Recovery Of Functional Mobility Research Articles

Recovery of Functional Mobility with a Long-Term Nursing Facility Patient Utilizing the Fascial Distortion Model: A Case Study

Abstract Functional immobility has demonstrated a higher risk of all-cause mortality in geriatric population. It is noted that musculoskeletal pain is one major factor involved with geriatric functional immobility. The fascial distortion model (FDM) utilizes pathognomonic physical gestures to diagnose and treat musculoskeletal pain. In this case study, a long-term nursing facility patient with significantly prolonged wheelchair-to-bed transfer presented with several upper and lower extremity fascial distortions. After FDM treatment, the patient demonstrated a moderate return of functional mobility. This case presents the utility of FDM treatment in cases of decreased functional mobility due to musculoskeletal pain as well as treatment for patients in skilled nursing facility settings.

645 Adjustable Dynamic Ankle Foot Orthosis for Recovery of Functional Mobility

Abstract Introduction We present a case of a 23-year-old woman with primary-onset peroneal nerve impairment following diagnosis of purpura fulminans involving 30% total body surface area, who was treated in our burn center. Medical complexity required a unique rehabilitation intervention. The purpose of this case study is to demonstrate the effectiveness of a dynamic ankle-foot orthosis (AFO) to recover functional ambulation. Methods Upon initial evaluation and during weekly re-evaluations, a physical therapist (PT) and an occupational therapist (OT) measured active range of motion (AROM), passive range of motion (PROM), and strength. Absent to trace common peroneal nerve function was identified bilaterally 8 days after admission. The patient underwent 41 surgeries and spent 231 days in the burn intensive care unit. Medical complications included 3 episodes of acute respiratory distress syndrome and septic shock, acute renal failure requiring 150 days of continuous renal replacement therapy, and 51 ventilator days. Due to post-operative restrictions and/or medical complications, lower-extremity ROM was restricted for 63 days and supine position was restricted for 49 days. Rehabilitation interventions included PROM, AROM and continuous passive motion. Weight-bearing activities included a tilt table, Moveo™, standing frame, transfer and gait training with a rolling walker (RW). Positional interventions were sitting in a Total Lift Chair, serial casting, and custom AFO fabrication. Results On hospital day 215 the patient ambulated 15 feet using a platform walker and required assistance of 4 staff to support the ankle and foot. On hospital day 229, static custom AFOs were implemented and the patient ambulated 325 feet with contact guard assist (CGA). The static AFOs required frequent re-fabrication due to daily ROM progress. Adjustable dynamic AFOs were fabricated to decrease resource burden. With the dynamic AFOs, the patient progressed to 745 feet CGA on hospital day 258. The patient discharged to an acute rehabilitation center on hospital day 260. Conclusions Extensive medical, surgical and positional restrictions required innovative interventions by a multidisciplinary team. This resulted in the fabrication of dynamic custom AFOs for gait training. Utilization of these AFOs significantly increased activity tolerance and ambulation distance, and enabled eventual discharge to a rehabilitation center.

Neurophysiological markers predicting recovery of standing in humans with chronic motor complete spinal cord injury

The appropriate selection of individual-specific spinal cord epidural stimulation (scES) parameters is crucial to re-enable independent standing with self-assistance for balance in individuals with chronic, motor complete spinal cord injury, which is a key achievement toward the recovery of functional mobility. To date, there are no available algorithms that contribute to the selection of scES parameters for facilitating standing in this population. Here, we introduce a novel framework for EMG data processing that implements spectral analysis by continuous wavelet transform and machine learning methods for characterizing epidural stimulation-promoted EMG activity resulting in independent standing. Analysis of standing data collected from eleven motor complete research participants revealed that independent standing was promoted by EMG activity characterized by lower median frequency, lower variability of median frequency, lower variability of activation pattern, lower variability of instantaneous maximum power, and higher total power. Additionally, the high classification accuracy of assisted and independent standing allowed the development of a prediction algorithm that can provide feedback on the effectiveness of muscle-specific activation for standing promoted by the tested scES parameters. This framework can support researchers and clinicians during the process of selection of epidural stimulation parameters for standing motor rehabilitation.

Exercise as potential countermeasure for the effects of 70 days of bed rest on cognitive and sensorimotor performance.

Background: Spaceflight has been associated with changes in gait and balance; it is unclear whether it affects cognition. Head down tilt bed rest (HDBR) is a microgravity analog that mimics cephalad fluid shifts and body unloading. In consideration of astronaut’s health and mission success, we investigated the effects of HDBR on cognition and sensorimotor function. Furthermore, we investigated if exercise mitigates any cognitive and sensorimotor sequelae of spaceflight.Method: We conducted a 70-day six-degree HDBR study in 10 male subjects who were randomly assigned to a HDBR supine exercise or a HDBR control group. Cognitive measures (i.e., processing speed, manual dexterity, psychomotor speed, visual dependency, and 2D and 3D mental rotation) and sensorimotor performance (functional mobility (FMT) and balance performance) were collected at 12 and 8 days pre-HDBR, at 7, 50, and 70 days in HDBR, and at 8 and 12 days post-HDBR. Exercise comprised resistance training, and continuous and high-intensity interval aerobic exercise. We also repeatedly assessed an outside-of-bed rest control group to examine metric stability.Results: Small practice effects were observed in the control group for some tasks; these were taken into account when analyzing effects of HDBR. No significant effects of HDBR on cognition were observed, although visual dependency during HDBR remained stable in HDBR controls whereas it decreased in HDBR exercise subjects. Furthermore, HDBR was associated with loss of FMT and standing balance performance, which were almost fully recovered 12 days post-HDBR. Aerobic and resistance exercise partially mitigated the effects of HDBR on FMT and accelerated the recovery time course post-HDBR.Discussion: HDBR did not significantly affect cognitive performance but did adversely affect FMT and standing balance performance. Exercise had some protective effects on the deterioration and recovery of FMT.