Abstract Background Context A previous study demonstrated that in seniors, the presence of cervical musculoskeletal impairment was not specific to cervicogenic headache but was present in various ...recurrent headache types. Physiotherapy treatment is indicated in those seniors diagnosed with cervicogenic headache but could also be adjunct treatment for those with cervical musculoskeletal signs who are suspected of having transitional headaches. Purpose This study aimed to determine the effectiveness of a physiotherapy program for seniors with recurrent headaches associated with neck pain and cervical musculoskeletal dysfunction, irrespective of the headache classification. Study Design This is a prospective, stratified, randomized controlled trial with blinded outcome assessment. Patient Sample Sixty-five participants with recurrent headache, aged 50–75 years, were randomly assigned to either a physiotherapy (n=33) or a usual care group (n=32). Outcome Measures The primary outcome was headache frequency. Secondary outcomes were headache intensity and duration, neck pain and disability, cervical range of motion, quality of life, participant satisfaction, and medication intake. Methods Participants in the physiotherapy group received 14 treatment sessions. Participants in the usual care group continued with their usual care. Outcome measures were recorded at baseline, 11 weeks, 6 months, and 9 months. This study was funded by a government research fund of $6,850. No conflict of interest is declared. Results There was no loss to follow-up for the primary outcome measure. Compared with usual care, participants receiving physiotherapy reported significant reductions in headache frequency immediately after treatment (mean difference −1.6 days, 95% confidence interval CI −2.5 to −0.6), at 6-month follow-up (−1.7 days, 95% CI −2.6 to −0.8), and at 9-month follow-up (−2.4 days, 95% CI −3.2 to −1.5), and significant improvements in all secondary outcomes immediately posttreatment and at 6- and 9-month follow-ups, (p<.05 for all). No adverse events were reported. Conclusions Physiotherapy treatment provided benefits over usual care for seniors with recurrent headache associated with neck pain and dysfunction.
Although lateralization of the brain affects some specialized cortical functions, there are still limited data to address its influence on clinically important outcomes. This study aimed to reveal ...the prognostic variables that relate to functional recovery in stroke patients with a left-sided hemispheric lesion during 6 months of follow-up. Data from 167 left-sided and 183 right-sided hemispheric strokes were reviewed retrospectively. Outcomes in this study included walking capacity and functional recovery, assessed by the modified Rankin Scale (mRS). In order to obtain independent predictive variables, this study used the step-backward method of multivariable regression analysis of parameters. The final model demonstrated that motor function of the hemiparetic leg was the strongest independent predictor for both walking ability and functional recovery (risk ratio (RR) of 2.41, 95% CI: 1.61–3.60, and p<0.001 and RR of 1.83, 95% CI: 1.03–3.26, and p=0.04, resp.). Therefore, lateralization did not seem to be involved. Understanding predictable variables that are associated with recovery can guide the rehabilitation team in setting priority and appropriate treatment for stroke patients.
Objectives
To examine whether combined center‐ and home‐based Tai Chi training can improve cognitive ability and reduce physiological fall risk in older adults with amnestic mild cognitive impairment ...(a‐MCI).
Design
Randomized controlled trial.
Setting
Chiang Mai, Thailand.
Participants
Adults aged 60 and older who met Petersen's criteria for multiple‐domain a‐MCI (N = 66).
Intervention
Three weeks center‐based and 12 weeks home‐based Tai Chi (50 minutes per session, 3 times per week).
Measurements
Cognitive tests, including Logical Memory (LM) delayed recall, Block Design, Digit Span forward and backward, and Trail‐Making Test Part B–A (TMT B–A), and fall risk index using the Physiological Profile Assessment (PPA).
Results
At the end of the trial, performance on LM, Block Design, and TMT B–A were significantly better for the Tai Chi group than the control group after adjusting for baseline test performance. The Tai Chi group also had significantly better composite PPA score and PPA parameter scores: knee extension strength, reaction time, postural sway, and lower limb proprioception.
Conclusion
Combined center‐ and home‐based Tai Chi training three times per week for 15 weeks significantly improved cognitive function and moderately reduced physiological fall risk in older adults with multiple‐domain a‐MCI. Tai Chi may be particularly beneficial to older adults with this condition.
Most stroke survivors spent their lifetime with disability which not only affects the clients themselves and the family but also brings economic cost to the country. Therefore, this retrospective ...cohort study aimed to identify independent prognostic determinants associated with functional recovery in ischemic stroke within 6 months after onset.
Data from all first-onset ischemic stroke patients admitted to the acute stroke unit of the tertiary, university hospital were reviewed for 5 years consecutively. The functional outcome of the patients was recorded during 6-month follow-up by using the modified Rankin Scale (mRS). Baseline characteristics, motor assessment and all stroke-related variables were assessed during first week after stroke and 6-month follow-up. In order to derive clinical predictors, the backward stepwise multivariable risk regression analyses were used with the generalized linear model.
The result revealed that in the 358 patients recruited into this study, 255 (71.2%) were in the functional recovery group (mRS score of 1 - 3) within 6 months after onset. The final model of multivariable risk regression analysis, with generalized linear model, demonstrated that the independent variables of functional recovery were leg score with a risk ratio (RR = 1.92, 95% confidence interval (CI): 1.14 - 3.21, P = 0.013), arm score (RR = 1.75, 95% CI: 1.02 - 3.01, P = 0.042) and age older than 75 years (RR = 1.36, 95% CI: 1.04 - 1.77, P = 0.025).
Achieving functional recovery during 6 months post stroke was related to age and motor improvement. With limited resources, continuity of rehabilitation training in the community system or allocation of caregiver training should be a part of discharge planning to promote recovery.
Abstract Background Evidence suggests that cervicogenic headache is associated with increasing age. Cervical musculoskeletal impairments are common features in individuals with cervicogenic headache. ...There is some suggestion that the structure (size and fatty infiltration) of neck muscle may factor in or contribute to these impairments. Objective To investigate relative cross sectional areas (rCSAs) and fatty infiltrate in the cervical muscles in elders with cervicogenic headache compared to controls. Methods Fourteen elder women with cervicogenic headache and 14 controls participated in the study. The rCSAs and fat infiltration were measured for the rectus capitis posterior major, rectus capitis posterior minor, multifidus, semispinalis capitis, splenius capitis, longus capitis/colli, and sternocleidomastoid. Results Elder women with cervicogenic headache had significantly reduced rCSAs of the rectus capitis posterior major and multifidus muscles compared to controls ( p < 0.05). Larger amounts of fat infiltrates were also observed in the rectus capitis posterior major and minor and splenius capitis muscles in the cervicogenic headache group ( p < 0.05). There were no changes in the size and fat infiltrate in the cervical flexor muscles ( p > 0.05). Conclusion The study demonstrated muscle atrophy with increased fatty infiltration in regionally select muscles of the upper and segmental cervical spine in older women with cervicogenic headache. While such changes and their influence on clinical symptoms are unknown, they may have management implications. Future research investigations are required to determine whether such alterations could be modified with specific exercise and modifications to daily living to positively influence clinical symptoms.
BACKGROUND: Walking difficulty is one of the important neurological consequences after stroke, early prediction of factors related to walking ability may benefit for rehabilitation team to set ...suitable goals and discharge planning. PURPOSE: This study was performed to identify independent prognostic determinants associated with mobility recovery from ischemic stroke during six months after onset. METHODS: Medical records from first-ever stroke patients who were admitted to the rehabilitation unit were retrospectively reviewed. Baseline characteristics including demographic data, stroke risk factors, motor assessment and stroke-related complications were collected. Outcome measure was ability to walk. To identify clinical predictors, multivariable risk regression analysis was used for analysis. RESULTS: Of a total 146 stroke survivors, 81 patients (55.5%) could be independent in walking and 65 (45.5%) were non-functional mobility at six months follow-up. Stepwise, multivariable risk regression analysis with generalized linear model demonstrated that follow-up leg score was the strongest independent predictor of walking with risk ratio RR of 2.23 (P < 0.01). The association of some stroke-related factors, aphasia and unilateral neglect were found in univariable analysis but revealed no significance from the final model. CONCLUSION: Identification of early predictors associate walking recovery provided meaningful information for stroke care team to consider the amount of care needed and to initiate optimal plan according to realistic goal.
Objectives: The objectives of this study were to compare gait characteristics during obstacle crossing between older adults with amnestic Mild Cognitive Impairment (a-MCI) and non-MCI and to ...investigate effects of obstacle height on obstacle crossing in both groups. Methods: Nineteen older adults with a-MCI (mean age 69.89±6.43 years) and 19 age, gender and body mass index matched non-MCI (mean age 70.58±6.40 years) participated in the study. Participants were tested on two walking conditions: 1) low obstacle (10% of leg length), and 2) high obstacle (30% of leg length). Spatial and temporal gait parameters were recorded and analyzed using 3-D motion capture and analysis system. Results: For the low obstacle condition, the a-MCI group demonstrated shorter crossing step length and slower crossing velocity than the non-MCI group (p=0.019 and 0.012, respectively). For the high obstacle condition, the a-MCI group demonstrated shorter crossing step length, leading heel distance and slower crossing velocity than the non-MCI group (p=0.041, 0.025 and 0.001, respectively). Conclusion: Gait characteristics during obstacle crossing in older adults with a-MCI differed from those without MCI. Furthermore, the differences were prominent in the high obstacle condition. The reduced crossing step length, leading heel distance, and crossing velocity may place older adults with a-MCI at risk of tripping falls. Bull Chiang Mai Assoc Med Sci 2015; 48(3): 204-213. Doi: 10.14456/jams.2015.19
•Administration of normal saline for 72h in patients with acute ischemic stroke is safe.•Patients without intravenous fluid had significantly higher rate of early neurological deterioration.•This ...study supports the use of intravenous fluid in acute ischemic stroke in patients who have no contraindications.
To compare the outcome of patients with acute ischemic stroke who received or did not receive intravenous fluid.
This study was a prospective, multicenter, randomized, open-label trial with blinded outcome assessment. We enrolled acute ischemic stroke patients without dehydration aged between 18 and 85 years with NIH Stroke Scale score (NIHSS) score from 1 to 18 who presented within 72h after onset. Patients were randomly assigned to receive 0.9% NaCl solution 100ml/h for 3days or no intravenous fluid.
On the interim unblinded analysis of the safety data, significant excess early neurological deterioration was observed among patients in the non-intravenous fluid group. Therefore, the study was prematurely discontinued after enrollment of 120 patients, mean age 60 years, 56.6% male. Early neurological deterioration (increased NIHSS ≥3 over 72h) not of metabolic or hemorrhagic origin was observed in 15% of the non-IV fluid group and 3.3% of the IV fluid group (p=0.02). Predictors of neurological deterioration were higher NIHSS score, higher plasma glucose, and increased pulse rate. There was no difference in the primary efficacy outcome, NIHSS≤4 at day 7, 83.3% vs 86.7%, p=0.61 or secondary efficacy outcomes.
Administration of 0.9% NaCl 100ml/h for 72h in patients with acute ischemic stroke is safe and may be associated with a reduced risk of neurological deterioration. These study findings support the use of intravenous fluid in acute ischemic stroke patients with NIHSS less than 18 who have no contraindications.
Objectives: The objective of this study was to examine effects of home-based Tai Chi training on balance in older adults with mild cognitive impairment (MCI). Methods: Thirty-four older adults with ...MCI were randomly assigned to the Tai Chi group (n=17; mean age 68.8±5.56 years) and control group (n=17; mean age 65.29±5.49 years). Both groups were age and gender matched. Participants in Tai Chi group practiced Tai Chi at home for 50 minutes per session, 3 times a week for 12 consecutive weeks. Postural sway was evaluated under 4 conditions (stand with eyes open on floor, eyes closed on floor, eyes open on foam, eyes closed on foam). Trunk coordination stability was evaluated using Lord sway meter. All evaluations were performed before and after 12-week period. Student’s t-tests were conducted to compare differences of each outcome measure between and within groups. Significance level was set at p≤0.05. Results: After 12-week Tai Chi training, the Tai Chi group demonstrated significant improvement from baseline in all outcome variables (p<0.05). In contrast, the control group showed no significant differences in all outcome variables when compared between baseline and at 12-week period (p>0.05). Due to baseline differences between groups, outcome measures were normalized to their baseline values for between-group comparisons at 12-week period. Results showed that postural sway tested while standing on floor under both eyes open and eyes closed conditions as well as trunk coordination stability significantly improved for the Tai Chi group as compared to controls (p<0.05). There were no significant differences in postural sway between two groups for foam conditions both under eyes open and eyes closed (p>0.05). Specifically, there was a trend for participants in Tai Chi group to decrease postural sway from baseline more than those in control group when tested with eyes open on foam (p=0.061) while there was no significant difference in postural sway with eyes closed on foam conditions between groups (p=0.242). Conclusion: Home-based Tai Chi training for 50 minutes per session, 3 times per week for 12 consecutive weeks could improve balance in older adults with MCI. Bull Chiang Mai Assoc Med Sci 2016; 49(1): 123-133. Doi: 10.14456/jams.2016.6
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