Walking Function Research Articles

Change in Walking Parameters of Paralympic Athletes Diagnosed with Cerebral Palsy Using WALKBOT Training System at Recovery Stage of Rehabilitation

INTRODUCTION: The publication is devoted to studying the rehabilitative effect of the Walkbot innovative training system on restoring the walking function in Paralympic athletes diagnosed with cerebral palsy (CP). The novelty of the developed Walkbot robot-assisted training system (TS) and insufficient experience of its use in rehabilitation practice require investigations on contingents of patients with musculoskeletal disorders in CP to develop protocols and programs of the rehabilitation use of the Walkbot TS. AIM: Study of effectiveness of rehabilitation use of the Walkbot robotic TS to restore the walking function in Paralympic athletes with spastic cerebral palsy. MATERIALS AND METHODS: The study was conducted at the Medical Rehabilitation Center ‘Sergievskie Mineral Waters’ in 2023. Forty Paralympic athletes (all men) aged 30-35 years were examined. The experimental group (EG) and control group (CG) included 20 Paralympic athletes each with standardization of the groups by the main parameters. The classes were conducted for 60 minutes according to the rehabilitation program. In the experimental group, besides exercise therapy (ET), the participants also exercised on the robotic Walkbot TS to restore the walking function, namely, they used Go world game with the known tasks symbolizing counties of the world, Go palace game that permits to take a walk around the palace, when patients move to the right or left as they choose; Go undersea game occurring against the background of a fairy sea world where they must go through the route controlling the direction of movement. The Paralympians of the control group used the standard rehabilitation program including ET with no training and gaming technologies. RESULTS: The obtained results showed a pronounced improvement in the parameters of motor actions in Paralympians of the EG, while in the CG, positive rehabilitation changes were 2–3 times less expressed. At the initial and final rehabilitation stages, an increase of the tolerated duration of classes was recorded: by 5 times in the EG and 3 times in the CG, post-rehabilitation increase in the EG was 23.4% compared to that in CG. After training on the Walkbot TS, the volume of the performed load increased 5.9 times in the EG and 2.1 times in the CG. The increase in the EG made 64.5% compared to the CG, which indicated an increase in speed-strength qualities and endurance of para-athletes. At the end of rehabilitation, the amount of steps on the Walkbot TS in the EG increased 5.9 times (in the CG — 2.9 times), increase in the EG made 48.3% compared to the CG. CONCLUSION: The experiment established a complex multisided positive effect of training sessions on the Walkbot TS in the EG versus the effect of only exercise therapy in the CG. The obtained data suggest that training on the Walkbot TS confer a significant restorative and normalizing effect on the neurophysiological mechanisms of functioning of the central parts of the motor cortex.

THE STUDY OF THE WORK OF THE MUSCLES RESPONSIBLE FOR THE FUNCTIONALITY OF THE HIP JOINT AFTER TOTAL HIP ARTHROPLASTY USING DIFFERENT SURGICAL APPROACHES

Muscles that can be damaged during endoprosthesis are indicated. Objective. To study the features of muscle work to ensure walking function after hip arthroplasty depending on the surgical approach. Methods. The basis of the simulation is the basic OpenSim Gate2392 model. Six models were created that predicted the condition of the muscles of the lower limb in normal conditions, during coxarthrosis and after 6 and 12 months. after surgery with lateral and anterior approaches. The results. For lateral access in 6 months. after the operation, the adductor muscles responsible for stabilizing the pelvis in the single-support phase of the step and during the transfer of the foot do not work enough, while the hip flexor muscles (in the model, the rectus femoris muscle) take over the responsibility for the step, but with overvoltage. On the contrary, with the front approach, we observe a weakening of the flexor muscles, which leads to overstrain of the gluteal muscles and hip stabilizer muscles. After 12 months, the muscle strength normalizes for most of them to 90–95 % of the norm, a 2–3 times increase in the torque of the hip flexor muscles and hip stabilizer muscles is observed. Taking a normal step causes muscle strain. During the anterior approach, the foot is transferred during the phase, that is, when most of the muscles are involved. The rectus femoris muscle, which is the strongest of the muscles discussed in the paper, does the main work of moving the foot. In the case of possible damage to the rectus muscle during anterior access, even after a year there is a violation of its work — excessive overexertion and involvement of the reserves of other muscles. Conclusions. Mathematical modeling of the work of muscles that may be damaged during hip arthroplasty surgery, conditional muscle strength for 6 months. after the operation, they are not able to develop the necessary torque to take a normal step. For muscle strength, which in the model corresponded to 12 months,the muscles are able to perform a normal function regardless of surgical access, but their overstrain is observed.

Evidence that robot-assisted gait training modulates neuroplasticity after stroke: An fMRI pilot study based on graph theory analysis

ObjectivesTo investigate alterations of whole-brain network after stroke and therapeutic mechanisms of robot-assisted gait training (RAGT). Methods21 stroke patients and 20 healthy subjects were enrolled, with the stroke patients randomized to either control group (n = 11) or robot group (n = 10), and resting-state functional magnetic resonance imaging data were collected. The global network metrics were obtained using graph theory analysis and compared between stroke patients and healthy subjects, and the effect of the RAGT on the whole-brain networks was explored. ResultsCompared to healthy subjects, area under the curve (AUC) for small-worldness (σ), clustering coefficient (Cp), global efficiency (Eg) and mean local efficiency (Eloc) were significantly lower in stroke patients, whereas AUC for characteristic path length (Lp) were significantly higher. Compared with the control group, patients in robot group showed significant improvement in lower limb motor function, balance function and walking function after intervention, with a significant reduction in the AUC of Cp. Moreover, the improvement of walking function was positively correlated with the changes of AUC of σ and Eg, and negatively correlated with the changes of AUC of Cp. ConclusionsSmall-worldness and network efficiency were significantly reduced after stroke, whereas RAGT decreased characteristic path length and promoted normalization of the whole-brain network, and this change was associated with improvement in walking function. Our findings reveal the mechanism by which RAGT regulates network reorganization and neuroplasticity after stroke.

Effects of short-term dietary nitrate supplementation on exercise and coronary blood flow responses in patients with peripheral artery disease.

Peripheral arterial disease (PAD) is a prevalent vascular disorder characterized by atherosclerotic occlusion of peripheral arteries, resulting in reduced blood flow to the lower extremities and poor walking ability. Older patients with PAD are also at a markedly increased risk of cardiovascular events, including myocardial infarction. Recent evidence indicates that inorganic nitrate supplementation, which is abundant in certain vegetables, augments nitric oxide (NO) bioavailability and may have beneficial effects on walking, blood pressure, and vascular function in patients with PAD. We sought to determine if short-term nitrate supplementation (via beetroot juice) improves peak treadmill time and coronary hyperemic responses to plantar flexion exercise relative to placebo (nitrate-depleted juice) in older patients with PAD. The primary endpoints were peak treadmill time and the peak coronary hyperemic response to plantar flexion exercise. Eleven PAD patients (52-80 yr.; 9 men/2 women; Fontaine stage II) were randomized (double-blind) to either nitrate-rich (Beet-IT, 0.3 g inorganic nitrate twice/day; BRnitrate) or nitrate-depleted (Beet-IT, 0.04 g inorganic nitrate twice/day, BRplacebo) beetroot juice for 4 to 6 days, followed by a washout of 7 to 14 days before crossing over to the other treatment. Patients completed graded plantar flexion exercise with their most symptomatic leg to fatigue, followed by isometric handgrip until volitional fatigue at 40% of maximum on day 4 of supplementation, and a treadmill test to peak exertion 1-2 days later while continuing supplementation. Hemodynamics and exercise tolerance, and coronary blood flow velocity (CBV) responses were measured. Although peak walking time and claudication onset time during treadmill exercise did not differ significantly between BRplacebo and BRnitrate, the diastolic blood pressure response at the peak treadmill walking stage was significantly lower in the BRnitrate condition. Increases in CBV from baseline to peak plantar flexion exercise after BRplacebo and BRnitrate showed a trend for a greater increase in CBV at the peak workload of plantar flexion with BRnitrate (p = 0.06; Cohen's d = 0.56). Overall, these preliminary findings suggest that inorganic nitrate supplementation in PAD patients is safe, well-tolerated, and may improve the coronary hyperemic and blood pressure responses when their calf muscles are most predisposed to ischemia.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT02553733.

Previously healthy unvaccinated adults have significant functional limitations in the medium and long term after mild COVID-19.

Ongoing symptoms of COVID-19 can persist for weeks or months after the initial COVID-19 infection. The aim of this study was to identify persistent symptoms (fatigue, cognition, quality of life, anxiety, depression and physical measures) in unvaccinated community-managed patients following COVID-19 infection. This was a prospective nested observational study of health and wellbeing measures determined seven and 13 months after COVID-19 infection, alongside physical abilities after 18 months. Data analyses were completed on 62 participants (60% female, median age 35 years). Severe fatigue was noted in 47% of participants at seven months and this had not improved significantly by 13 months (45%). Quality of life and mental health scores were significantly worse in individuals with severe fatigue. One-quarter of participants demonstrated mild cognitive impairment at seven months. After 18 months, walking and lung function were normal, but grip strength was reduced in 26% of participants. A significant proportion of unvaccinated COVID-19 patients had not returned to pre-illness levels of health and function after one year; screening functional ability and mental wellbeing is warranted in unvaccinated people with COVID-19.

Investigating the association between intralimb strength ratio, interlimb strength and range of motion asymmetry index, and functional limitations with fall incidence among older adults: protocol for a prospective cohort study

The present study aims to identify the intralimb strength ratio, interlimb strength and range of motion asymmetry index in elderly individuals and then investigate the association between these asymmetry indices...

The effect of home-based exercise with functional overload on functional independence, balance, walking and electromyography changes in acute stroke patients

The effect of home-based exercise with functional overload on functional independence, balance, walking and electromyography changes in acute stroke patients

Comparable cerebral cortex activity and gait performance in elderly hypertensive and healthy individuals during dual-task walking: A fNIRS study.

Hypertension increases the risk of cognitive impairment and related dementia, causing impaired executive function and unusual gait parameters. However, the mechanism of neural function illustrating this is unclear. Our research aimed to explore the differences of cerebral cortex activation, gait parameters, and working memory performance between healthy older adults (HA) and older hypertensive (HT) patients when performing cognitive and walking tasks. A total of 36 subjects, including 12 healthy older adults and 24 older hypertensive patients were asked to perform series conditions including single cognitive task (SC), single walking task (SW), and dual-task (DT), wearing functional near-infrared spectroscopy (fNIRS) equipment and Intelligent Device for Energy Expenditure and Activity equipment to record cortical hemodynamic reactions and various gait parameters. The left somatosensory cortex (L-S1) and bilateral supplementary motor area (SMA) showed higher cortical activation (p<.05) than HA when HT performed DT. The intragroup comparison showed that HT had higher cortical activation (p<.05) when performing DT as SW. The cognitive performance of HT was significantly worse (p<.05) than HA when executing SC. The activation of the L-S1, L-M1, and bilateral SMA in HT were significantly higher during SW (p<.05). Hypertension can lead to cognitive impairment in the elderly, including executive function and walking function decline. As a result of these functional declines, elderly patients with hypertension are unable to efficiently allocate brain resources to support more difficult cognitive interference tasks and need to meet more complex task demands by activating more brain regions.

Effects of Maitland Vertebra Joint Mobilization and Evjenth Trunk Muscle Stretching Exercise on Walking Function in Patients with Chronic Stroke

Effects of Maitland Vertebra Joint Mobilization and Evjenth Trunk Muscle Stretching Exercise on Walking Function in Patients with Chronic Stroke

Indirect Tax Reform And Market Efficiency: An Empirical Study of Indian Stock Market

The biggest tax reform of the Indian Government in this present decade is the Goods and Services Tax (GST), which was passed in parliament on 8th September 2016 and was enforced from 1st July 2017. Eight years of data from the Bombay Stock Exchange Sensex and the National Stock Exchange Nifty50 index is studied. The data is divided into two sub-periods before GST was passed from parliament period - I and after GST was passed from the parliament of India period - II. The study intends to test the market efficiency in its weak form. To check the time series data for normality, stationarity, random walk, and autocorrelation function, Kolmogorov-Smirnov (KS) test, Augmented Dickey-Fuller (ADF) test, Phillips Perron (PP) test is used for the analyse of the time-series data. The study found that returns are not normally distributed and the market is inefficient in a weak form for both periods under study.

Generating functions of non-backtracking walks on weighted digraphs: Radius of convergence and Ihara's theorem

It is known that the generating function associated with the enumeration of non-backtracking walks on finite graphs is a rational matrix-valued function of the parameter; such function is also closely related to graph-theoretical results such as Ihara's theorem and the zeta function on graphs. In Grindrod et al. [13], the radius of convergence of the generating function was studied for simple (i.e., undirected, unweighted and with no loops) graphs, and shown to depend on the number of cycles in the graph. In this paper, we use technologies from the theory of polynomial and rational matrices to greatly extend these results by studying the radius of convergence of the corresponding generating function for general, possibly directed and/or weighted, graphs. We give an analogous characterization of the radius of convergence for directed (unweighted or weighted) graphs, showing that it depends on the number of cycles in the undirectization of the graph. We also consider backtrack-downweighted walks on unweighted digraphs, and we prove a version of Ihara's theorem in that case. Finally, for weighted directed graphs, we provide for the first time an exact formula for the radius of convergence, improving a previous result that exhibited a lower bound, and we also prove a version of Ihara's theorem.

Facilitators and Barriers to Implementing High-Intensity Gait Training in Inpatient Stroke Rehabilitation: A Mixed-Methods Study.

(1) Background: High-intensity gait training (HIT) is a recommended intervention that improves walking function (e.g., speed and distance) in individuals who are undergoing stroke rehabilitation. This study explored clinicians' perceived barriers and facilitators to implementing HIT utilizing a mixed-methods approach comprising a survey and exploratory qualitative research. (2) Methods: Clinicians (n = 13) who were implementing HIT at three facilities participated. We collected and analyzed data using the consolidated framework for implementation research. Three focus groups were recorded and transcribed, and data were coded and thematically categorized. (3) Results: Survey results identified that the facilitators with a strong impact on implementation were access to knowledge/resources and intervention knowledge/beliefs. The only agreed-upon barrier with a strong impact was lack of tension for change. The focus groups resulted in 87 quotes that were coded into 27 constructs. Frequently cited outer setting facilitators were cosmopolitanism and peer pressure, and the only barrier was related to the patient needs. Innovation characteristics that were facilitators included relative advantage and design quality and packaging, and complexity was a barrier. Inner setting facilitators included networks and communication, learning climate, leadership engagement, and readiness for implementation. However, communication, leadership engagement, and available resources were also barriers. Regarding characteristics of individuals, knowledge and beliefs were both barriers and facilitators. In the implementation process domain, common facilitators were formally appointed implementation leaders and innovation participants. Barriers in this domain were related to the patients. (4) Conclusions: Clinicians identified many barriers and facilitators to implementing HIT that often varied between facilities. Further research is warranted to deepen our understanding of clinicians' experiences with HIT implementation.

Cutoff values of motor and cognitive measures for predicting and discriminating levels of activities of daily living after stroke: a scoping review.

The various assessments performed by rehabilitation professionals not only indicate the patient's current functional status but can also help determine the future status (prediction) or the ability to perform untested tasks (discrimination). In particular, the cutoff values are the simplest predictive and discriminative tool that can be widely used in clinical practice. The purpose of this scoping review was to summarize the current literature on cutoff values of motor and cognitive function for predicting or discriminating levels of activities of daily living after stroke. A literature search was conducted using the PubMed, CINAHL, and Scopus databases. The creation of the search criteria, primary screening of titles and abstract, and secondary screening by full-text review were performed by two rehabilitation professionals. A total of 54 articles were included. The summary of the cutoff values for prediction based on longitudinal studies revealed that an NIHSS score ≤8 and mRMI score ≥19 at acute hospitalization can predict good functional independence and walking independence, respectively, indicating reliable cutoff values. Cutoff values for predicting specific ADLs, such as toilet use or dressing, were not reported, which was a potential research gap identified in this review. Alternatively, the summary of the cutoff values for discrimination based on cross-sectional studies revealed that 288-367.5 m on the 6-min walk test and 25.5-27.6 points on the FMA-LL can discriminate community and noncommunity walkers. Considering the difference between prediction and discrimination, the reliable predicted cutoff values revealed in this review are useful for planning an intervention based on early prediction. Conversely, cutoff values for discrimination can estimate different performances with simpler test, or use as target values during rehabilitation.

Improving trunk posture control in children with CP through a cable-driven robotic hippotherapy: A randomized controlled feasibility study

BackgroundMany children with cerebral palsy (CP) show impairments in trunk posture control, one crucial factor contributing to impairments in gait and arm manipulation. Research questionThe goal of this study was to test the feasibility of the cable-driven hippotherapy system on improving trunk posture control and walking function in children with CP. MethodTen children were recruited in this study with average age 6.4 ± 3.0 years old, and were randomly assigned to the robotic group and the conventional balance training group. A custom designed cable-driven robotic hippotherapy system was used to deliver controlled pelvis perturbations while children were sitting astride. Participants from both groups underwent intensive robotic hippotherapy training or conventional balance training, depending on their group assignment, for 6 weeks (3 time/week). Outcome measures were assessed pre and post 6 weeks of robotic or conventional balance training, and 8 weeks after the end of training (follow-up test). The primary outcome measure was trunk control, which was measured using the Trunk Control Measurement Scale (TCMS). In addition, the Gross Motor Function Measure (GMFM-66), self-selected overground walking speed, and 6-minute walking distance were also assessed. ResultsThe change in TCMS score from baseline to the post intervention was significantly greater for the robotic group than that for the conventional group (i.e., 6 ± 3 vs. −1 ± 5, p = 0.048, Mann-Whitney test). GMFM scores, self-selected overground walking speed, and 6-minute walking distance showed no significant improvement after robotic hippotherapy and after conventional balance training (p > 0.05). SignificanceResults from this study indicated that it was feasible to improve trunk posture control in children with CP using a cable-driven robotic hippotherapy system. Knowledge obtained from this study may provide an insight for the development of new perturbation-based intervention approaches for improving trunk posture control in children with CP.

Minimally invasive stabilization using screws and cement for acetabular metastatic tumor: a case report

BackgroundThe aim of this case report is to evaluate minimally invasive stabilization using screws and cement for acetabular metastatic tumor and summarize the indications and contraindications for minimally invasive stabilization of acetabular metastatic tumors with screw and cement techniques.Case presentationUnder imaging guidance, a patient with acetabular metastatic tumor was treated with hollow screw combined with bone cement fixation. Ischial screw, ascending branch screw, and anterior and posterior screws were inserted to firmly fix the anterior and posterior column of the acetabulum. At the same time, the third screw connected the anterior and posterior columns together, combined with bone cement into the fracture site to further increase local stability and resist bone defects caused by local tumor osteolysis. The patient was a 52-year-old Uygur male. Herein, we summarize his clinical symptoms and operation. Differences in visual analog scale and walking function (Musculoskeletal Tumor Society) before operation and at 2 months, 6 months, and 12 months after operation were compared.ResultsPostoperative complications and tumor progression were recorded. The patient was followed up for 16 months, and the operative time was 60 minutes. In total, 20 ml of bone cement was injected into the acetabular posterior column and the top of the acetabulum. VIsual analog scale score was 8 before operation, 3 at 2 months, 3 at 6 months, and 2 at 12 months after operation. Musculoskeletal Tumor Society function was 13 before operation, 23 at 2 months, 25 at 6 months, and 26 at 12 months after operation. During follow-up, no cement leakage, fever, hip nerve injury, pulmonary embolism, or imaging findings of further destruction of the acetabulum and surrounding bone were noted.ConclusionThis case report shows that the treatment of acetabular metastatic cancer with minimally invasive stabilization using screws and cement under the C arm can effectively relieve pain and enhance the strength of the pelvis, and is innovative and feasible.

COVID-19 pandemic: Restrictions and functionality in the knees of physiotherapy students, preliminary study

Background: The COVID-19 pandemic declared by the WHO in 2020 led to restrictive measures that exerted an impact on physical activity, which can affect musculoskeletal health. Objective: The aim of the present study was to analyze the impact of the pandemic on knee pain and functioning among university students influenced by social isolation measures. Methods: An observational, cross-sectional study was conducted at the Evangelical University of Goiás (UniEVANGELICA) with 52 physiotherapy students. Data were collected with the aid of an online questionnaire addressing lifestyle habits, physical activity, knee pain, and functioning using the Lysholm knee score. Data analysis was performed with SPSS 21, using appropriate statistical tests. Results: The chi-square test revealed no significant association between COVID-19 and knee pain, but an apparent relationship was found between physical activity and pain. No significant association was found between COVID-19 and worse walking function, although a tendency was suggested. Discussion: Despite the apparent association between physical activity and pain, the lack of statistical significance indicates the need for more detailed analyses. The present results diverge from those of global studies, underscoring the complexity of the relationship between the pandemic and musculoskeletal health. Limitations of the study include the sample size and self-reporting. Conclusion: This study provides insights into the relationships between COVID-19, knee pain, physical activity, and walking function in university students. Although no significant association was found in some analyzes performed in this study, caution should be exercised when interpreting the results. Further research considering additional variables is recommended to gain a robust understanding of these relationships.

Feasibility of complex exercise therapy with Standing Ovation and peripheral neuromodulation for gait rehabilitation after incomplete spinal cord injury-acase report.

Spinal cord injuries (SCIs) are aglobal concern, annually affecting hundreds of thousands of individuals. Among these cases, incomplete SCIs, allowing some muscle activity below the injury, pose unique challenges. This case study focuses on a55-year-old male with amoderate incomplete SCI (AIS-D). After initial treatments and pharmaceutical antispastic therapy, anovel intervention was introduced featuring the Standing Ovation gait exercise system (Standing Ovation GmbH, Hallwang, Austria). This individually tailored system, equipped with arail system and seat-lifting unit, provided asecure environment for balance training. Over 14training sessions spanning from October13, 2021, to March23, 2022, improvements in functional walking were observed. Locomotor improvement in SCI rehabilitation is important; the potential of task-specific gait exercises with the Standing Ovation system in incomplete spinal cord injury seems to be apromising approach. Although promising, these findings call for further systematic studies with larger patient cohorts to strengthen their reliability. Ongoing research endeavors are essential to fully understand the benefits and limitations of this intervention in spinal cord injury rehabilitation.

GLIDE Score: Scoring System for Prediction of Procedural Success in Tricuspid Valve Transcatheter Edge-to-Edge Repair

BackgroundTricuspid valve transcatheter edge-to-edge repair (T-TEER) is the most widely used transcatheter therapy to treat patients with tricuspid regurgitation (TR). ObjectivesThe aim of this study was to develop a simple anatomical score to predict procedural outcomes of T-TEER. MethodsAll patients (n = 168) who underwent T-TEER between January 2017 and November 2022 at 2 centers were included in the derivation cohort. Additionally, 126 patients from 2 separate institutions served as a validation cohort. T-TEER was performed using 2 commercially available technologies. Core laboratory assessment of procedural transesophageal echocardiograms was used to determine septolateral and anteroposterior coaptation gap, leaflet morphology, septal leaflet length and retraction, chordal structure density, tethering height, en face TR jet morphology and TR jet location, image quality, and the presence of intracardiac leads. A scoring system was derived using univariable and multivariable logistic regression. Endpoints assessed were immediate postprocedural TR reduction ≥2 grades and TR grade moderate or less. ResultsThe median age was 82 years (Q1-Q3: 78-84 years); 48% of patients were women; and patients presented with severe (55%), massive (36%), and torrential (8%) TR. Five variables (septolateral coaptation gap, chordal structure density, en face TR jet morphology, TR jet location, and image quality) were identified as best predicting procedural outcome and were incorporated in the GLIDE (Gap, Location, Image quality, density, en-face TR morphology) score (range 0-5). TR reduction ≥2 grades and TR grade moderate or less were observed in >90% of patients with GLIDE scores of 0 and 1 and in only 5.6% and 16.7% of those with GLIDE scores ≥4. The GLIDE score was then externally validated in a separate cohort (area under the curve: 0.77; 95% CI: 0.69-0.86). TR reduction significantly correlated with functional improvement assessed by NYHA functional class and 6-minute walk distance at 3 months. ConclusionsThe GLIDE score is a simple, 5-component score that is readily obtained during patient imaging and can predict successful T-TEER.

Lung function and quality of life one year after severe COVID-19 in Brazil.

To evaluate symptoms, lung function, and quality of life of a cohort of patients hospitalized for severe COVID-19 12 months after hospital admission. This was a cross-sectional study. We included severe COVID-19 survivors hospitalized in one of three tertiary referral hospitals for COVID-19 in the city of Belo Horizonte, Brazil. Participants were submitted to lung function and six-minute walk tests and completed the EQ-5D-3L questionnaire. The whole sample comprised 189 COVID-19 survivors (mean age = 59.6 ± 13.4 years) who had been admitted to a ward only (n = 96; 50.8%) or to an ICU (n = 93; 49.2%). At 12 months of follow-up, 43% of patients presented with dyspnea, 27% of whom had a restrictive ventilatory disorder and 18% of whom presented with impaired DLCO. There were no significant differences in FVC, FEV1, and TLC between the survivors with or without dyspnea. However, those who still had dyspnea had significantly more impaired DLCO (14.9% vs. 22.4%; p < 0.020) and poorer quality of life. After one year, survivors of severe COVID-19 in a middle-income country still present with high symptom burden, restrictive ventilatory changes, and loss of quality of life. Ongoing follow-up is needed to characterize long COVID-19 and identify strategies to mitigate its consequences.

The effect of transcranial direct current stimulation on balance, gait function and quality of life in patients with stroke

ABSTRACT Transcranial direct current stimulation (tDCS) has been used in various neurological diseases due to its positive effects on cortical excitability. The aim of our study is to examine the effects of tDCS in stroke and 28 patients with stroke were randomly divided into two groups as intervention and control groups. Balance was evaluated with the Timed Up and Go Test and Berg Balance Scale. Walking functions were evaluated using the 10-meter Walk Test and the 6 Minutes Walk Test, lower extremity function was evaluated by Fugl Meyer Lower Extremity Scale, quality of life by Stroke-Specific Quality of Life Scale (SS-QOL). A task-oriented physiotherapy and rehabilitation program was applied to both groups. In addition to the task-oriented program, anodal tDCS was applied in the intervention group and carried out with a current of 2 mA, 5 days a week, 20 min, for a total of 4 weeks. In the control group, after the flow was opened for 30 s and the patient felt a tingling sensation, it was turned off without the patient noticing. As a result, significant improvement was obtained in all parameters in both groups (p < 0.05). At the difference values of both groups, only SS-QOL mobility subgroup was significant and other parameters were not significant. Considering all these results, it can be seen that tDAS applied in addition to the task-oriented training program in individuals with stroke makes a positive contribution to the patients’ balance, walking function and quality of life. We think that tDAS may be a feasible and safe additional approach in this patient group.