Extremity Function Research Articles

Ankle proprioception and functional performance in patients with Achilles tendinopathy.

The purpose of this study was to investigate differences in ankle plantar flexion proprioception and lower extremity function between Achilles tendinopathy (AT) patients and healthy controls. 17 patients with midportion AT (age 22.0±3.0, 7 females, and 10 males) and 17 healthy controls (age 21.5±2.1, 7 females, and 10 males) were recruited. The following tests were performed randomly: the ankle plantar flexion active movement extent discrimination assessment (AMEDA), weight-bearing lunge test (WBLT), single leg hop test, figure-of-eight hop test, Y Balance Test (YBT), and lower extremity functional test (LEFT). Group comparisons were made between the AT and healthy groups, and receiver operator characteristic (ROC) curves were used to analyze the ability of tests to differentiate between participants with and without AT. Results showed that the AT group performed significantly worse in the ankle proprioception test (p=0.016), single leg hop test (p=0.001), figure-of-eight hop test (p<0.001), unilateral LEFT (p=0.001), and LEFT injury risk score (p=0.001) than healthy controls. No significant between group difference was found in WBLT and YBT. Diagnostic analysis showed that the AMEDA (p=0.018), single leg hop test (p=0.003), figure-of-eight hop test (p=0.002), and LEFT (p=0.001) could differentiate between patients with AT and the healthy individuals. The current study demonstrated that ankle proprioception and functional performance involving explosive jump are impaired in patients with AT, suggesting poorer dynamic neuromuscular function and a higher risk of lower limb injury in this population, and furthermore, these tests should be considered in the assessment for AT.

Virtual reality-guided therapy on a stroke unit: a feasibility study

BackgroundVR (Virtual Reality) has emerged as a recent treatment approach in neurorehabilitation. The feasibility of VR-guided therapy in the acute phase after stroke has not been assessed.MethodsThis was a cohort study of consecutive patients with suspected stroke who were admitted to the Essen University Hospital Stroke Unit between March 2022 and May 2022. All patients who had an indication for physical or occupational therapy due to upper extremity sensorimotor, cognitive or perceptual deficits were included and considered for VR-guided treatment. We excluded patients with predominant deficits in lower extremity function, since these could not be targeted with our VR system. A multidimensional approach was used to assess the feasibility of VR-guided therapy, which included characterization of eligible patients, resource utilization as well as treatment acceptance. For this purpose, we analyzed baseline and clinical characteristics, causes for withholding the treatment as well as qualitative and quantitative treatment metrics in patients who received VR-guided therapy.ResultsOut of 326 patients admitted with suspected stroke, n = 172 were included in our final analysis. Of these, n = 37 (21.5%) received VR-guided therapy. The most common cause for withholding treatment were neuropsychological limitations (22.9%), followed by physical impairment, comorbidity and level of consciousness alterations (all 17.8%). Patients who received VR-guided therapy tended to have better functional status and less severe neurological deficits. VR-guided sessions had a median duration of 20 min (IQR 17–29) with additional 13 min (IQR 9–17) of preparation time. In the majority of patients who received VR-guided therapy, motivation was rated equal or higher as compared with conventional treatment (76%) and therapists considered VR-guided therapy well feasible (65%).ConclusionsDespite important treatment barriers, VR may provide additional opportunities to enhance functional recovery in the acute phase after stroke for selected patients. Our findings could aid in planning further randomized controlled trials which are required to refine approaches and assess the effectiveness of VR-guided therapy in the acute setting.

Investigation of the relationship between lower limb orthosis user satisfaction and quality of life and functionality in stroke patients: a cross-sectional study

ABSTRACT Background Orthosis satisfaction may be an important parameter that increases orthosis usage and reveals orthosis’ positive effect on rehabilitation. Objectives To investigate the relationship between lower limb orthosis user satisfaction and quality of life (QOL) and functionality in stroke patients. Methods Forty-four stroke patients with a mean age of 56.91 ± 14.08 years were included. Orthosis user satisfaction was evaluated using the Orthotics and Prosthetics Users’ Survey (OPUS). QOL was assessed using the Stroke-Specific Quality of Life Scale (SS-QOL). Lastly, functional status was evaluated using the Fugl – Meyer Assessment of Lower Extremity (FMA-LE) and Timed Up and Go Test (TUGT). Results The relationships were found between the OPUS total satisfaction and SS-QOL-selfcare (r = –0.412, p = 0.005), and upper extremity (r = –0.401, p = 0.007); OPUS device satisfaction and SS-QOL-selfcare (r = –0.484, p < 0.001) and upper extremity function (r = –0.379, p = 0.011); and OPUS service satisfaction and FMA-LE (r = 0.880, p = 0.001). There was no relationship between the OPUS total satisfaction, service satisfaction, and daily orthosis use time (p > 0.05). While participants’ QOL and lower extremity functionality were generally at low, those with better functional status had lower orthosis satisfaction because it made ambulation at home difficult. Conclusion Taking patient opinions into account in the orthotic design process will help to eliminate the problems related to comfort and orthotic wear that might affect orthotic satisfaction. The production of more comfortable orthoses might positively affect individuals’ use of orthoses and satisfaction. This outcome may be a good starting point for prospective studies.

Early pain findings in infants with brachial plexus birth injury: Relationship with function and comorbidities, and cut-off point for fractures

BackgroundInfants with birth brachial plexus injury (BPBI) may have various comorbidities such as fractures, torticollis, plagiocephaly, central nervous system disorders. In infants with BPBI, it is important to identify fractures, which are common among comorbidities, objectively assess pain, and investigate factors that may be associated with pain. AimThe aim of this study is to determine the pain level, comorbidities, and motor function in infants with BPBI and to examine the relationship between these parameters. The second aim is to determine the cut-off value of the pain score that may be a sign of fracture in patients with BPBI, in order to suspect and predict a fracture in the shoulder region and to request additional examinations. Subjects and measurements59 infants with BPBI aged 15–90 days were included in the study. Comorbidities, active joint movements, and total upper extremity function assessed with the Active Movement Scale and pain scores measured with the FLACC Pain Scale were retrospectively analyzed. In addition, pain, comorbidities and motor function were investigated according to types of Narakas, which indicates the degree of nerve injury. ResultsOf the 59 participants, 18 (30.5 %) had at least one comorbidity and 12 (20.3 %) had fractures. The number of comorbidities (p = 0.41), the number of fractures (p = 0.84), and the level of pain (p = 0.71) did not differ by types of Narakas. There was a moderate negative correlation between pain level and upper extremity motor function in upper trunk injuries (p < 0.5, −0.67 < r < −0.46). There was a difference in pain level measured by palpation (p < 0.01) and passive joint movement (p < 0.01) in infants with and without comorbidities. To suspect a fracture in the shoulder region and to request further evaluation, the cut-off value of the Flacc pain level, which may predict a fracture, was 3.5 points for palpation and passive shoulder abduction and 4.5 points for passive external rotation. ConclusionThis is the first study in the BPBI to measure pain in infants using a quantifiable and widely used assessment. Pain level was ranked from high to low as infants with fractures, infants with comorbidities other than fractures and infants without comorbidities. Increased pain adversely affects motor function and pain above the cut-off values is a predictor of fracture.

Improving Life After Childhood Stroke: Helping Your Child Get the Most Out of Their Home Activity Program to Improve Upper Extremity Function.

Improving Life After Childhood Stroke: Helping Your Child Get the Most Out of Their Home Activity Program to Improve Upper Extremity Function.

Effect of Virtual Reality-Based Upper Extremity Training on Upper Extremity Function, Visual Perception, and Brain Activ ity in a Child with Spastic Cerebral Palsy: A Case Report

Effect of Virtual Reality-Based Upper Extremity Training on Upper Extremity Function, Visual Perception, and Brain Activ ity in a Child with Spastic Cerebral Palsy: A Case Report

Coin Test: A Complementary Examination for Assessing Upper Extremity Function in Cervical Myelopathy.

A prospective observational study. To explore the potential utility of the Coin Test as a valuable tool for assessing and diagnosing cervical spondylotic myelopathy (CSM). In the first cohort, 36 patients with balance issues were assessed for CSM using the new Coin Test. In the second cohort, the Coin Test and mJOA scores were compared in 36 CSM patients before and 6weeks after surgery. Among the 36 patients with balance problems who failed tandem gait test, 15 out of 16 (94%) CSM patients failed the Coin Test. The other 20 patients (56%) without CSM completed the Coin Test successfully but failed the tandem gait test for various reasons. The Coin Test demonstrated high specificity (100%) and sensitivity (94%) for diagnosing CSM in patients who failed tandem gait test. In the second cohort, the mJOA score improved significantly from 12 to 15 6weeks postoperatively, and the Coin Test completion time decreased from 29.5 seconds to 16.4 seconds postoperatively (P < 0.0001). Higher mJOA scores correlate with better performance (shorter time) on the Coin Test, both at baseline and 6weeks post-surgery. The Coin Test is a useful tool for evaluating hand fine motor and sensory function in CSM patients with high specificity. It also can serve as a tool for assessing surgical outcomes in patients with CSM.

Smartphone tests quantify lower extremities dysfunction in multiple sclerosis.

Increasing shortage of neurologists compounded by the global aging of the population have translated into suboptimal care of patients with chronic neurological diseases. While some patients might benefit from expanding telemedicine, monitoring neurological disability via telemedicine is challenging. Smartphone technologies represent an attractive tool for remote, self-administered neurological assessment. To address this need, we have developed a suite of smartphone tests, called neurological functional test suite (NeuFun-TS), designed to replicate traditional neurological examination. The aim of this study was to assess the ability of two NeuFun-TS tests-short walk and foot tapping-to quantify motor functions of lower extremities as assessed by a neurologist. A cohort of 108 multiple sclerosis (MS) patients received a full neurological examination, imaging of the brain, and completed the NeuFun-TS smartphone tests. The neurological exam was digitalized using the NeurEx™ platform, providing calculation of traditional disability scales, as well as quantification of lower extremities-specific disability. We assessed unilateral correlations of 28 digital biomarkers generated from the NeuFun-TS tests with disability and MRI outcomes and developed machine learning models that predict physical disability. Model performance was tested in an independent validation cohort. NeuFun-TS-derived digital biomarkers correlated strongly with traditional outcomes related to gait and lower extremities functions (e.g., Spearman ρ > 0.8). As expected, the correlation with global disability outcomes was weaker, but still highly significant (e.g., ρ 0.46-0.65; p < 0.001 for EDSS). Digital biomarkers also correlated with semi-quantitative imaging outcomes capturing locations that can affect lower extremity functions (e.g., ρ ~ 0.4 for atrophy of medulla). Reliable digital outcomes with high test-retest values showed stronger correlation with disability outcomes. Combining strong, reliable digital features using machine learning resulted in models that outperformed predictive power of best individual digital biomarkers in an independent validation cohort. NeuFun-TS tests provide reliable digital biomarkers of lower extremity motor functions.

Paired associative stimulation improves motor function in the upper extremity in chronic incomplete spinal cord injury: a corroborative study.

To corroborate findings suggesting that spinally targeted paired associative stimulation improves upper extremity motor function in chronic incomplete spinal cord injury. Prospective interventional study. Five adults with chronic tetraplegia. Participants received paired associative stimulation, combining peripheral nerve stimulation and navigated transcranial magnetic stimulation towards 1 arm (16 1-h sessions during 4 consecutive weeks, targeting the 3 large nerves). Manual muscle testing (MMT) was performed in 23 muscles in each arm, at 3 time points (pre-stimulation, t0; the week following the stimulation period, t1; and 4-5 weeks post-stimulation, t2). Additionally, grip strength and changes in the Canadian Occupational Performance Measure were assessed. The mean improvement in manual muscle testing scores in the targeted extremity was +0.49 at t1 (p = 0.078) and +0.55 at t2 (p = 0.062). Grip strength in the stimulated extremity increased by 3.2 kg at t1 and 3.4 kg at t2, and in the non-targeted extremity by 2.2 and 3.6 kg, respectively. Performance and satisfaction increased by 2.1/2.4 points at t1, and by 2.0/1.9 points at t2. Paired associative stimulation improved motor function: at the group level, MMT of the stimulated hand (p = 0.06) and non-stimulated hand (p = 0.04). Most participants achieved clinically relevant improvement. Thus, the results corroborate prior studies. The method may complement conventional rehabilitation for improving upper extremity function in incomplete tetraplegia.

Effect of arm ergometer versus stabilization exercises on trunk control and pper extremity functions in children with diplegia: a randomized controlled trial.

One of the most prevalent clinical subtypes of cerebral palsy (CP) is diplegia. Most children with diplegia have weakness in axial muscles and spasticity in extremities which have adverse impacts on trunk control and manual coordination of upper extremities. To examine and compare between the effects of arm ergometer and stabilization exercises applied for duration of 12 weeks on upper extremity functioning, trunk control, and hand grip strength (HGS) in children with spastic diplegia. Forty-two children with spastic diplegia aged from 6 to 10 years were randomly assigned to either group A or B, (n = 21 each). Children in group A received a designed arm ergometer exercises for 30min while those in group B received trunk stabilization exercises for 30min. As well, children in both groups received 30min of a designed physical training for 30min. Treatment was delivered three times a week for 12 weeks in succession. The quality of upper extremity skill test (QUEST), hand held dynamometer (HHD) and Trunk control measuring scale (TCMS) were used to assess upper extremity functions, HGS and trunk control respectively before and after suggested treatment duration. In terms of all indicators measured at baseline, study groups were comparable (P > 0.05). Significant improvements in all outcome indicators were recorded in within-group comparison (P < 0.05). Further, between groups comparison showed significant higher improvements in upper extremity functions and HGS in favor of group A while trunk control scores showed no significant difference between the two groups (P > 0.05). Arm ergometer exercises have the capability to enhance upper extremity functions, HGS and trunk control. It is therefore beneficial for physical rehabilitation specialists to incorporate the arm ergometer exercises into the intervention plans for children with spastic diplegia.

Hindi version of the lower extremity functional scale: a study of translation, validation and cross-cultural adaptation

BACKGROUND: Lower Extremity Function Scale (LEFS) serves as a patient-reported outcome measure, used to evaluate the functional status of lower extremity in different musculoskeletal conditions. It was originally developed in English language (E-LEFS) and numerous translations in different languages are available to measure its usability among different cultures. OBJECTIVES: To translate the English version of the Lower Extremity Function Scale (E-LEFS) into Hindi language and to evaluate its content validity, cross-cultural adaptation along with the concurrent validity and reliability. METHOD: Process of forward and backward translation was carried out by two bilingual translators and a physiotherapist after obtaining developer’s approval, for which the Beaton guidelines were used. For the content validation, Delphi method of was employed in which 12 field experts of more than 5 years of experience participated. Cultural adaptation procedures were then carried out with 12 patients, who reported in out-patient department of the hospital through convenience sampling who were asked about whether the H-LEFS was well understood by the patients. Their responses were recorded as positive and negative responses. This process was followed by concurrent validation which was conducted by comparing the scores with the SF-36 scale, involving 30 patients with activity limitation in their daily life. Lastly, 50 patients were recruited for intra-rater reliability testing. RESULT: The scale was successfully translated and verified by the bi-lingual language experts. Content validity came out to be significant with each item scoring more than 0.92. Nearly all items, excluding item no. 8, 16, 17, 18, and 19 received universal agreement with a content validity ratio of 1. The average scale-level validity stood at 0.98, indicating excellent level of validity and the scale was found to be well adapted by the native people as out of 12 patients, 10 patients provided 100% positive response. Concurrent validation using Pearson’s correlation coefficient came out excellent with the values of 0.993 for E-LEFS and 0.890 for SF-36. Cronbach's alpha and ICC values were calculated as 1.00 for Intra-rater reliability. CONCLUSION: LEFS was well translated into Hindi language with an excellent content and concurrent validity and is found to be highly reliable. Hence, it is recommended for the usage of native Hindi speaking population.

Simultaneous reconstruction of tibial osteomyelitis-complicated soft tissue defects using free flap transplantation in conjunction with the masquelet technique: a retrospective study

ObjectiveTo investigate the clinical effect of anterolateral femoral free flap combined with Masquelet technique in the treatment of tibial osteomyelitis with wound surface.MethodsA retrospective study was conducted to analyze the clinical data of 25 patients with tibial osteomyelitis combined with defected wounds in Xijing Hospital of Fourth Military Medical University from Jun 2017 to Oct 2021. After one-stage treatment with free flap combined with Masquelet technique, the infection index, lower extremity function score (LEFS), and Mazur ankle function score were compared before bone defect repair and at the last follow-up.ResultsThe anterolateral femoral free flaps of 25 patients in phase I survived. The healing time of bone fracture after stage II operation was 8–12 months [(7.2 ± 0.9) months]. At the last follow-up, the infection index was significantly lower than that before bone defect repair (P < 0.01). The LEFS and Mazur ankle function scores [(56.2 ± 7.9) and (78.2 ± 16.1)] of the affected limb were significantly higher than those before bone defect repair [(26.0 ± 8.6) and (44.7 ± 18.2)] (P < 0.01). Wounds of all patients’ legs healed well, without complications (foot drop, joint dysfunction, or deformity in the affected limbs).ConclusionThe anterolateral femoral free flap combined with Masquelet technique is an effective treatment strategy for tibial osteomyelitis combined with soft tissue defects. This technology can effectively repair limb trauma, inhibit infection, and improve flexion and extension functions of knee and ankle joint.

A Randomized Feasibility Study of Rehabilitation Targeting Upper Extremity Function and Participation Using Hippotherapy and the Equine Environment for Children with Cerebral Palsy and Autism Spectrum Disorder.

Introduction: Children with upper extremity neuromotor impairments often have decreased participation in life activities. Hippotherapy and rehabilitation in the equine environment might be effective in targeting participation, given the community context and natural activity involvement. This randomized controlled feasibility trial assessed recruitment, retention, treatment fidelity, and acceptability of rehabilitation using hippotherapy and the equine environment, targeting upper extremity function and participation for children with neuromotor impairments to inform a larger trial. Methods: This 6-month trial occurred in Ohio, June-December 2021. Participants were 6-17 years old with upper extremity neuromotor impairment (and primary diagnosis of cerebral palsy and/or autism). Participants were randomized into treatment or waitlist control using REDCap. Treatment was 16 h (4 h/week/4 weeks) of rehabilitation using hippotherapy and the equine environment. Control participants completed a 4-week waiting period, then received the treatment. Recruitment, screening, enrollment, attendance, and retention were tracked. Nonblinded assessments of body structures and functions, activity, and participation were administered pre- and postcontrol and treatment. Assessment measure completion, treatment fidelity, and acceptability were recorded. Results: Twenty-six participants were screened between July and October 2021; 77% (20/26) met inclusion criteria; 70% (14/20) enrolled and randomized: 6 control and 8 treatment. Two withdrew after randomization and one was excluded for fear of horses. In total, n = 5 control and n = 6 treatment completed initial assessment. Retention was 80% (4/5) control and 83% (5/6) treatment, just below the a priori criteria (85%). Assessment measure completion was variable (77%-100%) and replacement of some should be considered before advancing to a clinical trial. Treatment fidelity and acceptability were moderate to high. There were no adverse events from study participation. Conclusions: Results demonstrated preliminary evidence of fidelity and acceptability of rehabilitation using hippotherapy and the equine environment for children with upper extremity neuromotor impairments. Some changes should be made to improve enrollment, retention, and outcome measure completion before advancing to a definitive trial. Trial registration: ClinicalTrials.gov identifier: NCT0653068. Trial funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Foundation for Physical Therapy Research, American Academy of Cerebral Palsy and Developmental Medicine, and Pedal With Pete Foundation.

EFFECTIVENESS OF PLYOMETRIC EXERCISE ON LOWER EXTREMITY FUNCTION AMONG CLASSICAL BHARATANATYAM DANCERS.

Background: Aramandi is the most basic position in Bharatanatyam which is like Demiplie position of ballet dancers in which both the legs were internally rotated. Gaining proficiency in Bharatanatyam requires rigorous training for prolonged periods of time while maintaining specific postures which begin at a very young age during the adolescent growth spurt. Objective. To find out the effectiveness of plyometric exercise on lower extremity function among classical Bharatanatyam dancers Methods. Totally 20 classical dancers were recruited in accordance with inclusion criteria. Classical dancers were given plyometric exercise. Post-test taken for 20 participants with regular follow up. The LEFS questionnaire is an outcome measure that is used before and after the treatment. Result. The obtained data were analyzed by using paired ‘t’ test comparison of pre and post-test value for LEFS questionnaire the p value is 0.001. Hence, it is concluded that the LEFS questionnaire has highly significant. Conclusion. This study concluded that plyometric exercise had beneficial effect to shows that there is an improvement on lower extremity function among classical Bharatanatyam dancers.

Efficacy of anodal transcranial direct current stimulation for upper extremity function after ischemic stroke: A systematic review of parallel randomized clinical trials

BackgroundAlthough existing studies had shown therapeutic effects of transcranial direct current stimulation (tDCS) on upper limb dysfunction after stroke, previous systematic reviews had mostly provided general analyses on the polarity of tDCS and the type of stroke, with inconsistent results. We aimed to determine the efficacy of anodal transcranial direct current stimulation in enhancing upper extremity function following ischemic stroke. MethodsA comprehensive search was conducted across a variety of databases, spanning from their inception to March 15th, 2024.The focus was on parallel randomized clinical trials published that explored the impact of anodal transcranial direct current stimulation on upper extremity function in ischemic stroke patients. Data extraction and quality assessment were conducted independently by two reviewers. The Cochrane Risk of Bias Tool was utilized to assess the risk of bias in the included studies. ResultsA total of 19 studies involving 1032 participants were included in the analysis. The pooled results of these studies indicated that anodal transcranial direct current stimulation had a positive impact on the Fugl-Meyer Assessment Upper Extremity, Wolf Motor Function Test, Resting Motion Threshold, and Barthel Index Score in ischemic stroke patients with upper extremity dysfunction. Follow-up data suggested the potential long-term efficacy of anodal transcranial direct current stimulation in ischemic stroke. Reported adverse reactions indicated that anodal transcranial direct current stimulation was relatively safe for stroke patients. ConclusionsAnodal transcranial direct current stimulation is an effective intervention and relatively safe and effective intervention for improving upper extremity function in ischemic stroke patients.

Risk Factors and Injury Prevention in the Throwing Athlete

Arm injuries are the most common throwing injury, with growing concern as the most severe injuries, such as UCL reconstruction continue to rise. Furthermore, throwing injuries are frequently recurrent suggesting once injured, players are at increased risk for another arm injury. The increase in injury rates and severity has been attributed to increases in pitching volume and year around participation, and specialized training. Thus, initial efforts to prevent arm injuries by USA Baseball and Little League have focused on the extrinsic factor of pitching exposure in the form of pitch counts, yet arm injury rates have stayed constant. Therefore, injury prevention strategies should include extrinsic factors, and address modifiable, intrinsic factors that are associated with arm injury. Collectively addressing factors such as shoulder range of motion and strength deficits, trunk and lower extremity function, and implantation of training programs yields a comprehensive approach to reduce arm injury rates. We will use a directed acyclic graph (DAG) to organize how the internal factors (i.e. fatigue, injury history, ROM and strength) interact with the external factors (i.e. training load and pitching exposure) and how together they are thought contribute to potential injury and inform arm injury reduction strategies. This will provide a roadmap to build adaptable arm injury reduction strategies to improve the modifiable physical factors in context of the external factors that change over time and between throwing athletes. Level of EvidenceLevel V, Expert Opinion

Hospitalization and Hospitalized Delirium Are Associated With Decreased Access to Kidney Transplantation and Increased Risk of Waitlist Mortality.

Kidney transplant (KT) candidates often experience hospitalizations, increasing their delirium risk. Hospitalizations and delirium are associated with worse post-KT outcomes, yet their relationship with pre-KT outcomes is less clear. Pre-KT delirium may worsen access to KT due to its negative impact on cognition and ability to maintain overall health. Using a prospective cohort of 2374 KT candidates evaluated at a single center (2009-2020), we abstracted hospitalizations and associated delirium records after listing via chart review. We evaluated associations between waitlist mortality and likelihood of KT with hospitalizations and hospitalized delirium using competing risk models and tested whether associations differed by gerontologic factors. During a median of 1.8 years after listing, 735 (31.0%) candidates had ≥1 hospitalizations. Candidates with less education, frailty, depressive symptoms, and lower extremity function impairment were more likely to be hospitalized. Hospitalization was associated with higher waitlist mortality (aSHR = 3.65, 95% CI: 2.99-4.45) and a lower likelihood of KT (aSHR = 0.74, 95% CI: 0.66-0.84). Among candidates who were hospitalized, 80 (11%) had ≥1 delirium episodes. Candidates who were older, frail, and impaired in lower extremity function were more likely to have delirium, which was associated with higher waitlist mortality (aSHR = 4.87, 95% CI: 3.42-6.93) and a lower likelihood of KT (aSHR = 0.45, 95% CI: 0.27-0.74). The association between hospitalization and KT differed by candidate age (pinteraction<0.001), with those aged ≥65 having a 61% lower likelihood of KT. Hospitalization and delirium are associated with worse pre-KT outcomes and have serious implications on candidates' access to KT. Providers should work to reduce preventable instances of delirium.

Gender differences in effects of Graston technique, active release technique, and PNF stretching on hamstring flexibility in knee osteoarthritis

Aims. To seek gender differences among the effects of the Graston Technique (GT), Active Release Technique (ART), and Proprioceptive Neuromuscular Facilitation (PNF) stretching on hamstring flexibility, pain, lower extremity function, and physical function in patients with knee osteoarthritis. Materials and methods. A multicenter, single-blind randomized controlled trial was conducted involving 45 patients – aged above 30 years with knee osteoarthritis – randomly allocated to three equal groups: Group-A (GT), Group-B (ART), and Group C (PNF). Each group received 12 physiotherapy sessions over a four-week intervention period (3 visits per week). Data were collected before and after rehabilitation using the Numeric Pain Rating Scale, Active Knee Extension Test, Lower Extremity Function Scale, and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Results. A statistically significant interaction between the effects of gender and Active Release Technique on lower extremity function was present (p &lt; 0.001) with males (42.4 ± 2.2) showed more improvement than females (35.6 ± 6.6). On the contrary, females showed more improvement (p &lt; 0.001) than males when Graston Technique and PNF techniques were applied. Conclusion. There were no significant gender-based differences among GT, ART, and PNF regarding pain, hamstring flexibility and WOMAC score. However, males showed significantly more improvement in lower extremity function than females with ART, and females showed more improvement in lower extremity function as compared to males with GT and PNF.

At-home wearable-based monitoring predicts clinical measures and biological biomarkers of disease severity in Friedreich’s Ataxia

BackgroundFriedreich ataxia (FRDA) results in progressive impairment in gait, upper extremity coordination, and speech. Currently, these symptoms are assessed through expert examination at clinical visits. Such in-clinic assessments are time-consuming, subjective, of limited sensitivity, and provide only a limited perspective of the daily disability of patients.MethodsIn this study, we recruited 39 FRDA patients and remotely monitored their physical activity and upper extremity function using a set of wearable sensors for 7 consecutive days. We compared the sensor-derived metrics of lower and upper extremity function as measured during activities of daily living with FRDA clinical measures (e.g., mFARS and FA-ADL) and biological biomarkers of disease severity (guanine-adenine-adenine (GAA) and frataxin (FXN) levels), using Spearman correlation analyses.ResultsThe results show significant correlations with moderate to high effect sizes between multiple sensor-derived metrics and the FRDA clinical and biological outcomes. In addition, we develop multiple machine learning-based models to predict disease severity in FRDA using demographic, biological, and sensor-derived metrics. When sensor-derived metrics are included, the model performance enhances 1.5-fold and 2-fold in terms of explained variance, R², for predicting FRDA clinical measures and biological biomarkers of disease severity, respectively.ConclusionsOur results establish the initial clinical validity of using wearable sensors in assessing disease severity and monitoring motor dysfunction in FRDA.

The effect of trunk control on sitting balance and upper extremity functions in patients with subacute stroke.

Impairment of trunk control is a common problem after stroke, and trunk impairment may affect many functions such as breathing, speech, limb movements and transfers. The present study was aimed to investigate the effect of trunk control on sitting balance and upper extremity functions in individuals with subacute stroke. A total of 30 patients with subacute stroke (14 female, 16 male) were included in this study. The mean age of the included patients was 59.80 ± 13.22 years, and the mean disease duration was 2.90 ± 1.38 months. Trunk Impairment Scale (TIS), Trunk Control Test (TCT), Function in Sitting Test (FIST), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Brunnstrom Recovery Stages of Arm (BRS-A) and Brunnstrom Recovery Stages of Hand (BRS-H) were performed to the patients. The results of our study showed that there was a strong positive correlation was found between TIS and FIST (r = 0.765, p < 0.001). There was also a positive moderate correlation between TCT and FIST, FMA-UE, BRS-A and BRS-H (r = 0.67, r = 0.49, r = 0.49, r = 0.44; p < 0.05; respectively). There was a positive moderate correlation between TIS and FMA-UE, BRS-A and BRS-H (r = 0.67, r = 0.65 and r = 0.58; p < 0.005; respectively). In conclusion, trunk control has been shown to be a factor associated with sitting balance and upper extremity function in patients with subacute stroke.