Optimal Rehabilitation Strategies Research Articles

Prospective randomized comparison of functional bracing versus rigid immobilization with early weightbearing after modified percutaneous achilles tendon repair under local anesthesia

ObjectiveThe optimal treatment and rehabilitation strategy for acute Achilles tendon rupture (ATR) remain a debate. This study aimed to compare the results of the two postoperative regimens after treatment for ATR with modified closed percutaneous repair under local anesthesia. MethodsIn a 4-year study, 72 consecutive patients with acute complete ATR were randomized after percutaneous repair into a functional group (FG), using a modified brace (28 males, three females; mean age 41.9 [29–71] years) and an immobilization group (IG), wearing a rigid plaster (28 males, two females; mean age 42.2 [29–57] years), for a period of 6 weeks. Except for immobilization, they followed the same weight-bearing and rehabilitation protocols. The follow-up period was 3 years. The complication rate, active and passive ankle range of motion, standing heel-rise test, clinical outcome using the American Foot and Ankle Society (AOFAS) hindfoot-ankle score, return to the previous activity level, and subjective assessment were assessed. ResultsThere was one rerupture in the IG and two transient sural nerve disturbances in the FG and one in the IG, and one suture extrusion in the IG, with no other complications. The average AOFAS scores were 96.9 ± 4.3 and 96.0 ± 4.9 in the FG and IG, respectively. Patients in the FG reached a final range of motion and muscular strength sooner without limping and were more satisfied with the treatment. No significant differences could be detected between groups according to the results in any of the assessed parameters. ConclusionEarly dynamic functional bracing in patients with ATR treated with modified closed percutaneous repair under local anesthesia resulted in earlier functional recovery with similar final results in terms of complications and functional outcomes, such as rigid postoperative immobilization with standardized rehabilitation and weight-bearing protocol. Level of evidenceI, Prospective randomized study

Complex rehabilitation of patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a common chronic autoimmune disease characterized by symmetrical polyarthritis, joint pain, and morning stiffness. It significantly impairs physical condition and increases the risk of functional disability. While conventional treatments include drug therapy, many patients continue to experience symptoms and seek alternative therapies to improve their condition. This article describes two clinical cases of RA patients treated with a comprehensive rehabilitation program, including moderate-intensity walking, yoga, and nutritional therapy. The study aimed to evaluate this approach's effectiveness in improving the patients' functional capacity and quality of life. The first patient (50 year-old female) noted a significant reduction in the number of painful joints (by 14) and swollen joints (by 12) after a three-month rehabilitation course. The visual analog scale (VAS) pain level decreased from 80mm to 50mm, and the duration of morning stiffness decreased from several hours to 80min. The second patient (45 year-old female) also showed improvement: painful joints decreased from 13 to 2, and swollen joints from 7 to 1. VAS pain level decreased from 80mm to 40mm, and morning stiffness decreased by 50min. Both patients reported an average reduction in excess weight by 1.65kg/m², along with improvements in general well-being and mood. The results confirm that a comprehensive rehabilitation approach, including physical activity, yoga, and diet therapy, significantly improves the condition of RA patients. This approach helps reduce pain, decrease the number of inflamed joints, and improve overall functionality. Further studies with a larger sample are needed to determine the optimal rehabilitation strategies and the most impactful interventions.

Fuzzy Rule Based System of Optimal Pavement Maintenance and Rehabilitation Strategies for Yangon-Mandalay Expressway

Purpose: Systematic pavement management plays a vital role in the better Road Asset Management system. The lifespan of pavement can be preserved and prolonged by adequate maintenance measures in proper time. By early detection and repair of defects at initial stages with predictive maintenance reduces the rapid deterioration of the pavement. Moreover, inaccuracy in pavement deterioration prediction leads to an improper maintenance with wastage of time, cost and labor strength. To overcome all of these obstacles, this paper attempts an approach on optimal pavement maintenance strategy by means of fuzzy rule-based system. Materials and Methods: In this research, four pavement indicators of PCI, IRI, PSR and PSI have been taken into account as antecedents and five different types of pavement maintenance as consequents. In this research, ASTM D-6433, Road Lab Pro software, AASHTO guidelines and Fuzzy Logic (Mamdani) model have been used to evaluate the current pavement condition and optimal pavement maintenance strategies. Findings: According to research area, 130 total pavement sample units were undertaken to study for the mean pavement condition of PCI value 54.93 (poor), IRI 7.01 (fair), PSR 3.33 (fair) and PSI 3.35 (fair). Due to 13 years-old life span of traffic volume, temperature and other external factors, this expressway is suffering from potholes, bleeding, longitudinal and transverse cracking, weathering, joint reflection cracking for Asphalt Concrete (AC) overlay and linear cracking, joint seal failure, scaling, faulting, depression, lane/shoulder drop off for existing concrete pavement. According to the fuzzy logic model results, 42 numbers of fuzzy If-Then maintenance rules were verified as the most relevant pavement maintenance and rehabilitation strategies for Yangon-Mandalay Expressway. Implications to Theory, Practice and Policy: This research provide implications to the study and contributions to theory, practice and policy. This research paper insights into effective infrastructure maintenance and investment, emphasizing the role of advanced computational techniques in transportation economics. The key advantage of this research paper is to be effective, supportive, easy and accessible decision-making tool for transportation and pavement engineers, expressway planners and highways department authorities especially from developing countries.

Deep learning survival model predicts outcome after intracerebral hemorrhage from initial CT scan.

Predicting functional impairment after intracerebral hemorrhage (ICH) provides valuable information for planning of patient care and rehabilitation strategies. Current prognostic tools are limited in making long term predictions and require multiple expert-defined inputs and interpretation that make their clinical implementation challenging. This study aimed to predict long term functional impairment of ICH patients from admission non-contrast CT scans, leveraging deep learning models in a survival analysis framework. We used the admission non-contrast CT scans from 882 patients from the Massachusetts General Hospital ICH Study for training, hyperparameter optimization, and model selection, and 146 patients from the Yale New Haven ICH Study for external validation of a deep learning model predicting functional outcome. Disability (modified Rankin scale [mRS] > 2), severe disability (mRS > 4), and dependent living status were assessed via telephone interviews after 6, 12, and 24 months. The prediction methods were evaluated by the c-index and compared with ICH score and FUNC score. Using non-contrast CT, our deep learning model achieved higher prediction accuracy of post-ICH dependent living, disability, and severe disability by 6, 12, and 24 months (c-index 0.742 [95% CI -0.700 to 0.778], 0.712 [95% CI -0.674 to 0.752], 0.779 [95% CI -0.733 to 0.832] respectively) compared with the ICH score (c-index 0.673 [95% CI -0.662 to 0.688], 0.647 [95% CI -0.637 to 0.661] and 0.697 [95% CI -0.675 to 0.717]) and FUNC score (c-index 0.701 [95% CI- 0.698 to 0.723], 0.668 [95% CI -0.657 to 0.680] and 0.727 [95% CI -0.708 to 0.753]). In the external independent Yale-ICH cohort, similar performance metrics were obtained for disability and severe disability (c-index 0.725 [95% CI -0.673 to 0.781] and 0.747 [95% CI -0.676 to 0.807], respectively). Similar AUC of predicting each outcome at 6 months, 1 and 2 years after ICH was achieved compared with ICH score and FUNC score. We developed a generalizable deep learning model to predict onset of dependent living and disability after ICH, which could help to guide treatment decisions, advise relatives in the acute setting, optimize rehabilitation strategies, and anticipate long-term care needs.

Case Report: Thalamic Stroke Patient with Neuropsychiatric Symptoms

Vascular dementia presents a complex clinical picture when compounded by rare vascular events of such as thalamic stroke. This case report highlights the pivotal role of early psychiatric consultation and neuropsychological testing in the management of vascular dementia, particularly in the context of a thalamic stroke. A 81-year-old male presented with cognitive decline, depressive symptoms, and functional impairment following a vascular stroke. Prompt psychiatric evaluation and comprehensive neuropsychological assessment revealed concurrent vascular dementia and geriatric depression along with localization of vascular stroke. Early intervention with tailored pharmacotherapy targeting both cognitive and mood symptoms yielded significant improvement in cognitive function, mood, management of delirium and overall functional status. Moreover, the incorporation of psychiatric rehabilitation strategies facilitated enhanced recovery and long-term prognosis. This case underscores the critical importance of multidisciplinary collaboration involving psychiatrists, neurologists, and rehabilitation specialists in the holistic management of vascular dementia. Early identification of psychiatric symptoms through thorough evaluation and timely intervention not only improves short-term outcomes but also holds promise for mitigating long-term disability and optimizing the quality of life in patients with vascular dementia and associated thalamic stroke. Further research is warranted to delineate optimal treatment approaches and rehabilitation strategies in this vulnerable population

Postoperative Long-Term Monitoring of Mechanical Characteristics in Reconstructed Soft Tissues Using Biocompatible, Immune-Tolerant, and Wireless Electronic Sutures.

Accurate postoperative assessment of varying mechanical properties is crucial for customizing patient-specific treatments and optimizing rehabilitation strategies following Achilles tendon (AT) rupture and reconstruction surgery. This study introduces a wireless, chip-less, and immune-tolerant in vivo strain-sensing suture designed to continuously monitor mechanical stiffness variations in the reconstructed AT throughout the healing process. This innovative sensing suture integrates a standard medical suturing thread with a wireless fiber strain-sensing system, which incorporates a fiber strain sensor and a double-layered inductive coil for wireless readout. The winding design of Au nanoparticle-based fiber electrodes and a hollow core contribute to the fiber strain sensor's high sensitivity (factor of 6.2 and 15.1 pF for revised sensitivity), negligible hysteresis, and durability over 10,000 stretching cycles. To ensure biocompatibility and immune tolerance during extended in vivo periods, an antibiofouling lubricant layer was applied to the sensing suture. Using this sensing system, we successfully monitored the strain responses of the reconstructed AT in an in vivo porcine model. This facilitated the postoperative assessment of mechanical stiffness variations through a well-established analytical model during the healing period.

Application of Biomechanics in Medical Sciences

Abstract Biomechanics, the study of the mechanical behavior of living organisms, finds numerous applications in medicine, from understanding normal physiological functions to designing medical devices and treatments. Biomechanics plays a vital role in various medical specialties and applications, from diagnosing and treating musculoskeletal disorders to designing medical devices, optimizing rehabilitation strategies, and advancing regenerative medicine. Integrating biomechanics into medical physiology enhances our understanding of human function and drives innovation in medical technology and therapies.

Individualized trajectories in postradiotherapy neurocognitive functioning of patients with brain metastases.

The increasing incidence of brain metastases (BMs) and improved survival rates underscore the necessity to investigate the effects of treatments on individuals. The aim of this study was to evaluate the individual trajectories of subjective and objective cognitive performance after radiotherapy in patients with BMs. The study population consisted of adult patients with BMs referred for radiotherapy. A semi-structured interview and comprehensive neurocognitive assessment (NCA) were used to assess both subjective and objective cognitive performance before, 3 months and ≥ 11 months after radiotherapy. Reliable change indices were used to identify individual, clinically meaningful changes. Thirty-six patients completed the 3-month follow-up, and 14 patients completed the ≥ 11-months follow-up. Depending on the domain, subjective cognitive decline was reported by 11-22% of patients. In total, 50% of patients reported subjective decline in at least one cognitive domain. Intracranial progression 3 months postradiotherapy was a risk-factor for self-reported deterioration (P = .031). Objective changes were observed across all domains, with a particular vulnerability for decline in memory at 3 months postradiotherapy. The majority of patients (81%) experienced both a deterioration as well as improvement (eg, mixed response) in objective cognitive functioning. Results were similar for the long-term follow-up (3 to ≥11 months). No risk factors for objective cognitive change 3 months postradiotherapy were identified. Our study revealed that the majority of patients with BMs will show a mixed cognitive response following radiotherapy, reflecting the complex impact. This underscores the importance of patient-tailored NCAs 3 months postradiotherapy to guide optimal rehabilitation strategies.

Cardiorespiratory fitness, physical activity, and fatigue three months after first-ever ischemic stroke

ABSTRACT Background Research on cardiorespiratory fitness (CRF) in relation to physical activity (PA) and fatigue after stroke is limited. Increased knowledge of interrelationships between these factors can help optimize rehabilitation strategies and improve health-outcomes. Objectives We aimed to: 1) evaluate CRF, PA, and fatigue, 2) characterize patients with impaired versus non-impaired CRF, and 3) examine associations of CRF with PA and fatigue, three months after first-ever ischemic stroke. Methods In this cross-sectional study CRF was measured as peak oxygen uptake (VO2peak) by cardiopulmonary exercise testing. PA was measured using accelerometers. Fatigue was assessed with the 7-item Fatigue Severity Scale (FSS). Results The sample (n=74, mean age 64±13 years, 36% women) had a mean VO2peak of 27.0±8.7 (86% of predicted). Fifty-one percent met the World Health Organization’s recommendation of ≥150 min of moderate PA/week. Mean steps-per-day was 9316±4424 (113% of predicted). Thirty-five percent of the sample had moderate-to-high fatigue (FSS≥4), mean FSS score was 3.2±1.8. Patients with impaired CRF (VO2peak<80% of predicted) had higher body-fat-percent (p<0.01), less moderate-to-vigorous PA (MVPA) (p<0.01) and a trend toward higher fatigue (p=0.053) compared to the non-impaired. Backward regression analysis showed that higher CRF was associated with more MVPA (unstandardized beta [95% CI]: 0.38 [0.15, 0.63], p=0.002) and less fatigue (unstandardized beta [95% CI]: -3.9 [-6.4, -1.6], p=0.004). Conclusions Stroke patients had lower CRF compared to reference values. Impaired CRF was mainly related to overweight. Higher CRF was associated with more MVPA and less fatigue. Exercise after stroke may be especially beneficial for patients with impaired CRF.

Comparison of Intensive Physical Therapy and Electrical Stimulation to Reduce Spasticity in Stroke

Background: Stroke is a leading cause of disability worldwide, often resulting in spasticity that significantly impairs the functional recovery of individuals. The comparative efficacy of intensive physical therapy and electrical stimulation in mitigating post-stroke spasticity remains a critical area of research. Understanding the impacts of these treatments can guide clinicians in optimizing rehabilitation strategies for stroke survivors. Objective: The study aimed to compare the effectiveness of intensive physical therapy and electrical stimulation in reducing spasticity among stroke patients, with an emphasis on how these interventions influence muscle tone and functional outcomes. Methods: This quasi-experimental trial was conducted at Nishtar Hospital, Multan, over six months, involving 30 participants aged 50-65 years who had experienced a stroke. Participants were randomly assigned to receive either intensive physical therapy or electrical stimulation. Baseline and post-treatment assessments of spasticity were conducted using the Modified Ashworth Scale (MAS). Data were analyzed using SPSS version 25, focusing on changes in MAS scores before and after the interventions. Results: Both interventions showed significant improvements in spasticity levels. The intensive physical therapy group exhibited notable reductions in MAS scores across various joints: shoulder flexors (from 3.13 ± 0.51 to 1.20 ± 0.41), shoulder extensors (from 3.00 ± 0.65 to 1.20 ± 0.67), and hip abduction (from 3.00 ± 0.65 to 1.33 ± 0.72). The electrical stimulation group also demonstrated significant improvements, with MAS scores in wrist flexion (from 2.73 ± 0.70 to 1.33 ± 0.61) and hip extension (from 2.80 ± 0.67 to 1.26 ± 0.45) showing notable reductions. However, no statistically significant differences were observed between the two groups in terms of overall effectiveness in reducing spasticity (p &gt; 0.05). Conclusion: Both intensive physical therapy and electrical stimulation are effective in reducing post-stroke spasticity, with no significant difference in their overall efficacy. This suggests that either treatment can be considered as part of a comprehensive rehabilitation strategy for stroke survivors, depending on individual patient needs, preferences, and specific functional goals.

Impact of Hand Grip Strength on Functional Independence and Arm Motor Performance in Stroke Survivors

Background: Stroke remains a leading cause of disability worldwide, with a significant number of survivors experiencing impairments in upper limb function and hand grip strength, which are crucial for performing activities of daily living (ADLs). Understanding the relationship between hand grip strength, functional independence, and arm motor performance is essential for optimizing rehabilitation strategies. Objective: This study aimed to investigate the impact of hand grip strength on functional independence and arm motor performance in stroke survivors and to evaluate the effectiveness of Mirror Therapy in enhancing these outcomes. Methods: An analytical cross-sectional study was conducted at DHQ Teaching Hospital Sargodha, involving 22 stroke survivors, evenly split between genders. Participants were aged 45-65 years, clinically diagnosed with ischemic stroke in the subacute stage, and exhibited Modified Ashworth Scale scores of 1 to 1+ for hand flexors. The study employed randomized assignments to intervention groups, utilizing assessments such as the Action Research Arm Test (ARAT), Fugl-Meyer Assessment for Upper Extremity (FMA UE), Hand-Held Dynamometer (HHD), and Stroke Impact Scale (SIS) at baseline, 3 weeks, and 6 weeks. Statistical analysis was performed using Pearson’s coefficient of correlation with SPSS version 25. Results: Significant improvements were observed in upper limb strength and hand dexterity, particularly in the group undergoing Mirror Therapy. The correlation coefficients among ARAT, HHD, and SIS were .676**, .748**, and .704** respectively, indicating strong positive relationships between hand grip strength, functional ability, and quality of life. Mirror Therapy demonstrated notable enhancements in ARAT (p = .001), FMA UE (p &lt; .000), HHD (p = .000), and SIS scores (p = .000), reflecting increased functional ability, grip strength, and improved quality of life. Conclusion: The study confirmed the significant impact of hand grip strength on the functional independence and arm motor performance of stroke survivors, with Mirror Therapy providing substantial benefits. These findings advocate for the inclusion of grip strength-focused interventions and Mirror Therapy in stroke rehabilitation programs to improve survivors' functional outcomes and quality of life.

Evaluating optimal rehabilitation strategies in ICU: study protocol for a multicentre cohort study to assess Physical Activity dosing, Muscle mass, and physICal outcomeS (IPAMICS study)

Evaluating optimal rehabilitation strategies in ICU: study protocol for a multicentre cohort study to assess Physical Activity dosing, Muscle mass, and physICal outcomeS (IPAMICS study)

Rehabilitation of Chronic Pain in Post-Critical Care Patients. A Narrative Review

Chronic pain in post-critical care patients is a multifaceted issue with profound implications for patient well-being and quality of life. This review aims to address the rehabilitation of patients who suffer from chronic pain following discharge from the intensive care unit (ICU). Despite growing awareness of the prevalence and impact of this condition, significant gaps in knowledge persist regarding the optimal rehabilitation strategies for these patients. To conduct this study, an extensive literature search was undertaken, encompassing peer-reviewed articles, clinical trials, and observational studies in Medline, Scopus, and Cinahl databases, using specific keywords. Studies were identified based on their titles, abstracts, and those that met the inclusion criteria. Sixteen studies were eligible for inclusion in this review, varying in methodology, assessment tool, assessment time, or follow-up. The findings of this review illuminate the existing gaps in knowledge by synthesizing evidence on the various rehabilitation approaches employed, their effectiveness, and the factors influencing patient outcomes. So far, healthcare professionals have targeted either pain treatment, finding an analgesic medication or the proper position/exercise, or pain management, helping the patient manage life despite the unrelieved pain. Conventional pain treatment or control has been replaced by pain rehabilitation, in which a biopsychosocial approach enables healthcare professionals to provide patients with the knowledge and skills to manage their pain and disability through personal multidimensional choices. Early rehabilitation programs, quick mobilization, and greater family participation should be encouraged. The strengths of this study lie in its thorough analysis of the available literature and the provision of valuable insights into the heterogeneous nature of chronic pain in post-critical care patients. However, limitations include the limited availability of high-quality randomized controlled trials in this domain. Overall, this review contributes to an improved understanding of rehabilitation strategies for chronic pain in post-critical care patients and underscores the need for further research to enhance patient care and outcomes.

Comparison of Early versus Traditional Rehabilitation Protocol after Rotator Cuff Repair: An Umbrella-Review.

Rehabilitation after rotator cuff repair is crucial for functional recovery and for minimizing the risk of retear. There are two rehabilitation protocols (early and traditional) and the debate about which is the best is open. This umbrella review aimed to compare the effect of these rehabilitation protocols in terms of reduction in pain, functional recovery, and retear risk. We selected systematic reviews and meta-analyses published between 2012 and 2022 dealing with the aim. Nineteen systematic reviews were included. No significant differences were found between early and traditional protocols in terms of pain reduction. Early rehabilitation provided better short-term results regarding Range of Motion improvement, but long-term functional outcomes were similar. Retear risk remains a significant concern for the early protocol. We found major differences between the analyzed protocols. This review suggests that both protocols are useful to recover global shoulder function, but the standard protocol has a greater safety profile for larger tears. On the other hand, the early protocol may be preferable for smaller lesions, allowing a faster recovery and having less impact on medical costs. Further research is needed to identify optimal rehabilitation strategies tailored to the individual patient's needs and characteristics.

Intensive Multimodal Treatment for A Young Adult with Friedreich Ataxia: A Case Report

Background: Friedreich’s ataxia (FRDA) is a progressive, neurodegenerative autosomal recessive disorder affecting multiple systems of the body. Physical therapy has been found to be beneficial for improving function and quality of life in individuals with FRDA. However, there is little evidence supporting specific interventions that would address functional concerns in these patients, and the most optimal rehabilitation strategy has yet to be determined. Case Presentation: The participant was a twenty-six-year-old female who had been diagnosed with FRDA ten years earlier. After discontinuing physical therapy for three years, she started using a wheelchair and her function declined. The primary outcome measures employed to assess FRDA were the scale for assessment and rating of ataxia (SARA) and the functional independence measure (FIM). Other measures included strength, range of motion and neurologic screening. At initial examination, the participant presented with muscle weakness, poor balance and coordination, and mobility restrictions. The patient received intensive physical therapy with five weekly sessions over a period of three months. Interventions focused on coordinative, balance, and strength training activities. Results: The patient demonstrated a 30-point increase in the FIM, a 9-point decrease in the SARA, and amelioration in manual muscle testing scores upon completion of the rehabilitation program. Conclusion: The FRDA patient displayed improvement in all outcome measures. Strength, ataxia severity and functional abilities were enhanced while a higher level of independence was gained. Our observations suggest that an intensive multimodal approach holds potential in the management of FRDA and call for further research. KEYWORDS: Friedreich’s ataxia, Rehabilitation outcomes, Physical therapy.

Impaired Voluntary Activation of an Ankle Dorsiflexor Muscle Predicts Walking Capacity in Multiple Sclerosis

Background and Purpose Walking impairments are highly prevalent in people with Multiple Sclerosis (pwMS) and are related to factors including motor deficits and balance. Reductions in voluntary activation (VA) (i.e., reduced neural drive known as central fatigability) is a key contributor to motor deficits during fatiguing tasks in pwMS; however, the relationship between central fatigability and walking function is poorly understood. The purpose of this study was to determine associations between reductions in VA after a fatiguing task and walking capacity (WC) in pwMS and controls. Methods 19 pwMS (female=9) and 10 age-matched controls (female=6) participated. PwMS were sub-grouped for disease severity into those mildly affected (n=11, female=5, EDSS=2.5-4.0) and moderately affected (n=8, female=4, EDSS= 4.5-6.5). Twitch interpolation during a maximal voluntary contraction quantified VA of the tibialis anterior muscle before and immediately after a fatiguing time-to-task failure isometric task performed at 50% of maximal strength. The 6-minute walk test determined baseline WC. Values are mean ± SD. Results Moderately affected pwMS showed greater central fatigability after the fatiguing task compared with mildly affected pwMS (p=0.01), and controls (p=0.07) (moderately affected= 23.5% ± 24.9, mildly affected= 0.3% ± 5.4, controls= 6.4% ± 14.4). Both groups of pwMS showed lower WC than controls (moderately affected= 299.5m ± 75.2, mildly affected= 527.7m ± 68.9, controls= 613.7m ± 88.9, p<0.001). Further analyses revealed an association between central fatigability and WC, but only in the moderately affected pwMS (R2= 0.7, standardized estimate= -0.8, t=-3.8, p=0.009). Discussion Impaired neural drive of the ankle dorsiflexor muscles is a predictor of WC in pwMS who experience greater disease severity. Thus, mechanisms for limitation in walking function may be different based on disease severity in pwMS and this knowledge may assist in optimizing rehabilitation strategies to improve walking function in pwMS. Walking impairments are highly prevalent in people with Multiple Sclerosis (pwMS) and are related to factors including motor deficits and balance. Reductions in voluntary activation (VA) (i.e., reduced neural drive known as central fatigability) is a key contributor to motor deficits during fatiguing tasks in pwMS; however, the relationship between central fatigability and walking function is poorly understood. The purpose of this study was to determine associations between reductions in VA after a fatiguing task and walking capacity (WC) in pwMS and controls. 19 pwMS (female=9) and 10 age-matched controls (female=6) participated. PwMS were sub-grouped for disease severity into those mildly affected (n=11, female=5, EDSS=2.5-4.0) and moderately affected (n=8, female=4, EDSS= 4.5-6.5). Twitch interpolation during a maximal voluntary contraction quantified VA of the tibialis anterior muscle before and immediately after a fatiguing time-to-task failure isometric task performed at 50% of maximal strength. The 6-minute walk test determined baseline WC. Values are mean ± SD. Moderately affected pwMS showed greater central fatigability after the fatiguing task compared with mildly affected pwMS (p=0.01), and controls (p=0.07) (moderately affected= 23.5% ± 24.9, mildly affected= 0.3% ± 5.4, controls= 6.4% ± 14.4). Both groups of pwMS showed lower WC than controls (moderately affected= 299.5m ± 75.2, mildly affected= 527.7m ± 68.9, controls= 613.7m ± 88.9, p<0.001). Further analyses revealed an association between central fatigability and WC, but only in the moderately affected pwMS (R2= 0.7, standardized estimate= -0.8, t=-3.8, p=0.009). Impaired neural drive of the ankle dorsiflexor muscles is a predictor of WC in pwMS who experience greater disease severity. Thus, mechanisms for limitation in walking function may be different based on disease severity in pwMS and this knowledge may assist in optimizing rehabilitation strategies to improve walking function in pwMS.

Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke.

Though rare, stroke in infants and children is an important cause of mortality and chronic morbidity in the pediatric population. Neuroimaging advances and implementation of pediatric stroke care protocols have led to the ability to rapidly diagnose stroke and in many cases determine the stroke etiology. Though data on efficacy of hyperacute therapies, such as intravenous thrombolysis and mechanical thrombectomy, in pediatric stroke are limited, feasibility and safety data are mounting and support careful consideration of these treatments for childhood stroke. Recent therapeutic advances allow for targeted stroke prevention efforts in high-risk conditions, such as moyamoya, sickle cell disease, cardiac disease, and genetic disorders. Despite these exciting advances, important knowledge gaps persist, including optimal dosing and type of thrombolytic agents, inclusion criteria for mechanical thrombectomy, the role of immunomodulatory therapies for focal cerebral arteriopathy, optimal long-term antithrombotic strategies, the role of patent foramen ovale closure in pediatric stroke, and optimal rehabilitation strategies after stroke of the developing brain.

Etiology and duration of the disease in the assessment of intellectual functioning of pediatric patients with epilepsy: An observational study

Childhood epilepsy can be frequently associated with impaired cognitive functioning. Previous research has suggested an increased risk of cognitive impairment that may be related to the etiology, the electro-clinical pattern and the load of anti-seizure medications (ASMs). The aim of this study was to evaluate the impact of different clinical features on the global intellectual functioning in a cohort of children and adolescents with epilepsy. We studied eighty patients diagnosed and followed in a tertiary care center. These factors were examined: 1. Etiology of epileptic syndrome; 2. Type of seizure; 3. Number of ASMs; 4. Seizure frequency; 5. Age at seizure onset; 6. Total duration of epilepsy; and 7. Active duration of epilepsy. Multiple regression analysis showed that the etiology and the total duration of epilepsy were the best indicators of intellectual functioning. The present data indicate that children with symptomatic epilepsy (SE) have lower IQ scores (M = 63.5), while children with self-limited focal epilepsy and generalized idiopathic epilepsy, i.e. age-related epileptic syndromes (ARES), have a higher IQ (M = 100.0; p < 0.01). Children with epilepsy of unknown etiology (UEE) (M = 75.1; p < 0.05) are positioned at an intermediate level between the SE and the ARES group (p < 0.01). Increased duration of epilepsy was associated with decreased intellectual functioning. In conclusion, knowledge about the risks associated with etiologic factors and the duration of the disease may guide the definition of optimal neuropsychological rehabilitation strategies.

Expert consensus guidance on respiratory physiotherapy and rehabilitation of patients with rib fractures: An international, multidisciplinary e-Delphi study.

There is limited research supporting optimal respiratory physiotherapy or physical rehabilitation strategies for patients with rib fractures. The aim of this study was to develop key recommendations for the physiotherapy management of patients with rib fractures. A three-round modified e-Delphi survey design, using an international Delphi panel including physiotherapy clinicians, researchers and lecturers, physician associates, trauma surgeons, and intensivists, was used in this study. The draft recommendations were developed by the Steering Group, based on available research. Over three rounds, panelists rated their agreement (using a Likert scale) with regard to recommendation for physiotherapists delivering respiratory physiotherapy and physical rehabilitation to patients following rib fractures. Recommendations were retained if they achieved consensus (defined as ≥70% of panelists ≥5/7) at the end of each round. A total of 121 participants from 18 countries registered to participate in the study, with 87 (72%), 77 (64%), and 79 (65%) registrants completing the three rounds, respectively. The final guidance document included 18 respiratory physiotherapy and rehabilitation recommendations, mapped over seven clinical scenarios for patients (1) not requiring mechanical ventilation, (2) requiring mechanical ventilation, (3) with no concurrent fracture of the shoulder girdle complex, (4) with a concurrent fracture of the shoulder girdle complex, (5) with/without concurrent upper limb orthopedic injuries, (6) undergoing surgical stabilization of rib fractures, and (7) at hospital discharge. This guidance provides key recommendations for respiratory physiotherapy and physical rehabilitation of patients with rib fractures. It could also be used to inform future research priorities in the field. Therapeutic/Care Management; Level IV.

Optimizing Rehabilitation Strategies for Sports Injuries: A Comprehensive Analysis of Evidence-Based Interventions and Rehabilitation Protocols

Athletes commonly become injured during competition, emphasizing the necessity for appropriate recovery. This research examines if standard sporting injury treatments and rehabilitation work in China. The issue Despite the high occurrence of sports injuries in China, rehabilitation therapy efficacy research is scarce. Interview-based research addresses such problems. This research examines how different therapy and rehabilitation programs help Chinese athletes recover from competition-related injuries. The researchers interviewed wounded athletes to acquire data. Structured interviews were conducted to collect qualitative data from participants regarding their rehabilitation therapies' efficacy, adherence, and results. The study revealed fresh information on the efficacy of evidence-based treatments and rehabilitation methods for Chinese sports injuries. The interviews revealed how different rehabilitation methods impacted on the athletes' recoveries and what variables influenced program adherence and positive results. Based on the findings, medical practitioners, sports trainers, and Chinese athletes should prioritize scientifically backed rehabilitation regimens. Using this data to create individualized rehabilitation programs for athletes with sports-related injuries may improve their chances of a complete and quick recovery. In conclusion, an interview-based study in China revealed the effectiveness of evidence-based sports injury treatment and rehabilitation. The study will help the Chinese sports community better rehabilitate and recover faster.