Early Stages Of Rehabilitation Research Articles

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.

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.

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.

Mini All-Suture Anchors for Repairing the Central Slip of the Extensor Tendon at the Proximal Interphalangeal Joint: A Biomechanical Investigation

This study evaluated 1.0-mm mini suture anchors for repairing the central slip of the extensor mechanism at the proximal interphalangeal joint. Studies have reported a requirement for central slip fixation to withstand 15 N during postoperative rehabilitation exercises and 59 N during forceful contraction. Index and middle fingers from 10 matched pairs of cadaveric hands were prepared with 1.0-mm mini suture anchors with 2-0 sutures or threaded with 2-0 sutures through a bone tunnel (BTP). In total, 10 index fingers from unmatched hands were prepared with suture anchors and fixed to the extensor tendons to evaluate the tendon/suture interface response. Each distal phalanx was secured to a servohydraulic testing machine, and ramped tensile loads were applied to suture or tendon until failure. All anchors for the all-suture bone tests failed because of pullout from the bone (Mean failure force= 52.5+/-17.3 N). Three anchors from the tendon-suture pull out test failed by pullout from the bone and seven failed at the tendon/suture interface (Mean failure force= 49.0+/-10.1 N). The 1.0-mm mini suture anchor provides enough strength for early short-arc motion, but it may not be adequate for forceful contraction in the early postoperative rehabilitation stage. The site of fixation, the type of anchor, and the type of suture used are key factors to consider for early range of motion, after surgery.

Effects of muscle energy technique on improving the range of motion and pain in patients with frozen shoulder

Introduction and Aim: Muscle Energy Technique (MET) is a type of manual treatment that utilises the energy of the muscle in the form of a mild isometric contraction to stretch the muscle and relax the muscles through reciprocal or autogenic inhibition. An idiopathic ailment of the shoulder joint known as frozen shoulder is characterised by a rapid onset of shoulder discomfort and a limitation in mobility. Much research has been conducted to determine how various manual approaches affect shoulder discomfort. This study focuses on how MET affects pain and range of motion during the initial stages of rehabilitation.&#x0D; Materials and Methods: Patients who are diagnosed with frozen shoulders with fulfilling the inclusion and exclusion criteria were selected for the study. In the current study, thirty patients who had a prevalence of musculoskeletal complications of the frozen shoulder were selected. Out of which eighteen are male and twelve are female. To identify the prevalence each patient's range of motion and VAS Score for pain sensation were recorded. The same patients have been introduced to MET for another seven days. MET includes 5 repetitions/sets, 3 sets/session, and 1 session/day. A statistical test was performed to identify the significant difference between pre and post-values.&#x0D; Results: Most of the patients had an average range of motion (Flexion) (of 132±18.96), range of motion (Abduction) of (107.00±12.77), range of motion (Rotation) of (63.50±9.39) and VAS score was (5.96±1.29). Most patients showed the improvement in range of motion and a decrease in pain sensation as per the VAS Score.&#x0D; Conclusion: This study shows that MET effectively improves the range of motion and functional ability, relieving pain in Frozen Shoulder patients in the early stage of rehabilitation.

Relation between Lower Urinary Tract Dysfunction and Functional Outcome in Patients After Brain Tumor Resection.

This study aimed to compare functional outcomes after rehabilitation with initial degree of urinary retention (UR) in patients operated on for brain tumors. Medical records of 61 patients transferred to the Department of Rehabilitation Medicine of single center, from January 2011 to December 2021, were reviewed retrospectively. Patient data included post-void residual (PVR) urine, tumor characteristics, and functional status. Functional status was evaluated on the Mini-Mental Status Examination (MMSE), Modified Barthel Index (MBI), Functional Ambulation Category (FAC), Modified Rankin Scale (mRS), Motricity Index (MI)-lower limb, and Berg Balance Scale (BBS). MMSE, FAC, mRS, and MI-lower limb were re-evaluated 3 weeks after standard inpatient rehabilitation. Twenty-four patients were in the UR group and 37 in the non-UR group. Initial MMSE, MBI, BBS, FAC, and mRS were significantly worse in the UR group, and both groups showed significant functional improvement after rehabilitation. After rehabilitation, MMSE, FAC, MRS, MI-lower were still worse in the UR group, but the degree of improvement between the groups was not significantly different. Rehabilitation was shown to be effective for brain tumor patients regardless of UR. Initial UR after brain tumor surgery is significantly associated with poor functional status in both the early stages of rehabilitation and after rehabilitation.

Cardiopulmonary Response to Robot-Assisted Tilt Table With Regard to Its Components.

Cardiopulmonary function is exceptionally critical during the early stages of rehabilitation after neurological disorders such as stroke, spinal cord injury and Parkinson's disease. This study aimed to demonstrate how robot-assisted and tilt table exercises affect cardiopulmonary function. In this study, ten healthy young adults performed six combinations of conditions according to robot-assisted mode (on/off), angle of tilt table (20°/60°), and functional electrical stimulation (FES) mode (on/off). Four conditions had FES mode off with combinations of robot-assisted mode (on/off) and tilt angle (20°/60°) and two conditions had robot-assisted mode and FES on with tilt angle (20°/60°). Cardiopulmonary effects (oxygen uptake [VO2], peak oxygen uptake [VO2peak], metabolic energy cost [MET], rate pressure product [RPP], heart rate [HR], maximum heart rate [%HRmax], and minute ventilation [VE]) were compared in each condition. As a result, in the angle and FES mode effect, VO2, VO2peak, MET, RPP, HR, and %HRmax, unlike that for VE, showed major effects in angle. In addition, in the robot-assisted mode and angle effect, when the FES was switched off, VO2, METs, and VE values showed major effects in the robot-assisted mode, whereas all other values showed major effects in angle. Compared to earlier reported findings, we can expect that robot-assisted tilt table training can lead to changes in the cardiopulmonary function.

Loaded open-kinetic-chain exercises stretch the anterior cruciate ligament more than closed-kinetic-chain exercises: In-vivo assessment of anterior cruciate ligament length change

BackgroundUsage of open-kinetic-chain (OKC) or closed-kinetic-chain (CKC) exercises during rehabilitation planning after anterior cruciate ligament (ACL) reconstruction has been debated for decades. However, the ACL elongation pattern during different rehabilitation exercises at different loadings remains unclear. ObjectivesThis study aimed to determine the effects of OKC and CKC exercises on the length of ACL anteromedial bundle (AMB) and posterolateral bundle (PLB) to provide biomechanical support for making rehabilitation schedules. DesignLaboratory Descriptive Study. MethodEighteen healthy volunteers were asked to perform two OKC motions, including non-weight-bearing and 10 kg loaded seated knee extension (OKC-0, OKC-10), as well as two CKC motions, including box squat (BS) and deep single-legged lunge (Lunge). Techniques of 2D-to-3D image registration and 3D ligament simulation were used to quantify length changes of ACL. ResultsThe motion which led to the least and most ACL elongation were OKC-0 and OKC-10, respectively. The AMB and PLB were significantly longer in OKC-10 than those in OKC-0 during 0–60° and 0–55° of knee flexion (p < 0.01). Compared with reference length, the AMB and PLB were stretched during 0–30° and 0–10° respectively during OKC-10. During CKC exercises, the AMB and PLB were also stretched from 0 to 25°and 0–5°, respectively. Additionally, no significant difference was found in the length change of ACL bundles between BS and lunge. ConclusionsOKC-0 may be safe for the rehabilitation program after ACL reconstruction, and loaded exercises shall be applied when restricted with >30° in early-stage rehabilitation.

Hyperacute immune responses associate with immediate neuropathology and motor dysfunction in large vessel occlusions.

Despite successful endovascular therapy, a proportion of stroke patients exhibit long-term functional decline, regardless of the cortical reperfusion. Our objective was to evaluate the early activation of the adaptive immune response and its impact on neurological recovery in patients with large vessel occlusion (LVO). Nineteen (13 females, 6 males) patients with acute LVO were enrolled in a single-arm prospective cohort study. During endovascular therapy (EVT), blood samples were collected from pre and post-occlusion, distal femoral artery, and median cubital vein (controls). Cytokines, chemokines,cellular and functional profiles were evaluated with immediate and follow-up clinical and radiographic parameters, including cognitive performance and functional recovery. In the hyperacute phase (within hours), adaptive immune activation was observed in the post-occlusion intra-arterial environment (post). Ischemic vascular tissue had a significant increase in T-cell-related cytokines, including IFN-γ and MMP-9, while GM-CSF, IL-17, TNF-α, IL-6, MIP-1a, and MIP-1b were decreased. Cellularity analysis revealed an increase in inflammatory IL-17+ and GM-CSF+ helper T-cells, while natural killer (NK), monocytes and B-cells were decreased. A correlation was observed between hypoperfused tissue, infarct volume, inflammatory helper, and cytotoxic T-cells. Moreover, helper and cytotoxic T-cells were also significantly increased in patients with improved motor function at 3 months. We provide evidence of the activation of the inflammatory adaptive immune response during the hyperacute phase and the association of pro-inflammatory cytokines with greater ischemic tissue and worsening recovery after successful reperfusion. Further characterization of these immune pathways is warranted to test selective immunomodulators during the early stages of stroke rehabilitation.

Use of an Intramedullary Allogenic Fibular Strut Bone and Lateral Locking Plate for Distal Femoral Fracture with Supracondylar Comminution in Patients over 50 Years of Age.

Background and Objectives: Distal femoral fracture is a severe injury that makes surgery challenging, particularly comminuted fractures in the supracondylar region. This study aimed to evaluate the outcomes of distal femoral fracture treated with the application of an intramedullary fibular allogenic bone strut in open reduction and internal fixation (ORIF) with precontoured locking plates in patients over 50 years of age. Materials and Methods: The study retrospectively enrolled 202 patients over 50 years of age with traumatic comminuted distal femoral fracture (AO/OTA 33-A3, 33-C2 and 33-C3) treated with ORIF with a locking plate from January 2016 to December 2019. The two groups were divided into patients who received an intramedullary allogenic bone strut and those who did not. Patients were followed for at least 1 year, with their function scores and radiographic data recorded. Results: A total of 124 patients were recruited, comprising 60 men and 64 women with an average age of 62.4 ± 8.5 years. The 36 patients who had received an intramedullary allogenic fibular bone strut reported lower postoperative pain scores at 1 month and lower postoperative Knee Society Scores (KSS) at 3 months than the control group. The application of an intramedullary allogenic fibular bone strut appeared to be significantly correlated with better 3-month postoperative KSS. Conclusions: The ORIF of distal femoral comminuted fracture with an intramedullary allogenic fibular bone strut can reduce pain and improve knee function in the early stages of postoperative rehabilitation and may reduce the time to union in patients over 50 years of age.