Showing papers in "American Journal of Physical Medicine & Rehabilitation in 2018"
TL;DR: Women physicians have been underrepresented by the AAP in recognition awards, and although the reasons are not clear, these findings should be further investigated.
Abstract: ObjectiveDetermine representation by gender for individual recognition awards presented to physicians by the Association of Academic Physiatrists (AAP).DesignCross-sectional survey was used. Lists of individual recognition award recipients for the 27-yr history of the AAP awards (1990–2016) were ana
51 citations
TL;DR: In this paper, the efficacy of myofascial release therapy (MRT) for improving pressure pain thresholds (PPTs) and pain in patients with mechanical neck pain was investigated, and participants with neck pain were randomly allocated to either a MRT group (five sessions) or a physic
Abstract: ObjectiveThis study aimed to investigate the efficacy of myofascial release therapy (MRT) for improving pressure pain thresholds (PPTs) and pain in patients with mechanical neck pain.DesignForty-one participants with neck pain were randomly allocated to either a MRT group (five sessions) or a physic
33 citations
Association of Academic Physiatrists1, Rutgers University2, Burke Rehabilitation Hospital3, Harvard University4, University of Texas Health Science Center at San Antonio5, University of Puerto Rico6, University of California, Irvine7, University of Pittsburgh8, Columbia University9, Nassau University Medical Center10
TL;DR: A women's task force convened in 2016 agreed on a list of metrics that would permit retrospective data review pertaining to the representation and inclusion of women physicians in the society, and found areas in which women physiatrists have been underrepresented.
Abstract: The Association of Academic Physiatrists (AAP) convened a women's task force in 2016, and the members agreed on a list of metrics that would permit retrospective data review pertaining to the representation and inclusion of women physicians in the society. Examples of categories examined included leadership positions (i.e., board membership, board presidents, committee membership, committee chairs, and resident fellow physician chairs), conference presentations (i.e., annual meeting session proposals, annual meeting faculty, annual meeting plenary speakers), and recognition awards (i.e., recognition award nominations and recipients). The findings highlight areas in which the Association of Academic Physiatrists has been successful in supporting gender equity and other areas in which women physiatrists have been underrepresented. The task force worked with the Board of Trustees to construct an action plan, asking the respective committees to address areas of underrepresentation. A volunteer from each committee was deemed a "diversity steward" and going forward will work directly with the task force as a liaison to document an action plan and collect data. The board plans to transparently report progress to members and other stakeholders, and the task force aims to publish a follow-up report within the next 5 years.
33 citations
TL;DR: This study investigates the feasibility of decoding gait kinematics from chronic stroke patients undergoing gait rehabilitation based on a lower extremity gait system (H2 NeuroExo) integrated with a noninvasive neural interface based on electroencephalography (EEG).
Abstract: ObjectiveAdvancements in robot-assisted gait rehabilitation and brain-machine interfaces may enhance stroke physiotherapy by engaging patients while providing information about robot-induced cortical adaptations. We investigate the feasibility of decoding walking from brain activity in stroke surviv
33 citations
TL;DR: Physiotherapy interventions can be a safe and beneficial option forSpasticity in people with multiple sclerosis and no firm conclusion can be drawn on overall spasticity.
Abstract: ObjectiveThe aim of the study was to examine the effectiveness of physiotherapy (PT) interventions on spasticity in people with multiple sclerosis.DesignA systematic search was performed using PRISMA guidance. Studies evaluate the effect of PT interventions on spasticity were included. Peopl
31 citations
TL;DR: Gaps regarding cancer rehabilitation services are discussed, opportunities to improve quality of cancer care in developing countries are identified, and future collaborations among international organizations and stakeholders of health care delivery systems are required to initiate and improve high-quality cancer rehabilitation in the developing countries.
Abstract: Cancer diagnosis often substantially affects patient's physical, psychological, and emotional status. Most patients with cancer experience declining of energy, activity levels, social-cultural participation, and relationships. In addition, cancer progression and adverse effects of aggressive cancer treatment often cause debilitating pain, fatigue, weakness, joint stiffness, depression, emotional instability, limited mobility, poor nutritional status, skin breakdown, bowel dysfunction, swallowing difficulty, and lymphedema leading into functional impairment and disability that can be addressed through rehabilitation care. Comprehensive care models by involving cancer rehabilitation have resulted in significant improvement of patient's quality of life. Although cancer rehabilitation has been implemented in many high-income countries, it is either not yet or suboptimally delivered in most low- and middle-income countries. In this review, we discussed gaps regarding cancer rehabilitation services and identified opportunities to improve quality of cancer care in developing countries. Future collaborations among international organizations and stakeholders of health care delivery systems are required to initiate and improve high-quality cancer rehabilitation in the developing countries.
30 citations
TL;DR: In this paper, the prevalence of depressive mood and its determinants in the chronic phase after a stroke was investigated in five hundred seventy-six consecutive patients who were invited to participate 2 to 5 yrs after hospitalization for a first-ever stroke.
Abstract: ObjectiveThe aim of the study was to ascertain the prevalence of depressive mood and its determinants in the chronic phase after stroke.DesignFive hundred seventy-six consecutive patients were invited to participate 2 to 5 yrs after hospitalization for a first-ever stroke. Stroke characteristics at
30 citations
TL;DR: Water-based aerobic exercise performed on a motorized aquatic treadmill had beneficial effect on isometric muscle strength in the lower limb in subacute stroke patients.
Abstract: OBJECTIVE The aim of this study was to assess whether the effects of a motorized aquatic treadmill exercise program improve the isometric strength of the knee muscles, cardiorespiratory fitness, arterial stiffness, motor function, balance, functional outcomes, and quality of life in subacute stroke patients. DESIGN Thirty-two patients were randomly assigned to 4-wk training sessions of either aquatic therapy (n = 19) or land-based aerobic exercise (n = 18). Isometric strength was measured using an isokinetic dynamometer. Cardiopulmonary fitness was evaluated using a symptom-limited exercise tolerance test and by measuring brachial ankle pulse wave velocity. Moreover, motor function (Fugl-Meyer Assessment [FMA] and FMA-lower limb [FMA-LL]), balance (Berg Balance Scale [BBS]), Activities of daily living (Korean version of the Modified Barthel Index [K-MBI]), and quality of life (EQ-5D index) were examined. RESULTS There were no intergroup differences between demographic and clinical characteristics at baseline (P > 0.05). The results shows significant improvements in peak oxygen consumption (P = 0.02), maximal isometric strength of the bilateral knee extensors (P < 0.01) and paretic knee flexors (P = 0.01), FMA (P = 0.03), FMA-LL (P = 0.01), BBS (P = 0.01), K-MBI (P < 0.01), and EQ-5D index (P = 0.04) after treatment in the aquatic therapy group. However, only significant improvements in maximal isometric strength in the knee extensors (P = 0.03) and flexors (P = 0.04) were found within the aquatic therapy group and control group. CONCLUSIONS Water-based aerobic exercise performed on a motorized aquatic treadmill had beneficial effect on isometric muscle strength in the lower limb. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Articulate the rationale for including walking on an aquatic treadmill in the rehabilitation of subacute stroke patients; (2) Describe the beneficial effects of a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients; and (3) Determine the appropriate indications for incorporating a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients.Level: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
30 citations
Journal Article•
TL;DR: In the chronic phase after stroke, a considerable proportion of patients has depressive symptoms, and this seems to be related to sex, country of origin, anxiety, coping style, daily activities, quality of life, and caregivers' strain.
Abstract: Objective The aim of the study was to ascertain the prevalence of depressive mood and its determinants in the chronic phase after stroke. Design Five hundred seventy-six consecutive patients were invited to participate 2 to 5 yrs after hospitalization for a first-ever stroke. Stroke characteristics at hospitalization were collected retrospectively from medical records. Patients and their caregivers completed questionnaires on depression (Hospital Anxiety and Depression Scale [HADS]), sociodemographic characteristics, healthcare usage, daily activities, quality of life, and caregiver strain. Patients with HADS depression scores of less than 8 were compared with patients with HADS depression scores of 8 or higher by means of univariate logistic regression analyses, adjusted for age, sex, and Barthel Index at discharge. Results Two hundred seven patients (36%) returned the questionnaires. After a mean follow-up of 36.3 mos, 67 patients (34%) had a HADS depression score of 8 or higher. Male sex and being born abroad were statistically significantly associated with a high HADS depression score, adjusted for age, sex, and stroke severity. Depressed patients had higher anxiety levels, a more avoidant coping style, less daily activities, and a lower quality of life; their caregivers experienced a higher burden. Conclusions In the chronic phase after stroke, a considerable proportion of patients has depressive symptoms. This seems to be related to sex, country of origin, anxiety, coping style, daily activities, quality of life, and caregivers' strain. Future research should focus on causal relationships and opportunities for treatment.
27 citations
TL;DR: The present review article aims to delineate sonoanatomy of the posterior lateral hip and to exemplify several common ultrasound guided procedures at the greater trochanteric, gluteal, and ischial tuberosity regions.
Abstract: Ultrasound has emerged as one of the most utilized tools to diagnose musculoskeletal disorders and to assist in interventions. Traditionally, sonographic examination of the hip joint has been challenging because most of the major structures are deeply situated, thus requiring the use of curvilinear transducer for better penetrance. The posterior lateral hip is a frequent area for musculoskeletal pain and nerve entrapments. Common disorders include greater trochanteric pain syndrome, gluteus medius tendinopathy, piriformis syndrome, pudendal neuralgia, and proximal hamstring tendinopathy. The present review article aims to delineate sonoanatomy of the posterior lateral hip and to exemplify several common ultrasound guided procedures at the greater trochanteric, gluteal, and ischial tuberosity regions.
27 citations
TL;DR: Despite no significant change in ankle range of motion or spasticity, shear wave elastography was able to detect a difference in lateral gastrocnemius passive muscle properties in children with cerebral palsy after BoNT-A injections.
Abstract: Objective A pilot study was conducted to longitudinally quantify effect of onabotulinum toxin A (BoNT-A) on passive muscle properties in children with cerebral palsy using ultrasound shear wave elastography. Design This was a prospective longitudinal cohort study. Results Between 1 and 3 mos post-BoNT-A, a significant improvement in the shear modulus of the lateral gastrocnemius was found at 10-degrees plantar flexion (PF) (-7.57 [-10.98, -5.07], P = 0.02) and 0-degrees PF (-14.74 [-18.21, -9.38], P = 0.03). There was a notable, but nonsignificant, difference in shear modulus at 20-degrees PF, 10-degrees PF, and 0-degrees PF between pre-BoNT-A and 1 mo post-BoNT-A. Pre-BoNT-A shear modulus was not significantly different from 3 mos post-BoNT-A at all foot positions. No significant differences in ankle passive range of motion or spasticity were found. Conclusion Despite no significant change in ankle range of motion or spasticity, shear wave elastography was able to detect a difference in lateral gastrocnemius passive muscle properties in children with cerebral palsy after BoNT-A injections. The difference in passive muscle properties resolved by 3 mos post-BoNT-A.
TL;DR: Clinicians treating individuals with spina bifida should be aware of the potential for earlier mortality in individuals with myelomeningocele, hydrocephalus, and Chiari II malformation, especially with regard to infection, respiratory failure, renal failure, shunt malfunction, and cancer.
Abstract: ObjectiveThe aims of this quality improvement project were to identify secondary conditions and medical co-morbidities in adult patients with spina bifida and to determine which factors were associated with an earlier age of death.DesignRetrospective chart review of 487 patients who attended the Uni
TL;DR: Extracorporeal shock wave therapy exerted a positive overall effect on pain and function for lower-limb tendinopathy, and high-dosage focused shock wave, high- Dosage radial shockwave, and low-dosages radial shock wave had superior pooled effects on overall clinical outcomes.
Abstract: OBJECTIVE Extracorporeal shock wave therapy, including radial shock wave and focused shock wave types, is widely used for managing tendinopathies. The difference in efficacy between the 2 shock wave characteristics with different dosage levels remains controversial, and the purpose of this meta-analysis was to examine it for patients with lower-limb tendinopathy. DESIGN A comprehensive search of online databases and search engines was performed. This study included randomized controlled trials reporting the efficacy of extracorporeal shock wave therapy in treating lower-limb tendinopathy. The included randomized controlled trials were subjected to a meta-analysis and risk of bias assessment. RESULTS In total, 29 randomized controlled trials were included, all of which had a good methodological quality, with a PEDro score of ≥6/10. General extracorporeal shock wave therapy showed significant effects at the immediate follow-up [pain score: standardized mean difference = -1.41, 95% confidence interval = -2.01 to -0.82, P < 0.00001; function: standardized mean difference = 2.59, 95% confidence interval = 1.54 to 3.64, P < 0.00001] as well as at 3, 6, and ≥12 months. In sequence, high-dosage focused shock wave, high-dosage radial shock wave, and low-dosage radial shock wave had superior pooled effects on overall clinical outcomes. CONCLUSIONS Extracorporeal shock wave therapy exerted a positive overall effect on pain and function for lower-limb tendinopathy. Shock wave types and dosage levels may have different contributions to treatment efficacy. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe benefits of extracorporeal shock wave therapy for individuals with lower-limb tendinopathy; (2) Understand the impact of dosing and type of extracorporeal shock wave therapy has on treatment efficacy; and (3) Identify appropriate indications for incorporating extracorporeal shock wave therapy into the treatment plan for patients with lower-limb tendinopathy. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
TL;DR: Corticosteroid injections into the lumbar z-joints were not effective in reducing the need for radiofrequency neurotomy of the medial branches in those with z-Joint pain confirmed by dual comparative medial branch blocks.
Abstract: BackgroundCorticosteroid injections into the intra-articular zygapophysial (z-joints) are frequently used to treat this cause of low back pain. No studies have been done on the efficacy of intra-articular corticosteroids in those with z-joint pain confirmed by dual comparative medial branch blocks.O
TL;DR: Anodal tDCS or physical therapy could be used alone or together as a combination treatment to improve the walking speed of patients with Parkinson disease but the combination treatment was not superior to the use of tDCS and physical therapy alone.
Abstract: ObjectiveThe aim of the study was to study the combined effects of transcranial direct current stimulation (tDCS) and physical therapy on the walking ability of patients with Parkinson disease (PD).Study DesignThe study used an experimental, double-blinded, randomized controlled trial.ResultsAfter i
TL;DR: Clinicians should consider patient age and history of stroke, peripheral vascular disease, or anxiety/panic disorders when optimizing a lower limb prosthesis users' mobility because these variables may be predictive of modest but clinically meaningful decreased prosthetic mobility.
Abstract: Objective The aim of the study was to determine the impact of comorbidities on mobility in patients with lower limb prostheses. Design Cohort database chart review was conducted to examine mobility in lower limb prosthesis users grouped according to comorbidities. Regression models were used to determine significant predictor comorbidities for mobility. General linear univariate models were implemented to investigate differences in mobility among cohorts (N = 596). Results Patient age and history of stroke, peripheral vascular disease, and anxiety/panic disorders were predictors of decreased mobility. After adjusting for covariates, the differences in mobility reported by patients older than 65 yrs was compared with those younger than 65 yrs; in addition, we compared those with a history of peripheral vascular disease with those without. The comparative analyses for both categories did not satisfy the minimal clinically important difference. There were no significant differences when comparing overall comorbid health after adjusting for covariates. Conclusions Clinicians should consider patient age and history of stroke, peripheral vascular disease, or anxiety/panic disorders when optimizing a lower limb prosthesis users' mobility because these variables may be predictive of modest but clinically meaningful decreased prosthetic mobility. By contrast, common comorbid health conditions such as arthritis, chronic obstructive pulmonary disease, congestive heart failure, and diabetes do not seem predictive of decreased mobility among lower limb prosthesis users.
TL;DR: The systematic implementation of screening and intervention for Delirium as well as the epidemiology of delirium are discussed to increase the awareness and guide clinical practice for clinicians in inpatient rehabilitation facilities.
Abstract: Delirium is an acute and fluctuating disturbance in cognition attention and awareness that is often a reflection of abnormal physiological condition of an individual. Delirium is highly prevalent among an older population and is associated with high mortality, poor medical and functional outcomes, and high healthcare cost. Delirium often has iatrogenic triggers, and it has been recognized as a quality indicator of healthcare organizations. Despite its high prevalence and significance, more than 50% of the delirium cases are underrecognized by healthcare professionals and remained untreated. Most patients in inpatient rehabilitation facilities are older adults with multiple risk factors for delirium including operation, intensive care stay, multiple co-morbidities, and impaired mobility. Early detection, intervention, and primary prevention of delirium will allow patients to avoid additional morbidities and reach their maximum functional potential during their rehabilitation stay. After the systematic implementation of delirium screening in our inpatient rehabilitation facility, we found that 10.3% of patients were screened positive for delirium at admission. This review discusses the systematic implementation of screening and intervention for delirium as well as the epidemiology of delirium to increase the awareness and guide clinical practice for clinicians in inpatient rehabilitation facilities.
TL;DR: It is concluded that local anesthetic agents have time- and concentration-dependent detrimental effects on MSCs, however, in vivo studies will be required to understand the interactions of these agents with M SCs, because in vitro studies cannot replicate the pharmacokinetics of anesthetics in vivo or the recovery of MSCS in a more physiological environment.
Abstract: Cell therapy based on the trophic, mitogenic, and immunomodulatory capacity of mesenchymal stem cells is a promising treatment modality for degenerative musculoskeletal conditions. Local anesthetics have been commonly used in interventional procedures for alleviating pain, but local anesthet
TL;DR: It seems that structural improvements are not required for a positive clinical outcome after a 4-wk isometric or isotonic exercise program for athletes with patellar tendinopathy in-season, despite an improvement in symptoms.
Abstract: Objectives The aim of this study was to investigate the effects of a 4-wk in-season exercise program of isometric or isotonic exercises on tendon structure and dimensions as quantified by ultrasound tissue characterization (UTC). Design This was a randomized clinical trial. Volleyball and basketball players (16-31 yrs, n = 29) with clinically diagnosed patellar tendinopathy were randomized to a 4-wk isometric or isotonic exercise program. The programs were designed to decrease patellar tendon pain. A baseline and 4-wk UTC scan was used to evaluate change in tendon structure. Results No significant change in tendon structure or dimensions on UTC was detected after the exercise program despite patellar tendinopathy symptoms improving. The percentage and mean cross-sectional area of aligned fibrillar structure (echo types I + II) (Z = -0.414, P = 0.679) as well as disorganized structure (echo types III + IV) (Z = -0.370, P = 0.711) did not change over the 4-wk exercise program. Change in tendon structure and dimensions on UTC did not differ significantly between the groups. Conclusion Structural properties and dimensions of the patellar tendon on UTC did not change after a 4-wk isometric or isotonic exercise program for athletes with patellar tendinopathy in-season, despite an improvement in symptoms. It seems that structural improvements are not required for a positive clinical outcome.
TL;DR: Anodal transcranial direct current stimulation over the primary somatosensory cortex may be a useful adjuvant therapy for the recovery of somatosensation and activities of daily living function in patients with sensory deficits after stroke.
Abstract: Objective The aim of this study was to evaluate the effect of anodal transcranial direct current stimulation over the primary somatosensory cortex on the recovery of somatosensation, motor function, and the activities of daily living in patients with subacute stroke. Design This study was a prospective, randomized sham controlled, double-blinded study. Patients with subacute stroke having somatosensory deficits (N = 24) were enrolled and assigned randomly to the anodal and sham stimulation groups. Patients received 10 consecutive anodal or sham transcranial direct current stimulations over the primary somatosensory cortex on the side of the stroke lesion. Before and after each stimulation session, Nottingham sensory assessments, Semmes Weinstein monofilaments examination, and manual function tests were performed, and modified Brunnstrom classification, modified Barthel index, and functional ambulation categories were assessed. Results Although there was no clear significant difference between the two groups, when the changes from baseline to posttreatment evaluation were compared between the groups, a partially significant improvement was observed in the anodal stimulation group compared with the sham stimulation group. Interestingly, the tactile sensation of the unaffected side also improved. Moreover, the greater improvement in activities of daily living function was observed in the anodal stimulation group too. Conclusion Anodal transcranial direct current stimulation over the primary somatosensory cortex may be a useful adjuvant therapy for the recovery of somatosensation and activities of daily living function in patients with sensory deficits after stroke.
TL;DR: The potential for resistance exercise training to reduce youth athletes' risk for sport-related concussion by increasing neck girth and strength is suggested, with greater increases in the neck strengthening group.
Abstract: Greater neck girth and strength may be associated with a lower risk of sport-related concussion due to mitigation of head accelerations by the neck. However, neck strengthening exercise remains unstudied in youth athletes. Therefore, this pilot study assessed the feasibility and effect of targeted neck strengthening exercises in youth athletes. Seventeen participants were allocated to perform 8-wk manual resistance-based neck strengthening (n = 13) or control resistance exercise (n = 4) programs. Before and after the intervention, participants completed laboratory-based assessments of neck size, strength, and head kinematics during standardized test loading in each plane of motion. Descriptive statistics were calculated to compare pre-post changes between the two groups. All participants safely and successfully completed the intervention. Neck girth and strength increased in both groups, with greater increases in the neck strengthening group. Across all planes of motion, overall changes in head linear and angular velocity decreased in both groups, with greater decreases in ΔV in the neck strengthening group and greater decreases in Δω in controls. These results suggest the potential for resistance exercise training to reduce youth athletes' risk for sport-related concussion by increasing neck girth and strength. Additional research is needed to determine optimal neck strengthening programs.
TL;DR: Although inadequate mechanical loading may initiate poor skeletal development, subsequent expansion of bone marrow fat may further impede skeletal acquisition and increase cardiometabolic disease risk in those with cerebral palsy.
Abstract: Individuals with cerebral palsy exhibit neuromuscular complications and low physical activity levels. Adults with cerebral palsy exhibit a high prevalence of chronic diseases, which is associated with musculoskeletal deficits. Children with cerebral palsy have poor musculoskeletal accretion accompanied by excess bone marrow fat, which may lead to weaker bones. Mechanistic studies to determine the role of bone marrow fat on skeletal growth and maintenance and how it relates to systemic energy metabolism among individuals with cerebral palsy are lacking. In this review, we highlight the skeletal status in children with cerebral palsy and analyze the existing literature on the interactions among bone marrow fat, skeletal health, and cardiometabolic disease risk in the general population. Clinically vital questions are proposed, including the following: (1) Is the bone marrow fat in children with cerebral palsy metabolically distinct from typically developing children in terms of its lipid and inflammatory composition? (2) Does the bone marrow fat suppress skeletal acquisition? (3) Or, does it accelerate chronic disease development in children with cerebral palsy? (4) If so, what are the mechanisms? In conclusion, although inadequate mechanical loading may initiate poor skeletal development, subsequent expansion of bone marrow fat may further impede skeletal acquisition and increase cardiometabolic disease risk in those with cerebral palsy.
TL;DR: Cancer patients receiving acute inpatient rehabilitation demonstrated significant improvements in functional outcomes from admission to discharge, thereby potentially reducing caregiver burden and ensuring safer discharges back to the community.
Abstract: Objective This study describes characteristics and trends of inpatient rehabilitation among cancer patients within the United States over a 13-yr period. Design This was a retrospective study of data from the Uniform Data System for Medical Rehabilitation from 2002 to 2014. Patients older than 17 yrs admitted to inpatient rehabilitation facilities with a diagnosis of malignant cancer were included. Trends of rehabilitation outcomes including length of stay, Functional Independence Measure (FIM) Instrument scores, and discharge location were examined. Results Data from 115,570 cancer patients were evaluated. Mean age was 66 ± 14 yrs and 49% were women. Mean length of stay decreased over time (2002: 14 days to 2014: 13 days; P 70%) were discharged to the community. Conclusions Cancer patients receiving acute inpatient rehabilitation demonstrated significant improvements in functional outcomes from admission to discharge. Cancer patients became more independent in important activities of daily living, thereby potentially reducing caregiver burden and ensuring safer discharges back to the community. This study suggests potential benefit of inpatient rehabilitation for appropriate cancer patients.
TL;DR: A role for eNOS in cognitive performance after stroke is supported and may lead to the development of novel interventions to treat poststroke cognitive deficits.
Abstract: Objectives Cognitive dysfunction and dementia are common following ischemic stroke. Endothelial nitric oxide synthase (eNOS) has been found to play an important role in neurologic function and cognition. The purpose of the present study was to assess the specific role of eNOS in cognitive performance after stroke. Design Male wild-type and mice lacking eNOS (eNOS) underwent middle cerebral artery occlusion or sham-surgery. Primary outcomes were repeated measures of neurologic score, limb asymmetry, sensory/motor function, and spatial memory/learning assessed at intervals up to 28 days postsurgery. Group differences in brain microglia activation and infiltration and levels of interferon-gamma were examined. Results There was no genotype × surgery interaction effect on the pattern of change in neurologic score, limb asymmetry, or sensory motor function across the 28 days postsurgery. In the Morris water maze, eNOS-/- middle cerebral artery occlusion mice displayed learning and memory deficits not evident in wild-type middle cerebral artery occlusion mice. Poorer spatial memory and learning in eNOS-/- middle cerebral artery occlusion mice was associated with a reduction in the number of activated microglia in the striatum on the lesion side and decreased brain tissue levels of interferon-gamma. Conclusions This study's data support a role for eNOS in cognitive performance after stroke. This finding may lead to the development of novel interventions to treat poststroke cognitive deficits.
TL;DR: Inability to perform the repeated chair stand task was associated with increased hazard of an injurious fall for 2 yrs among a cohort of older adult primary care patients.
Abstract: OBJECTIVE The aim of the study was to examine whether the chair stand component of the Short Physical Performance Battery predicts fall-related injury among older adult primary care patients. DESIGN A 2-yr longitudinal cohort study of 430 Boston-area primary care patients aged ≥65 yrs screened to be at risk for mobility decline was conducted. The three components of the Short Physical Performance Battery (balance time, gait speed, and chair stand time) were measured at baseline. Participants reported incidence of fall-related injuries quarterly for 2 yrs. Complementary log-log discrete time hazard models were constructed to examine the hazard of fall-related injury across Short Physical Performance Battery scores, adjusting for age, sex, race, Digit Symbol Substitution Test score, and fall history. RESULTS Participants were 68% female and 83% white, with a mean (SD) age of 76.6 (7.0). A total of 137 (32%) reported a fall-related injury during the follow-up period. Overall, inability to perform the chair stand task was a significant predictor of fall-related injury (hazard ratio = 2.11, 95% confidence interval = 1.23-3.62, P = 0.01). Total Short Physical Performance Battery score, gait component score, and balance component score were not predictive of fall-related injury. CONCLUSIONS Inability to perform the repeated chair stand task was associated with increased hazard of an injurious fall for 2 yrs among a cohort of older adult primary care patients.
TL;DR: Evidence of the positive association between gait variability and cost of walking during overground walking in persons with multiple sclerosis is provided, thereby reducing the energetic demands of walking in this population.
Abstract: ObjectiveThis study examined the associations between gait variability based on common spatiotemporal parameters and energetic cost of walking in persons with multiple sclerosis.DesignEighty-six persons with multiple sclerosis underwent the 6-min walk while wearing a portable metabolic unit. The cos
TL;DR: In this article, the effects of repetitive transcranial magnetic stimulation (rTMS) on walking and balance function in patients with stroke were investigated using the Physiotherapy Evidence Database (PED).
Abstract: ObjectiveThe aim of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on walking and balance function in patients with stroke.DesignMEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CENTRAL, and the Physiotherapy Evidence Database were comprehensively
TL;DR: Early mobilization is an early predictor of favorable outcome in stroke survivors admitted to rehabilitation, according to the Barthel Index and modified Rankin Scale.
Abstract: PurposeThe aim of the study was to assess early poststroke prognostic factors in patients admitted for postacute phase rehabilitation.MethodsA 1-yr multicenter prospective project was conducted in four Italian regions on 352 patients who were hospitalized after a first stroke and were eligible for p
TL;DR: Addition of traction in the prone position to other modalities resulted in larger immediate improvements in terms of pain and disability, and the results suggest that when using traction, prone traction might be first choice.
Abstract: ObjectiveThe aim of the study was to compare the effects of mechanical lumbar traction either in the supine or in the prone position with conventional physical therapy (PT) in patients with chronic low back pain and lumbosacral nerve root involvement in terms of disability, pain, and mobility.Design