Good Functional Ability Research Articles

Cerebral palsy in children: A clinical practice review

Cerebral palsy is a disorder characterized by abnormal tone, posture, and movement. In clinical practice, it is often useful to approach cerebral palsy based on the predominant motor system findings – spastic hemiplegia, spastic diplegia, spastic quadriplegia, extrapyramidal or dyskinetic, and ataxic. The prevalence of cerebral palsy is between 1.5 and 3 per 1,000 live births with higher percentage of cases in low to middle income countries and geographic regions. Pre-term birth and low birthweight are recognized as the most frequent risk factors for cerebral palsy; other risk factors include hypoxic-ischemic encephalopathy, maternal infections, and multiple gestation. In most cases of cerebral palsy, the initial injury to the brain occurs during early fetal brain development. Intracerebral hemorrhage and periventricular leukomalacia are the main pathologic findings found in preterm infants who develop spastic cerebral palsy. The diagnosis of cerebral palsy is primarily based on clinical findings. Early recognition of infants at risk for cerebral palsy as well as those with cerebral palsy is possible based on a combination of clinical history, use of standardized neuromotor assessment and findings on magnetic resonance imaging; however, in clinical practice, cerebral palsy is more reliably diagnosed by 2 years of age. Magnetic resonance imaging scan is indicated to delineate the extent of brain lesions and to identify congenital brain malformations. Genetic testing and tests for inborn errors of metabolism are indicated to identify specific disorders, especially treatable disorders. Because cerebral palsy is associated with multiple associated and secondary medical conditions, its management requires a sustained and consistent collaboration among multiple disciplines and specialties. With appropriate support, most children with cerebral palsy grow up to be adults with good functional abilities.

Sex differences in physical functioning among older adults: cross-sectional results from the OUTDOOR ACTIVE study

BackgroundMaintaining good functional ability is a key component of healthy ageing and a basic requirement for carrying out activities of daily living, staying independent, and delaying admission to a nursing home. Even though women have a higher life expectancy and slower age-related muscle mass loss than men, they often show a higher prevalence of limitations in physical functioning. However, the reasons behind these sex differences are still unclear. Therefore, the aims of this study were to investigate sex differences among older adults regarding physical functioning and to study which factors are explaining these sex differences.MethodsCross-sectional data from participants of the OUTDOOR ACTIVE study residing in Bremen, Germany, aged 65 to 75 years, were included in the analyses. Physical functioning was assessed via a self-administered questionnaire using the SF-36 10-item Physical Functioning Scale. Social, lifestyle, and health-related factors were also assessed using the questionnaire. Physical activity was measured objectively using wrist-worn accelerometers over seven consecutive days. Descriptive analyses with absolute and relative frequencies, means and standard deviations, as well as T-tests and chi-square tests were carried out. To test for associations between sex, physical functioning, and several individual factors, linear regressions were performed.ResultsData of 2 141 participants (52.1% female) were included in the study. Women and men showed statistically significant differences in physical functioning, with men perceiving fewer limitations than women. On average, women had a physical functioning score of 81.4 ± 19.3 and men 86.7 ± 17.0. Linear regression showed a statistically significant negative association between physical functioning score and sex (β: -0.15, 95% CL: -0.19, -0.10). The association remained statistically significant when adding individual factors to the model. All factors together were only able to explain 51% of the physical functioning-sex association with health indicators and the presence of chronic diseases being the most influential factors.ConclusionsWe found sex differences in physical functioning, with older women having more limitations than older men. The results showed that health-related factors and chronic diseases played the biggest roles in the different physical functioning scores of women and men. These findings contribute to future longitudinal, more in-depth research.Trial registrationGerman Clinical Trials Register DRKS00015117 (Date of registration 17-07-2018).

The waist injuries and treatment methods of rowers

Rowing is one of the worlds competitive sports, and it is an extremely energy intensive aerobic sport. This sport requires very strict physical fitness for athletes. Therefore, rowers need to withstand extreme load training and ultra-high intensity endurance training, whether in daily training or in actual competitions. Rowers must possess good physical fitness and functional abilities, as well as flexibility and agility. However, the prolonged physical wear and tear experienced by rowing athletes during training and competition can easily lead to sports injuries. Due to the influence of many factors, emphasis has been placed on rowing physical fitness training. In the specific operation process, it is necessary to closely combine the characteristics of rowing and the actual physical condition of athletes and develop a scientific and reasonable plan for rowing and injury treatment. Therefore, this article first starts from the investigation of physical injuries and types of injuries among different athletes and finds that the proportion of waist injuries is the highest. At the same time, it elaborates on the basic reasons for waist injuries, and finally provides rehabilitation treatment plans, allowing rowing athletes to make more progress and development.

Cortical Activation During Single-Legged Stance in Patients With Chronic Ankle Instability.

Chronic ankle instability (CAI) has been considered a neurophysiological condition, with dysfunctional somatosensory and motor system excitability. However, few researchers have explored the changes in cortical activation during balance tasks of patients with CAI. To compare the cortical activity during single-legged stance among CAI, copers, and uninjured control participants and to compare dynamic balance across groups. Cross-sectional study. Biomechanics laboratory. A total of 22 participants with CAI (median [interquartile range]; age = 34.5 [11.0] years, height = 170.0 [15.8] cm, mass = 67.0 [16.2] kg), 17 copers (age = 27.0 [14.0] years, height = 170.0 [9.5] cm, mass = 66.5 [16.5] kg), and 21 uninjured control participants (age = 25.0 [10.5] years, height = 170.0 [11.0] cm, mass = 64.0 [16.5] kg). Participants performed single-legged stance while cortical activation was tested with functional near-infrared spectroscopy. The peak oxyhemoglobin response of the activated cortex was calculated and compared across groups. The Y-Balance test outcomes and patient-reported outcomes were assessed and compared across groups. The CAI group had worse Y-balance test and patient-reported outcomes than the coper and uninjured control groups. Differences in the peak oxyhemoglobin response were observed for the primary somatosensory cortex (S1; F2,57 = 4.347, P = .017, ηp2 = 0.132) and superior temporal gyrus (STG; F2,57 = 4.548, P = .015, ηp2 = 0.138). Specifically, copers demonstrated greater activation in S1 and STG than the CAI (d = 0.73, P = .034, and d = 0.69, P = .043, respectively) and uninjured control (d = 0.77, P = .036, and d = 0.88, P = .022, respectively) groups. No differences were found in the cortical activation between CAI and uninjured control participants. Copers displayed greater cortical activation in S1 and STG than CAI and uninjured control participants. Greater activation in S1 and STG suggested a better ability to perceive somatosensory stimuli and may represent a compensatory mechanism that allows copers to maintain good functional ability after the initial severe ankle sprain.

P027 Immune checkpoint inhibitor associated vasculitis: a limitation to cancer therapy

Abstract Background/Aims The increasing use of immune checkpoint inhibitors (ICIs) underlies the importance of close monitoring and recognition of associated adverse events. We report a rare case of nivolumab-related peripheral vasculitis with digital gangrene and auto-amputation in a patient treated for mesothelioma. Methods A 69-year-old male with T4M0N0 pulmonary sarcoid mesothelioma was commenced on second-line Nivolumab therapy. 11 days later, he presented with worsening dyspnoea and dry cough. CTPA demonstrated new bilateral lower zone and peripheral predominant ground glass patchy consolidation consistent with acute pneumonitis. He sustained a significant clinical benefit from IV methylprednisolone and cessation of Nivolumab. 20 days after the pneumonitis episode, the patient re-presented with extremely tender, blue-black discoloration of the 2nd, 3rd and 4th fingers bilaterally, accompanied by localised sensory loss. Petechiae were also seen distributed across the digital pulp and nailbeds. Although bilateral, the left side was notably worse, with clear evidence of digital ischaemia and dry gangrene. Urine dipstix was bland. Immunology revealed normal C3/C4, ANCA and dsDNA serology, but mildly raised ANA (1.5). An echocardiogram excluded infective emboli. High dose IV methylprednisolone and iloprost infusion was commenced to treat ICI-associated peripheral vasculitis. Concurrently, dalteparin was required for a non-occlusive right subclavian venous thrombus. Nevertheless, his digital ischaemia progressed proximally to the left middle distal phalanx. MDT decision was made to avoid Cyclophosphamide given the infection risk. Sildenafil was introduced alongside a reduction regime of oral prednisolone. Unfortunately, the patient was subsequently hospitalised for acute PCP infection requiring high flow oxygen and intravenous antimicrobials. Following this stormy course, a slow but consistent and substantial clinical improvement was noted with respect to his digital ischaemia with minimal tissue loss. 7 months on, the patient’s digits remain free from ischaemia, infection and pain with good functional ability on Sildenafil treatment. Results Reports of PD-1 blockade-associated vasculitides mention ANCA-vasculitis, IgA vasculitis, leukocytoclastic vasculitis, eGPA and granulomatous vasculitis; however, drug-induced digit necrosis and auto-amputation is not widely reported. In this rare presentation of digital gangrene, immediate discontinuation of nivolumab treatment with initiation of high dose steroids and sildenafil, allowed eventual recovery of digits with limited auto-amputation and minimal sequelae. Management of nivolumab-associated vasculitis and pneumonitis required a multidisciplinary approach involving oncology, rheumatology, plastics and respiratory medicine. In the context of nivolumab discontinuation, the patient remains only on symptomatic treatment and follow up with no active cancer therapy meaning that prognosis is poor, in keeping with other reports of vasculitic reactions to nivolumab in cancer patients. Conclusion ICIs have revolutionised the management and outcomes across a range of malignancies. However, their mechanism can inadvertently induce undesired toxicity, the awareness of which is paramount. Disclosure M. Au: None. A. Faher: None. E. Htut: None.

Perceived benefits of digital health and social services among older adults: A population-based cross-sectional survey.

The aim of this study was to describe the benefits of digital health and social services perceived by older adults and to examine factors associated with perceiving these benefits. Several factors related to (a) sociodemographic characteristics, (b) area of residence, (c) physical, cognitive, psychological, and social functioning, and (d) Internet use, were examined. The present sample included 8019 respondents aged between 75 and 99 years. The inverse probability weighting method was used to correct for bias. Linear regression analyses were used to examine the associations. The ease of use of the services regardless of the time and location was perceived as the most beneficial. Convenient distance to local health or social services (parameter estimate = 0.15 [0.08-0.23]), good functional ability (PE = 0.08 [0.01-0.14]), good vision (PE = 0.15 [0.04-0.25]), ability to learn (PE = 0.05 [0.01-0.10]) and living with someone (PE = 0.08 [95% CI 0.04-0.13]) were associated with perceiving more benefits. In addition, access to the Internet (PE = 0.12 [0.06-0.19]) and independent use of the Internet (PE = 0.23 [0.17-0.29]) were associated with perceiving more benefits. Older adults who are healthier, have a social relationship in their everyday life or have easier access to traditional services seem to perceive more benefits from digital health and social services. Digital services should be developed to correspond with special needs caused by disadvantages in health and the social environment. To facilitate the use of digital health and social services, more efforts should be made to enhance older adults' perceptions of their benefits.

Assessment of Social Functioning among Adolescent School-going Children in Hooghly District, West Bengal, India: A Cross-sectional Study

Introduction: Adolescents form a socially significant segment of the population. The analysis of social functioning, a sensitive indicator of underlying mental ailments, amongst them is a good measure to find out their mental health status. Aim: To assess the social functioning skills and its associated factors among adolescent school-going children in Hooghly District, West Bengal, India. Materials and Methods: A descriptive, cross-sectional questionnaire-based was conducted among 1056 (mean {SD) age=15.53±1.3 years} school-going adolescent children in four randomly selected English medium private co-educational schools, from Class IX to XII, in Hooghly District, West Bengal, India, for a period of two months from June 2022-July 2022. The Child and Adolescent Social and Adaptive Functioning Scale (CASAFS), a validated tool consisting of 24 items designed to measure psychosocial functioning, was used. A Likert scale scoring was done for each item. Adolescents scoring below the 75th percentile of the total score were classified as “poor social adaptive functioning skill” and those above 75th percentile as “good social adaptive functioning skill”. The data was analysed using IBM Statistical Package for the Social Sciences (SPSS), version 23.0 software. Descriptive statistics like mean, median, percentile, standard deviation were generated. Analytical statistics like chi-square test was applied to find out the relationship between categorical variables i.e., social functional skill and socio-demographic profile and a p-value of <0.05 was considered as significant. Result: Out of 1056 students included in the study. There were 318 (30.1%) Class IX students, 229 (21.7%) Class X students, 204 (19.3%) Class XI students and 305 (28.9%) Class XII students. The age of the students ranged from 13 to 18 years. 219 (20.7%) had the good social functioning skill and 837 (79.3%) had poor social functioning skill. The mean (SD) score of all the domains combined was 70.5 (8.05), with ‘Family Relationship domain’ having highest mean (SD) score 19.5±3.0 and ‘Peer relationship domain’ having the least mean (SD) score 15.9±3.1. ‘Good social functioning skills’ was significantly associated with those belonging to the age group of 17-18 years, having increased number of siblings (p=0.001) higher mother’s educational status (p=0.003). Conclusion: From the present study, it was observed that a very meagre number of students possessed good social functional ability. Improvement of social functioning skills indirectly helps in improving mental health and adolescents are the corner stones to initiate this process.

Fitusiran Prophylaxis Improves Health-Related Quality of Life in People with Hemophilia a or B, with or without Inhibitors: Results of ATLAS-PPX Study

Background: Fitusiran is a prophylactic investigational therapeutic comprised of synthetic small interfering ribonucleic acid (siRNA) that targets antithrombin to enhance thrombin generation and rebalance hemostasis in people with hemophilia A or B (PwHA/B), irrespective of inhibitor status. In previous Phase 3 trials, once-monthly fitusiran prophylaxis significantly improved HRQoL in PwHA/B, with or without inhibitors versus episodic/on-demand treatment Objective: We present health-related quality of life (HRQoL) results from the phase 3 ATLAS-PPX study (NCT03549871) comparing fitusiran prophylaxis versus prior prophylaxis with clotting factor concentrates (CFC) or bypass agents (BPA) in PwHA/B with or without inhibitors. Methods: This multicenter, multinational, open-label, Phase 3 study recruited male patients aged ≥12 years with severe hemophilia A or B, with or without inhibitors. Participants continued factor/BPA prophylaxis (6 months between month -6 and Day 0) before switching to once-monthly 80 mg SC fitusiran prophylaxis (7 months between Day 1 and month 7). Aside from annualized bleeding rates (ABR), the study assessed HRQoL at Month -6, Day 1 (baseline) and Month 7, during factor/BPA prophylaxis and during treatment with fitusiran using the following questionnaires: Hemophilia Quality of Life Questionnaire (Haem-A-QoL & Haemo-QoL; lower scores = improved HRQoL), Hemophilia Activity List (HAL & PedHal; range 0-100, higher scores = improved HRQoL), EuroQoL-5 Dimension 5-Level (EQ-5D-5L; index score ranges 0-1, higher scores = improved HRQoL), Treatment Satisfaction Questionnaire for Medication (TSQM-9), and the Hemophilia Joint Health Score (HJHS). Results: A total of 80 participants were enrolled and 65 were evaluable for efficacy analyses (inhibitor/non-inhibitor, n=19/46; hemophilia A/hemophilia B, n=50/15). At enrollment (Month -6), the mean (SD) age was 24.8 (11.2) years, transformed Haem-A-QoL physical health and total scores were 32.87 (23.68) and 31.63 (18.54) respectively, EQ-5D-5L index score was 0.83 (0.13), HAL total score was 79.11 (20.29) and TSQM-9 baseline score for effectiveness, convenience and satisfaction were 66.76 (18.06), 61.29 (17.97) and 69.35 (15.91), respectively. Fitusiran achieved the study primary endpoint and significantly reduced the frequency of bleeding episodes; observed median (IQR) ABR for treated bleeds was 0.0 (0.0; 2.3) in the fitusiran efficacy period and 4.35 (2.2; 10.9) in the factor /BPA prophylaxis period. The least squares (LS) mean difference between change from Month -6 to baseline (Day 1) and change from Month -6 to Month 7 in Haem-A-QoL scores demonstrated significant improvement in transformed total score with fitusiran treatment vs factor/BPA prophylaxis (-4.55 [95% CI: -7.56, -1.54]) and nominal improvement in physical health score in favor of fitusiran (-3.60 [95%-CI: -10.52, 3.33]). In addition to showing a good functional ability to perform activities of daily living, patients rated an even better physical ability over the two periods of assessment of the study as evidenced by changes in HAL scores: mean (SD) changes in total score were 3.05 (20.04) and 2.45 (19.42) for fitusiran and factor/BPA prophylaxis, respectively. Similar to the results from disease specific questionnaire, fitusiran also demonstrated nominal improvements in the EQ-5D-5L index score versus factor/BPA prophylaxis, with mean (SD) changes from Month -6 to Month 7/ Day 1of 0.04 (0.13) versus 0.0 (0.13). Overall results of the mean (SD) TSQM-9 score consistently favored fitusiran prophylaxis versus factor/BPA prophylaxis in all three domains of effectiveness, convenience, and global satisfaction (Table 1). Conclusions: Associated with a marked ABR reduction, PwHA/B with or without inhibitors on fitusiran prophylaxis consistently improved all HRQoL endpoints, demonstrating added value in PwHA/B beyond the improvement in bleeding phenotype. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

STUDY OF PHYSIOLOGICAL AND PSYCHOLOGICAL INDICES OF UNIVERSITY STUDENTS

Purpose: assessment of functional indices of external respiration, the level of physical health and the general state of the autonomic nervous system of university students. Material: There were examined 192 students aged 18-21 years. All examined were divided into groups depending on gender, age and future profession. Anthropometric indices and parameters of the circulatory system were studied. Spirometer was used to measure the respiratory system functional indices. An express assessment of physical health level was made. Index of functional changes, the Kerdo vegetation index, the orthostatic index, and the Skibinskaya index were calculated. Stange test, Hench test and Martin-Kushelevsky’s test were conducted. Results: The results are showed that the minute blood volume was higher in all examined young girls, whereas in young boys designers and pharmacists aged 17-18 years and 19-21 years, respectively it was lower than due values. Similar data were obtained after the Ruffier test (dynamic load tolerance). The index of vital lung capacity (VC) was significantly lower than due values in all students. The parameters of maximal pulmonary ventilation indicated good functional ability of the external respiration apparatus in young boys. This index was higher than that of young girls and exceeded due values. The adaptation capacities of the student body (index of functional changes (IFI)) were at a satisfactory level. The indices of physical health level of all students had average values. Conclusions: Studies have revealed the most characteristic shifts of cardiorespiratory system indices, which are most expressed in students. Cardiorespiratory system shifts are caused by the influence of a complex of factors: increased academic load; requirements for the professionalization process continuity; performance of various structured activity types, manipulations, a high degree of responsibility. Increased pulse rate and minute blood volume; prevalence of the hyperkinetic type of blood circulation self-regulation at rest; irrational cardiovascular system response to dosed physical load; positive value of the Kerdo vegetation index; decreased ventilatory lung capacity and reserve capacity of cardiorespiratory system; tension of adaptation mechanisms; average level of physical health were recorded in students.

Whole-Grain Intake in the Mediterranean Diet and a Low Protein to Carbohydrates Ratio Can Help to Reduce Mortality from Cardiovascular Disease, Slow Down the Progression of Aging, and to Improve Lifespan: A Review.

Increase in the aging population is a phenomenon all over the world. Maintaining good functional ability, good mental health, and cognitive function in the absence of severe disease and physical disability define successful aging. A healthy lifestyle in middle age predisposes successful aging. Longevity is the result of a multifactorial phenomenon, which involves feeding. Diets that emphasize fruit and vegetables, whole grains rather than refined grains, low-fat dairy, lean meats, fish, legumes, and nuts are inversely associated with mortality or to a lower risk of becoming frail among elderly subjects. A regular physical activity and a regular intake of whole grain derivatives together with the optimization of the protein/carbohydrate ratio in the diet, where the ratio is significantly less than 1 such as in the Mediterranean diet and the Okinawan diet, reduces the risk of developing aging-related diseases and increases healthy life expectancy. The purpose of our review was to analyze cohort and case-control studies that investigated the effects of cereals in the diet, especially whole grains and derivatives as well as the effects of a diet with a low protein–carbohydrate ratio on the progression of aging, mortality, and lifespan.

Prevalence and risk factors of delirium and subsyndromal delirium in older adults

BackgroundDelirium is a common geriatric problem associated with poor outcomes. Subsyndromal delirium (SSD) is characterized by the presence of certain symptoms of delirium yet, not satisfying the definition of full-blown delirium, defined by categorical elements, and is usually referred to as the presence of one or more symptoms in the confusion assessment method (CAM). This study aimed to investigate the prevalence and risk factors of delirium and SSD in older adults admitted to the hospital. Five hundred eighty-eight elderly (above 65 years) Egyptian patients were recruited from January 2019 to February 2020. After explaining the purpose of the study and assuring the confidentiality of all participants, an informed consent was obtained from the participant or a responsible care giver for those who were not able to give consent. All patients were subjected ‘on admission’ to thorough history taking, clinical examination, and comprehensive geriatric assessment including confusion assessment tools, mini-mental state examination, and functional assessment using Barthel index score.ResultsThe current study showed that 19.6% of patients had delirium and 14.1% of patients had SSD with combined prevalence of 33.7%. Most common causes included metabolic, infection, organic brain syndrome, and dehydration. The current study reported significant proportionate relation between cognitive assessment and functional ability, so patients with a score of 23 MMSE had good functional ability, while cognitive assessment using mini-mental score shows inversed relation to delirium and SSD using CAM score.ConclusionDelirium is independently associated with adverse short-term and long-term outcomes, including an increase in mortality, length of hospital stay, discharge to an institution, and functional decline on discharge. Subsyndromal delirium (SSD) is characterized by the presence of certain symptoms of delirium, not yet satisfying the definition of full-blown delirium but it can identify patients with early cognitive and functional disabilities, and because of high prevalence of delirium and SSD. Efforts to prevent or early detection may identify patients who warrant clinical attention.

Meta-Analysis the Effect of Constraint-Induced Movement Therapy on Hands Functional Ability and Occupational Performance in Children with Cerebral Palsy

Background: Children with cerebral palsy generally experience hand functional disorders which then affect the child's occupational performance. Hand functional ability is the ability to use the hand in doing activities. To be able to perform occupational performance, good hand functional abilities are needed. To achieve this, interventions are needed, one of which is constraint-induced movement therapy (CIMT) which is hypothesized to be able to improve hand functional ability and occupational per-formance. The purpose of this study was to determine the effect of CIMT on the hands functional ability and the occupation performance of children with cerebral palsy. Subjects and Method: This study used a systematic review design and meta-analysis using the PRISMA flow chart guidelines. The process of searching for articles was carried out between 2005-2020 using databases from PubMed, Science Direct, AJOT, Springer Link, and Google Scholar. Based on the database, there were 20 articles that met the inclusion criteria. This study involved 669 subjects of hand functional ability and 440 subjects of occupational performance. The analysis was performed using the RevMan 5.3 software. Results: A total of 20 articles conducted a meta-analysis review. A total of 18 articles conducted a meta-analysis showing that giving CIMT to children with cerebral palsy was significantly able to improve hands functional ability of children with cerebral palsy (SMD = 0.40; 95% CI 0.09 to 0.71; p = 0.01). A total of 11 articles conducted a meta-analysis showing that giving CIMT to children with cerebral palsy was able to improve occupational performance abilities but it was not statistically significant (SMD = 0.18; 95% CI 0.17 to 0.52; p = 0.32). Conclusion: CIMT can improve hand functional abilities and occupational performance of children with cerebral palsy. Keywords: constraint-induced movement therapy (CIMT), hand functional ability, occupational performance, cerebral palsy, meta-analysis Correspondence: Mutiana Agustin Sholikah. Masters Program in Public Health. Universitas Sebelas Maret, Jl.Ir. Sutami 36A, Surakarta 57126, Jawa Tengah, Indonesia. Email: mutiana.ash@gmail.com. Mobile: 081215038686. Journal of Epidemiology and Public Health (2021), 06(01): 1-11 https://doi.org/10.26911/jepublichealth.2021.06.01.01

Longitudinal factors associated with living well outcomes in people with mild‐to‐moderate dementia: Initial findings from the IDEAL cohort

AbstractBackgroundUnderstanding the factors associated with quality of life (QoL), satisfaction with life (SwL) and wellbeing can help us become more effective in optimizing the potential for people with mild‐to‐moderate dementia to ‘live well’ with the condition. Identifying individuals at risk of declining well‐being could help to target support more appropriately, but there is little evidence available about factors that may influence ability to ‘live well’ longitudinally.MethodsWe used longitudinal data from 1547 individuals with mild‐to‐moderate dementia participating in the IDEAL cohort, who have been assessed on entry and followed up 12 months and 24 months later. We examined how factors found to be important at baseline were associated with change over time using growth curve modelling. Factors were grouped into four domains: psychological characteristics and health; physical health; social capitals, assets and resources; and functional ability.ResultsPsychologically, individuals who were less depressed and lonely, and had positive attitudes to ageing, had better QoL, SwL and wellbeing over three waves. Decreasing loneliness was associated with increasing QoL and Wellbeing, increasing depression with decreasing SwL, and a decrease in their attitude to ageing less wellbeing over time. Physically, better self‐rated health, sleep quality, eyesight, hearing, appetite and olfaction predict better QoL and wellbeing, and all but olfaction predict better SwL, over the 3 waves. Socially, less isolation, greater cultural capital and greater reciprocity and trust in the local neighbourhood predict better QoL, SwL and wellbeing over the 3 waves. Good functional ability was associated with better QoL, SwL and wellbeing over the 3 waves.ConclusionsUsing longitudinal data showed remarkable consistency with different methods of measuring how people with dementia “live well”. Understanding these longitudinal changes is vital to identify potential factors for intervention.

Functional classification of grasp strategies used by hemiplegic patients.

This study aimed to identify and qualify grasp-types used by patients with stroke and determine the clinical parameters that could explain the use of each grasp. Thirty-eight patients with chronic stroke-related hemiparesis and a range of motor and functional capacities (17 females and 21 males, aged 25–78), and 10 healthy subjects were included. Four objects were used (tissue packet, teaspoon, bottle and tennis ball). Participants were instructed to “grasp the object as if you are going to use it”. Three trials were video-recorded for each object. A total of 456 grasps were analysed and rated using a custom-designed Functional Grasp Scale. Eight grasp-types were identified from the analysis: healthy subjects used Multi-pulpar, Pluri-digital, Lateral-pinch and Palmar grasps (Standard Grasps). Patients used the same grasps with in addition Digito-palmar, Raking, Ulnar and Interdigital grasps (Alternative Grasps). Only patients with a moderate or relatively good functional ability used Standard grasps. The correlation and regression analyses showed this was conditioned by sufficient finger and elbow extensor strength (Pluri-digital grasp); thumb extensor and wrist flexor strength (Lateral pinch) or in forearm supinator strength (Palmar grasp). By contrast, the patients who had severe impairment used Alternative grasps that did not involve the thumb. These strategies likely compensate specific impairments. Regression and correlation analyses suggested that weakness had a greater influence over grasp strategy than spasticity. This would imply that treatment should focus on improving hand strength and control although reducing spasticity may be useful in some cases.

Multiple limb salvage attempts for diabetic foot infections: is it worth it?

Limb salvage for diabetic foot infections often require multiple procedures. Some patients will eventually end up with below knee amputation (BKA) when all limb salvage attempts fail. We seek to study the patients' ability to return to normal life, functional status, prosthesis usage and perspectives on multiple limb salvage procedures that culminated in BKA to review if they would undertake a similar path if their situation was repeated. A total of 41 patients who underwent BKA between July 2011 and June 2013 were reviewed. They were divided into primary and creeping (prior multiple salvage procedures) amputations. The Barthel's Index (BI) and the Reintegration to Normal Living Index (RNLI) were used. A questionnaire was used to identify whether the patient would undergo the same multiple attempts at limb salvage again if faced with the same problem. All patients had a good mean BI of 14.2 (3 to 20) and RNLI of 73.2 (31 to 100). There was no difference in prosthesis usage, BI and RNLI between both groups. We found that 16 (94.1%) out of 17 patients with creeping amputation would undergo the same multiple salvage procedures if given a similar option. Conversely, only 15 (62.5%) patients with primary amputation would do the same again while the other nine (37.5%) patients choose to do everything possible to save their leg if faced with a similar situation (p = 0.001). Most patients preferred to undergo multiple procedures to salvage the limb from diabetic foot infection even if it ultimately concluded with a BKA. All the patients had a moderately good functional outcome and ability to return to normal living after BKA. Cite this article: Bone Joint J 2017;99-B:1502-7.

From disability to ability: comprehensive rehabilitation providing a holistic functional improvement in a child with neglected neural tube defect

Neural Tube defects are one of the most common congenital disorders, presenting in a paediatric rehabilitation set-up. With its wide spectrum of clinical presentation and possible complications, the condition can...

Planovalgus foot deformity in cerebral palsy corrected by botulinum toxin injection in the peroneus longus: Clinical and radiological evaluations in young children

BackgroundIn children with cerebral palsy (CP), overactivity of the peroneus longus (PL) muscle is a major contributor to pes planovalgus. This retrospective study assessed whether abobotulinumtoxinA injections into a PL showing premature activity on electromyography (EMG) clinically improved foot morphology in children with CP. MethodsStudy participants were <6 years old, had a diagnosis of CP, good functional abilities (Gross Motor Function Classification System level 1 or 2), equinovalgus (initial contact with the hallux or head of the first metatarsal) and overactive PL on EMG. The fore-, mid- and hindfoot were evaluated clinically and radiologically before and after injection of abobotulinumtoxinA (6–7 U/kg) into the PL. Radiological data were compared with reference values for children without pes planovalgus. ResultsIn total, 16 children (8 males; 10 hemiplegia, 6 diplegia; mean age: 3.2±1.5 years) received treatment. Mean pre-and post-treatment angles in clinical assessment of dorsiflexion of the talocrural articulation did not differ with both knees flexed (24.4±7.5 vs. 22.2±8.0 degrees; P=0.19) or extended (17.2±8.0 vs. 16.6±6.8 degrees; P=0.36). Radiographic data pre-treatment versus reference data revealed forefoot pronation (metatarsal stacking angle 2.1±8.3 vs. 8.0±2.9 degrees; P=0.002), midfoot planus (lateral talo-first metatarsal 28.5±15.0 vs. 13.0±7.5 degrees; P<0.001; talocalcaneal angle 54.6±8.6 vs. 49.0±6.9 degrees; P=0.004) and significantly decreased calcaneus dorsiflexion, without hindfoot equinus (calcaneal pitch angle 7.9±6.0 vs. 17.0±6.0 degrees; P<0.001). After treatment, the metatarsal stacking angle did not differ from reference values (P=0.15). As compared with before treatment, treatment improved mean angles for metatarsal stacking (2.1±8.3 vs. 7.1±3.9 degrees, respectively, P=0.002), lateral talo-first metatarsal and talocalcaneal (both P<0.001), with no change in the hindfoot. ConclusionPL may be an early target for abobotulinumtoxinA treatment in pes planovalgus associated with premature PL activity in children with CP.

Functional Outcome after Partial Hip Replacement for Femoral Neck Fracture (Subcapital Fracture) with Austin Moore Prosthesis

Background: Femoral neck fracture or Subcapital fracture of the hip is one of the most common fractures at old age. There is a debate about the use of monopolar monoblock prosthesis for the treatment of those fractures. This paper is a retrospective examination of the functional and ambulation outcome of patients after partial hip replacement with cementless Austin Moore prosthesis. Methods: Between 2002-2009, 320 patients with femoral neck fracture were treated by hip hemiarthroplasty with cementless Austin Moore prosthesis in our department. All patients had displaced femoral neck fractures. The anterolateral approach was used for all operations. Seventy nine patients who underwent 84 hip hemiarthroplasty with cementless Austin Moore prosthesis agree to participate and were enrolled to this study. (Five patients had bilateral femoral neck fracture at separate occasions during the study period). All patients were followed at the out patients clinic and filled a questionnaire about functional and ambulation before fracture and after rehabilitation period. The functional outcome was divided into four levels, Poor Fair Good and Excellent functional ability. The scale of ambulation ability was 1-7 in which 1 is ambulation with no means and 7 is bed or chair ridden. Results: The average functional score before the fracture was 22.87 and 10.43 after surgery. The average ambulation ability before the fracture and after rehabilitation was (1.62) (4.29) respectively. Out of the 320 patients, three prosthetic hip dislocated (0.94%), four were (1.25%) infected and five (1.56%) experienced a periprosthetic fracture. Conclusion: Our study reveals that only small number of patients achieved good or excellent functional and ambulation score. The decline in functional and ambulation ability was statistical significant. We showed a relatively low incidence of complications.

PNF 통합패턴 트레이닝이 하키선수들의 균형능력과 기능적 능력에 미치는 영향

이 연구는 PNF 통합패턴 트레이닝이 하키선수들의 균형능력 및 기능적 능력에 미치는 영향을 알아보기 위해 연구대상자를 28명(대조군 14명과 실험군 14명)을 무선 배정하였으며, 실험군에서 총 12주간 주 3회, 하루 60분 동안 PNF 통합패턴 트레이닝을 실시하였다. 각 군은 사전, 6주 후, 12주 후에 전산화밸런스시스템을 이용하여 균형 능력을 측정하였으며, 기능적 능력은 카리오카, 셔틀런 능력을 측정하였다. 이상의 측정값을 통계학적 검정을 위해 반복측정분산분석으로 분석한 결과 다음과 같은 결론을 얻었다. 균형능력을 비교한 결과, 눈감고 양발로 지지하면서 선 자세에서 실험군의 전-후, 움직임 영역에서 유의한 차이가 나타났다(p<.05). 눈감고 오른발로 지지하면서 선 자세에서 실험군의 전-후, 내-외 및 움직인 영역 모두에서 유의한 차이가 나타났다(p<.05). 또한 동적 균형능력에서 실험군의 전-후, 움직인 거리에서 유의한 차이가 나타났다(p<.05). 운동수행관련 기능적 능력을 비교한 결과, 실험군의 셔틀런 능력에서 유의한 차이가 나타났다(p<.05). 이상의 결론을 통해 하키선수들에게 적용한 PNF 통합패턴의 대칭적인 트레이닝을 통해 하키선수들의 균형능력이 향상되었다는 것을 알 수 있었으며, 이를 통해 운동학적 기능이 향상된 것으로 판단되어 하키선수들의 경기력 향상을 위한 트레이닝 방법으로 적극 권장되어져야 된다고 사료된다. This study was performed to examine effects of PNF combined pattern training on balance ability and functional ability of hockey players. In order to achieve this purpose, total 28 participants were separated into two group: 14 comparison group and 14 experiment group, and the experiment group performed PNF combined pattern training for 12 week, 3 times a week, 60 minutes a day. Each group was measured beforehand, after 6 week and 12 week. balance ability was measured using GOOD BALANCE system and functional ability was measured using carioca and shuttle-run test. For statistically verifying above measured values, repeated measure analysis of variance was analyzed and have following results. As the comparing results of balance ability, normal standing eye close(NSEC) was ant-post and velocity moment of experiment group showed significant differences(p<.05). And one leg right eye close(OLREC) was ant-post, med-lat and velocity moment of experiment group showed significant differences (p<.05). Also, dynamic balance ability was ant-post and velocity moment of experiment groups showed significant differences(p<.05). As the comparing results of functional ability, shuttle-run of experiment group sowed significant differences(p<.05). From above results, balance ability of hockey players was shown to be improved through symmetric training of PNF combined pattern applied to hockey players, and it can be considered that this is actively recommended for training method to improve athletic performance of hockey players.

Who cares? Implications of care-giving and -receiving by HIV-infected or -affected older people on functional disability and emotional wellbeing.

This paper examines how care-giving to adults and/or children and care-receiving is associated with the health and wellbeing of older people aged 50+ in rural South Africa. Data used are from a cross-sectional survey adapted from World Health Organization's Study on Global Ageing and Adult Health (SAGE) conducted in 2009/10 in rural South Africa. Bivariate statistics and multivariate logistical regression were used to assess the relationship between care-giving and/or care-receiving with functional disability, quality of life or emotional wellbeing, and self-rated health status, adjusted for socio-demographic factors. Sixty-three per cent of 422 older people were care-givers to at least one young adult or child; 27 per cent of older people were care-givers due to HIV-related reasons in young adults; 84 per cent of participants were care-recipients mainly from adult children, grandchildren and spouse. In logistic regressions adjusting for sex, age, marital status, education, receipt of grants, household headship, household wealth and HIV status, care-giving was statistically significantly associated with good functional ability as measured by ability to perform activities of daily living. This relationship was stronger for older people providing care-giving to adults than to children. In contrast, care-givers were less likely to report good emotional wellbeing; again the relationship was stronger for care-givers to adults than children. Simultaneous care-giving and -receiving was likewise associated with good functional ability, but about a 47 per cent lower chance of good emotional wellbeing. Participants who were HIV-infected were more likely to be in better health but less likely to be receiving care than those who were HIV-affected. Our findings suggest a strong relationship between care-giving and poor emotional wellbeing via an economic or psychological stressor pathway. Interventions that improve older people's socio-economic circumstances and reduce financial hardship as well as those that provide social support would go some way towards mitigating this relationship.