Early Stages Of Rehabilitation Research Articles

The impact of rehabilitation on the recovery of executive functions in stroke patients with different location of the ischemic focus.

Cognitive dysfunction is part of the clinical picture of stroke. Most of the executive dysfunctions are diagnosed in the early stage of rehabilitation, a few weeks after the vascular incident. Coexistence of executive dysfunctions with other disorders in stroke patients may hinder patient's functions, slow down the rehabilitation process, and disrupt self-awareness, interpersonal communication, and professional activity in everyday life. Ninety patients after ischemic stroke were examined (right hemisphere stroke: N = 33, left hemisphere stroke: N = 57). The study group (N = 45) consisted of patients rehabilitated in the Department of Rehabilitation and Physical Medicine of the University Teaching Hospital of the Military Medical Academy in Lodz, Łódź, Poland, in whom a comprehensive neurorehabilitation program was implemented, consisting of motor and neuropsychological rehabilitation. The control group (N = 45) consisted of patients awaiting admission to the department, who were covered by comprehensive environmental rehabilitation including exercise therapy and neuropsychological therapy. Executive function was measured with 3 popular diagnostic tools: the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT part A, TMT part B), and the letter test and category test with the Verbal Fluency Test (VFT). The tests were carried out twice: the first time before the start of rehabilitation and 5 weeks later after its completion. Although patients with right-hemispheric stroke showed better improvement in executive functions, stroke location did not prove to have significant impact on how effective the rehabilitation was. Right hemisphere stroke patients showed greater improvement in restoring executive functions after rehabilitation compared to left hemisphere stroke patients. The location of the stroke did not significantly correlate with the efficiency of the rehabilitation setting. Int J Occup Med Environ Health. 2024;37(4).

Changes in Y-Balance Test Scores During Months 4, 5, and 6 of ACL Reconstruction Rehabilitation.

The anterior cruciate ligament (ACL) is well researched since injuries typically result in lengthy recoveries and rehabilitation periods until athletes can return to full activity. Although a large body of literature on the early and late stages of rehabilitation following ACL reconstructive (ACLR) surgery exists, less is known regarding the mid-phase of ACL rehabilitation and healthy versus injured limb differences in functional testing during this stage. The purpose of this study is to determine if Y-Balance Test (YBT) scores obtained during the mid-phase of ACLR rehabilitation change over months 4, 5, and 6. Case Series. Research laboratory. Patients or Other Participants: A total of 27 participants (17 females; 18.96±3.02 years (range 15-24); 173.63±10.29cm; 72.55±17.83kg) who sustained a unilateral ACL injury, experienced no episodes of instability or knee giving away, had not suffered a previous ACL injury, and expressed a desire to return to sport at the end of rehabilitation came in once a month following ACLR to participate in a battery of tests. YBT scores in the anterior, posterolateral (PL), and posteromedial (PM) directions in the healthy and reconstructed limbs. A main effect for limb was observed for the anterior (Healthy: m4: 78.8cm±5.8, m5: 79.5cm±5.2, m6: 79.4±5.8; Reconstructed: m4: 77.2±5.9, m5: 78.5±5.1, m6: 78.1±6.4, p=0.023) and PM (Healthy: m4: 80.0cm±8.7, m5: 81.0cm±9.1, m6: 82.9cm±8.9; Reconstructed: m4: 79.3cm±6.8, m5: 79.4cm±8.2, m6: 81.1cm±8.5, p=0.013). directions indicating that the reconstructed limb performed worse than the healthy limb. A main effect for time was observed for the PL direction (Healthy: m4: 78.8cm±5.8, m5: 79.5cm±5.2, m6: 79.4cm±5.8; Reconstructed: m4: 77.2cm±5.9, m5:78.5cm±5.1, m6: 78.1cm±6.4, p=0.023). The YBT measured improvement in the PL direction across time in the reconstructed limb. In the PM and anterior directions, the YBT did not measure these same improvements across this period.

Use of the ECG-Controlled Six-Minute Walk Test to Assess Exercise Capacity: a Comparative Cohort Study

INTRODUCTION. In clinical practice, stress tests are carried out to draw up an individual patient rehabilitation plan, assess tolerance and optimize the load, and evaluate its clinical effectiveness. The Six-minute walk test (6MWT), in the presence of contraindications to the bicycle ergometer test or the impossibility of performing it, is a tool for assessing the response of the cardiovascular and respiratory systems to the load being performed. There is no description in the literature of the relationship between the distance traveled during 6MWT and the peak metabolic equivalent (MET) assessed during the bicycle ergometer test. AIM. Study the relationship between 6MWT indicators and the results of bicycle ergometer test in patients who have suffered a myocardial infarction. MATERIALS AND METHODS. During the examination, 56 patients underwent a symptom limited bicycle ergometer test and 6MWT, the peak MET and the distance traveled during 6MWT, as well as changes in the ECG during both tests were assessed. RESULTS AND DISCUSSION. The average values of maximum heart rate during the bicycle ergometer test and ECG-controlled 6MWT did not differ significantly. The distance in meters during 6MWT and the power of the exercise performed during bicycle ergometer test in MET have a significant relationship, which indicates the comparability of the data from these tests as a criterion of exercise tolerance. CONCLUSION. The use of 6MWT and bicycle ergometer test allows us to assess various aspects of cardiorespiratory function and physical fitness in patients undergoing a cardiac rehabilitation program. Further study of the possibility of using ECG-controlled 6MWT in the early stages of rehabilitation is necessary to create the most effective and safe physical training for patients who have suffered a myocardial infarction.

Exploring the effectiveness of eHealth interventions in treating Post Intensive Care Syndrome (PICS) outcomes: a systematic review

BackgroundIt remains unclear how to optimise critical care rehabilitation to reduce the constellation of long-term physical, psychological and cognitive impairments known as Post Intensive Care Syndrome (PICS). Possible reasons for poor recovery include access to care and delayed treatment. eHealth could potentially aid in increasing access and providing consistent care remotely. Our review aimed to evaluate the effectiveness of eHealth interventions on PICS outcomes.MethodsStudies reporting eHealth interventions targeting Post Intensive Care Syndrome outcomes, published in Medline, CINAHL, PsycINFO, Embase, and Scopus from 30th January 2010 to 12th February 2024, were included in the review. Study eligibility was assessed by two reviewers with any disagreements discussed between them or resolved by a third reviewer. Study quality and risk of bias were assessed using the Mixed Method Appraisal Tool. Further to the identification of effective strategies, our review also aimed to clarify the timeline of recovery considered and the outcomes or domains targeted by the interventions.ResultsThirteen studies were included in our review. Study duration, eHealth intervention delivery format, and outcome measures varied considerably. No studies reported a theory of behavioural change and only one study was co-produced with patients or carers. Most studies were conducted in the early post-discharge phase (i.e., < 3 months) and had feasibility as a primary outcome. The cognitive domain was the least targeted and no intervention targeted all three domains. Interventions targeting the psychological domain suggest generally positive effects. However, results were underpowered and preliminary. Though all studies were concluded to be feasible, most studies did not assess acceptability. In studies that did assess acceptability, the main facilitators of acceptability were usability and perceived usefulness, and the main barrier was sensitivity to mental health and cognitive issues.ConclusionOur systematic review highlighted the promising contributions of eHealth with preliminary support for the feasibility of interventions in the early stages of post-critical care rehabilitation. Future research should focus on demonstrating effectiveness, acceptability, the cognitive domain, and multi-component interventions.

Immediate Effects of Wearing an Ankle Bandage on Fine Coordination, Proprioception, Balance and Gait in the Subacute Phase of Ankle Sprains.

Ankle sprains are the most frequently occurring musculoskeletal injuries among recreational athletes. Ankle support through bandages following the initial orthotic treatment might be beneficial for rehabilitation purposes. However, the literature is sparse regarding the use of an ankle support directly after the acute phase of an ankle sprain. Therefore, this study investigates the hypothesis that wearing an ankle bandage immediately after an acute ankle sprain improves motor performance, stability and reduces pain. In total, 70 subjects with acute unilateral supination trauma were tested. Subjects were tested five weeks post-injury to assess immediate effects of the ankle bandage. On the testing day, subjects completed rating questionnaires and underwent comprehensive biomechanical assessments. Biomechanical investigations included fine coordination and proprioception tests, single leg stances, the Y-Balance test, and gait analysis. All biomechanical investigations were conducted for the subject's injured leg with and without a bandage (MalleoTrain® Bauerfeind AG, Zeulenroda-Triebes, Germany) and the healthy leg. Results indicated moderate to strong improvements in ankle stability and pain relief while wearing the bandage. Wearing the bandage significantly normalized single leg stance performance (p < 0.001), stance phase duration (p < 0.001), and vertical ground reaction forces during walking (p < 0.05). However, the bandage did not have a clear effect on fine coordination and proprioception. The findings of our study suggest that ankle bandages may play a crucial role in early-stage rehabilitation by enhancing motor performance and reducing pain.

Early functional factors for predicting outcome of independence in daily living after stroke: a decision tree analysis.

This study aimed to investigate the predictive functional factors influencing the acquisition of basic activities of daily living performance abilities during the early stages of stroke rehabilitation using classification and regression analysis trees. The clinical data of 289 stroke patients who underwent rehabilitation during hospitalization (164 males; mean age: 62.2 ± 13.9 years) were retrospectively collected and analysed. The follow-up period between admission and discharge was approximately 6 weeks. Medical records, including demographic characteristics and various functional assessments with item scores, were extracted. The modified Barthel Index on discharge served as the target outcome for analysis. A "good outcome" was defined as a modified Barthel Index score ≥ 75 on discharge, while a modified Barthel Index score < 75 was classified as a "poor outcome." Two classification and regression analysis tree models were developed. The first model, predicting activities of daily living outcomes based on early motor functions, achieved an accuracy of 92.4%. Among patients with a "good outcome", 70.9% exhibited (i) ≥ 4 points in the "sitting-to-standing" category in the motor assessment scale and (ii) 32 points on the Berg Balance Scale score. The second model, predicting activities of daily living outcome based on early cognitive functions, achieved an accuracy of 82.7%. Within the "poor outcome" group, 52.2% had (i) ≤ 21 points in the "visuomotor organization" category of Lowenstein Occupational Therapy Cognitive Assessment, (ii) ≤ 1 point in the "time orientation" category of the Mini Mental State Examination. The ability to perform "sitting-to-standing" and visuomotor organization functions at the beginning of rehabilitation emerged as the most significant predictors for achieving successful basic activities of daily living on discharge after stroke.

Technical Sprinting in the Early Phase of Hamstring Injury Rehabilitation to Accelerate Return to Full Participation in Track and Field Athletes: A Comparative Study of Two Rehabilitation Strategies.

Hamstring injuries are common in track and field athletes with a higher incidence in males than females. It causes a significant loss in training time and a decline in performance. This study evaluated rehabilitation strategies to accelerate return to full participation following hamstring injury. Thirty-three athletes (22 males; 11 females) were screened from November 2021 to October 2023 until their final major competition. Out of these, 17 athletes with hamstring injuries were included in this study which were further divided into two groups, A (n=8) and B (n=9), using stratified random sampling with single blinding. Group A received technical sprints using mini hurdles as part of their training from the early stages of rehabilitation, while Group B underwent high-volume low-intensity rehabilitation before progressing to sprints. The progress of each group was monitored on a weekly basis. The average time loss was calculated using Microsoft Excel (Microsoft® Corp., Redmond, WA) and Google Forms (Google, Inc., Mountain View, CA) with built-in validation. The two groups demonstrated a significant difference in recovery times. In group A, the length of hamstring tenderness (LHT) improved from 9 ± 2.7 (95% CI 2.27) to 0.15 ± 0.3 (95% CI 0.62), active total knee extension (ATKE) from 161.8 ± 7.1 (95% CI 5.95) to 175.4 ± 2 (95% CI 2.3), and Numeric Pain Rating Scale (NPRS) in the isometric test from 5.6 ± 1.09 (95% CI 0.88) to 0.6 ± 0.5 (95% CI 0.63) with p<0.05, and in Group B, LHT improved from 6.8 ± 2.1 (95% CI 1.62) to 0.6 ± 0.7 (95% CI 0.55), ATKE improved from 168.7 ± 8.2 (95% CI 6.3) to 178.7 ± 2.7 (95% CI 2.06) and NPRS with resisted isometric test improved from 6 ± 1.4 (95% CI 1.08) to 0.8 ± 0.7 (95% CI 0.51) with p<0.05. However, Group A took an average of 3.55 weeks (1.22 SD 95% CI 1.08) and Group B took an average of 4.53 weeks (1.98 SD, 95% CI 1.52) to resume full participation. Three athletes from Group A and six athletes from Group B experienced hamstring tightness during the competition, two athletes from Group B were forced to withdraw from the competition due to hamstring reinjury. The findings indicate that an early technical sprint program can facilitate an early return to full participation. This research can be a guide towardaccelerated and integrated hamstring injury rehabilitation among track and fieldathletes.

Comparative Electromyographic Study of Scapular Stabilizing Muscles During Five Main Rehabilitation Exercises.

The aim of the study is to compare the surface electromyographic amplitude, activation ratio, and onset latency of the main scapular stabilizing muscles between five typical rehabilitative exercises. Twenty-seven healthy participants performed five scapular exercises (wall slide, wall push-up plus, prone horizontal abduction with external rotation, external rotation in side lying, and low row) while simultaneously recording surface electromyographic of serratus anterior, middle trapezius, lower trapezius, and upper trapezius. Surface electromyographic amplitudes, onset latencies, and activation ratios were calculated. Prone horizontal abduction with external rotation showed an excellent upper trapezius/middle trapezius (0.43) and upper trapezius/lower trapezius (0.30) muscle balance with high (>50% maximum voluntary isometric contraction) middle trapezius and lower trapezius amplitudes, a low (<20% maximum voluntary isometric contraction) upper trapezius amplitude, and an early activation of the scapular stabilizing muscles (-474.7 to 89.9 ms) relative to upper trapezius. External rotation in side lying showed excellent upper trapezius/serratus anterior (0.26), upper trapezius/middle trapezius (0.32), and upper trapezius/lower trapezius (0.21) activation ratios and, along with low row and wall slide, showed early activation of the scapular stabilizing muscles (-378.1 to -26.6 ms). Prone horizontal abduction with external rotation presented optimal scapular neuromuscular control. Although external rotation in side lying, low row, and wall slide did not meet all the criteria associated with optimal scapular neuromuscular control, these exercises could be used in early stages of shoulder rehabilitation because they favor early activation of the scapular stabilizing muscles.

ДИФФЕРЕНЦИРОВАННЫЙ ПОДХОД К ПЕДАГОГИЧЕСКОЙ РАБОТЕ С РОДИТЕЛЯМИ В УСЛОВИЯХ ДЕТСКОЙ РЕАБИЛИТАЦИИ: НАЧАЛЬНЫЙ ЭТАП ИЗУЧЕНИЯ СЕМЬИ

Introduction. The article deals with topical issues of providing pedagogical assistance to parents (substituting persons) raising children with the consequences of neurotrauma in hospital conditions: the features of including adults close to the child in a complex of rehabilitation measures are studied; groups of parents are presented, accounting for which makes it possible to effectively build a comprehensive content of the rehabilitation process. The purpose of the study is to present the results of studying the specifics of parental attitudes towards a child with the consequences of neurotrauma. Materials and methods. 106 families were involved. Research methods: the study of psychological, medical, and pedagogical documentation; questionnaires and conversations with parents; directed observation; psychological and pedagogical examination of the child. Results. The methods of studying the parental position in a hospital are determined. The criteria of parental activity and factors that both improve and complicate the inclusion of loved ones in complex rehabilitation are described (biological, individual psychological, micro, and macrosocial). Differentiated parent groups have been identified, accounting for which allows the development of pedagogical assistance, content, and methods variably both at the early stage of rehabilitation and in the long-term recovery period of the child. Discussion and conclusion. All families raising children with the consequences of neurotrauma need comprehensive medical, psychological and pedagogical assistance throughout the rehabilitation/habilitation process. The content of pedagogical work with loved ones is built differentially, based on the levels of parental groups. The results of the study may be useful to specialists providing comprehensive care to children with severe neurotrauma, as wellas close adults.

Effects of visual feedback balance system combined with weight loss training system on balance and walking ability in the early rehabilitation stage of stroke: a randomized controlled exploratory study.

Previous studies have suggested that the Pro-Kin visual feedback balance system can promote the recovery of balance function in stroke patients. However, this system has not been used effectively in the early stages of stroke rehabilitation. This study aimed to investigate the effect of Pro-Kin system combined with weight loss system for the early recovery of balance and walking ability following a stroke. A total of 62 patients who underwent radiological diagnosis of stroke were randomly divided into two groups: a control group (n = 31) and a treatment group (n = 31). Both groups received conventional balance training. The treatment group also received training on the Pro-Kin system in conjunction with a weight loss system. Balance was measured using the Berg Balance Scale (BBS), Timed 'Up & Go' (TUG) test and Pro-Kin system. Walking ability was assessed using the Functional Ambulation Classification (FAC). The tests were performed before the start of treatment and on the 4th week following the training. There was no statistically significant difference between the groups before training. After 4 weeks of training in both groups, there were significant improvements in balance and walking ability. BBS values and FAC were significantly higher (p < 0.01), TUG times, ellipse area and motion trajectory length were significantly reduced (p < 0.01, p < 0.05) after training. The treatment group outperformed the control group (p < 0.05). In addition, there was a positive correlation between balance function and walking ability (p < 0.01). The Pro-Kin system combined with weight loss system is a viable method that promotes early reconstruction of balance and walking ability following a stroke. Clinical trial number ChiCTR1900026370. https://www.chictr.org.cn/showprojEN.html?proj=43736.

Features of Neuropsychological Support of Patients with Impaired Consciousness at the Early Stage of Rehabilitation: a Narrative Review

INTRODUCTION. In the neuropsychological support of patients with impaired consciousness at an early stage of rehabilitation, methodological and practical problems arise related to the choice and procedure for using methods of neuropsychological diagnostics and neuropsychological rehabilitation. To develop methods of working with such patients, it is necessary to address the concepts of the structure of consciousness and the content of consciousness.&#x0D; RESULTS. The article presents a review of the literature devoted to the problem of the work of a neuropsychologist with patients with impaired consciousness. In the reviewed literature, attention is drawn to the insufficient development of the neuropsychological content of the concept of “consciousness”; methodological and procedural limitations that arise when a neuropsychologist works with patients with disorders of consciousness of varying degrees of severity; the possibilities of conducting and limiting psychostimulotherapy and sensory stimulation in domestic and foreign approaches are discussed.&#x0D; CONCLUSION. The analysis of publications on the topic of accompanying patients with impaired consciousness reflects the presence of a number of unresolved issues. At the present stage of development of neuropsychological work with patients with impaired consciousness, there is no single approved and detailed protocol regulating the conduct of neuropsychological diagnostics and neurorehabilitation with them. The problem is at the stage of solution and requires further research.

Retrospective case-control study to compare exoskeleton-assisted walking with standard care in subacute non-traumatic brain injury patients.

Advanced technologies are increasingly used to address impaired mobility after neurological insults, with growing evidence of their benefits for various populations. However, certain robotic devices have not been extensively investigated in specific conditions, limiting knowledge about optimal application for healthcare. To compare effectiveness of conventional gait training with exoskeleton-assisted walking for non-traumatic brain injury during early stage rehabilitation. Clinical evaluation data at admission and discharge were obtained in a retrospective case-control design. Patients received standard of care physical therapy either using Ekso GT or not. Within- or between-group statistical tests were performed to determine change over time and interventional differences. This study analyzed forty-nine individuals (33% female), 20 controls and 29 Ekso participants who were equivalent at baseline. Both groups improved in Functional Independence Measure scores and ambulation ability (p < .00001 and p < .001, respectively). Control subjects demonstrated significantly different distance walked and assistance level values at discharge from those who were treated with the exoskeleton (p < .01). Robotic locomotion is non-inferior for subacute functional recovery after non-traumatic brain injury. Conventional therapy produced larger gait performance gains during hospitalization. Further research is needed to understand specific factors influencing efficacy and the long-term implications after rehabilitation.

The unmet needs of patients in the early rehabilitation stage after lung cancer surgery: a qualitative study based on Maslow's hierarchy of needs theory.

This study aimed to explore the unmet needs of lung cancer patients in early rehabilitation, based on Maslow's hierarchy of needs theory. Information on the experiences of 20 patients was collected through semi-structured interviews. The interviews were conducted in the surgical nursing clinic within 1week of discharge from hospital. The data were analysed using a combination of deductive (theory-driven) and inductive (data-driven) methods, using Maslow's Hierarchy of Needs as a framework for identifying and organising themes. Patients had a mean age of 50.92years (SD 11.88); n = 11 (55%) were female. Major themes aligned with the dimensions of Maslow's hierarchy of needs model. Five major themes with 12 corresponding sub-themes emerged: (1) physiological needs, including "self-care and independence in life", "return to pre-operative status as soon as possible", "increase exercise under specialist guidance" and "reduce cough and pain and improve sleep quality"; (2) safety and security needs, such as "symptom management", "regulation of the emotions of worry and fear" and "access accurate treatment information"; (3) love and belonging needs, including "accompany family members" and "chat with friends";(4)Esteem needs: "live with dignity";(5) Self-actualization, such as "accept and submit to the reality of cancer" and "live meaningfully". The findings of this study indicated that there were many unmet needs for patients during the early recovery period after lung cancer surgery. An overview of the different areas of need identified in this study may guide future research and development of interventions to improve patients' quality of life during the home rehabilitation phase.

Prediction of Changes in Functional Outcomes During the First Year After Inpatient Stroke Rehabilitation: A Longitudinal Study

ObjectiveTo identify meaningful changes in patients in 3 functional domains (basic mobility [BM], daily activity [DA], and applied cognition [AC]) after discharge from inpatient stroke rehabilitation and to identify the predictors of 1-year functional improvement. DesignA longitudinal, multicenter, prospective cohort study. SettingThe acute care wards of 3 hospitals in the Greater Taipei area of Taiwan. ParticipantsFive hundred patients with stroke in acute care wards (mean age=60±12.2 years, 62% men, N=500). InterventionsNot applicable. Main Outcome Measure(s)The Mandarin version of the Activity Measure for Post-Acute Care (AM-PAC) short forms were assessed at discharge and 3-, 6-, and 12-month follow-up. The minimal detectable change (MDC) was used to categorize changes in the scores as improved and unimproved at the 4 time points. ResultsThe mean scores of the AM-PAC BM and DA subscales substantially increased over the first 3 months after discharge (86% of participants exhibited improvement) and slightly increased during the subsequent 9 months (5∼26% of participants exhibited improvement). However, the mean score of the AC subscale decreased within the first 3 months and increased over the subsequent 9 months (22-23% of participants exhibited improvement). The BM, AC scores at discharge were the dominant predictors of subsequent functional improvement (P<.05). Patients with a higher functional stage at discharge were more likely to experience significant improvement. ConclusionThis study established the capacity of the AM-PAC to predict functional improvement in 3 domains during the early, middle, and late stages of recovery. The findings can assist clinicians in identifying patients at risk of unfavorable long-term functional recovery and providing such patients with tailored interventions during the early stage of rehabilitation.

The effect of home-based cardiac rehabilitation on arterial stiffness and peak oxygen consumption in patients with myocardial infarction.

This study aims to investigate the effectiveness of home-based cardiac rehabilitation (CR) on arterial stiffness in patients with acute myocardial infarction (AMI). Between January 2015 and December 2017, a total of 135 patients (120 males, 15 females; mean age: 58.8±11.1 years) with AMI who were referred for CR were included. Home-based CR was prescribed based on a cardiopulmonary exercise test (CPET) for at least six months. All patients completed three consecutive CPETs and brachial-ankle pulse wave velocity (baPWV) measurements at one, four, and seven months after onset. After six months of CR, there was an improvement in peak oxygen consumption (pVO2) (Month 1, 28.7±6.4 mL/kg/min; Month 4, 31.6±6.3 mL/kg/min; Month 7, 31.2±7.1 mL/kg/min, p<0.001) and a reduction in baPWV (Month 1, left, 1546.0±311.2 cm/sec, right 1545.5±301.5 cm/sec; Month 4, left, 1374.9±282.5 cm/sec, right 1371.6±287.5 cm/sec; Month 7, left, 1362.9±287.0 cm/sec, right 1365.5±281.1 cm/sec, p<0.001). In patients with AMI, arterial stiffness and aerobic capacity improved after six months of home-based CR, particularly in the early stages of rehabilitation. These results suggest that changes in baPWV are useful in determining the effectiveness of CR and pVO2 in the initial stages of CR.

Decision Tree Analysis Accurately Predicts Discharge Destination After Spinal Cord Injury Rehabilitation

ObjectivesTo predict discharge destination after spinal cord injury (SCI) rehabilitation. Study DesignA retrospective, single-center study. We collected the following data from medical charts: age, sex, living arrangement before injury, acute length of stay (LOS), level of injury on admission, American Spinal Injury Association Impairment Scale (AIS) on admission, Upper Extremity Motor Score (UEMS) on admission, Lower Extremity Motor Score on admission (LEMS), Spinal Cord Independence Measure (SCIM) scores on admission and discharge, and discharge destination. A decision tree algorithm was used to establish prediction models in a train-test split manner using features on admission or discharge. SettingA spinal center in Tokyo, Japan. ParticipantsParticipants were individuals with SCI admitted to our hospital from March 2016 to October 2021 for the first rehabilitation after the injury. The study included 210 participants divided into 2 groups: training (n=140) and testing (n=70). Random sampling without replacement was used. InterventionsNot applicable. Main Outcome MeasuresPrediction accuracy was evaluated with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating curve (AUC). ResultsAIS was significantly different between the groups. The prediction model using total SCIM scores on discharge (D-Classification and Regression Tree [CART]) revealed that a cut-off value of 40 accurately predicted the discharge destination. In contrast, the prediction model using features on admission (A-CART) revealed that subtotal SCIM mobility scores of 5, age of 74 years, and UEMS of 23 were significant predictors. Sensitivity, specificity, PPV, NPV, and AUC of D-CART and A-CART were 0.837, 0.810, 0.911, 0.680, and 0.832 and 0.857, 0.810, 0.913, 0.708, and 0.869, respectively. ConclusionsD-CART and A-CART showed comparable prediction accuracies. This suggests that, even during the early stages of rehabilitation, it is possible to predict the discharge destination.

Effects of extremely low-pressure pneumoperitoneum on postoperative recovery after single site robot-assisted cholecystectomy: a randomized controlled trial.

A robotic platform has enabled extremely low-pressure pneumoperitoneum (ELPP, 4 mmHg) to reduce surgical insults to human physiology during a minimally invasive surgery. The objective of this study was to investigate the effect of ELPP in single-site robotic cholecystectomy (SSRC) on postoperative pain, shoulder pain, and physiological changes during surgery compared to a standard pressure pneumoperitoneum (SPP, 12-14 mmHg). A total of 182 patients who underwent an elective cholecystectomy were randomized into an ELPP SSRC group (n = 91) and an SPP SSRC group (n = 91). Postoperative pain was assessed at 6, 12, 24, and 48 h after surgery. The number of patients complaining of shoulder pain was observed. Intraoperative changes of ventilatory parameters were also measured. Postoperative pain scores (p = 0.038, p < 0.001, p < 0.001, and p = 0.015 at 6, 12, 24, and 48 h after surgery, respectively) and the number of patients with shoulder pain (p <0.001) were significantly lower in the ELPP SSRC group than in the SPP SSRC group. Intraoperative changes in peak inspiratory pressure (p < 0.001), plateau pressure (p < 0.001), EtCO2 (p < 0.001), and lung compliance (p < 0.001) were also less in the ELPP SSRC group. The ELPP during robotic cholecystectomy could significantly relieve postoperative pain and shoulder pain. In addition, the ELPP can reduce changes in lung compliance during surgery and the demand for postoperative analgesics, thereby improving the quality of life of patients during early stages of postoperative rehabilitation.

Variation of muscle recruitment during exercises performed below horizontal arm elevation that target the lower trapezius: A repeated measures cross-sectional study on asymptomatic individuals

The gold standard exercise for recruitment of the lower trapezius is the Y prone exercise which is performed above 90° of shoulder elevation. However, clinicians often prescribe exercises that avoid high elevation postures during early stages of rehabilitation. Comparatively little data exists on relative muscle recruitment during lower arm elevation exercises. This study examined the EMG activity of four shoulder girdle muscles during four exercises accomplished below 90° of shoulder elevation and compared them to the Y prone while considering sex effects. Variance across exercises of the ratio between upper trapezius and lower trapezius was also explored. 32 healthy participants completed standardized muscle-specific MVCs and two repetitions of each exercise. The side lying external rotation and the wall slide exercises produced the highest peak EMG for the lower trapezius, both 33 and 29% lower than the Y Prone. For the upper trapezius to lower trapezius ratio, the side lying external rotation elicited the lowest value, followed by the Y prone and wall slide (53 and 59% respectively higher). Sex influenced some EMG values, typically interacting with exercise type. Thus, side lying external rotation and the wall slide are recommended for targeting the lower trapezius muscle during early rehabilitation.

Randomized controlled trial to compare conventional physiotherapy with task-oriented exercises after total hip replacement.

Different interventions are used during rehabilitation after hip replacement surgery, but it is unclear if task-oriented exercise is more effective than conventional physiotherapy. This study compared the effectiveness of conventional physiotherapy (CPT) programme with task-oriented exercise (TOE) on hip pain, function, static and dynamic balance during the early rehabilitation stage after total hip replacement. This randomized controlled parallel-group trial was executed in an inpatient physical medicine and rehabilitation centre. The study included 40 patients who were randomly classified into CPT and TOE groups (n= 20 in each). Hip pain (assessed by visual analogue scale), function in the operated leg (assessed by modified Harris Hip Score, mHHS), static balance (assessed by Abili Balance analyser system) and dynamic balance (assessed by Berg Balance Scale) were evaluated at baseline and after 18 days of rehabilitation. Cohen's effect size (d) was calculated. Greater pain reduction (p< 0.05; d= 0.08) was observed after TOE (1.6 ± 0.68 scores) compared with the CPT programme (2.2 ± 0.83 scores). Hip function assessed by the modified mHHS improved more (p< 0.05; d= 0.30) in the TOE group (73.45 ± 6.23 scores) than in the CPT group (54.90 ± 6.28 scores). Static balance improved significantly in both groups after the interventions but did not differ significantly between the groups. The improvement in dynamic balance was significantly greater (p< 0.05; d= 0.45) after TOE (50.55 ± 1.57 scores) than after CPT (38.55 ± 3.43 scores). Both interventions reduced pain and improved function of the operated leg and static and dynamic balance. The effect on hip function was superior for TOE compared with CPT.

Knee Loading With Blood Flow Restriction Can Enhance Recovery After Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is one of the most performed operations in the world, especially in the elderly. Aging has a significant effect on joint cartilage, muscle strength, and muscle mass. Following a TKA, despite the significant reduction of symptoms and the improvement in mobility, muscle strengthand muscle mass recovery remains a significant challenge. Restrictions that arise from the surgical procedure include joint loading, functional activities, and range of motion, along with limitations related to the age of the individual and their previous loading history, these are the significant restrictions, at least in the early stages of rehabilitation. Evidence indicates that blood flow restriction (BFR) training has significant potential to enhance recovery via implementation of low-load or low-intensity exercise. While respecting the indications and contraindications related to BFR application, the optimization of metabolic stress seems to offer a bridging therapy to heavy load while reducing pain and inflammation. Thus, the combination of BFR and low loads may improve muscular recovery (strength and mass), and aerobic training protocols appear to show significant enhancement of multiple cardiopulmonary parameters. Mounting evidence, direct and indirect, indicate that BFR training may have the potential to benefit the pre-operative and post-operative TKA rehabilitation phases and enhance functional recoveryand physical abilities in the elderly.