Weeks Of Inpatient Rehabilitation Research Articles

Effects of multidisciplinary inpatient rehabilitation on everyday life physical activity and gait in patients with multiple sclerosis

BackgroundMultiple sclerosis is a progressive neurological disease that affects the central nervous system, resulting in various symptoms. Among these, impaired mobility and fatigue stand out as the most prevalent. The progressive worsening of symptoms adversely alters quality of life, social interactions and participation in activities of daily living. The main objective of this study is to bring new insights into the impact of a multidisciplinary inpatient rehabilitation on supervised walking tests, physical activity (PA) behavior and everyday gait patterns.MethodsA total of 52 patients, diagnosed with multiple sclerosis, were evaluated before and after 3 weeks of inpatient rehabilitation. Each measurement period consisted of clinical assessments and 7 days home monitoring using foot-mounted sensors. In addition, we considered two subgroups based on the Expanded Disability Status Scale (EDSS) scores: ‘mild’ (EDSS < 5) and ‘severe’ (EDSS ≥ 5) disability levels.ResultsSignificant improvements in fatigue, quality of life and perceived mobility were reported. In addition, walking capacity, as assessed by the 10-m walking test, two-minute walk test and timed-up-and-go test, improved significantly after rehabilitation. Regarding the home assessment, mildly disabled patients significantly increased their locomotion per day and complexity of daily PA pattern after rehabilitation, while severely disabled patients did not significantly change. There were distinct and significant differences in gait metrics (i.e., gait speed, stride length, cadence) between mildly and severely disabled patients, but the statistical models did not show a significant overall rehabilitation effect on these gait metrics.ConclusionInpatient rehabilitation showed beneficial effects on self-reported mobility, self-rated health questionnaires, and walking capacity in both mildly and severely disabled patients. However, these improvements do not necessarily translate to home performance in severely disabled patients, or only marginally in mildly disabled patients. Motivational and behavioral factors should also be considered and incorporated into treatment strategies.

Variation in processes of care for total hip arthroplasty across high-income countries.

Total hip arthroplasty (THA) is among the most commonly performed elective surgeries in high-income countries, and wait times for THA have frequently been cited by US commentators as evidence that countries with universal insurance programs or national health systems "ration" care. This novel qualitative study explores processes of care for hip replacement in the United States and 6 high-income countries with a focus on eligibility, wait times, decision-making, postoperative care, and payment policies. We found no evidence of rationing or government interference in decision-making across high-income countries. Compared with the 6 other high-income countries in our study, the United States has developed efficient care processes that often allow for a same-day discharge. In contrast, THA patients in Germany stay in the hospital 7-9 days and receive 2-3 weeks of inpatient rehabilitation. However, the payment per THA in the United States remains far above other countries, despite far fewer inpatient days.

Improvements in urinary symptoms, health-related quality of life, and psychosocial distress in the early recovery period after radical cystectomy and urinary diversion in 842 German bladder cancer patients: data from uro-oncological rehabilitation

PurposeThis study aims to investigate urinary symptoms (continence and stoma care), health-related quality of life (HRQoL) and psychosocial distress (PD) in the early postoperative period after radical cystectomy (RC) and urinary diversion for ileal conduit (IC) and ileal neobladder (INB) to obtain a better basis for patient counseling.MethodsData for 842 bladder cancer patients, who underwent 3 weeks of inpatient rehabilitation (IR) after RC and urinary diversion (447 IC, 395 INB) between April 2018 and December 2019 were prospectively collected. HRQoL, PD, and urinary symptoms were evaluated by validated questionnaires at the beginning (T1) and the end of IR (T2). In addition, continence status and micturition volume were objectively evaluated in INB patients by 24-h pad test and uroflowmetry, respectively.ResultsGlobal HRQoL was severely impaired at T1, without significant difference between the two types of urinary diversion. All functioning and symptom scales of HRQoL improved significantly from T1 to T2. In INB patients, all continence parameters improved significantly during IR, while patients with an IC reported fewer problems concerning urostomy management. The proportion of patients suffering from high PD decreased significantly from 50.7 to 34.9%. Age ≤ 59 years was the only independent predictor of high PD. Female patients and patients ≤ 59 years were more likely to use individual psycho-oncological counseling.ConclusionHRQoL, PD and urinary symptoms improved significantly in the early recovery period after RC. Patients with urinary continence reported higher HRQoL and less PD. Psychosocial support should be offered especially to younger patients.

Family members’ and friends’ reports after standard and intensive group treatment for social communication difficulties following acquired brain injury – a mixed method approach

ABSTRACT Objective To examine family members/friends’ perception of change following standard and intensive group interactive structured treatment (GIST) for persons with social communication difficulties (SCDs). Methods A parallel mixed methods design combining data from questionnaires, the Goal Attainment Scale, and interviews. Participants Forty-nine adult (>18 years) family members/friends (69.4% female) of persons with SCDs and acquired brain injury (ABI) (cohabitating partner, 53.1%; other relatives, 30.6%; friends, 16.3%). Intervention Standard GIST consisted of 12 weekly outpatient sessions (2.5 h). Intensive GIST consisted of 4 weeks of inpatient rehabilitation (2 × 3 days/week, 2 × 4 days/week). Both treatments included 3- and 6-month follow-ups. Main outcome measures Quantitative measures (n = 49) included the following informant reports: Latrobe Communication Questionnaire (LCQ), Social Communication Skills Questionnaire-Adapted (SCSQ-A), Behavior Rating Inventory for Executive Functions-Adult version (BRIEF-A), and Goal Attainment Scale. The qualitative measure (n=9) was an interview performed at 6-month follow-up. Results Converging results were found, suggesting a perceived positive change over time for both standard and intensive GIST, with no substantial differences reported between the treatments. Conclusions Family members/friends reported improved social communication skills of the persons with SCDs following standard and intensive GIST. However, the integration of data showed the complexity of assessing SCDs and the need for further investigation.

Unusual presentation of antepartum lumbosacral plexopathy: A rehabilitation approach

Background: This case report focuses on a woman in her late thirties (gravida three para three) referred from Neurology to Physical Medicine &amp; Rehabilitation department due to pain, lower limb weakness, walking difficulties, and dependence in daily activities. Her symptoms, which began during the second trimester of pregnancy, progressed from burning sensations in her feet to muscle weakness affecting her legs and thighs in the peripartum period. Case presentation: Following delivery, diagnostic investigations indicated lower creatine phosphokinase levels, MRI findings showed muscle atrophy in the posterior compartment of both thighs, and an electromyography and nerve conduction study confirmed bilateral lumbosacral plexopathy. Treatment and outcomes: Rehabilitation commenced six weeks postpartum, but the patient faced challenges due to her functional limitations. The treatment included a multifaceted approach encompassing medical management, physical therapy, and occupational therapy. Notably, the patient demonstrated significant improvement within two weeks of inpatient rehabilitation. Conclusion: This case underscores the effective management of antepartum lumbosacral plexopathy using a comprehensive rehabilitation strategy. Early intervention and a multidisciplinary approach are pivotal in achieving positive outcomes in similar clinical presentations.

Psychosocial distress and quality of life in patients after radical cystectomy - one year follow-up in 842 German patients.

This study aims to report on psychosocial distress and QoL in bladder cancer patients after radical cystectomy (RC) and urinary diversion to obtain a better basis for patient counseling and postoperative care. The study relied on prospectively collected data for 842 patients, who underwent three weeks of inpatient rehabilitation after RC and creation of an ileal conduit (IC) or ileal neobladder (INB). Data on QoL and psychosocial distress were collected by validated questionnaires. Multivariate logistic regression was performed to identify predictors for high psychosocial distress. Four-hundred and forty-seven patients (326 male, 121 female) received an IC, while 395 patients (357 male, 38 female) received an INB. Health-related QoL improved steadily in the whole cohort during follow-up. Patients with an INB reported better physical function but suffered more from diarrhea and financial worries. Patients with an IC reported reduced satisfaction with their body image, increased worries about the future, and suffered more from constipation. Psychosocial distress increased significantly during follow-up. One year after surgery, 43.1% of patients suffered from high psychosocial distress. Multivariate regression analysis identified age ≤ 59years (OR 1.731; CI 1.056-2.838; p = 0.030) and lymph node metastases (OR 2.073; CI 1.133-3.793; p = 0.018) as independent predictors for high psychosocial distress. QoL improves significantly in all patients one year after RC. However, psychosocial distress remains high in a substantial number of patients. To prevent chronic psychological disorders, easily accessible opportunities for psycho-oncological counseling are needed for patients following RC.

Return to work improves quality of life and reduces psychosocial distress after radical cystectomy: data from a contemporary series of 230 German patients.

This study aims to evaluate health-related quality of life (HRQoL), psychosocial distress, and return to work (RTW) 2years after radical cystectomy (RC) and inpatient rehabilitation (IR). The study relied on prospectively collected data for 842 patients, who underwent 3weeks of IR after RC and creation of an ileal conduit (IC) or ileal neobladder (INB). Validated questionnaires surveyed patients on HRQoL and psychosocial distress (EORTC QLQ-C30, QSC-R10). Furthermore, employment status was evaluated. Regression was performed to identify predictors for HRQol, psychosocial distress, and RTW. Two-hundred and thirty patients were employed pre-surgery (77.8% INB, 22.2% IC). Patients with an IC suffered significantly more often from locally advanced disease (≥ pT3: 43.1% vs 22.9%; p = 0.004). Two years after surgery, 16.1% of patients had died (median days of survival 302 (IQR 204-482). Global HRQoL improved steadily, while high psychosocial distress was present in 46.5% of patients 2years after surgery. Employment was reported by 68.2% of patients, of which 90.3% worked full-time. Retirement was reported by 18.5%. Multivariate logistic regression analysis identified age ≤ 59years as the only positive predictor for RTW 2years after surgery (OR 7.730; 95% CI 3.369-17.736; p < 0.001). Gender, surgical technique, tumor stage, and socioeconomic status did not influence RTW in this model. In multivariate linear regression analysis, RTW was identified as an independent predictor of better global HRQoL (p = 0.018) and lower psychosocial distress (p < 0.001), whereas younger patient age was identified as an independent predictor for higher psychosocial distress (p = 0.002). Global HRQoL and RTW are high among patients two years after RC. However, role and emotional, cognitive, and social functioning were significantly impaired, while high psychosocial distress persists in a material number of patients. Our study highlights how a successful RTW decreases psychosocial distress and increases QoL in patients after RC for urothelial cancer. Nonetheless, additional efforts by employers and healthcare providers are needed in aftercare after creation of an INB or IC.

LBA02-06 PSYCHO-SOCIAL DISTRESS AND QUALITY OF LIFE IN PATIENTS AFTER RADICAL CYSTECTOMY: ONE YEAR FOLLOW-UP IN 842 GERMAN PATIENTS

You have accessJournal of UrologyCME1 Apr 2023LBA02-06 PSYCHO-SOCIAL DISTRESS AND QUALITY OF LIFE IN PATIENTS AFTER RADICAL CYSTECTOMY: ONE YEAR FOLLOW-UP IN 842 GERMAN PATIENTS Henning Bahlburg, Karl Tully, Florian Roghmann, Joachim Noldus, and Guido Mueller Henning BahlburgHenning Bahlburg More articles by this author , Karl TullyKarl Tully More articles by this author , Florian RoghmannFlorian Roghmann More articles by this author , Joachim NoldusJoachim Noldus More articles by this author , and Guido MuellerGuido Mueller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003361.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As both screening and treatment of patients with muscle-invasive bladder cancer improve, the rate of cancer survivors will increase. Therefore, long term medical, psychological and social effects should be investigated. This study aims to investigate psycho-social distress and quality of life in German patients after radical cystectomy (RC). METHODS: This study relied on prospectively collected data for patients, who underwent three weeks of inpatient rehabilitation after RC between April 2018 and December 2019. Data on psycho-social distress and quality of life were collected 4 weeks (T1), 6 months (T2) and 12 months (T3) post-surgery by validated instruments (QLQ-C30, QLQ-BLM, QSC-R10). Uni- and multivariate logistic regression was performed to identify predictors for high psycho-social distress. RESULTS: 842 patients (683 male, 159 female) were included. 447 patients (326 male, 121 female) received an IC, 395 (357 male, 38 female; p<0.001) received an INB. Tumor stage ≥pT3a (41.4% vs 24.1%; p<0.001) and lymph node metastases (19.9% vs 11.8%; p<0.001) were significantly more often present in patients with an IC. Health related quality of life (HRQoL) did not differ between the cohorts and steadily improved during follow-up. At T2, social, emotional and cognitive function as well as future worries and body image worsened in patients only to improve again at T3 in all patients, but especially in patients with an INB. Overall, 34.9% of all patients reported high psycho-social distress (QSC-R10 ≥15) at T1. During follow-up, no significant difference in psychosocial distress between both cohorts was observed. However, at both T2 and T3, over 40% of all patients still reported high psycho-social distress. Univariate regression analysis identified lymph node metastases as a predictor for high psycho-social distress at T3 (OR 2,123; CI 1,194–3,777; p=0,010). Multivariate regression analysis revealed both age ≤ 59 (OR 1,731; CI 1,056–2,838; p=0,030) and lymph node metastases (OR 2,073; CI 1,133–3,793; p=0,018) as predictors for high psycho-social distress at T3. CONCLUSIONS: Overall, HRQoL improves in all patients one year after RC. However, some sub-scales such as future worries, role function and emotional function still bother patients to varying degrees. A significant portion of both patients with an IC and an INB suffer from high psychosocial distress one year after RC. Especially young patients with lymph node metastases should be monitored regularly and undergo psychological counselling if necessary. Source of Funding: This study was funded by the “Nordrhein-Westfalen Association for the Fight Against Cancer, Germany.” The funder had no influence on the study design, data collection and analysis or preparation of the abstract. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1188 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henning Bahlburg More articles by this author Karl Tully More articles by this author Florian Roghmann More articles by this author Joachim Noldus More articles by this author Guido Mueller More articles by this author Expand All Advertisement PDF downloadLoading ...

Three weeks of rehabilitation improves walking capacity but not daily physical activity in patients with multiple sclerosis with moderate to severe walking disability.

Patients with multiple sclerosis have low levels of physical activity. This is of concern because low activity levels are related to cardiovascular disease, poor walking ability, and reduced quality of life. The aim of this study was to evaluate the impact of rehabilitation on daily physical activity and walking capacity in patients with multiple sclerosis who have moderate to severe walking disability. This exploratory, observational study of 24 patients with multiple sclerosis examined daily physical activity, walking capacity and fatigue before and after 3 weeks of inpatient rehabilitation. Inpatient rehabilitation included physiotherapy (30-60 min, 5 times/week), strength and endurance training (30-45 min, 3-5 times/week), occupational therapy (30 min, 2-3 times/week), and neuropsychological training (30 min, 2 times/week). There were no specific interventions to target daily levels of physical activity. Daily physical activity did not change after rehabilitation (physical activity: effect size = -0.23, 95% confidence interval (95% CI) 0.02‒0.62). There were significant improvements in walking capacity (Two-Minute Walk Test: effect size = 0.74, 95% CI 0.31‒1.16, +17 m, 20.2%) and mobility (Timed Up and Go Test: effect size = 0.65, 95% CI 0.22‒1.07, ‒2.1 s, 14.9%). Motor and cognitive fatigue (Fatigue Scale for Motor: effect size = 0.56, 95% CI 0.14‒0.99 and Cognitive Functions: effect size = 0.44, 95% CI 0.01‒0.86) improved significantly after rehabilitation. Three weeks of rehabilitation improved walking capacity, but not daily physical activity, in patients with multiple sclerosis with moderate to severe walking disability. To increase physical activity, it may be necessary to add specific behavioural interventions to the rehabilitation programme. The intervention plan should include strategies to overcome personal and environmental barriers.

Quantitative Functional Recovery Assessment of Spinal Cord Injury by using “Spinal Cord Injury-Ability Realization Measurement Index (SCI-ARMI)”: An Observational Study

Background: Spinal cord injury (SCI) refers to a physical injury to the spinal cord that distorts normal spinal cord function. The sudden occurrence of SCI leading to paralysis of the muscles below the level of injury leads to major functional limitations. Thus, the Spinal Cord Injury- Ability Realization Measurement Index (SCI-ARMI) tool was developed that evaluates functional recovery quantitatively. Purpose: To assess changes in quantitative functional recovery before and after rehabilitation of spinal cord injury by using Quadric Formula of SCI-ARMI. Methodology: SCI-ARMI was used as an outcome measure. Participants followed a routine conventional approach. They were assessed before starting inpatient rehabilitation and after 4 weeks of inpatient rehabilitation by taking Spinal Cord Independence Measure version III (SCIM-III) and AIS motor score (AMS) along with age and gender as a factor for calculation of SCI-ARMI. Results: A highly significant difference was found with a p-value of &lt;0.001. That is suggestive of significant changes in SCI-ARMI scores before and after conventional rehabilitation. Change in this score and improvement in functional performance was influenced by the conventional approach of inpatient rehabilitation. Conclusion: The present study concludes that SCI ARMI is useful and effective tool that monitors achievement of rehabilitation potential and helps to observe changes in quantitative functional recovery in individuals with SCI. Clinical Implication: SCI-ARMI is valid and reliable tool and also takes less time for calculation that can be incorporated into routine clinical assessment for the evaluation of functional performance and rehabilitation potential in SCI population. Keywords: SCI-ARMI, Quantitative Functional Recovery, Spinal Cord Injury.

Associations between Patient-Reported and Clinician-Reported Outcome Measures in Patients after Traumatic Injuries of the Lower Limb.

Both clinician-reported outcome measures (CROMs) measures and patient-reported outcome measures (PROMs) are applied to evaluate outcomes in rehabilitation settings. The previous data show only a low to moderate correlation between these measures. Relationships between functional performance measures (Clinician-Reported Outcome Measures, CROMs) and Patient-Reported Outcome Measures (PROMs) were analysed in rehabilitation patients with traumatic injuries of the lower limb. A cohort of 315 patients with 3 subgroups (127 hip, 101 knee and 87 ankle region) was analysed before and after 3 weeks of inpatient rehabilitation. All three groups showed significant improvements in PROMs with low to moderate effect sizes. Moderate to high effect sizes were found for CROMs. Correlation coefficients between CROMs and PROMs were low to moderate. The performance consistency between PROMs and CROMs ranged from 56.7% to 64.1%. In this cohort of rehabilitation patients with traumatic injuries, CROMs showed higher effect sizes than PROMs. When used in combination, patient-reported outcome and performance measures contribute to collecting complementary information, enabling the practitioner to make a more accurate clinical evaluation of the patient’s condition.

Psychosocial Distress in the Early Recovery Period after Radical Prostatectomy

Purpose: This study aimed to evaluate psychosocial distress in the context of continence and oncological outcome during the early recovery period after radical prostatectomy (RP) for prostate cancer. Patients and Methods: Retrospectively collected data from 587 patients who underwent inpatient rehabilitation after RP in 2016 and 2017 were analyzed. Psychosocial distress (measured by using a Questionnaire on Stress in Cancer Patients [QSC-R10]) and continence status (urine loss on a 24-h pad test and urine volume on uroflowmetry) were evaluated at the beginning (T1) and end (T2) of a 3-week inpatient rehabilitation. Multivariate logistic regression was performed to identify predictors for high distress (QSC-R10 score ≥15). Results: The median patient age was 65 years. At the start of rehabilitation, 204 patients (34.8%) demonstrated high distress. Psychosocial distress decreased significantly (p < 0.001) from a median of 11.0 at T1 (median 16 days after surgery) to a median of 6.0 at T2 (median 37 days after surgery). Complete continence increased significantly (p < 0.001) from 39.0% at T1 to 58.9% at T2. The median urine volume increased significantly (p < 0.001) from 161 mL at T1 to 230 mL at T2. Often, distress is higher in younger patients, whereas incontinence is higher in older patients. Multivariate logistic regression analysis identified age ≤69 years (p = 0.001) and tumor stage ≥pT3 (p = 0.006) as independent predictors of high distress. Conclusions: Distress and incontinence decreased significantly during the 3 weeks of inpatient rehabilitation after RP. Patient age ≤69 years and tumor stage ≥pT3 are independent predictors of high psychosocial distress.

Management of persistent sinus tachycardia during post-acute rehabilitation in a critical patient with COVID-19: a single-case study

BackgroundSinus tachycardia is a common arrhythmia in patients with COVID-19, and may pose challenges during rehabilitation.Case descriptionThis is a case report of a 39-year-old critically ill patient with COVID-19 with no premorbid conditions, who presented with intensive care unit-acquired weakness and persistent sinus tachycardia after their stay in an intensive care unit. The sinus tachycardia and exertional symptoms contributed to a severely limited exercise capacity (assessed through the 6-Minute Walk Test and 2-Minute Step Test), which impaired the progress of inpatient rehabilitation. This was addressed through the use of bisoprolol for heart rate control and a rehabilitation programme based on cardiac rehabilitation principles.ResultsThe patient's intensive care unit-acquired weakness improved with exercise-based rehabilitation, and the Functional Independence Measure motor subscore improved from 54/91 to 91/91 on discharge after 6 weeks of inpatient rehabilitation. After bisoprolol was started for sinus tachycardia, the patient's resting heart rate improved from 106 beats per minute to less than 90 beats per minute during this period of inpatient rehabilitation. During the same period, the patient exhibited concurrent improvement in exercise capacity on weekly 6-Minute Walk Test measurements. Improvements in the 2-Minute Step Test were also documented.ConclusionsPatient assessment using submaximal exercise testing with serial 6-Minute Walk Tests and 2-Minute Step Tests, along with using beta-blockers and cardiac rehabilitation principles, can be useful in the post-acute rehabilitation of patients recovering from COVID-19 with persistent sinus tachycardia.

Heterotopic Ossification in Shoulder and Knee as a Rare Complication of Hemiplegia Following Ischemic Stroke

Neurogenic heterotopic ossification (HO) is a complication of neurologic disorders which is characterized by formation of new extra osseous in soft tissue surrounding peripheral joints. HO can cause pain, progressive decrease in range of joint motion and a decline in functional capacity. We herein report a 52-year-old female patient with right hemiplegia due to ischemic stroke. She was admitted to the clinic with pain and limitation of movement in her right knee and shoulder for 6 months. Her imaging studies revealed HO. After 8 weeks of inpatient rehabilitation, shoulder range of motion improved but the contracture in the knee joint remained the same. HO is most commonly seen around the hip joint. However, in the presented case, it differs in that it is observed in the knee and shoulder. HO should be considered in the differential diagnosis of pain and joint limitation in patients with hemiplegia.

Early continence after ileal neobladder: objective data from inpatient rehabilitation.

To evaluate early continence of patients who underwent inpatient rehabilitation after radical cystectomy (RC) and orthotopic bladder substitution (ONB). We conducted a retrospective analysis on the data of 283 patients who underwent a three weeks inpatient rehabilitation after RC and ONB for bladder cancer between January 2016 and July 2017. All patients were treated with a special multimodal continence therapy. The continence status was evaluated by measuring urine loss by a 24-h pad test and urine volume on uroflowmetry at the beginning (T1) and at the end (T2) of inpatient rehabilitation. Multivariate linear regression analysis was performed to identify independent predictors of urine loss. Median patient age was 63years. NS was documented for 142 patients (50.2%). Median urine loss decreased significantly (p < 0.001) in the 24-h pad test, from 442gm at T1 (median 29days after surgery) to 88gm at T2 (median 50days after surgery). Urine volume increased significantly (p < 0.001) from a median of 78ml at T1 to a median of 157ml at T2. Age (p = 0.002), diabetes (p = 0.031), obesity (p = 0.003), and nerve sparing (p = 0.011) were identified as independent predictors for urine loss at the end of inpatient rehabilitation. Continence improved significantly during the three weeks of inpatient rehabilitation. Younger age, the absence of diabetes or obesity, and NS resulted in better continence in the early postoperative period after ONB.

Changes in cardiorespiratory fitness and activity levels over the first year after discharge in ambulatory persons with recent incomplete spinal cord injury

Study designSecondary analysis of a clinical trial.ObjectivesTo investigate changes in cardiorespiratory fitness (CRF) and activity level in ambulatory persons with SCI during the first year after discharge from inpatient rehabilitation.SettingSunnaas Rehabilitation Hospital, Nesoddtangen, Norway.MethodsThirty persons with incomplete SCI, all community walkers (25 males and 5 females, 18–69 years old) were recruited to a clinical trial of a 12 weeks home-based aerobic exercise program of either high or moderate intensity. During the last week of inpatient rehabilitation (baseline), participants performed a maximal exercise test on a treadmill (peak oxygen uptake; peak VO2) and a 6-min walking test (6MWT). Also, total daily energy expenditure (TDEE) and daily amount of steps were measured continuously during 7 days in the participants’ homes. All tests were repeated after 3 and 12 months (post tests).ResultsTwenty of the 30 clinical trial participants performed baseline and both posttests and are included in this secondary analysis. We found no statistically significant between-group differences in the time course over the first year of either peak VO2, 6MWT, or physical activity outcomes. Therefore, data from both exercise groups and the control group were merged for secondary analyses, revealing statistically significant increase over time in peak VO2, 6MWT, and TDEE. The increase over time in the average daily steps did not reach statistical significance.ConclusionsAmbulatory persons with SCI were able to increase their CRF levels over the first year after discharge from inpatient rehabilitation, despite a minimal increase in activity levels.

Temporal Profile of Recovery of Communication in Patients With Disorders of Consciousness After Severe Brain Injury

ObjectiveCharacterize the temporal profile of recovery of communication after severe brain injury. DesignRetrospective cohort study. SettingInpatient rehabilitation hospital. ParticipantsPatients with severe acquired brain injury and no evidence of communication on the Coma Recovery Scale-Revised (CRS-R) (N=175). Main Outcome MeasuresTime from injury to recovery of intentional communication (IC, inconsistent yes/no responses) and functional communication (FC, consistent and accurate yes/no responses) on the CRS-R Communication subscale. ResultsPatients (N=175) were included in the primary observation period of the first 8 weeks of inpatient rehabilitation (median [interquartile range, IQR]: 48 [27-61] years old, 105 men, 28 [21-38] days postinjury, 100 traumatic etiology). Fifty-four patients (31%) did not recover IC or FC. Thirty patients (17%) recovered IC only (median [IQR] days from injury to IC= 40 [34-54]), 72 patients (41%) recovered IC followed by FC (days from injury to FC=50 [42-61]), and 19 patients (11%) recovered FC without first recovering IC (43 [32-63]). The patients who recovered neither IC nor FC within 8 weeks of admission were admitted to rehabilitation later than those who recovered IC and/or FC (P<.01). Sixteen patients who did not recover communication within 8 weeks of admission to rehabilitation subsequently recovered FC prior to discharge. ConclusionsIn patients with severe brain injury receiving inpatient rehabilitation, discernible yes-no responses emerged approximately 6 weeks postinjury and became reliable 1 week later. Approximately 1 in 3 patients did not demonstrate IC or FC within 8 weeks of admission to rehabilitation, although 33% of these individuals recovered communication prior to discharge. In total, 61% of patients recovered FC prior to discharge from rehabilitation.

Correlates of fear of falling and falls efficacy in geriatric patients recovering from hip/pelvic fracture

Objective: To gain a better understanding about the nature of fear of falling, this study analyzed associations between psychological and physical aspects related to fear of falling and falls efficacy in hip/pelvic fracture patients. Design: Baseline data of a randomized controlled trial. Setting: Geriatric inpatient rehabilitation hospital. Subjects: In all, 115 geriatric patients with hip/pelvic fracture (mean age: 82.5 years) reporting fear of falling within first week of inpatient rehabilitation. Interventions: None. Main measures: Falls efficacy (Short Falls Efficacy Scale–International; Perceived Ability to Manage Falls), fear of falling (one-item question), fall-related post-traumatic stress symptoms (six items based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria), physical performance (Short Physical Performance Battery) and psychological inflexibility (Acceptance and Action Questionnaire-II) were assessed. Results: Path analyses demonstrated that low falls efficacy (Short Falls Efficacy Scale International) was significantly related to poor physical performance (β* = –.277, P ⩽ .001), but not to psychological inflexibility and fall-related post-traumatic stress symptoms (P ⩾ .05.). Fear of falling was directly associated with fall-related post-traumatic stress symptoms (β*= .270, P = .007) and indirectly with psychological inflexibility (β*= .110, P = .022). Low perceived ability to manage falls was significantly related to previous falls (β* = –.348, P ⩽ .001), psychological inflexibility (β* = –.216, P = .022) and female gender (β* = –.239, P ⩽ .01). Conclusion: Falls efficacy and fear of falling constitute distinct constructs. Falls efficacy measured with the Short Falls Efficacy Scale International reflects the appraisal of poor physical performance. Fear of falling measured by the single-item question constitutes a fall-specific psychological construct associated with psychological inflexibility and fall-related post-traumatic stress symptoms.

Midline Suboccipital Subtonsillar Approach with C1 Laminectomy for Resection of Foramen Magnum Meningioma: 2-Dimensional Operative Video

We present a case of a medium-sized foramen magnum meningioma that was resected through a midline suboccipital subtonsillar approach with C1 laminectomy in prone (Concorde) position. The patient is a 77-year-old woman with a 6-month history of intermittent vertigo, moderate gait instability, and slight decline of memory.On magnetic resonance imaging (MRI) an extra-axial intradural lesion was discovered that originated from the right epicondylar region just inferior to the jugular tubercle and occupied the anterolateral aspect of the foramen magnum. There was moderate transposition and compression of the medulla at the level of the cerebellar tonsils.On physical examination the patient was ambulatory independently without motor weakness but exhibited some gait instability. The function of the lower cranial nerves was preserved.A gross-total resection was achieved, histopathology confirmed a WHO grade-I meningothelial meningioma with a low-proliferation index. The patient was discharged home 5 days after surgery, her gait instability improved significantly immediately after surgery and had resolved completely after 2 weeks of inpatient rehabilitation. There was no other neurological deficit. At 3-month follow-up MRI, there was no indication of meningioma residual or recurrence.In summary, the midline suboccipital subtonsillar approach is a powerful tool with limited morbidity in the armamentarium for the microsurgical management of a variety of pathologies residing in the posterior cranial fossa and the craniocervical junction. Oftentimes the space created by the pathology opens up corridors that can be exploited for microsurgical access to avoid more extensive surgical approaches. The link to the video can be found at: https://youtu.be/0uUxs13ze7w .

Motor learning outcomes of handrim wheelchair propulsion during active spinal cord injury rehabilitation in comparison with experienced wheelchair users

Purpose To investigate changes in wheelchair propulsion technique and mechanical efficiency across first five weeks of active inpatient spinal cord injury rehabilitation and to compare the outcomes at discharge with experienced wheelchair users with spinal cord injury. Methods Eight individuals with recent spinal cord injury performed six weekly submaximal exercise tests. The first and last measurement additionally contained a wheelchair circuit and peak graded exercise test. Fifteen experienced individuals performed all above-mentioned tests on one occasion. Results Mechanical efficiency and propulsion technique did not change during the five weeks of inpatient rehabilitation. Peak power output during peak graded test and performance time on the wheelchair circuit improved between the first and the last week. No difference in propulsion technique, peak power output, and performance time was found between the persons with a recent injury and the experienced group. Mechanical efficiency was higher after the correction for the difference in relative power output in the experienced group. Conclusion The group with a recent injury did not improve mechanical efficiency and propulsion technique over the period of active rehabilitation, despite significant improvements on the wheelchair circuit and in work capacity. The only significant difference between the groups was found in mechanical efficiency. Implications for rehabilitation The lack of time-dependent changes in mechanical efficiency and propulsion technique in the group with a recent spinal cord injury, combined with the lack of differences in technique, work capacity and on the wheelchair circuit between the groups, suggest that important adaptations of motor learning may happen even earlier in rehabilitation and emphasize that the group in active rehabilitation was relatively skilled. Standardized observational analyses of handrim wheelchair propulsion abilities during early spinal cord injury rehabilitation provide detailed understanding of wheelchair technique, skill as well as wheelchair propulsion capacity. Measurement of external power output is critical to interpretation of gross efficiency, propulsion technique, and capacity. Wheelchair quality and body weight – next to wheelchair fitness and skill – require careful consideration both in early rehabilitation as well as in the chronic phase of spinal cord injury.