Motor Function Training Research Articles

Effectiveness of Bobath Technique on Walking Speed and Balance in Hemiplegic Patients: A Review

Worldwide, stroke is the largest cause of disability, affecting walking speed and balance, especially in hemiplegics. Bobath, or Neurodevelopmental Treatment (NDT), is a specialist physiotherapy method that improves motor control and movement patterns for motor deficits. Given the prevalence of stroke and the importance of rehabilitation in recovery, the Bobath technique's ability to improve walking speed and balance, which are crucial to stroke survivors' functional independence, must be assessed. Methods: This Review examined how the Bobath method affected walking speed and balance in hemiplegic individuals. A total of 15 studies were evaluated. Most of studies uses 2 groups The Bobath group received three-times-weekly motor function and balance training for 12 weeks Data was collected at Baseline, 6-week, and 12-week. Aim: This research focused on to review whether the Bobath approach improved walking speed and balance in hemiplegic patients. Results: The research revealed a substantial improvement in walking speed using the Bobath approach, with a mean increase of 0.25 meters per second compared to 0.10 meters per second in the control group (p < 0.05). Significant balance improvements were seen in the Bobath group, with a mean gain of 10 points on the Berg Balance Scale and 5 cm on the Functional Reach Test, compared to 4 points and 2 centimetres in the control group (p < 0.05). The Bobath approach improved walking speed and balance no more than traditional physiotherapy. Conclusion: This research found that Bobath improves walking speed and balance in hemiplegics no more than traditional physiotherapy. These findings suggest that stroke therapy programs using the Bobath technique may improve functional outcomes. To validate these results and investigate the Bobath technique's long-term stroke healing advantages, bigger sample sizes and longer follow-ups are needed. Keyword: - Bobath concept, stroke, hemiplegia, rehabilitation.

Trial of Brain–Computer Interface for Continuous Motion Using Electroencephalography and Electromyography

Most BCI systems used in neurorehabilitation detect EEG features indicating motor intent based on machine learning, focusing on repetitive movements, such as limb flexion and extension. These machine learning methods require large datasets and are time consuming, making them unsuitable for same-day rehabilitation training following EEG measurements. Therefore, we propose a BMI system based on fuzzy inference that bypasses the need for specific EEG features, introducing an algorithm that allows patients to progress from measurement to training within a few hours. Additionally, we explored the integration of electromyography (EMG) with conventional EEG-based motor intention estimation to capture continuous movements, which is essential for advanced motor function training, such as skill improvement. In this study, we developed an algorithm that detects the initial movement via EEG and switches to EMG for subsequent movements. This approach ensures real-time responsiveness and effective handling of continuous movements. Herein, we report the results of this study.

Enhancing EEG and sEMG Fusion Decoding Using a Multi-Scale Parallel Convolutional Network with Attention Mechanism.

Electroencephalography (EEG) and surface electromyography (sEMG) have been widely used in the rehabilitation training of motor function. However, EEG signals have poor user adaptability and low classification accuracy in practical applications, and sEMG signals are susceptible to abnormalities such as muscle fatigue and weakness, resulting in reduced stability. To improve the accuracy and stability of interactive training recognition systems, we propose a novel approach called the Attention Mechanism-based Multi-Scale Parallel Convolutional Network (AM-PCNet) for recognizing and decoding fused EEG and sEMG signals. Firstly, we design an experimental scheme for the synchronous collection of EEG and sEMG signals and propose an ERP-WTC analysis method for channel screening of EEG signals. Then, the AM-PCNet network is designed to extract the time-domain, frequency-domain, and mixed-domain information of the EEG and sEMG fusion spectrogram images, and the attention mechanism is introduced to extract more fine-grained multi-scale feature information of the EEG and sEMG signals. Experiments on datasets obtained in the laboratory have shown that the average accuracy of EEG and sEMG fusion decoding is 96.62%. The accuracy is significantly improved compared with the classification performance of single-mode signals. When the muscle fatigue level reaches 50% and 90%, the accuracy is 92.84% and 85.29%, respectively. This study indicates that using this model to fuse EEG and sEMG signals can improve the accuracy and stability of hand rehabilitation training for patients.

Correlation study between motor rehabilitation level and psychological state in patients with limb movement disorders after stroke

BACKGROUND The psychological state of patients with post stroke limb movement disorders undergoes a series of changes that affect rehabilitation training and recovery of limb motor function. AIM To determine the correlation between motor rehabilitation and the psychological state of patients with limb movement disorders after stroke. METHODS Eighty patients with upper and lower limb dysfunction post stroke were retrospectively enrolled in our study. Based on Hospital Anxiety and Depression Scale (HADS) scores measured before rehabilitation, patients with HADS scores ≥ 8 were divided into the psychological group; otherwise, the patients were included in the normal group. Motor function and daily living abilities were compared between the normal and psychological groups. Correlations between the motor function and psychological status of patients, and between daily living ability and psychological status of patients were analyzed. RESULTS After 1, 2, and 3 wk of rehabilitation, both the Fugl-Meyer assessment and Barthel index scores improved compared to their respective baseline scores (P < 0.05). A greater degree of improvement was observed in the normal group compared to the psychological group (P < 0.05). There was a negative correlation between negative emotions and limb rehabilitation (-0.592 ≤ r ≤ -0.233, P < 0.05), and between negative emotions and daily living ability (-0.395 ≤ r ≤ -0.199, P < 0.05). CONCLUSION There is a strong correlation between motor rehabilitation and the psychological state of patients with post stroke limb movement disorders. The higher the negative emotions, the worse the rehabilitation effect.

The effectiveness of robotic rehabilitation for the functional recovery of the upper limb in post-stroke patients: a systematic review

Stroke is a significant contributor to global mortality and disability, and it is typically classified as a neurological disorder. A key component of stroke rehabilitation is improving upper limb function to reduce impairments and disabilities and their impact on activities of daily living. In the last few years, robot-assisted therapy (RT) arises as a novel and expanding approach in poststroke rehabilitation, which utilizes robotic devices to facilitate the recovery of motor function and task-oriented training. The aim of this systematic review, conducted through MEDLINE, CINAHL and EMBASE consultation, was to investigate the association between functional outcomes of the upper limb in patients with stroke after-effects and the use of robotic rehabilitation.The results of the included studies have highlighted the impact of robot-assisted rehabilitation, whether integrated with traditional physiotherapy, on several clinical outcomes such as pain, spasticity, motor function, hand and finger function and cognitive abilities. The introduction of the robot-assisted intervention, coupled with traditional treatment, maybe a valuable approach to improving quality of life and enhance not only motor function but also the cognitive ability of stroke patients, especially whether focusing on the early phase of stroke recovery with a high potential impact on clinical practice. Keywords: Stroke; Upper limb; Robotic rehabilitation; Neurological disorders; robot-assisted therapy;

Efficacy analysis of virtual reality-based training for activities of daily living and functional task training in stroke patients: A single-subject study.

Virtual reality (VR)-based training for functions such as cognition, upper extremities, balancing, and activities of daily living (ADL) has been used on stroke patients, and its efficacy has been reported. However, no comparison has been made between the efficacy of VR-based training for daily activities that exactly reproduces ADL and functional training. Therefore, this study sought to analyze the difference in independency enhancement of VR-based training for daily activities compared to cognitive and motor functional training. This study was conducted on 4 patients who have been diagnosed with stroke and are currently receiving rehabilitation therapy in G hospital located in the city of Gwangju, using A-B-A'-B' design from single-subject experimental designs. Intervention was performed in 2 ways: application of VR-based training for daily activities after the application of cognitive and motor function training; and application of cognitive and motor function training after the application of VR-based training for daily activities. The Assessment of Motor and Process Skills, Computer Cognitive Screening Assessment System, Box and Block Test, and Grip and Pinch Strength Test were used to measure the changes in the performance of daily activities, cognitive function, and upper extremities function. The results confirmed that the performance of daily activities, cognitive function, and upper extremities function was improved after the application of VR-based intervention. In addition, the efficacy of independency enhancement was maximized by the early approach of training for daily activities at the time of VR-based intervention in stroke patients. VR-based intervention of training for daily activities and functional training can be considered to benefit the improvement of the performance of daily activities, cognitive function, and upper extremities function in stroke patients. In addition, although functional training was also effective in enhancing independency and functional improvement in stroke patients, an early approach to training for ADL based on tasks with objectives was deemed to be more effective.

Spinal cord epidural stimulation for motor and autonomic function recovery after chronic spinal cord injury: A case series and technical note.

Traumatic spinal cord injury (tSCI) is a debilitating condition, leading to chronic morbidity and mortality. In recent peer-reviewed studies, spinal cord epidural stimulation (scES) enabled voluntary movement and return of over-ground walking in a small number of patients with motor complete SCI. Using the most extensive case series (n = 25) for chronic SCI, the present report describes our motor and cardiovascular and functional outcomes, surgical and training complication rates, quality of life (QOL) improvements, and patient satisfaction results after scES. This prospective study occurred at the University of Louisville from 2009 to 2020. scES interventions began 2-3 weeks after surgical implantation of the scES device. Perioperative complications were recorded as well as long-term complications during training and device related events. QOL outcomes and patient satisfaction were evaluated using the impairment domains model and a global patient satisfaction scale, respectively. Twenty-five patients (80% male, mean age of 30.9 ± 9.4 years) with chronic motor complete tSCI underwent scES using an epidural paddle electrode and internal pulse generator. The interval from SCI to scES implantation was 5.9 ± 3.4 years. Two participants (8%) developed infections, and three additional patients required washouts (12%). All participants achieved voluntary movement after implantation. A total of 17 research participants (85%) reported that the procedure either met (n = 9) or exceeded (n = 8) their expectations, and 100% would undergo the operation again. scES in this series was safe and achieved numerous benefits on motor and cardiovascular regulation and improved patient-reported QOL in multiple domains, with a high degree of patient satisfaction. The multiple previously unreported benefits beyond improvements in motor function render scES a promising option for improving QOL after motor complete SCI. Further studies may quantify these other benefits and clarify scES's role in SCI patients.

Retracted] Sensor‐Based Exercise Rehabilitation Robot Training Method

In order to provide convenience for rehabilitation doctors to formulate rehabilitation plans for patients, this paper proposes a training method for exercise rehabilitation robots based on sensors. In this research, the customized wearable sensor and universal mobile terminal are used as the hardware. Based on the sensor, the motion capture algorithm and motion reconstruction algorithm are developed. The table of experimental results shows that the cost can be saved by using the sensor, and the data can be captured accurately, which can meet the needs of rehabilitation medicine for motor function evaluation and training guidance. The range of motion of the joint and the manual measurement value are within 5°, which can meet the needs of rehabilitation medicine for motor function evaluation and training guidance. The system delay is less than 0.5 s, which has good real‐time performance and can respond quickly to emergencies, ensuring the safety of patients’ out‐of‐hospital rehabilitation. The training method of motion rehabilitation robot based on sensor is helpful for rehabilitation doctors to carry out statistical data of functional evaluation and is of great significance for rehabilitation doctors to make training plans for patients and carry out rehabilitation training.

Effect of hand arm bimanual intensive therapy (HABIT) on gross motor functions in upper extremity of spastic CP

To review studies that can examine whether there’s effect of hand arm bimanual intensive training(HABIT) and neurodevelopmental treatment on gross motor function in spastic cerebral palsy. Journal articles published between 2011 and 2021 were secured by searching computerized bibliographical databases. High evidence studies as randomized control trials, systematic reviews and cross sectional studies were included. A total of 30 studies were selected. After analyzing the studies, it was seen that; there is effect of HABIT in upper extremity on gross motor function, functional training , manual dexterity and activities of daily living and NDT was also improved gross motor function, spasticity and strength in upper extremity.

Activities of Daily Living-Based Rehabilitation System for Arm and Hand Motor Function Retraining After Stroke.

Most stroke survivors have difficulties completing activities of daily living (ADLs) independently. However, few rehabilitation systems have focused on ADLs-related training for gross and fine motor function together. We propose an ADLs-based serious game rehabilitation system for the training of motor function and coordination of both arm and hand movement where the user performs corresponding ADLs movements to interact with the target in the serious game. A multi-sensor fusion model based on electromyographic (EMG), force myographic (FMG), and inertial sensing was developed to estimate users' natural upper limb movement. Eight healthy subjects and three stroke patients were recruited in an experiment to validate the system's effectiveness. The performance of different sensor and classifier configurations on hand gesture classification against the arm position variations were analyzed, and qualitative patient questionnaires were conducted. Results showed that elbow extension/flexion has a more significant negative influence on EMG-based, FMG-based, and EMG+FMG-based hand gesture recognition than shoulder abduction/adduction does. In addition, there was no significant difference in the negative influence of shoulder abduction/adduction and shoulder flexion/extension on hand gesture recognition. However, there was a significant interaction between sensor configurations and algorithm configurations in both offline and real-time recognition accuracy. The EMG+FMG-combined multi-position classifier model had the best performance against arm position change. In addition, all the stroke patients reported their ADLs-related ability could be restored by using the system. These results demonstrate that the multi-sensor fusion model could estimate hand gestures and gross movement accurately, and the proposed training system has the potential to improve patients' ability to perform ADLs.

Remote Delivery of Motor Function Assessment and Training for Clinical Trials in Neuromuscular Disease: A Response to the COVID-19 Global Pandemic.

Clinical outcome assessments of function or strength, assessed by physical therapists, are commonly used as primary endpoints in clinical trials, natural history studies and within clinics for individuals with neuromuscular disorders. These evaluations not only inform the efficacy of investigational agents in clinical trials, but also importantly track disease trajectory to prospectively advise need for equipment, home and work modifications, and other assistive devices. The COVID-19 pandemic had a global impact on the safety and feasibility of in-person visits and assessments, necessitating rapid development of mitigation strategies to ensure ongoing collection of key clinical trial endpoints and access to expert clinical care despite travel restrictions. Physical therapists who are expert in neuromuscular disorders working across clinics, countries, and clinical trials developed initial guidelines and methods for the suitability and feasibility of performing remote evaluations. A number of Sponsors introduced amendments to their study protocols to enable remote evaluations, supported by live video streaming of the assessment to their local clinical evaluators. Similarly, application of these techniques to clinical telemedicine enabled objective evaluations for use in payer discussions, equipment procurement, and general access to expert physical therapy services. Here we report on our methodology for adapting current practices to remote testing and considerations for remote evaluations.

Design and Preliminary Evaluation of a Tongue-Operated Exoskeleton System for Upper Limb Rehabilitation.

Stroke is a devastating condition that may cause upper limb paralysis. Robotic rehabilitation with self-initiated and assisted movements is a promising technology that could help restore upper limb function. Previous studies have established that the tongue motion can be used to communicate human intent and control a rehabilitation robot/assistive device. The goal of this study was to evaluate a tongue-operated exoskeleton system (TDS-KA), which we have developed for upper limb rehabilitation. We adopted a tongue-operated assistive technology, called the tongue drive system (TDS), and interfaced it with the exoskeleton KINARM. We also developed arm reaching and tracking tasks, controlled by different tongue operation modes, for training and evaluation of arm motor function. Arm reaching and tracking tasks were tested in 10 healthy participants (seven males and three females, 23–60 years) and two female stroke survivors with upper extremity impairment (32 and 58 years). All healthy and two stroke participants successfully performed the tasks. One stroke subject demonstrated a clinically significant improvement in Fugl-Meyer upper extremity score after practicing the tasks in six 3-h sessions. We conclude that the TDS-KA system can accurately translate tongue commands to exoskeleton arm movements, quantify the function of the arm, and perform rehabilitation training.

Differential effects of the cell cycle inhibitor, olomoucine, on functional recovery and on responses of peri-infarct microglia and astrocytes following photothrombotic stroke in rats

BackgroundFollowing stroke, changes in neuronal connectivity in tissue surrounding the infarct play an important role in both spontaneous recovery of neurological function and in treatment-induced improvements in function. Microglia and astrocytes influence this process through direct interactions with the neurons and as major determinants of the local tissue environment. Subpopulations of peri-infarct glia proliferate early after stroke providing a possible target to modify recovery. Treatment with cell cycle inhibitors can reduce infarct volume and improve functional recovery. However, it is not known whether these inhibitors can influence neurological function or alter the responses of peri-infarct glia without reducing infarction. The present study aimed to address these issues by testing the effects of the cell cycle inhibitor, olomoucine, on recovery and peri-infarct changes following photothrombotic stroke.MethodsStroke was induced by photothrombosis in the forelimb sensorimotor cortex in Sprague-Dawley rats. Olomoucine was administered at 1 h and 24 h after stroke induction. Forelimb function was monitored up to 29 days. The effects of olomoucine on glial cell responses in peri-infarct tissue were evaluated using immunohistochemistry and Western blotting.ResultsOlomoucine treatment did not significantly affect maximal infarct volume. Recovery of the affected forelimb on a placing test was impaired in olomoucine-treated rats, whereas recovery in a skilled reaching test was substantially improved. Olomoucine treatment produced small changes in aspects of Iba1 immunolabelling and in the number of CD68-positive cells in cerebral cortex but did not selectively modify responses in peri-infarct tissue. The content of the astrocytic protein, vimentin, was reduced by 30% in the region of the lesion in olomoucine-treated rats.ConclusionsOlomoucine treatment modified functional recovery in the absence of significant changes in infarct volume. The effects on recovery were markedly test dependent, adding to evidence that skilled tasks requiring specific training and general measures of motor function can be differentially modified by some interventions. The altered recovery was not associated with specific changes in key responses of peri-infarct microglia, even though these cells were considered a likely target for early olomoucine treatment. Changes detected in peri-infarct reactive astrogliosis could contribute to the altered patterns of functional recovery.

Early combined rehabilitation intervention to improve the short-term prognosis of premature infants

BackgroundTo explore the clinical effect of early combined rehabilitation intervention on premature infants in the neonatal intensive care unit (NICU).MethodsPremature infants with gestational ages less than 32 weeks or birth weights less than 1500 g were included in the present study.The participants were divided into the intervention group and control group. All infants received the current routine treatment based on the clinical guidelines, and the intervention group was additionally treated by visual and auditory stimulation, oral motor function, respiratory function and neurodevelopmental training. The following clinical outcomes were compared: durations of oxygen supplementation and indwelling gastric tube use; incidences of retinopathy of prematurity (ROP) and neonatal necrotizing enterocolitis (NEC); Sliverman scores; incidences of bronchopulmonary dysplasia (BPD) and intraventricular haemorrhage; days of hospitalization; and neurodevelopmental outcomes. Datas were analysed using the following statistical tests: the chi-square test, the independent samples or paired t test, repeated measures ANOVA, and the Wilcoxon rank sum test.ResultsCompared with those in the control group, premature infants in the intervention group had shorter durations of oxygen supplementation and indwelling gastric tube use, fewer hospitalization days and lower incidences of ROP, BPD, and NEC.The intervention group had lower Sliverman scores and higher Ballard neuromuscular scores than the control group.ConclusionEarly combined rehabilitation intervention can improve the short-term clinical outcomes of premature infants.

Sensory enhancement amplifies interlimb cutaneous reflexes in wrist extensor muscles

Interlimb neural connections support motor tasks such as locomotion and cross-education strength training. Somatosensory pathways that can be assessed with cutaneous reflex paradigms assist in subserving these connections. Many studies show that stimulation of cutaneous nerves elicits reflexes in muscles widespread across the body and induces neural plasticity after training. Sensory enhancement, such as long-duration trains of transcutaneous stimulation, facilitates performance during rehabilitation training or fatiguing motor tasks. Performance improvements due to sensory stimulation may be caused by altered spinal and corticospinal excitability. However, how enhanced sensory input regulates the excitability of interlimb cutaneous reflex pathways has not been studied. Our purpose was to investigate the effects of sensory enhancement on interlimb cutaneous reflexes in wrist extensor muscles. Stimulation to provide sensory enhancement (2-s trains at 150 Hz to median or superficial radial nerves) or evoke cutaneous reflexes (15-ms trains at 300 Hz to superficial radial nerve) was applied in different arms while participants (n = 13) performed graded isometric wrist extension. Wrist extensor electromyography and cutaneous reflexes were measured bilaterally. We found amplified inhibitory reflexes in the arm receiving superficial radial and median nerve sensory enhancement with net reflex amplitudes decreased by 709.5% and 695.3% repetitively. This suggests sensory input alters neuronal excitabilities in the interlimb cutaneous pathways. These findings have potential application in facilitating motor function recovery through alterations in spinal cord excitability enhancing sensory input during targeted rehabilitation and sports training.NEW & NOTEWORTHY We show that sensory enhancement increases excitability in interlimb cutaneous pathways and that these effects are not influenced by descending motor drive on the contralateral side. These findings confirm the role of sensory input and cutaneous pathways in regulating interlimb movements. In targeted motor function training or rehabilitation, sensory enhancement may be applied to facilitate outcomes.

The Spinal Cord, Not to Be Forgotten: the Final Common Path for Development, Training and Recovery of Motor Function.

Research on learning, memory, and neural plasticity has long focused on the brain. However, the spinal cord also exhibits these phenomena to a remarkable degree. Following a spinal cord injury, the isolated spinal cord in vivo can adapt to the environment and benefit from training. The amount of plasticity or recovery of function following a spinal injury often depends on the age at which the injury occurs. In this overview, we discuss learning in the spinal cord, including associative conditioning, neural mechanisms, development, and applications to clinical populations. We take an integrated approach to the spinal cord, one that combines basic and experimental information about experience-dependent learning in animal models to clinical treatment of spinal cord injuries in humans. From such an approach, an important goal is to better inform therapeutic treatments for individuals with spinal cord injuries, as well as develop a more accurate and complete account of spinal cord and behavioral functioning.

Evaluation of leap motion control for hand rehabilitation in burn patients: An experience in the dust explosion disaster in Formosa Fun Coast

Hand burns cause functional impairment. Leap motion control (LMC), a kind of virtual reality games, employs a novel system that provides biofeedback and training of fine motor function and functional skills. In this study, we hypothesized that LMC would improve burned hand function.Sixteen participants were allocated to either the LMC group or the control group. The LMC group played 20min identical leap motion video games after 40min traditional occupational therapy (OT). The control group received traditional OT for 60min. Both groups received interventions 2 days a week for 4 months.A series of questionnaires were administered, including BSHS-B, QuickDASH, iADL, and Barthel index. Data on baseline characteristics including joint range of motion (ROM), grip and pinch strength, and scar thickness were obtained. Furthermore, we used the Mann–Whitney U test and Wilcoxon signed-rank test for comparison, as appropriate.We found improvements in BSHS-B, QuickDASH, and iADL in the LMC group (all p<0.05) compared to those in the control group. In the LMC-trained hand, the ROM of the thumb IP joint and pinch strength increased, whereas the scar thickness over the first dorsal interossei muscle decreased (p<0.05). In conclusion, leap motion training could help patients with hand burns to increase finger ROM, decrease scar thickness, and improve hand function.

Occupational activity disorders of extremely severe mass burn patients in recovery period after injury: a cross-sectional survey

Objective: To observe the distribution of occupational activity disorders of extremely severe mass burn patients in recovery period after injury. Methods: From December 2014 to December 2015, 65 extremely severe burn patients conforming to the inclusion criteria involved in August 2 Kunshan factory aluminum dust explosion accident were admitted to Kunshan Rehabilitation Hospital. They received comprehensive rehabilitation treatment after burns, including wearing pressure clothes, ultrasound treatment, semiconductor laser and red light irradiation, motor function training, and so on. Over 2 years after injury, a cross-sectional survey was conducted on the patients' occupational activity disorders. Modified Barthel index (MBI) was used to assess the degree of activities of daily living (ADL) disorder of patients and to grade the independent level of completing each item of MBI, and then the independent level of patients completing self-care MBI items (bathing, dressing, grooming, eating, going to the toilet, urine control, and stool control) was compared with that of mobility items (going up and down stairs, bed and chair transfer, and walking). The Canadian Occupational Performance Measure (COPM) was used to assess the distribution of occupational activity disorders of patients. The distribution of the five most serious occupational activity disorders was counted, then the frequency and probability of which with frequency greater than or equal to 16 times were calculated. Data were processed with Pearson Chi-square test. Results: Over 2 years after injury, the MBI score of patients was (76±22) points, and the ADL of 83.08% (54/65) patients reached completely self-care or light ADL disorder level. The MBI items arranged according to the completing independent level of patients from high to low were urine control/stool control, walking, bed and chair transfer, going up and down stairs, going to the toilet, eating, grooming, dressing, and bathing. The independent level of patients completing self-care MBI items was lower than that of mobility items (χ(2)=62.298, P<0.001). Over 2 years after injury, the five most serious occupational activity disorders in COPM dimension were mainly concentrated in the self-care dimension, accounting for 55.38% (180/325), followed by 22.46% (73/325) of production activities and 22.15% (72/325) of recreational activities, and the centrally distributed item was the personal self-care item under self-care dimension, accounting for 42.46% (138/325). Over 2 years after injury, the five most serious occupational activity disorders with frequency greater than or equal to 16 times were dressing and undressing, bathing, perineal cleaning, wearing pressure clothes, caring for children, visiting relatives and friends, 31, 25, 16, 17, 18, and 22 times respectively, with a probability of 47.69%, 38.46%, 24.62%, 26.15%, 27.69%, and 33.85% respectively. Conclusions: Over 2 years after injury, most of the patients with extremely severe burns caused by the aluminum dust explosion were completely or basically self-care in their daily life. The disorder of self-care ADL was more serious than that of mobility, and the disorder of individual self-care activity was still the most serious occupational activity disorder of patients in this stage. Clinical trial registration: Chinese clinical trial registry, ChiCTR-OOC-16009188.

Clinical remission of myopathy with MYH2 mutations after rehabilitation treatment: A case report

Myosin myopathies consist of a set of inherited diseases caused by mutations in myosin heavy chain (MyHC) genes. Among them, MYH2 mutations have been reported to lead myopathy with ophthalmoplegia, mild to moderate muscle weakness characterized by lack of type 2A muscle fibers. To date, there is still no specific treatment for MYH2 mutated patients. A 35-month-old girl was admitted for her motor developmental disorder associated with intellectual disability. A physical examination revealed the decreased muscle strength and muscle tone of her lower limbs and facial muscles combined with poor function of sitting and standing balance. Based on the primary assessment, a general rehabilitation therapy plan for the girl was set-up, which involved balance training, muscle strength training in low extremity, walking training, gross and fine motor function training, as well as family education. However, after the first phase of training, her motor skills were only improved mildly as well as her balance function. In the meantime, whole-exome sequencing was performed, and a novel heterozygous mutation was discovered in her MYH2 gene. These two mutations were predicted to be pathogenic, which can lead to proximal myopathy and extraocular muscle paralysis, mainly involved in type 2A muscle fibers. After her accurate diagnosis, active exercise and endurance exercise were added in addition to original rehabilitation training program and aim to shift the expression of myosin heavy chain isoform from fast to slow. Twelve weeks after the optimized rehabilitation training, the function of her gross and fine motor was improved notably. In addition, her ability of standing, walking and jumping was enhanced significantly as well. In this study, we described for the first time the clinical remission of myopathy with MYH2 missense mutations after effective rehabilitation. Precision medicine is incredibly helpful for patients with unexplained myopathies to develop a suitable rehabilitation program.

Physical Therapy Dosing: Frequency and Type of Intervention in Pediatric Postacute Hospital Care.

To examine differences in physical therapy dosing frequency recommendations based on children's characteristics and to describe types of intervention recommended at postacute hospital admission. Demographic and clinical information, recommended physical therapy intervention frequency, and intervention types were collected for all admissions from April 1, 2015, to March 1, 2016. Differences across 2 groups, children with recommendations for "less" (≤3x/wk) or "more" (≥4x/wk) frequent therapy, were examined. Types of interventions recommended were described and the measure of association between frequency and type was determined. Older children, those with higher admission functional scores, and children with less dependence on medical technology were recommended for "more." Therapeutic exercise was the most common intervention recommended. Greater physical therapy frequency was associated with Functional Training and Motor Function Training. Children's age, functional level, and technology dependence influence dosing recommendations. Interventions focused on function are associated with greater physical therapy frequency.