Functional Ambulation Research Articles

Homoeopathic Treatment of Postnatal Stage IV Pressure Ulcer: A Case Report

AbstractPressure ulcer or decubitus ulcer is generally caused due to constant pressure on the dependent parts of the body owing to impaired blood circulation. Due to this condition, the affected area shows varying changes from disruption of normal skin texture to formation of ulcer, many a times with discharge. Very commonly seen in cases with restricted ambulatory functions and /or immunodeficiency, pressure ulcers become a nuisance if left unattended.A case of a 28-year-old female patient presented with stage IV decubitus ulcer on her right gluteus since the delivery of her 6 month old child. She had complaints of stinging or splinter like pain and itching of affected area with discharge of offensive pus worsening at night and with slightest touch. On the basis of totality, Acidum nitricum 200 was given, which provided a very favourable result in terms of healing the ulcer and progressing the state to a healthier one within 3 months. The outcome assessment in this case report was done by using the ‘MONARCH Inventory’.

Assistive Technology Involving Postural Control and Gait Performance for Adults with Stroke: A Systematic Review and Meta-Analysis.

This study aimed to comprehensively summarize assistive technology devices for postural control and gait performance in stroke patients. In the study, we searched for randomized controlled trials (RCTs) published until 31 December 2022 in four electrical databases. The most frequently applied assistive technology devices involving postural stability and gait function for stroke patients were robot-assistive technology devices. Out of 1065 initially retrieved citations that met the inclusion criteria, 30 RCTs (12 studies for subacute patients and 18 studies for chronic patients) were included in this review based on eligibility criteria. The meta-analysis included ten RCTs (five studies for subacute patients and five for chronic patients) based on the inclusion criteria of the data analysis. After analyzing, the variables, only two parameters, the Berg balance scale (BBS) and the functional ambulation category (FAC), which had relevant data from at least three studies measuring postural control and gait function, were selected for the meta-analysis. The meta-analysis revealed significant differences in the experimental group compared to the control group for BBS in both subacute and chronic stroke patients and for the FAC in chronic stroke patients. Robot-assistive training was found to be superior to regular therapy in improving postural stability for subacute and chronic stroke patients but not gait function. This review suggests that robot-assistive technology devices should be considered in rehabilitative approaches for postural stability and gait function for subacute and chronic stroke patients.

Agreement between video-based clinician-rated tools and patient-reported outcomes on gait assessment in individuals with multiple sclerosis.

To our knowledge, no studies compared the video-clinician-based tools and patient-reported questionnaires in assessing gait and balance in people with MS (pwMS). The present study investigated the correlation and agreement between video-clinician-based objective measurement tools and patient-reported outcome measures (PROMs) in gait and balance evaluation. A prospective cross-sectional study was conducted with 55 pwMS. Video analysis-based gait was evaluated by the Tinetti Gait Assessment (TGA), Gait Assessment and Intervention Tool (GAIT), and Functional Ambulation Classification Scale (FACS) by the clinician. Participants' self-reported gait and balance were assessed with the Multiple Sclerosis Walking Scale-12 (MSWS-12) and Activity-Specific Balance Confidence Scale (ABC). There was a moderate positive correlation between ABC with TGA and FACS (r1: 0.552, r2: 0.510, p < 0.001). ABC was strongly correlated with GAIT (r: - 0.652, p < 0.001). A moderate positive correlation was observed between MSWS-12 with TGA and FACS (r1: - 0.575, r2: - 0.524, p < 0.001). In addition, there was a strong positive correlation between MSWS-12 and GAIT (r: - 0.652, p < 0.001). Clinician-rated tools and PROMs were within the agreement limits regarding the unstandardized beta values p < 0.001). Clinician-based gait and balance tools demonstrate consistent results with PROMs in pwMS. Considering the low cost and practical use of PROMs, in cases where video-based clinician-based measurements cannot be provided (time, space, and technical inadequacies), questionnaires can provide concordant results at moderate and severe levels compared with objective tools.

Exoskeletal wearable robot on ambulatory function in patients with stroke: a protocol for an international, multicentre, randomised controlled study

IntroductionThe purpose of this study is to determine the effect of overground gait training using an exoskeletal wearable robot (exoskeleton) on the recovery of ambulatory function in patients with subacute...

Relationship between disability and psychiatric outcome in multiple sclerosis patients and its determinants

BackgroundMultiple sclerosis (MS) is an inflammatory demyelinating central nervous system disease with diverse clinical manifestations. The present study aimed to compare the psychiatric outcomes of MS patients with full ambulatory versus impaired ambulatory function and identify the potential risk factors for disability in MS. Seventy MS patients were classified into two groups based on their Expanded Disability Status Scale (EDSS) scores, Group A: full ambulatory (EDSS ≤ 4.5) (N = 48), Group B: impaired ambulatory (EDSS ≥ 5) (N = 22). All participants were evaluated by the Socioeconomic Scale, Hamilton Anxiety Scale, Hamilton Depression Scale, Brief Psychiatric Rating Scale, and The Pittsburgh Sleep Quality Index.ResultsIn the total cohort (N = 70), females represented (77.1%). The mean age was 31.16 ± 6.46, the mean age of onset was 26 ± 6.083, and the mean disease duration was 5.33 ± 3.653 years which was less in Group A than in Group B. Relapsing–remitting multiple sclerosis (RRMS) was the most common presentation (80%), representing 93.6% of Group A. Group A reported more severe depression and anxiety, while Group B had more poor sleep quality. Correlation analysis showed increased relapses, progressive-relapsing multiple sclerosis (PRMS), cervical or dorsal plaques, sensory or motor manifestations, and precipitancy increased disability, while RRMS type decreased disability.ConclusionsFull ambulatory MS patients had high anxiety and depression, while impaired ambulatory MS patients had poor sleep quality. Associated factors for disability were frequent relapses, plaque location, MS subtype, sphincter, and sensory symptoms.Trial registration clinicaltrials.gov, NCT05029830. Registered: September 01, 2021, https://clinicaltrials.gov/ct2/show/NCT05029830

The effect of pre-rehabilitation and rehabilitation period on functional status in hospitalized stroke patients

Objective: In this study, we aimed to investigate the effect of pre-rehabilitation and rehabilitation hospitalization periods on the functional status of the patient. Methods: In this retrospective study, stroke patients hospitalized in our rehabilitation clinic were screened. Patients' age, gender, type of stroke, affected hemisphere, spasticity, functional ambulation category (FAC), mini-mental status, length of pre-rehabilitation and rehabilitation period, Brunsstrom staging, and Barthel index were investigated. Results: One hundred eight patients were included in the study. The mean age was 64.9±14.8. The mean length of pre-rehabilitation was 16.2±12.8 and rehabilitation was 20.7±9.1 days. A significant negative correlation was observed between the length of the rehabilitation period and all Brunnstrom sub-assessments after rehabilitation. A significant positive correlation was observed between the length of the rehabilitation period and the change in Brunnstrom stage for upper and lower extremity values, the stroke effect scale after rehabilitation, and the change in stroke impact scale value. A significant negative correlation was observed between pre-rehabilitation time and the Barthel index before and after rehabilitation. Conclusion: The prolongation of the pre-rehabilitation period is not a negative factor for functional gain in rehabilitation. The rehabilitation period of the patient should be decided by considering the functional status of the patient.

Physiotherapy applied to palliative care patients: a descriptive practice-based study

BackgroundOver the last few years, the presence of physiotherapists in Palliative Care Units (PCU) has considerably grown based on evidence from studies supporting the use of non-pharmacological measures as part of Palliative Care (PC) treatments. However, more accumulated data are needed to definitively establish its added value. The present study describes the type of patients receiving physiotherapy in a PCU and the benefits obtained in relation to their degree of functional dependence.MethodsAn observational, prospective, descriptive, practice-based study was undertaken involving patients admitted to the PCU of Fundación Instituto San José (Madrid, Spain), who according to the PCU´s clinical practice, met the criteria for physiotherapy intervention. Daily clinical practice was unchanged for study reasons. Participants were assessed prior to initiating and at the end of the physiotherapy program using the following standard scales: the Barthel Index, the Functional Ambulation Categories scale, the Palliative Performance Scale, and the Braden scale. A descriptive analysis was performed and scale scores prior to and after treatment were compared using the Wilcoxon signed-rank test. Significance was set at 0.05.ResultsA total of 63 patients were included (mean age 71.98 ± 12.72; 61.9% males). Fifty-eight patients (92.1%) were oncological patients; of them, 35 (60.3%) had metastases. Prior to treatment, 28 (44.4%) participants had total dependence according to the Barthel index, and 37 (58.7%) were non-functional ambulator according to the FAC scale. At the end of treatment, the number of patients with total dependence decreased to 15 (23.8%) and those non-functional ambulator to 12 (19.0%).ConclusionsPatients who benefited from physical therapy during their admission to our PCU were predominantly males with oncological processes, mainly lung cancer. PC including physiotherapy improved their functionality, independence and skills for activities of daily living in this sample of PCU patients.

Feasibility of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability: a randomized controlled trial.

Treadmill training shows advantages in the specificity, amount, and intensity of gait and balance practice for the rehabilitation of stroke patients. To investigate the feasibility and effectiveness of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability. For this randomized controlled trial (Chinese Clinical Trials.gov registration number ChiCTR-IOR-16009536) with blinded testers, we recruited 33 ambulatory stroke participants with restricted community ambulation capacity and randomly assigned them into two groups: the experimental group with 2 week treadmill speed-dependent gait training combined with 2 week treadmill perturbation-induced balance training (EXP) or the control group with traditional gait and balance training (CON). Various variables were recorded during EXP training, including the rating of perceived exertion, heart rate, causes of pauses, treadmill speed, and perturbation intensity. Outcome measures were examined before training and at 2 and 4 weeks after training. They included gait velocity during five-meter walk test at comfortable and fast speed and reactive balance ability in the compensatory stepping test as primary outcome measures, as well as dynamic balance ability (timed up-and-go test and 5 times sit-to-stand test) and balance confidence as secondary outcome measures. All participants completed the study. The treadmill speed and perturbation intensity significantly increased across training sessions in the EXP group, and no adverse effects occurred. The normal and fast gait velocities showed significant time and group interaction effects. They significantly increased after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05). Likewise, dynamic balance ability measured using the timed up-and-go test at a fast speed significantly improved after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05), although without a significant time and group interaction effect. Surprisingly, the reactive balance ability did not show improvement after treatment in the EXP group (p > 0.05). Challenging treadmill speed-dependent gait and treadmill perturbation-induced balance training is feasible and effective to improve ambulation function in chronic stroke patients with low ambulation ability.

Effects of strength training on functional ambulation following knee replacement: a systematic review, meta-analysis, and meta-regression

Strength training is recommended by the American Physical Therapy Association to improve muscle strength, mobility, and balance following knee replacement. Few studies have focused on the direct effects of strength training on functional ambulation, and potential dose–response relationships between strength training parameters and the effect remain unclear. The aim of this systematic review, meta-analysis, and meta-regression was to evaluate the effects of strength training on functional ambulation following knee replacement (KR). We also aimed to explore potential dose–response relationships between strength training parameters and performance in functional ambulation. A systematic literature search of eight online databases was performed on March 12, 2023, for randomized controlled trials evaluating the effects of strength training on functional ambulation by six-minute walk test (6MWT) or timed-up and go test (TUG) after KR. Data were pooled by random-effect meta-analyses and presented as weighted mean difference (WMD). A random-effect meta-regression was performed for four predetermined training parameters, namely, duration (weeks), frequency (sessions per week), volume (time per session), and initial time (after surgery) separately to explore dose–response relationships with WMD. Fourteen trials encompassing 956 participants were included in our study. Meta-analyses showed an improvement in 6MWT performance after strength training (WMD: 32.15, 95% CI 19.44–44.85) and a decrease in time to complete TUG (WMD: − 1.92, 95% CI − 3.43 to − 0.41). Meta-regression revealed a dose–response relationship only between volume and 6MWT, with a decreasing trend (P = 0.019, 95% CI − 1.63 to − 0.20). Increasing trends of improvement in 6MWT and TUG were observed with increasing training duration and frequency. A slight decreasing trend of improvement was observed in 6MWT with postponed initial time, while an opposite trend was observed in TUG. Based on existing studies, moderate-certainty evidence suggests that strength training could increase 6MWT distance, and low-certainty evidence shows that strength training could decrease the time to complete TUG after KR. Meta-regression results only suggested a dose–response relationship between volume and 6MWT with a decreasing trend.Registration: PROSPERO: CRD42022329006.

Physical function and activity, pain, and health status in adults with myelomeningocele after orthotic management from childhood: a descriptive study

BackgroundIndividuals with myelomeningocele (MMC) exhibit neurological deficits below the lesion level involving both motor and sensory functions. Ambulation and functional outcomes in patients offered orthotic management since childhood were investigated.MethodsPhysical function, physical activity, pain, and health status were assessed in a descriptive study.ResultsOf 59 adults with MMC, aged 18–33 years, 12 were in the community ambulation (Ca), 19 in the household ambulation (Ha), six in the non-functional (N-f), and 22 in the non-ambulation (N-a) groups. Orthoses were used by 78% (n = 46), i.e., by 10/12 in the Ca, 17/19 in the Ha, 6/6 in the N-f, and 13/22 in the N-a groups. In the ten-metre walking test, the non-orthosis group (NO) walked faster than those wearing ankle-foot orthoses (AFOs) or free-articulated knee-ankle-foot orthoses (KAFO-Fs), the Ca group faster than the Ha and N-f groups, and the Ha group faster than the N-f group. In the six-minute walking test, the Ca group walked farther than the Ha group. In the five times sit-to-stand test, the AFO and KAFO-F groups required longer than the NO group, and the KAFO-F group longer than the foot orthosis (FO) group. Lower extremity function with orthoses was higher in the FO than the AFO and KAFO-F groups, higher in the KAFO-F than the AFO group, and higher in the AFO group than in those using trunk-hip-knee-ankle-foot orthoses. Functional independence increased with ambulatory function. Time spent in physical recreation was higher in the Ha than the Ca and N-a groups. There were no differences between the ambulation groups in rated pain or reported health status.ConclusionThe physical function results in persons with MMC improve our understanding of this population’s heterogeneity and shed light on the importance of individualized orthotic management. The similarities between the various ambulatory levels in physical activity, pain, and health status may mirror opportunities to achieve equal results regardless of disability level. A clinical implication of the study is that orthotic management is likely to be beneficial for the patient with MMC of which the majority used their orthoses for most time of the day.

Inpatient rehabilitation outcomes in patients with the new diagnosis of COVID-19 tractopathy: a case series.

Retrospective Case Series. Describe the inpatient rehabilitation outcomes of four patients with COVID-19 tractopathy. Olmsted County, Minnesota, United States of America. Retrospective review of medical records was performed to collect patient data. Four individuals (n = 4, 3 men and 1 woman, mean age 58.25 years [range 56-61]) completed inpatient rehabilitation during the COVID-19 pandemic. All presented after COVID-19 infection and were admitted to acute care with progressive paraparesis. None were able to ambulate on admission to acute care. All received extensive evaluations which were largely negative except for mildly elevated CSF protein and MRI findings of longitudinally extensive T2 hyperintensity signal changes in the lateral (n = 3) and dorsal (n = 1) columns. All patients experienced incomplete spastic paraparesis. All patients experienced neurogenic bowel dysfunction; a majority experienced neuropathic pain (n = 3); half experienced impaired proprioception (n = 2); and a minority experienced neurogenic bladder dysfunction (n = 1). Between rehabilitation admission and discharge, the median improvement in lower extremity motor score was 5 (0-28). All patients were discharged home, but only one was a functional ambulator at time of discharge. While the underlying mechanism is yet to be elucidated, in rare cases a COVID-19 infection can lead to a tractopathy, presenting as weakness, sensory deficits, spasticity, neuropathic pain, and neurogenic bladder/bowel. Patients with COVID-19 tractopathy would benefit from inpatient rehabilitation to enhance their functional mobility and independence.

Surgical and long-term functional outcomes of patients with Duchenne muscular dystrophy following spinal deformity correction.

Life expectancy in patients with Duchenne muscular dystrophy (DMD) has improved due to advances in medical care. DMD patients develop progressive spinal deformity after loss of ambulatory function and onset of wheelchair dependence for mobility. There is limited published data on the effect of spinal deformity correction on long-term functional outcomes, quality of life (QoL), and satisfaction in DMD patients. To investigate the long-term functional outcomes following spinal deformity correction in DMD patients. This was a retrospective cohort study from 2000-2022. Data was collected from hospital records and radiographs. At follow-up, patients completed the muscular dystrophy spine questionnaire (MDSQ). Statistical analysis was performed by linear regression analysis and ANOVA to analyse clinical and radiographic factors significantly associated with MDSQ scores. Forty-three patients were included with mean age 14.4 years at surgery. Spino-pelvic fusion was performed in 41.9% of patients. Mean surgical time was 352.1 min and mean blood loss was 36% of estimated total blood volume. Mean hospital stay was 14.1 d. Postoperative complications occurred in 25.6% of patients. Mean preoperative scoliosis was 58°, pelvic obliquity 16.4°, thoracic kyphosis 55.8°, lumbar lordosis 11.1°, coronal balance 3.8 cm, and sagittal balance + 6.1 cm. Mean surgical correction of scoliosis was 79.2% and of pelvic obliquity was 80.8%. Mean follow-up was 10.9 years (range: 2-22.5). Twenty-four patients had died at follow-up. Sixteen patients completed the MDSQ at mean age 25.4 years (range 15.2-37.3). Two patients were bed-ridden and 7 were on ventilatory support. Mean MDSQ total score was 38.1. All 16 patients were satisfied with the results of spinal surgery and would choose surgery again if offered. Most patients (87.5%) reported no severe back pain at follow-up. Factors significantly associated with functional outcomes (MDSQ total score) included greater duration of post-operative follow-up, age, scoliosis postoperatively, correction of scoliosis, increased lumbar lordosis postoperatively, and greater age at loss of independent ambulation. Spinal deformity correction in DMD patients leads to positive long-term effects on QoL and high patient satisfaction. These results support spinal deformity correction to improve long-term QoL in DMD patients.

Validity, reliability and minimal detectable change of Mini-BESTest Turkish version in neurological disorders.

It is aimed to investigate the psychometric properties of Mini-BESTestTR in Turkish patients with neurological disorders. A total of 61 people between the ages of 42 and 80, who were patients with Parkinson's disease, stroke or multiple sclerosis for more than 1year, were included in the study. For inter-rater reliability, two independent researchers applied the scale two times within 5days for test-retest reliability. The relationship of mini-BESTestTR with Berg Balance Scale (BBS) to assess concurrent validity, and Timed Get up and Go (TUG), Functional Reach Test (FRT) and Functional Ambulation Classification (FAC) for convergent validity was investigated. The scores of the two evaluators were within the range of agreement (mean = -0.278 ± 1.484, p > 0.05), and the Mini-BESTestTR had excellent inter-rater reliability [ICC (95% CI) = 0.989 (0.981-0.993)] and test-retest reliability [ICC (95% CI) = 0.998 (0.996-0.999)]. Mini-BESTestTR had a strong correlation with BBS (r = 0.853, p < 0.001) and TUG (r = - 0.856, p < 0.001), had a moderate correlation with FAC (r = 0.696, p < 0.001) and FRT (r = 0.650, p < 0.001). Mini-BESTestTR showed significant correlations with other balance assessment measures, and concurrent and convergent validity of Mini-BESTestTR was demonstrated when administered to a sample of patients with chronic stroke, Parkinson's disease and multiple sclerosis.

Community-wide feasibility of the Lower Extremity Amputation Protocol amongst vascular amputees

BackgroundThe Lower Extremity Amputation Protocol (LEAP) is a multidisciplinary enhanced recovery after surgery pathway for vascular amputees. The objective of this study was to examine feasibility and outcomes of community-wide implementation of LEAP. MethodsLEAP was implemented at three safety net hospitals for patients with peripheral artery disease or diabetes requiring major lower extremity amputation. Patients who underwent LEAP (LEAP) were matched 1:1 with retrospective controls (NOLEAP) on hospital location, need for initial guillotine amputation, and final amputation type (above- vs below-knee). Primary endpoint was postoperative hospital length of stay (PO-LOS). ResultsA total of 126 amputees (63 LEAP and 63 NOLEAP) were included with no difference between baseline demographics and co-morbidities between the groups. After matching, both groups had the same prevalence of amputation level (76% below-knee vs 24% above-knee). LEAP patients had shorter duration of postamputation bed rest (P = .003) and were more likely to receive limb protectors (100% vs 40%; P ≤ .001), prosthetic counseling (100% vs 14%; P ≤ .001), perioperative nerve blocks (75% vs 25%; P ≤ .001), and postoperative gabapentin (79% vs 50%; P ≤ .001). Compared with NOLEAP, LEAP patients were more likely to be discharged to an acute rehabilitation facility (70% vs 44%; P = .009) and less likely to be discharged to a skilled nursing facility (14% vs 35%; P = .009). The median PO-LOS for the overall cohort was 4 days. LEAP patients had a shorter median PO-LOS (3 [interquartile range, 2-5] vs 5 [interquartile range, 4-9] days; P < .001). On multivariable logistic regression, LEAP decreased the odds of a PO-LOS of ≥4 days by 77% (odds ratio, 0.23; 95% confidence interval, 0.09-0.63). Overall, LEAP patients were significantly less likely to have phantom limb pain (5% vs 21%; P = .02) and were more likely to receive a prosthesis (81% vs 40%; P ≤ .001). In a multivariable Cox proportional hazards model, LEAP was associated with an 84% reduction in time to receipt of prosthesis (hazard ratio, 0.16; 95% confidence interval, 0.085-0.303; P < .001). ConclusionsCommunity wide implementation of LEAP significantly improved outcomes for vascular amputees demonstrating that utilization of core ERAS principles in vascular patients leads to decreased PO-LOS and improved pain control. LEAP also affords this socioeconomically disadvantaged population a greater opportunity to receive a prosthesis and return to the community as a functional ambulator.

First-time tethered cord release among adults with myelomeningocele: an analysis of people in the National Spina Bifida Patient Registry.

The authors analyzed the National Spina Bifida Patient Registry (NSBPR), a national registry that tracks the outcomes for people with various forms of spinal dysraphism, to determine the ongoing longitudinal risk for tethered cord release (TCR) among adults with myelomeningocele who had not previously undergone TCR during childhood. The authors also sought to identify the impact of lesion level, ambulation status, and prior treatments for hydrocephalus or Chiari malformations on TCR rates. Adults in the registry who had not previously undergone TCR during childhood were studied. This group was compared with the remaining adults in the registry. The frequency of first-time TCR and time to TCR (using Kaplan-Meier analysis) were determined independently for males and females. Cox proportional hazards analysis identified correlations between sex, best lesion level and ambulation status prior to TCR, and previous treatments for hydrocephalus and Chiari decompression. Among 967 adults in the NSBPR (422 [43.6%] males and 545 [56.4%] females) who had not undergone TCR during childhood, the authors identified 47 people (4.9%) who underwent their first TCR during adulthood. This study cohort had significantly better mean functional motor levels and ambulation compared with the remaining adult cohort (both p < 0.001). The study group included 35 females (74.5%) and 12 males (25.5%); this sex distribution was significantly different in comparison with the remaining adult cohort (p = 0.016). The Kaplan-Meier curves for first TCR for females and males were significantly different (p = 0.01, log-rank test). TCR rates were correlated with sex (males had decreased risk; OR 0.31, 95% CI 0.16-0.62, p < 0.001), prior treatment for hydrocephalus (those who underwent prior treatment had decreased risk; OR 0.21, 95% CI 0.20-0.42, p < 0.001), and prior treatment for Chiari malformation (those who underwent prior treatment had greater risk; OR 3.84, 95% CI 1.50-9.88, p = 0.005). Adults with myelomeningocele who escape childhood without undergoing TCR have an ongoing, albeit decreased, risk for spinal cord tethering requiring TCR. This risk is obviously not due to spinal column growth and therefore must reflect other factors such as dynamic changes in spinal cord health over time. Among people with MMC who underwent their first TCR as adults, females seemed to be overrepresented. Similar to the authors' prior childhood study, people who underwent previous Chiari decompression seemed to be overrepresented, whereas those who underwent previous treatment for hydrocephalus seem to be underrepresented. These novel findings deserve further study.

Wii Fit-Based Biofeedback Rehabilitation Among Post-Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trial.

Stroke is one of the most widespread reasons for acquired adult disability. Recent experimental studies have reported the beneficial influence of Wii Fit-based feedback on improving overall balance and gait for stroke survivors. We conducted a systematic review of the literature using the following keywords to retrieve the data: feedback, biofeedback, stroke, visual, auditory, tactile, virtual reality, videogame rehabilitation, Nintendo Wii stroke, videogame stroke, exergame stroke, Nintendo Wii rehabilitation, balance, and gait. A review and meta-analysis of RCTs regarding Wii Fit-based rehabilitation accompanied by conventional therapy effects on Berg Balance Scale (BBS), Timed Up and Go (TUG), functional reach test, and gait (speed) in stroke survivors was conducted. To determine the impacts of Wii Fit-based feedback combined with traditional therapy on balance and gait in stroke survivors. 22 studies were included. The meta-analysis results revealed statistically significant improvements in functional ambulation measured using TUG (p < 0.0001), balance measured using BBS (p = 0.0001), and functional reach test (p = 0.01), but not in gait speed (p = 0.32) following Wii Fit-based feedback. Regarding the types of feedback, significant differences were found in BBS scores when mixed visual and auditory feedback was used. Wii Fit-based feedback has desired effects on improving balance in stroke patients, making it a suitable adjunct to physical therapy.

Functional Status of Patients over 65 Years Old Intervened on for a Hip Fracture One Year after the Operation.

Evaluation of the functional status one year after a hip fracture surgery and the influence of sarcopenia and other clinical factors at the time of admission. Prospective observational study with 135 patients over 65 years of age. Functional status of basic (modified Katz) and instrumental activities (Lawton and Brody) and walking ability (Functional Ambulation Classification, FAC) was measured on admission, at discharge, and telephonically one year later. The risk or positive screening of sarcopenia (SARC-F) and cognitive status (Pfeiffer), as well as clinical variables, were evaluated. 72% of patients are women; 36% have a risk of sarcopenia (Sarc-F ≥ 4), and 43% have moderate-severe cognitive impairment (Pfeiffer ≥ 5). Walking capacity at one year was closer to the values at admission more often in women than in men (0.2 ± 1.3 points vs. 0.9 ± 1.6; p = 0.001), as well as in patients without risk of sarcopenia versus sarcopenic patients (0.3 ± 1.2 points vs. 0.7 ± 1.7; p = 0.001), although their evolution did not show significant differences (p = 0.183). Instrumental activities after one year have not been recovered (1.7 ± 2.5 points; p = 0.032), and patients at risk of sarcopenia showed worse values (1.7 ± 1.9 points vs. 3.7 ± 2.7; p < 0.001) and worse evolution (p = 0.012). The evolution of basic activities varied according to the risk of sarcopenia (0.6 ± 1.4 points vs. 1.4 ± 2.1; p = 0.008). Functional status at one year is related to the functional status at admission, the positive screening of sarcopenia, sex, and cognitive impairment of the patient. Knowing at the time of admission an estimate of the functional status at one year will help to reinforce the individual treatment of patients with a worse prognosis.

A Biopsychosocial Evaluation of Post-Acute Outcome of Patients with Severe Brain Lesions Recovering from Coma: An Exploratory Study.

Currently, very little is known about the holistic outcome of patients recovering from coma. The aim of this retrospective exploratory study was to evaluate the outcomes of patients recovering from coma after care in an acute neurorehabilitation unit with particular focus on their biopsychosocial and spiritual needs in the post-acute phase of recovery. We included 12 patients and evaluated clinical outcome evolution by comparing standard neurobehavioral scores from patient files measured in the acute and post-acute phases. We assessed patient needs using the Quality of Life after Brain Injury scale (QOLIBRI) and classified self-reported complaints mentioned in patient files according to the International Classification of Functioning, Disability and Health framework (ICF). Mean patient evolution was a Level of Cognitive Functioning Scale (LCF)-r increase of 3.33 levels (range = 2); a Disability Rating Scale score (DRS) of -3.27 points (SD = 3.78); a Functional Ambulation Classification (FAC) scale score of 1.83 (range = 5); and a Glasgow Outcome Scale (GOS) median = 0 (Interquartile range = 1). Main patient complaints concerned mental functioning (n = 7), sensory functioning and pain (n = 6), neuromusculoskeletal and movement problems (n = 5), and major life areas (n = 5). To conclude, a significant handicap that affects their daily life was present in the post-acute phase in most patients. Complaints involved biopsychosocial and spiritual elements. The neurobehavioral scale results do not necessarily correlate with the subjective representations patients had of their condition.

Long-term Outcomes Following Periprocedural and Spontaneous Spinal Cord Infarctions: A Population-Based Cohort Study.

Spinal cord infarction (SCInf) is a rare condition where consensus regarding diagnostic criteria is lacking and mis- or delayed diagnosis can be detrimental. The aim of this study was to describe baseline findings and predictors of long-term functional outcome in a population-based cohort of patients with SCInf. All adult patients (≥18 years) treated at the Spinal Cord Injury Unit of the study center, between 2006-2019, and discharged with a G95 diagnosis ("other and unspecified disease of the spinal cord") were screened for inclusion. The diagnostic criteria proposed by Zalewski et al. were retrospectively applied to evaluate the certainty of the SCInf diagnosis. 270 patients were screened and 57 were included in the study, of whom 30 had a spontaneous and 27 had a periprocedural SCInf. The median American Spinal Cord Injury Association Impairment Scale (AIS) on admission was C, which at median follow-up of 2.1 years had improved to D (p=0.002). Compared to periprocedural cases, spontaneous SCInf showed significantly better admission-AIS (median AIS D vs. B, p<0.001), fewer multilevel SCInf (27% vs. 59%, p=0.029), shorter hospital stay (median 22 vs. 44 days, p<0.001), as well as better AIS (median AIS D vs. C, p<0.001) and ambulatory status on long-term follow-up (66% vs. 1%, p<0.001). Regression analyses revealed that spontaneous SCInfs (OR=5.91 [1.92-18.1], p=0.002) and more favorable admission-AIS (OR=33.6 [7.72-146], p<0.001) were significant predictors of more favorable AIS at follow-up, with admission-AIS demonstrating independent predictive ability (OR=35.9 [8.05-160], p<0.001). SCInf is a rare neurological emergency lacking specific management guidelines. While the presumptive diagnosis is based on the typical presentation and clinical findings, T2-weighted and diffusion-weighted MRI were the most useful diagnostic tools in establishing a definitive diagnosis. Our data shows that spontaneous SCInf mostly affected a single spinal cord segment while periprocedural cases were more extensive, had poorer AIS on admission, poorer ambulatory function, and longer hospital stays. Regardless of the etiology, significant neurological improvements were seen at long-term follow-up, highlighting the importance of active rehabilitation.

The Effect of Rehabilitation without Specific Cognitive Rehabilitation on the Improvement of Cognitive Functions in Stroke Patients: Evaluation with Risk Factors

Aim: This study aimed to evaluate if rehabilitation without specific cognitive rehabilitation improved cognitive functions in patients who had suffered a stroke more than 1 year ago, and to correlate this finding with risk factors. Material and Methods: Thirty stroke patients were included in the study. A rehabilitation program was administered to the patients for a total of 30 sessions, 5 days a week. In addition, demographic data of the patients were collected, as well as several risk factors that may impair their cognitive function. The pre-and post-treatment cognitive function of the patients was evaluated using mini-mental state examination (MMSE) and functional independence measure (FIM)-cognitive. With the FIM cognitive evaluation, cognitive functions such as comprehension, expression, social interaction, problem solving, and memory were evaluated. With MMSE, from cognitive functions; orientation, registration, attention and calculation, recall, language, and praxis were evaluated. Pre- and post-treatment motor function was measured by the Brunnstrom motor recovery stage (BMRS). Pre- and post-treatment walking ability was assessed with Functional Ambulation Categories (FAC). Along with the general comparison of cognitive function pre- and post-treatment, additional pre- and post-treatment comparisons were made according to risk factors. Results: According to MMSE and FIM-cognitive scores, improvement in cognitive function was detected following treatment (p&amp;lt;0.001, p=0.001, respectively). There was no statistical improvement in FAC and BMRS scores. According to MMSE, cognitive functions were more impaired before treatment in women, those with &amp;lt;5 years of education, and those with aphasia (p=0.025, p=0.004, p=0.002, respectively). According to FIM-cognitive, cognitive functions were lower in patients with aphasia, and those with left-sided brain damage (p=0.002, p=0.045, respectively). There was no difference in the magnitude of improvement between the risk factors. Conclusion: This study showed that the rehabilitation program applied without a specific cognitive rehabilitation program in patients with chronic stroke can improve cognitive functions, although it does not cause a significant improvement compared to BMRS and FAC. Therefore, we believe that rehabilitation without specific cognitive rehabilitation will improve patients' daily activities and increase their participation in treatment.