Primary Goal Of Rehabilitation Research Articles

Optimizing Health-Related Outcomes Following Musculoskeletal Injury Through the Integration of Self-Efficacy Theory and the Fear Avoidance Model

A primary goal of rehabilitation is to produce optimal health-related quality of life outcomes, which includes returning patients to their desired level of activity. Injury-related fear, kinesiophobia, and fear-avoidance beliefs are psychological factors that negatively impact health-related quality of life and are associated with decreased levels of physical activity. Conversely, increased levels of self-efficacy have been linked to favorable rehabilitation outcomes. To promote full recovery and optimal health-related quality of life, the rehabilitation process should consider addressing self-efficacy and injury-related fear (e.g., kinesiophobia, fear-avoidance beliefs). Therefore, the purpose of this paper is to introduce a theoretical framework which integrates self-efficacy theory and the Fear-Avoidance Model to mitigate injury-related fear and optimize patient outcomes following musculoskeletal injury. The intention of this theoretical framework is to provide clinicians with psychosocial interventions to improve self-efficacy and prevent the progression of injury-related fear at varying times throughout the rehabilitation process.

Dynamics of Center of Pressure Trajectory in Gait: Unilateral Transfemoral Amputees Versus Non-Disabled Individuals.

The primary goal of rehabilitation for individuals with lower limb amputation, particularly those with unilateral transfemoral amputation (uTFA), is to restore their ability to walk independently. Effective control of the center of pressure (COP) during gait is vital for maintaining balance and stability, yet it poses a significant challenge for individuals with uTFA. This study aims to study the COP during gait in individuals with uTFA and elucidate their unique compensatory strategies. This study involved 12 uTFA participants and age-matched non-disabled controls, with gait and COP trajectory data collected using an instrumented treadmill. Gait and COP parameters between the control limb (CL), prosthetic limb (PL), and intact limb (IL) were compared. Notably, the mediolateral displacement of COP in PL exhibited significant lateral displacement compared to the CL from 30% to 60% of the stance. In 20% to 45% of the stance, the COP forward speed of PL was significantly higher than that of the IL. Furthermore, during the initial 20% of the stance, the vertical ground reaction force of PL was significantly lower than that of IL. Additionally, individuals with uTFA exhibited a distinct gait pattern with altered duration of loading response, single limb support, pre-swing and swing phases, and step time. These findings indicate the adaptability of individuals with uTFA in weight transfer, balance control, and pressure distribution on gait stability. In conclusion, this study provides valuable insights into the unique gait dynamics and balance strategies of uTFA patients, highlighting the importance of optimizing prosthetic design, alignment procedures, and rehabilitation programs to enhance gait patterns and reduce the risk of injuries due to compensatory movements.

Enhancing neurorehabilitation by targeting beneficial plasticity.

Neurorehabilitation is now one of the most exciting areas in neuroscience. Recognition that the central nervous system (CNS) remains plastic through life, new understanding of skilled behaviors (skills), and novel methods for engaging and guiding beneficial plasticity combine to provide unprecedented opportunities for restoring skills impaired by CNS injury or disease. The substrate of a skill is a distributed network of neurons and synapses that changes continually through life to ensure that skill performance remains satisfactory as new skills are acquired, and as growth, aging, and other life events occur. This substrate can extend from cortex to spinal cord. It has recently been given the name "heksor." In this new context, the primary goal of rehabilitation is to enable damaged heksors to repair themselves so that their skills are once again performed well. Skill-specific practice, the mainstay of standard therapy, often fails to optimally engage the many sites and kinds of plasticity available in the damaged CNS. New noninvasive technology-based interventions can target beneficial plasticity to critical sites in damaged heksors; these interventions may thereby enable much wider beneficial plasticity that enhances skill recovery. Targeted-plasticity interventions include operant conditioning of a spinal reflex or corticospinal motor evoked potential (MEP), paired-pulse facilitation of corticospinal connections, and brain-computer interface (BCI)-based training of electroencephalographic (EEG) sensorimotor rhythms. Initial studies in people with spinal cord injury, stroke, or multiple sclerosis show that these interventions can enhance skill recovery beyond that achieved by skill-specific practice alone. After treatment ends, the repaired heksors maintain the benefits.

Analyzing Language in the Picnic Scene Picture and in Conversation: The Type of Discourse Sample We Choose Influences Findings in People With Aphasia.

People with aphasia express that improved conversational discourse is a primary rehabilitation goal. Discourse is usually assessed using monologue, such as a picture description task, but research shows that language in monologue varies from language in everyday conversation. Consequently, we investigated the relationship of language in unstructured conversation and in the picnic scene picture because it is a part of the most often used aphasia battery (Western Aphasia Battery-Revised) and thus is frequently used to inform therapy. Second, because previous research suggests people with severe aphasia may not demonstrate language production variability between types of monologue-level discourse, we evaluated the relationship of severity and the difference in scores between conversation and the picnic scene task. Thirty-four people with mild-to-severe aphasia described the picnic scene and provided a conversation sample. We measured language production and communicative success using seven measures with established psychometrics in conversation/monologue. We conducted correlations to answer the research questions. Correlations were moderate and weaker for the measures in the two conditions. A strong negative relationship was demonstrated between aphasia severity and global coherence. All other relationships were moderate and weaker for the remaining measures when correlated with aphasia severity (also negative). Results are consistent with other studies indicating that language varies in different types of discourse. We conclude that for accurate, meaningful assessment, discourse sampling needs to include the specific type of discourse the individual wishes to address in therapy, because discourse samples and their findings are not interchangeable.

Influencing Factors Analysis of Rehabilitation for Patients with Spinal Cord Injury

The aim of spinal cord injury rehabilitation is to increase the independent ability of patients, so that patients can return to society and live a creative life. Regaining independence living is the primary goal of rehabilitation. Rehabilitation of patients with spinal cord injury is a long and lengthy process, which needs comprehensive dimensions support from medical workers, family members, and social support. At present, medical institutions and researchers mainly focus on the level of physical recovery and the treatment of complications in patients with spinal cord injury and pay less attention to social factors during the rehabilitation treatment of patients. Therefore, we collected data on patients with spinal cord injury, who hospitalized in the Rehabilitation Department of Sichuan Provincial People’s Hospital. And this paper uses a regression model to comprehensively analyze social and non-social factors that affect the rehabilitation after spinal cord injury, such as International Standards for Neurological Classification of Spinal Cord Injury from American Spinal Cord Injury Association, medical insurance, patient caregiver status, and so on. Moreover, systematic rehabilitation evaluation is carried out, and rehabilitation nursing goals are formulated to achieve precise rehabilitation. It promotes the self-care ability of patients with spinal cord injury, and makes patients integrate into the society as much as possible.

Switched Adaptive Concurrent Learning Control using a Stance Foot Model for Gait Rehabilitation using a Hybrid Exoskeleton

Lower-limb hybrid exoskeletons integrate powered mechanisms and functional electrical stimulation (FES) to provide assistive forces and activate muscles for restoring gait function after a neurological injury. Particularly, improving the load-bearing ability is a primary rehabilitation goal. Hence, the control of the exoskeleton and FES is critical within the stance phase of walking to ensure smooth weight transfer between limbs, and achieve a sound loading response and leg propulsion. This paper develops a concurrent learning adaptive control technique to provide torque assistance about the hip and knee joints using a cable-driven exoskeleton, and activate the quadriceps and hamstrings muscle groups via FES for treadmill walking. The human-exoskeleton dynamics are modeled with phase-dependent switching dynamics to strategically update the concurrent learning controller at early stance (heel strike), late stance (toe-off), and the swing phases of walking. Thus, the adaptive switching controller compensates for the dynamic changes within the stance phase and its transition to swing, while achieving joint kinematic tracking and estimating a subset of the leg's uncertain parameters. A multiple Lyapunov function analysis is developed to demonstrate stability of the overall phase-dependent switched system requiring a dwell-time condition that guarantees exponential tracking and parameter estimation convergence.

Validation of a Hybrid Exoskeleton for Upper Limb Rehabilitation. A Preliminary Study.

Recovery of therapeutic or functional ambulatory capacity in patients with rotator cuff injury is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients to perform repetitive practice with large movements to maximize recovery, even immediately after the acute event. The aim of this paper is to describe the usability, acceptability and acceptance of a hybrid exoskeleton for upper-limb passive rehabilitation using the System Usability Scale (SUS) questionnaire. This equipment, called ExoFlex, is defined as a hybrid exoskeleton since it is made up of rigid and soft components. The exoskeleton mechanical description is presented along with its control system and the way motion is structured in rehabilitation sessions. Seven patients (six women and one man) have participated in the evaluation of this equipment, which are in the range of 50 to 79 years old. Preliminary evidence of the acceptance and usability by both patients and clinicians are very promising, obtaining an average score of 80.71 in the SUS test, as well as good results in a questionnaire that evaluates the clinicians’ perceived usability of ExoFlex.

Effects of and Response to Mechanical Loading on the Knee.

Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.

Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial.

Returning to work is often a primary rehabilitation goal after traumatic brain injury (TBI). However, the evidence base for treatment options regarding return to work (RTW) and stable work maintenance remains scarce. This study aimed to examine the effect of a combined cognitive and vocational intervention on work-related outcomes after mild-to-moderate TBI. In this study, we compared 6 months of a combined compensatory cognitive training and supported employment (CCT-SE) intervention with 6 months of treatment as usual (TAU) in a randomised controlled trial to examine the effect on time to RTW, work percentage, hours worked per week and work stability. Eligible patients were those with mild-to-moderate TBI who were employed ≥50% at the time of injury, 18 to 60 years old and sick-listed ≥50% at 8 to 12 weeks after injury due to post-concussion symptoms, assessed by the Rivermead Post Concussion Symptoms Questionnaire. Both treatments were provided at the outpatient TBI department at Oslo University Hospital, and follow-ups were conducted at 3, 6 and 12 months after inclusion. We included 116 individuals, 60 randomised to CCT-SE and 56 to TAU. The groups did not differ in characteristics at the 12-month follow-up. Overall, a high proportion had returned to work at 12 months (CCT-SE, 90%; TAU, 84%, P=0.40), and all except 3 were stably employed after the RTW. However, a significantly higher proportion of participants in the CCT-SE than TAU group had returned to stable employment at 3 months (81% vs. 60%, P=0.02). These results suggest that the CCT-SE intervention might help patients with mild-to-moderate TBI who are still sick-listed 8 to 12 weeks after injury in an earlier return to stable employment. However, the results should be replicated and a cost-benefit analysis performed before concluding.

Confidence to Return to Play After Anterior Cruciate Ligament Reconstruction Is Influenced by Quadriceps Strength Symmetry and Injury Mechanism.

Although the restoration of quadriceps strength symmetry is a primary rehabilitation goal after anterior cruciate ligament reconstruction (ACLR), little is known about the potential relationship between quadriceps strength symmetry and psychological readiness to return to play (RTP). Quadriceps strength symmetry will be associated with psychological readiness to RTP after ACLR. Secondarily, injury mechanism will influence the association between quadriceps strength and psychological readiness to RTP. Retrospective cohort. Level 3 (cohort study). A total of 78 female patients completed strength testing and the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale at an outpatient clinical facility as part of return to sport testing after ACLR. Linear regression analysis was used to assess the relationship between the I-PRRS and the independent variables of interest (quadriceps strength symmetry and injury mechanism). For all patients combined, a significant symmetry × mechanism interaction was found. When split by injury mechanism, a significant linear relationship was found between quadriceps strength symmetry and the I-PRRS score in patients who experienced a noncontact injury (n = 55; P = 0.01; R2 = 0.24). No such relationship was found for those who experienced a contact injury (n = 23; P = 0.97; R2 = 0.01). Greater quadriceps strength symmetry was associated with greater psychological readiness to RTP in female athletes after ACLR. This relationship, however, was present only in those who experienced a noncontact injury. Clinicians should consider both the physical and the psychological factors in assessing a patient's readiness to RTP. This may be particularly important for those who have experienced an ACL tear through a noncontact mechanism.

Comparison of the quality of life in individuals with spinal cord injury wearing either reciprocating gait orthosis or hip knee ankle foot orthosis: a cross-sectional study

Background The quality of life (QoL) for patients with spinal cord injuries (SCI) is lower than that for healthy individuals. The main purpose of prescribing orthoses for these individuals is to improve their mobility and QoL. The hip knee ankle foot orthosis (HKAFO) has been the conventional choice for such patients, whilst the reciprocating gait orthosis (RGO) is a more contemporary option. Although the impact of these two types of orthoses on the biomechanics of walking has been previously evaluated in patients with SCI, there has been no specific comparison of their relative effects on QoL. Objectives This study aimed to evaluate the Sickness Impact Profile (SIP-68) QoL questionnaire’s total score and its sub-scores in patients with SCIs wearing either RGOs or HKAFOs. Methods This study was performed on 22 participants (11 participants wearing RGOs and 11 wearing HKAFOs). QoL scores were evaluated in each group of patients using the total and sub-scores from the SIP-68 questionnaire. Results There were no significant differences in the total SIP-68 scores between the RGO and HKAFO groups (p = .57). However, emotional stability and emotional independence sub-scores were significantly lower for the RGO users than for the HKAFO users (p = .03 and p = .01), respectively. Conclusions Based upon this preliminary study, participants wearing RGOs or HKAFOs had similar QoL scores. However, those wearing RGOs may experience better emotional stability, communication, and emotional independence. This preliminary study does not provide definite conclusions since a large randomized control trial is required to compare the effects of these orthoses on the QoL scores in patients with SCIs. Implications for rehabilitation Our main aim in the current investigation was to shed light on the question that does the biomechanical superiority of the RGO to the HKAFO leads to better quality of life in SCI subjects who are using RGO. Regarding the fact that the primary goal of rehabilitation of people with SCI is to improve their quality of life, it seems that the more complicated newer orthosis (RGO) has no difference with the older type (HKAFO) in achieving the rehabilitation goals. More studies will in fact be necessary to find a definitive answer for this important question. According to the findings of our study, it seems to be more appropriate to prescribe RGO for male participants with higher body weight.

Gait asymmetry pattern following stroke determines acute response to locomotor task

BackgroundGiven the prevalence of gait dysfunction following stroke, walking recovery is a primary goal of rehabilitation. However, current gait rehabilitation approaches fail to demonstrate consistent benefits. Gait asymmetry, prevalent among stroke survivors who regain the ability to walk, is associated with an increased energy cost of walking and is a significant predictor of falls post-stroke. Furthermore, differential patterns of gait asymmetry may respond differently to gait training parameters. Research questionThe purpose of this study was to determine whether differential responses to locomotor task condition occur on the basis of step length asymmetry pattern (Symmetrical, NPshort, Pshort) observed during overground walking. MethodsParticipants first walked overground at their self-selected walking speed. Overground data were compared against three task conditions all tested during treadmill walking: self-selected speed with 0% body weight support (TM); self-selected speed with 30 % body weight support (BWS); and fastest comfortable speed with 30 % body weight support and nonparetic leg guidance (GuidanceNP). Our primary metrics were: symmetry indices of step length, stride length, and single limb support duration. ResultsWe identified differences in the response to locomotor task conditions for each step length asymmetry subgroup. GuidanceNP induced an acute spatial symmetry only in the NPshort group and temporal symmetry in the Symmetrical and Pshort groups. Importantly, we found the TM and BWS conditions were insufficient to impact either spatial or temporal gait symmetry. SignificanceTask conditions consistent with locomotor training do not produce uniform effects across subpatterns of gait asymmetry. We identified differential responses to locomotor task conditions between groups with distinct asymmetry patterns, suggesting these subgroups may require unique intervention strategies. Despite group differences in asymmetry characteristics, improvements in symmetry noted in each group were driven by changes in both the paretic and nonparetic limbs.

Immediate effects of a novel walking assist device with auxiliary illuminator on patients after acute strokes.

Background:Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients.Objective:We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke.Methods:This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20 m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser.Results:The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 (, and , respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser.Conclusion:Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.

Immediate after-effects of robot-assisted gait with pelvic support or pelvic constraint on overground walking in healthy subjects

BackgroundRecovery of walking is a primary rehabilitation goal of most stroke survivors. Control of pelvic movements is one of the essential determinants of gait, yet surprisingly, conventional robot-assisted gait trainers constrain pelvic movements. Novel robot-assisted gait trainers, such as LOPES II, are able to support pelvic movements during gait. The aim of this cross-over study was to investigate the immediate after-effects of pelvic support (PS) or pelvic constraint (PC) gait training with LOPES II on overground walking in healthy subjects.MethodsThirteen able-bodied subjects (22.8 ± 2.1 years) participated in two 20-min gait training sessions with LOPES II; one with PS and one with PC. During the PS-training, the LOPES II actively guided the lateral displacement of the pelvis, while pelvic rotations were free. During the PC-condition, both lateral displacement and pelvic rotations were constrained and reduced to a minimum. The training sessions were separated by a 30-min resting period. Lateral displacement of the pelvis, hip and knee kinematics, and spatiotemporal parameters during overground walking were determined at baseline and immediately following the training using 3D gait analysis.ResultsDuring the PS-condition in LOPES II the lateral pelvic displacement was significantly greater (105.6 ± 0 .5 mm) than during the PC-condition (10.8 ± 0 .7 mm; p < 0.001). Analysis of the first five steps of overground walking immediately following PC-condition showed significantly smaller lateral displacements of the pelvis (32.3 ± 12.0 mm) compared to PS-condition (40.1 ± 9 .8 mm; p < 0.01). During the first five steps, step width was significantly smaller after PC-condition (0.17 ± 0. 04 m) compared to PS-condition (0.20 ± 0.04 m; p = 0.01) and baseline (0.19 ± 0. 03 m; p = 0.01). Lateral displacement of the pelvis and step width post training returned to baseline levels within 10 steps. PC- nor PS-condition affected kinematics, gait velocity, cadence, stride length or stance time.ConclusionsIn healthy subjects, robot-assisted gait training with pelvic constraint had immediate negative after-effects on the overground walking pattern, as compared to robot-assisted gait training with pelvic support. Gait training including support of the lateral displacement of the pelvis better resembles the natural gait pattern. It remains to be identified whether pelvic support during robot-assisted gait training is superior to pelvic constraint to promote gait recovery in individuals with neurological disorders.

Recovery and compensation after robotic assisted gait training in chronic stroke survivors

Background: Gait re-education is a primary rehabilitation goal after stroke. In the last decades, robots with different mechanical structures have been extensively used in the clinical practice for gait training of stroke survivors. However, the effectiveness of robotic training is still controversial, especially for chronic subjects. In this study, we investigated the short-term effects of gait training assisted by an endpoint robot in a population of chronic stroke survivors.Methods: Subjects were evaluated before and after training with clinical scales and instrumented gait analysis. Our primary outcome indicator was the walking speed. Next, we investigated the changes in kinetic and kinematic gait patterns as well as the intersegmental coordination at the level of the lower limbs.Results: Most subjects improved their speed in over-ground walking, by modifying the temporal more than the spatial gait parameters. These changes led to an improvement in the ankle power for both sides and to a slight reduction of the inclination of the pelvis during the swing phase, mainly due to a decreased knee flexion and an increased hip extension on the unimpaired leg.Conclusions: These results indicate that the proposed training induced mainly a functional change rather than an improvement of the quality of gait.Implication for RehabilitationGait re-education is a primary goal in stroke rehabilitation.Nowadays several robotic devices for gait rehabilitation are used in the clinical practice, but their effectiveness is controversial, especially for chronic survivors.After a 20-session training with an endpoint robot the chronic stroke survivors showed an improvement in overground gait speed.The increased gait speed was mainly due to functional changes of the temporal parameters and of the kinetic variables at the level of both ankle joints, as well as to a reduction of compensatory strategies observable in the unimpaired side.

Vocational rehabilitation for enhancing return-to-work in workers with traumatic upper limb injuries.

Traumatic upper limb injury is a leading cause of work-related disability. After return-to-work (RTW), many survivors of injuries are able to regain a quality of life (QoL) comparable with the normal population. Since RTW plays an important role in economic productivity and regaining health-related QoL, enhancing RTW in workers with traumatic limb injuries is the primary goal of rehabilitation. Vocational rehabilitation has been commonly employed in the field of occupational safety and health to increase the number of injured people returning to the labour market, prevent illness, increase well-being, and reduce disability. To assess the effects of vocational rehabilitation programmes for enhancing RTW in workers with traumatic upper limb injuries. This is an update of a Cochrane review previously published in 2013. We updated our searches of the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 9), MEDLINE (to 30 August 2017), EMBASE (to 3 September 2017), CINAHL (to 6 September 2017), and PsycINFO (to 6 September 2017), and we handsearched the references lists of relevant review articles. We aimed to include all randomised controlled trials (RCTs) comparing vocational rehabilitation with an alternative (control) intervention such as standard rehabilitation, a limited form of the vocational rehabilitation intervention (such as advice on RTW, referral information, or liaison with employer), or waiting-list controls. Two authors independently inspected abstracts, and we obtained full papers when necessary. When the two authors disagreed about the inclusion of a study, we resolved disagreements by discussion. A third author arbitrated when necessary. Our updated search identified 466 citations. Based on assessments of their titles and abstracts, we decided to evaluate the full texts of five records; however, none met our inclusion criteria. There is currently no high-quality evidence to support or refute the efficacy of vocational rehabilitation for enhancing RTW in workers with traumatic upper limb injuries. Since injured people in occupational settings frequently receive vocational rehabilitation with the aim of decreasing work disability, enhancing RTW, increasing productivity, and containing the welfare cost, further high-quality RCTs assessing the efficacy of vocational rehabilitation for workers with traumatic upper limb injury are needed to fill this gap in knowledge.

Combined Dietary Nitrate and Exercise Intervention in Peripheral Artery Disease: Protocol Rationale and Design.

BackgroundPeripheral artery disease (PAD) is caused by atherosclerotic occlusions in the legs. It affects approximately 8-12 million people in the United States alone, one-third of whom suffer from intermittent claudication (IC), defined as ischemic leg pain that occurs with walking and improves with rest. Patients with IC suffer a markedly impaired quality of life and a high perception of disability. Improving pain-free walking time is a primary goal of rehabilitation in this population.ObjectiveThe nitric oxide (NO)-PAD trial is designed to compare the effects that 12 weeks of supervised exercise training, in combination with a high inorganic nitrate-content (beetroot [BR] juice) beverage or placebo (PL) beverage, has on clinical outcomes of exercise and functional capacity in two groups of PAD+IC patients: exercise training plus beetroot (EX+BR) and exercise training plus placebo (EX+PL). The primary aims of this randomized controlled, double-blind pilot study are to determine group differences following 12 weeks of EX+BR versus EX+PL in the changes for (1) exercise capacity: pain-free walking time (claudication onset time, COT), peak walk time (PWT), and maximal exercise capacity (peak oxygen uptake, VO2peak) during a maximal-graded cardiopulmonary exercise test (max CPX) and (2) functional capacity: 6-minute walk (6MW) distance. The secondary aims will provide mechanistic insights into the exercise outcome measures and will include (1) gastrocnemius muscle oxygenation during exercise via near-infrared spectroscopy (NIRS); (2) gastrocnemius muscle angiogenesis: capillaries per unit area and per muscle fiber, and relative fraction of type I, IIa, IIb, and IId/x fibers; and (3) vascular health/function via brachial artery flow-mediated dilation, lower-limb blood flow via plethysmography, and pulse wave velocity and reflection.MethodsA total of 30 subjects between 40 and 80 years of age with PAD who are limited by IC will undergo exercise training 3 days per week for 12 weeks (ie, 36 sessions). They will be randomized to either the EX+BR or EX+PL group where participants will consume a beverage high in inorganic nitrate (4.2 mmol) or a low-nitrate placebo, respectively, 3 hours prior to each training session.ResultsData collection from this study has been completed and is in the process of analysis and write-up. While the study is too underpowered—EX+BR, n=11; EX+PL, n=13—to determine between-group differences in the primary outcomes of COT, PWT, and 6MW, preliminary observations are promising with Cohen d effect sizes of medium to large.ConclusionsExercise training is currently the most effective therapy to increase functional capacity in PAD+IC. If the addition of inorganic nitrate to an exercise regimen elicits greater benefits, it may redefine the current standard of care for PAD+IC.Trial RegistrationClinicalTrials.gov NCT01684930; https://clinicaltrials.gov/ct2/show/NCT01684930 (Archived by WebCite at http://www.webcitation.org/6raXFyEcP)

Wearable robotic exoskeleton for overground gait training in sub-acute and chronic hemiparetic stroke patients: preliminary results.

Recovery of therapeutic or functional ambulatory capacity in post-stroke patients is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients with gait dysfunctions to perform over-ground gait training, even immediately after the acute event. To investigate the feasibility and the clinical effects of an over-ground walking training with a wearable powered exoskeleton in sub-acute and chronic stroke patients. Prospective, pilot pre-post, open label, non-randomized experimental study. A single neurological rehabilitation center for inpatients and outpatients. Twenty-three post-stroke patients were enrolled: 12 sub-acute (mean age: 43.8±13.3 years, 5 male and 7 female, 7 right hemiparesis and 5 left hemiparesis) and 11 chronic (mean age: 55.5±15.9 years, 7 male and 4 female, 4 right hemiparesis and 7 left hemiparesis) patients. Patients underwent 12 sessions (60 min/session, 3 times/week) of walking rehabilitation training using Ekso™, a wearable bionic suit that enables individuals with lower extremity disabilities and minimal forearm strength to stand up, sit down and walk over a flat hard surface with a full weight-bearing reciprocal gait. Clinical evaluations were performed at the beginning of the training period (t0), after 6 sessions (t1) and after 12 sessions (t2) and were based on the Ashworth scale, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10-Meter Walking Test, 6-Minute Walking Test, and Walking Handicap Scale. Wilcoxon's test (P<0.05) was used to detect significant changes. Statistically significant improvements were observed at the three assessment periods for both groups in Motricity Index, Functional Ambulation Scale, 10-meter walking test, and 6-minute walking test. Sub-acute patients achieved statistically significant improvement in Trunk Control Test and Walking Handicap Scale at t0-t2. Sub-acute and chronic patient did not achieve significant improvement in Ashworth scale at t0-t2. Twelve sessions of over-ground gait training using a powered wearable robotic exoskeleton improved ambulatory functions in sub-acute and chronic post-stroke patients. Large, randomized multicenter studies are needed to confirm these preliminary data. To plan a completely new individual tailored robotic rehabilitation strategy after stroke, including task-oriented over-ground gait training.

Quadriceps Function and Gait Kinetics after Anterior Cruciate Ligament Reconstruction.

Chronic quadriceps dysfunction has been implicated as a contributor to knee osteoarthritis (OA) development after anterior cruciate ligament reconstruction (ACLR). This dysfunction potentially leads to impulsive/high-rate loading during gait, thus accelerating cartilage degradation. The purpose of this study was to examine relationships between several indices of quadriceps function and gait biomechanics linked to knee OA development in individuals with ACLR. Gait biomechanics and quadriceps function were assessed in 39 individuals with ACLR. Indices of quadriceps function included isometric peak torque and rate of torque development (RTD), isokinetic peak torque and power, and the central activation ratio. Gait biomechanics included the peak vertical ground reaction force and loading rate, and the heel strike transient (HST) magnitude and loading rate. Isometric peak torque was not associated with any of the gait biomechanical variables. However, greater RTD was associated with lesser peak vertical ground reaction force linear (r = -0.490, P = 0.003) and instantaneous (r = -0.352, P = 0.031) loading rates, as well as a lesser HST magnitude (r = -0.312, P = 0.049) and instantaneous loading rate (r = -0.355, P = 0.029). Greater central activation ratio was associated with greater HST instantaneous (r = 0.311, P = 0.050) and linear (r = 0.328, P = 0.033) loading rates. Isokinetic peak torque and power were not associated with any of the biomechanical variables. Poor quadriceps function, especially RTD, is associated with gait kinetics linked to cartilage degradation in individuals with ACLR. These results highlight the likely role of chronic quadriceps dysfunction in OA development after ACLR and the need to emphasize improving quadriceps function as a primary rehabilitation goal.

A Study to Analyze the Effectiveness of Functional Strength Training in Improving Gross Motor Function among the Children with Spastic Diplegic Cerebral Palsy

Objective: To compare the efficacy of functional strength training in improving gross motor function among the children with spastic diplegic cerebral palsy. Design: Experimental study design with pre-test and post-test. Background: The primary goal of rehabilitation for spastic dipelgic cerebral palsy is functional enhancement by maximizing the independence, life style, and dignity of the patient. A new development for treatment in specialized and well organized manner generated by different neurological treatment approach includes functional strength training. There has been less research explaining about the importance of functional strength training for improvement in functional activities. Method: Fifteen subjects spastic diplegic cerebral palsy were selected under purposive sampling technique and received functional strength training for a period of 10 weeks. Outcome measure: Gross motor function measure-the gross motor function measure is a standardized observational instrument designed to measure changes in gross motor function over time in children with CP. Results: Statistical analysis done by using student’s t-test and showed that there was significant improvement in subjects who received functional strength training. Conclusion: The statistical results show that there is an improvement in gross motor function after 10 weeks of functional strength training program