups of patients showed improvement in other motor functions and independence. ConclusionsThe present analysis suggests the potential role of SDR in the management of spasticity in HSP patients. We found no sign of SDR being a direct cause of deleterious effects on patients with HSP.

Prognostic value of balance performance for improvements of community ambulation among stroke patients: a cohort study.

Despite the positive impact of improving the level of community ambulation among stroke patients, little prognostic research has focused on this indicator. To investigate the prognostic value of the side-by-side, semi-tandem, and tandem standing balance positions and the five-sit-stand (5STS) test for discriminating patients undergoing physical rehabilitation who improve level of functional ambulation and predicting transition time. A cohort study with assessments repeated monthly until discharge for classifying patients in a community ambulation class. A neurological rehabilitation unit of a hospital in Spain. A consecutive sample of 109 stroke patients (68.5±12.0 years) was screened and included within four months post stroke. Of them no one refused, 3 died, and 5 were lost earlier to transition or discharge. Balance tests, the 5STS and gait speed were measured at the center at baseline and monthly until discharge. Transition from household or limited community ambulation to a higher ambulatory capacity or class. Area under the curve (AUC) were used to compare discriminative abilities of the tests and Cox regression analysis to evaluate the association between the tests and time of transition. For household non-ambulators, the semi-tandem was the best discriminative test (AUC=0.850) and the three balance tests showed an association with time to transition. Among the limited community ambulators, the 5STS test also revealed discriminative ability (AUC: 0.822 [0.63-1.00]), with a good prognostic cut-off (14.8 seconds) and association with time to transition (Hazard Ratio: 1.22; 95%CI: 1.05-1.43). Semi-tandem and the 5STS tests can discriminate patients who improve level of functional ambulation and predict transition times within three months in non-ambulators and limited community ambulation patients, respectively. The semi-tandem and the 5STS tests can be performed easily in clinical settings to predict improvement of functional ambulation level in patients following stroke.