Objective: Cerebral palsy (CP) is a condition characterized by abnormal pronunciation, posture, and movement, particularly spastic CP, which involves Gross motor dysfunction due to increased muscle ...tone and stiffness. This monocentric clinical study aims to evaluate the effectiveness of acupuncture and tuina (AT) in improving gross motor function and alleviating associated symptoms in children diagnosed with spastic CP. Methods: A total of 83 eligible patients received AT treatment, while 85 patients received conventional rehabilitation treatment. Both groups underwent a 12-week treatment period following the research protocol. Pre- and post-treatment assessments included the Modified Ashworth Muscle Tension Scale (MAS), Gross Motor Function Measure (GMFM-D and GMFM-E), 6-min walking distance measurement (6MWD), and Modified Children's Functional Independence Rating Scale (WeeFIM). Results: After 12 weeks of treatment, when compared with baseline, the scores of MAS in both AT group and control group are decreased (p<0.01, p<0.01), the scores of GMFM-D, GMFME, 6MWD, WeeFIM in both group are increased (p<0.01 in all indicators). When compared with control group, AT group had significantly lower MAS scores compared to the control group (p<0.01), indicating reduced muscle tension. Moreover, AT group showed significantly higher scores in GMFM-D, GMFM-E, 6MWD, and WeeFIM compared to the control group (p<0.01 in all indicators), indicating improved gross motor function and functional independence. The study also revealed an inverse correlation between the children's age and treatment efficacy (r= -0.496, p<0.01 in AT group, r=-0.540, p<0.01 in control group), highlighting the importance of early intervention in the management of CP in children. Conclusion: These findings suggest that AT may effectively enhance gross motor function and alleviate associated symptoms in children diagnosed with spastic CP. Moreover, early initiation of treatment is crucial to maximize therapeutic efficacy in children with spastic CP. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2200059823. Registered on 12 May 2022. Keywords: acupuncture, cerebral palsy, modified Ashworth muscle tension scale, gross motor function, the 6-minute walking distance measurement, children's functional Independence rating scale
To investigate the predictive value of a novel posterior circulation score (novel-PC score) based on baseline posterior circulation diffusion-weighted imaging (DWI) for functional independence after ...endovascular treatment (EVT) in patients with acute vertebral-basilar artery occlusion (VBAO).
The baseline DWI brain stem score (BSS), posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), and the novel-PC score were evaluated separately. A modified Rankin scale (mRS) ≤2 at 90 days was defined as a prognostic indicator of functional independence. Modified Thrombolysis in Cerebral Infarction grade 2b or 3 was defined as surgical success.
A total of 64 eligible patients were enrolled and divided into good and poor functional prognosis groups based on the mRS. The novel-PC score, BSS, and pc-ASPECTS (all P ≤ .001) were significantly better in the good functional prognosis group. The novel-PC score had a higher predictive value than BSS and pc-ASPECTS for 90-day functional independence (area under the receiver operating characteristic curve, 0.87 vs. 0.73 vs. 0.71; P < .05). Univariate binary logistic regression analysis showed that age (P = .006), Posterior National Institutes of Health Stroke Scale ≤18 (P < .001), BSS ≤2 (P = .008), pc-ASPECTS >7 (P = .002), and novel-PC score ≤5 (P = .001) were independently associated with function.
Our novel-PC score, based on DWI, can independently predict functional prognosis in patients with acute VBAO after EVT.
The novel-PC score based on baseline DWI was shown to be an independent predictor of function in patients with acute BVAO who are treated with EVT.
•Acute vertebrobasilar artery occlusion is often identified late, and accurately selecting patients for endovascular treatment is challenging.•Our novel posterior circulation score comprehensively considers the areas of lesion involvement and complete infarction.•The proposed score has a higher predictive value for 90-day functional independence after endovascular treatment than other commonly used scores.
The aim of our study was to assess the association between frailty and functional status in geriatric trauma patients.
3-year(2013–2015) prospective analysis and included all geriatric trauma ...patients(≥65y) discharged to a single rehabilitation center from our level-I trauma center. Frailty was measured using Trauma-Specific-Frailty-Index(TSFI) while Functional status was assessed using functional-independence-measure(FIM) at admission and discharge from rehabilitation center. Multivariate linear regression analysis was performed.
267 patients were enrolled. Mean age was 76.9 ± 7.1y, 63.6% were males. Overall, 22.8% were frail, and 37.4% were pre-frail. On linear regression, higher motor-FIM, higher cognitive-FIM scores at admission, and longer length-of-stay at rehab were independently associated with increased discharge FIM score. While, ISS(injury-severity-score), pre-frail and frail status were negatively correlated with FIM gain.
Frail patients were less likely to recover to their baseline functional status compared with non-frail patients. Early focused intervention in frail elderly patients is warranted to improve functional status in this population.
•Baseline functional status is less likely to be restored in frail patients after trauma.•Functional improvement in geriatrics is not dependent on age and insurance status.•Early identification of frailty allows focused intervention and resource allocation.
Objective: To identify sex/gender differences in functional, psychosocial and service use patterns in community-based post-acute care for acquired brain injury.
Design: Retrospective cohort study.
...Subjects/patients: Adults with acquired brain injury enrolled in post-acute neurorehabilitation and disability support in Western Australia (n = 1,011).
Methods: UK Functional Independence Measure and Functional Assessment Measure (FIM + FAM), Mayo-Portland Adaptability Inventory-4, goal attainment, length of stay (LOS), number of episodes of care and deaths were evaluated using routinely collected clinical and linked administrative data.
Results: At admission, women were older (p < 0.001) and displayed poorer functional independence (FIM + FAM; p < 0.05) compared with men. At discharge, there were no differences in goal attainment, psychosocial function or functional independence between men and women. Both groups demonstrated functional gains; however, women demonstrated clinically significant gains (+ 15.1, p < 0.001) and men did not (+ 13.7, p < 0.001). Women and men had equivalent LOS (p = 0.205). Aboriginal and/or Torres Strait Islander status predicted longer LOS for women but not for men. Being partnered predicted reduced LOS for women but not men. Women had a higher risk of multiple episodes of care (p < 0.001), but not death (p = 0.409), compared with that of men.
Conclusion: At admission to rehabilitation and disability support services for acquired brain injury, women have poorer functional independence and higher risk of multiple episodes of care, compared with men, suggesting greater disability in the community. By the time of discharge from these services, women and men make equivalent functional and psychosocial gains. The higher risk of multiple episodes of care for women relative to men suggest women may need additional post-discharge support, to avoid readmission.
This study analysed correlations between post-stroke, quantitative electroencephalographic (QEEG) indices, and cognition-specific, functional outcome measures. Results were compared between QEEG ...indices calculated from the standard 19 versus 4 frontal (or 4 posterior) electrodes to assess the feasibility and efficacy of employing a reduced electrode montage. Resting-state EEG was recorded at the bedside within 62–101h after onset of symptoms of middle cerebral artery, ischaemic stroke (confirmed radiologically). Relative power for delta, theta, alpha and beta, delta/alpha ratio (DAR) and pairwise-derived brain symmetry index (pdBSI) were averaged; over all electrodes (global), over F3, F4, F7, F8 (frontal) and P3, P4, T5, T6 (posterior). The functional independence measure and functional assessment measure (FIM–FAM) was administered at mean 105days post-stroke. Total (30 items) and cognition-specific (5 items) FIM–FAM scores were correlated with QEEG indices using Spearman's coefficient, with a Bonferroni correction. Twenty-five patients were recruited, 4 died within 3months and 1 was lost to follow-up. Hence 20 cases (10 female; 9 left hemisphere; mean age 68years, range 38–84) were analysed. Two QEEG indices demonstrated highly-significant correlations with cognitive outcomes: frontal DAR (ρ=−0.664, p≤0.001) and global, relative alpha power (ρ=0.67, p≤0.001). After correction there were no other significant correlations. Alpha activity – particularly frontally – may index post-stroke attentional capacity, which appears to be a key determinant of functional and cognitive outcomes. Likewise frontal delta pathophysiology influences such outcomes. Pending further studies, DAR from 4 frontal electrodes may inform early screening for post-MCA stroke cognitive deficits, and thereby, clinical decisions.
•Post-stroke cognitive deficits are common but screening for these is challenging.•We compare early post-stroke QEEG (global/regional indices) to cognitive outcomes.•Global relative alpha power was significantly correlated with cognitive outcomes.•Frontal delta-alpha power ratio was significantly correlated with cognitive outcomes.•DAR from 4 frontal electrodes may inform screening for post-stroke cognitive deficits.
Background. Sleep is important for consolidation of motor learning, but brain injury may affect sleep continuity and therefore rehabilitation outcomes. Objective. This study aims to assess the ...relationship between sleep quality and motor recovery in brain injury patients receiving inpatient rehabilitation. Methods. Fifty-nine patients with brain injury were recruited from 2 specialist inpatient rehabilitation units. Sleep quality was assessed (up to 3 times) objectively using actigraphy (7 nights) and subjectively using the Sleep Condition Indicator. Motor outcome assessments included Action Research Arm test (upper limb function), Fugl-Meyer Assessment (motor impairment), and the Rivermead Mobility Index. The Functional Independence Measure (FIM) was assessed at admission and discharge by the clinical team. Fifty-five age- and gender-matched healthy controls completed one assessment. Results. Inpatients demonstrated lower self-reported sleep quality (P < .001) and more fragmented sleep (P < .001) than controls. For inpatients, sleep fragmentation explained significant additional variance in motor outcomes, over and above that explained by admission FIM score (P < .017), such that more disrupted sleep was associated with poorer motor outcomes. Using stepwise linear regression, sleep fragmentation was the only variable found to explain variance in rate of change in FIM (R2adj = 0.12, P = .027), whereby more disrupted sleep was associated with slower recovery. Conclusions. Inpatients with brain injury demonstrate impaired sleep quality, and this is associated with poorer motor outcomes and slower functional recovery. Further investigation is needed to determine how sleep quality can be improved and whether this affects outcome.
A 27-year-old male presented with paralysis and tingling sensations in bilateral lower limbs. History revealed a D4-D6 spinal fixation secondary to a road traffic accident. Magnetic Resonance Imaging ...(MRI) diagnosed the case as post-traumatic syringomyelia secondary to spinal cord injury. Following the surgeon’s clearance, a targeted early rehabilitation intervention (TERI) for functional independence, bed mobility and transfers was initiated and continued for four weeks. Patient showed considerable improvements in Barthel index (40-85%) and Karnofsky Performance Status (20-70%). Physiotherapy Targeted early rehabilitation intervention can be a valuable adjunct to other management strategies in spinal cord lesions.
Introduction: Resilience involves the ability to adapt to the conditions of disability experienced by post-stroke patients. The purpose of this study was to investigate the resilience of post-stroke ...patients and determine the relationship with the patient's functional ability.
Methods: This research was a cross-sectional study that included 122 post-stroke patient respondents who had undergone a stroke recovery phase for 5 - 8 weeks. Selection of the sample used simple random sampling method. Univariate analysis was used to describe the characteristics of each respondent. Bivariate analysis was carried out to determine the relationship between resilience and functional abilities of respondents, especially functional abilities related to activities of daily living.
Results: The results of this study found that there was a significant relationship between resilience and functional ability of the respondents (p = 0.000; 95% CI).
Conclusions: Respondents with a high level of resilience can make better use of their abilities so that they can increase their functional independence abilities. Thus, it can achieve a better quality of life improvement.
Most research focuses around impairments in body function and structure, with relatively only a small number exploring their social impact.
1) compare characteristics for individuals who before ...stroke were blue collar vs. white collar workers 2) identify clinical, functional, and job-related factors associated with return to work within 1 year after discharge 3) identify specific ADL individual items (assessed at rehabilitation discharge) as return to work predictors and 4) identify return to work causal mediators.
Retrospective observational cohort study, analyzing adult patients with stroke admitted to rehabilitation between 2007 and 2021, including baseline Barthel Index (BI) and return to work assessments between 2008 and 2022. Kaplan-Meier survival curves and Cox proportional hazards were applied. Causal mediation analyses using 1000-bootstrapped simulations were performed.
A total of 802 individuals were included (14.6% returned to work), 53.6% blue-collar and 46.4% white-collar. Blue-collar workers showed significantly higher proportion of ischemic stroke, diabetes, dyslipidemia, and hypertension.Individuals not returning to work presented a higher proportion of blue collar, dominant side affected, aphasia, lower BI scores, and larger length of stay (LOS). Multivariable Cox proportional hazards identified age at injury, aphasia, hypertension, and total discharge BI score (C-Index = 0.74). Univariable Cox models identified three independent BI items at all levels of independence: bathing (C-Index = 0.58), grooming (C-Index = 0.56) and feeding (C-Index = 0.59). BI efficiency (gain/LOS) was a causal mediator.
Blue collar workers showed higher proportion of risk factors and comorbidities. Novel factors, predictors, and a return to work mediator were identified.
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