Archives of physical medicine and rehabilitation最新文献

{"title":"The Actionability of Physical Activity Guidelines for Multiple Sclerosis Care: A Systematic Review and AACTT Framework Analysis","authors":"Claudia H. Marck PhD ,&nbsp;Isabelle V. Weld-Blundell BSc(Hons) ,&nbsp;Marlena Klaic PhD ,&nbsp;Robert W. Motl PhD ,&nbsp;Yvonne C. Learmonth PhD","doi":"10.1016/j.apmr.2024.09.020","DOIUrl":"10.1016/j.apmr.2024.09.020","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to conduct a systematic review of clinical guidelines, guidance documents and consensus statements regarding physical activity (PA) promotion by health care providers (HCPs) to people with multiple sclerosis (MS) and to assess the methodological quality, and actionability of the recommendations. The protocol was registered with Prospero (CRD42023495137).</div></div><div><h3>Data Sources</h3><div>Clinical guidelines, guidance documents and consensus statements (hereafter guidelines) published in English between 2013 and 2023 were identified through extensive gray and scientific literature searches, and through contacting relevant HCP organizations in English speaking countries.</div></div><div><h3>Study Selection</h3><div>Two researchers independently screened titles and abstracts of the 939 identified records and included 19 guidelines, which were developed for PA promotion as part of MS clinical management and for which the target user was HCPs.</div></div><div><h3>Data Extraction</h3><div>Two researchers independently extracted data and appraised the methodological quality using the Appraisal of Guidelines for Research and Evaluation (AGREE-II). Behavioral actionability was analyzed using the Actor, Action, Context, Target and Time (AACTT) framework.</div></div><div><h3>Data Synthesis</h3><div>Seventy-eight recommendations from 19 guidelines were identified. Two guidelines had high methodological quality. Actor, Action, Context, Target and Time were clearly specified in 57 (73%), 45 (58%), 0 (0%), 51 (65%), and 24 (31%) of the 78 recommendations, respectively. Guidelines with the highest methodological quality did not always score well on actionability, and vice-versa.</div></div><div><h3>Conclusions</h3><div>Our comprehensive analysis of guidelines for PA promotion in MS reveals the need for more actionable recommendations and better reporting of guideline development, which has the potential to improve the translation of evidence into practice. &lt;END ABSTRACT&gt;</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 590-606"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NIDILRR ARRT: Translating Research to Clinical Practice: Implementing Surface Electromyography for Swallowing Management in a Rehabilitation Hospital","authors":"Mariana Mendes Bahia,&nbsp;Julia Carpenter,&nbsp;Leora Cherney","doi":"10.1016/j.apmr.2025.01.008","DOIUrl":"10.1016/j.apmr.2025.01.008","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine the perspectives of speech-language pathologists (SLPs) about the implementation of a surface electromyography (sEMG) device in swallowing therapy.</div></div><div><h3>Design</h3><div>Descriptive survey and qualitative study.</div></div><div><h3>Setting</h3><div>Rehabilitation hospital.</div></div><div><h3>Participants</h3><div>Forty-four SLPs (mean age, 32.9y, SD, 7.1y) answered a preimplementation survey about biofeedback use in swallowing management and barriers to sEMG use in clinical practice. Six clinicians (mean age, 35.2y, SD, 4.8y) participated in the sEMG implementation process for 5 months.</div></div><div><h3>Interventions</h3><div>sEMG.</div></div><div><h3>Main Outcome Measures</h3><div>Preimplementation survey addressed (i) biofeedback use in swallowing management, (ii) sEMG knowledge, and (iii) barriers to sEMG use in clinical practice. Implementation process included (i) number of patients and sessions using sEMG and (ii) SLPs perceptions of sEMG implementation.</div></div><div><h3>Results</h3><div>Preimplementation survey indicated that the most used biofeedback modalities in swallowing management were an oral manometry device (97.7%), sEMG (11.4%), and fiberoptic endoscopic examination of swallowing (11.4%). All clinicians reported that sEMG improves visualization of muscle activity to train swallowing exercises, improves patient outcomes (77.3%), and motivates patients during therapy (45.5%). Main barriers to sEMG use included reduced knowledge (86.4%), lack of training (86.4%), and equipment access (68.2%). The 6 SLPs attended 4 educational/training meetings prior to implementation. They used sEMG with 30 patients (ages, 35-93y) for a total of 105 sessions. Clinicians reported being satisfied using sEMG (median, 8; interquartile range, 2.25; on a scale from 0 to 10), and their confidence level in using it during swallowing therapy was high (median, 8; interquartile range, 2.25). Although the SLPs recommended the implementation of sEMG throughout the hospital, they suggested that implementation should include onsite mentoring and supervised sessions when clinicians initially use sEMG with patients.</div></div><div><h3>Conclusions</h3><div>The education and training meetings improved clinicians’ knowledge, skill acquisition, and competency, facilitating sEMG use in swallowing therapy. The acceptability and adoption of sEMG was enhanced by researchers working in partnership with clinicians to identify strategies to address implementation barriers.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e3"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive-communicative Abilities and Social Engagement: Self-reported Changes in Adults With Cancer-related Cognitive Impairment 8251","authors":"Patricia Geels","doi":"10.1016/j.apmr.2025.01.043","DOIUrl":"10.1016/j.apmr.2025.01.043","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the prevalence of cognitive communication deficits among adult cancer survivors with self-reported CRCI. To determine the impact of CRCI on social engagement and satisfaction with social roles and activities.</div></div><div><h3>Design</h3><div>This study used a cross-sectional design to collect data through an online survey distributed to cancer survivors.</div></div><div><h3>Setting</h3><div>The survey was disseminated online, reaching a diverse population of cancer survivors across various geographic locations.</div></div><div><h3>Participants</h3><div>Eligible participants were adult cancer survivors without primary or metastatic brain tumors or progressive neurological diseases. A total of 135 participants met the inclusion criteria for this study, with a majority of them being women (91.77%).</div></div><div><h3>Interventions</h3><div>Participants completed an online survey consisting of sections covering demographic information, self-perceived cognitive communication abilities, social participation, and satisfaction with social roles.</div></div><div><h3>Main Outcome Measures</h3><div>The main outcome measures included self-reported cognitive communication deficits (measured by the Cognitive Communication Checklist for Acquired Brain Injury), social participation (measured by Neuro-QOLv1.0), and satisfaction with social roles (measured by Neuro-QOLv1.1).</div></div><div><h3>Results</h3><div>Most participants (82.58%) reported experiencing CRCI, with self-perceived impairment across various cognitive communication domains. The most pronounced difficulties were observed in functional daily communication. Participants reported more difficulty in participating in social roles and activities compared with satisfaction with social participation. No significant differences in cognitive communication scores were found based on cancer type or stage at diagnosis. However, age significantly affected cognitive communication scores, with younger survivors experiencing distinct challenges.</div></div><div><h3>Conclusions</h3><div>The study highlights the multidimensional nature of CRCI and its impact on social well-being among cancer survivors. Findings suggest the importance of personalized interventions addressing cognitive communication deficits to enhance quality of life and overall well-being. Speech-language pathologists could play a crucial role in identifying and addressing these deficits. Future research should explore caregiver perspectives on CRCI, employ longitudinal designs, and investigate the effectiveness of specific interventions and supportive care services to improve outcomes for cancer survivors.</div></div><div><h3>Disclosures</h3><div>Patricia Geels is employed as an assistant professor in the Vera Z. Dwyer College of Health Sciences at Indiana University South Bend.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e17"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Feasibility and Acceptability of a Tailored Multicomponent Rehabilitation Program for Adolescent and Young Adult (AYA) Cancer Survivors 8267","authors":"Lauren Corke,&nbsp;Jennifer Jones,&nbsp;Scott Capozza,&nbsp;James Farrell,&nbsp;Marlie Smith,&nbsp;David Langelier,&nbsp;Abha A. Gupta,&nbsp;Jonathan Avery","doi":"10.1016/j.apmr.2025.01.044","DOIUrl":"10.1016/j.apmr.2025.01.044","url":null,"abstract":"<div><h3>Objectives</h3><div>To: (1) assess the feasibility, acceptability, and safety of CaRE-AYA and (2) obtain preliminary estimates of variability in clinical outcomes including disability, physical and social functioning, and mental health by adapting an existing evidence-based multidimensional cancer rehabilitation to address the needs of adolescent and young adult (AYA) cancer survivors (CaRE-AYA) and conducting a phase 1 study.</div></div><div><h3>Design</h3><div>Single-arm, explanatory sequential multimethods study conducted at Princess Margaret Cancer Centre.</div></div><div><h3>Setting</h3><div>AYA patients could be referred to the CaRE-AYA program from the Cancer Rehabilitation and Survivorship Program at Princess Margaret Cancer Centre.</div></div><div><h3>Participants</h3><div>AYA cancer survivors (aged 18-39y) who were treated for cancer at Princess Margaret Cancer Centre and were experiencing moderate to high levels of disability or treatment effects could be referred to CaRE-AYA.</div></div><div><h3>Interventions</h3><div>CaRE-AYA is an 8-week group program that includes individualized exercise prescribed by a registered Kinesiologist and weekly in-person group-based exercise and self-management skills education.</div></div><div><h3>Main Outcome Measures</h3><div>Feasibility outcomes include participation and retention rates, and program adherence. Acceptability is being assessed through surveys and qualitative interviews with a subset of participants. Clinical outcome data are collected before (T0) and after (immediate [T1] and 3-month [T2]) intervention through questionnaires and physiological assessments. Any adverse events resulting from the study were reported and evaluated on the CTCAE version 5.</div></div><div><h3>Results</h3><div>Four CaRE-AYA groups were delivered and 26 AYAs enrolled and provided consent (63%) (age, 33.2±5.5y), and 21 (81%) completed the program. Adherence was 80% to the exercise classes and education classes. Participants reported high satisfaction with the program; 100% rated the material as important and relevant to AYA survivors. Suggestions for improvements has included later start time, more interactive components, and modifications to the educational content. Interviews, qualitative analysis, and 3-month clinical outcome data collection for group 4 participants (n=11) are still underway. There were no adverse events resulting from the study procedure, therefore confirming the safety of the intervention. Preliminary T0 to T1 data suggest important improvements on the 6 minute walk test, grip strength, physical functioning (SF-36), disability (WHODAS), mental health outcomes (GAD-7), and social functioning (SDI).</div></div><div><h3>Conclusions</h3><div>Preliminary data suggests the CaRE-AYA program is feasible, acceptable, and safe. Updated T2 data will be presented.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e17"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Penetration-aspiration Scale Scoring with Deep Learning","authors":"Seokjoon Hwang,&nbsp;Heebong Moon,&nbsp;Jinwoo Park","doi":"10.1016/j.apmr.2025.01.075","DOIUrl":"10.1016/j.apmr.2025.01.075","url":null,"abstract":"<div><h3>Objectives</h3><div>To develop a deep learning algorithm that can automatically analyze Penetration-aspiration scale (PAS) and present its accuracy.</div></div><div><h3>Design</h3><div>Analysis of retrospectively collected data.</div></div><div><h3>Setting</h3><div>Tertiary care hospital.</div></div><div><h3>Participants</h3><div>A total of 1039 videofluoroscopic swallowing study (VFSS) video clips.</div></div><div><h3>Interventions</h3><div>Two experienced rehabilitation physicians consensually assigned PAS scores for data coding. Regions of interest (ROI) were established in the oral and pharyngeal regions of the video and deep learning model was designed to automatically classify PAS. The structure of the model was to find ROIs using a convolutional neural network, which extracts visual features related to penetration and aspiration of ROIs and classifies them based on those features without any further manipulation of the video clips.</div></div><div><h3>Main Outcome Measures</h3><div>Predictive accuracy of the deep learning algorithm.</div></div><div><h3>Results</h3><div>Out of 1039 video clips, the frequencies for PAS 1 through 8 were, in order, 226, 145, 178, 37, 137, 15, 132, and 129. PAS 4 and 6 were excluded from training due to their low frequency, and 7 and 8 were combined as they were not discriminated in the videos. As a result, the classification accuracy was 76.09%, 42.31% 70.97%, 69.23%, and 75.00%, respectively, and the overall accuracy was 68.93%.</div></div><div><h3>Conclusions</h3><div>We have conducted research on using deep learning to automatically score PAS and have shown good results, although not high accuracy. In the future, we will need to train with more data sets to improve accuracy.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e29"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Executive Function to Postural Control During Standing in People With Diabetes Mellitus—A Dual-task Study","authors":"Kai Cheng,&nbsp;Carl Luchies,&nbsp;Hannes Devos,&nbsp;John Miles,&nbsp;Chun-Kai Huang","doi":"10.1016/j.apmr.2025.01.028","DOIUrl":"10.1016/j.apmr.2025.01.028","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the contribution of executive function to postural control in people with diabetes mellitus (DM) and age-matched healthy adults (HC) during a dual-task paradigm.</div></div><div><h3>Design</h3><div>A cross-sectional and observational study.</div></div><div><h3>Setting</h3><div>Hospital and research institute setting.</div></div><div><h3>Participants</h3><div>Ten patients diagnosed with DM (age, 58.9±10.3y; 4 women) and 10 HC (age, 62.1±11.9y; 7 women) were recruited. Key inclusion criteria for DM patients included: (1) the age ranges from 19 to 79 years; (2) can stand independently; and (3) no neuromuscular conditions, which influence the balance.</div></div><div><h3>Interventions</h3><div>To perform the virtual reality-based sensory organization test (SOT), participants were instructed to stand on the force plate with virtual reality goggles with a harness system. A foam pad was used for conditions with the uneven surface. An auditory Stroop test (AST) was administered concurrently in the dual-task condition.</div></div><div><h3>Main Outcome Measures</h3><div>To measure postural sway, root mean square values of rambling-trembling displacement decomposed from center of pressure were calculated through the MATLAB. The SOT scores were calculated to measure the postural sway contributed by individual sensory systems. The correctness of AST and the dual-task cost (DTC) of postural sway were calculated to assess the executive function. We hypothesized that the poorer executive function presented by lower correctness of AST and greater DTC can be observed in DM group as compared with HC group.</div></div><div><h3>Results</h3><div>When compared with HC group, the significantly lowered AST correctness was observed in the DM group. The significantly lowered DTC of SOT score regarding root mean square rambling in the anteroposterior direction was observed in the DM group when the vision dominates.</div></div><div><h3>Conclusions</h3><div>The lowered AST correctness in people with DM indicated the altered executive function through the dual-task paradigm. The postural control was not altered in the DM group as the lower DTC of SOT score was observed. In the dual-task paradigm, people with DM may apply greater cognitive resource involvement in postural control than in the secondary task.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e11"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeatability and Validity of the Prosthetic Observational Gait Scale in Patients with Bilateral Lower Limb Amputations 4345","authors":"Oleh Burii","doi":"10.1016/j.apmr.2025.01.029","DOIUrl":"10.1016/j.apmr.2025.01.029","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the repeatability and validity of the Prosthetic Observational Gait Scale (POGS) in individuals with bilateral lower limb amputations. Establishing its repeatability and validity underscored the significance of POGS in clinical practice, providing a simple yet reliable means of quantitative gait assessment accessible to a broad range of clinicians.</div></div><div><h3>Design</h3><div>Prospective observational cohort study on the interrater and intrarater validation and repeatability of POGS.</div></div><div><h3>Setting</h3><div>The study participants were obtained from the Superhumans Center (Vynnyky, Lviv, Ukraine)—a medical center for prosthetics, reconstructive surgery, and the rehabilitation of people affected by the war. Outpatient rehabilitation and follow-up post discharge.</div></div><div><h3>Participants</h3><div>In the current study were observed 12 male patients (N=12), who had bilateral lower limb amputees due to combat actions: 4 TF bilateral, 4 TT bilateral, 3 hip disarticulation+TF, and 1 TF+TT. The average age of participants was 37±11 years.</div></div><div><h3>Interventions</h3><div>Six observers, all of whom were physiotherapists, scored the patients’ videos using the observational gait scale. All had access to video playback facilities, enabling pause and slow-motion viewing. These videos were then reassessed in a new, randomly selected order at least 1 week after the initial analysis.</div></div><div><h3>Main Outcome Measures</h3><div>The study aimed to investigate the consistency of gait assessments made by different observers (interrater) and the same observer over time (intrarater).</div></div><div><h3>Results</h3><div>The intraobserver (COR) had an average coefficient of 8.7 (range, 6.1-11.7), indicating poor repeatability over time. Observers: 1 COR, 6.9; 2 COR, 7.2; 3 COR, 10.4; 4 COR, 6.1; 5 COR, 9.6; and 6 COR, 11.7. Two-way analysis of variance for the factor “observer,” <em>P</em>=.0009. The overall percentage agreement ranged from 43% to 93%. Kappa statistics for the 26 items, 5 showed good agreement, 11 moderate agreement, 6 fair agreement, and 4 poor agreement.</div></div><div><h3>Conclusions</h3><div>In summary, the study reveals concerns regarding the scale's (POGS) reliability in individuals with bilateral lower limb amputations. Intraobserver repeatability demonstrated significant variability over time, with each observer showing varying levels of consistency. The interobserver repeatability also raised concerns, indicating poor agreement among different observers. Given these limitations, it is advisable to integrate instrumental video analysis into clinical practice for individuals with bilateral lower limb amputations.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e11"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in Postacute Care Utilization for Individuals with Traumatic Brain Injury 8255","authors":"Amol Karmarkar,&nbsp;Alexandra Ulbing,&nbsp;Amit Kumar","doi":"10.1016/j.apmr.2025.01.054","DOIUrl":"10.1016/j.apmr.2025.01.054","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine disparities in postacute care transitions across inpatient rehabilitation facility, skilled nursing facility, and home health care in individuals with traumatic brain injury.</div></div><div><h3>Design</h3><div>Secondary analysis of All-Payer Claims Data (2017-2021) from Virginia. We linked the individual-level data, with provider- and region-level data.</div></div><div><h3>Setting</h3><div>Acute hospitals and postacute settings in Virginia.</div></div><div><h3>Participants</h3><div>Patients with traumatic brain injury discharged to inpatient rehabilitation facility, skilled nursing facility, or home health care (N=8662).</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main Outcome Measures</h3><div>Postacute settings, adjusting for patient-level covariates (sociodemographic characteristics, type of insurance, acute length of stay, Elixhauser comorbidity index, hospital-acquired complications), and region-level covariates (postacute availability, county ranking, and population). We constructed hierarchical generalized linear mixed models and Blinder-Oaxaca models for decomposing race and region effects.</div></div><div><h3>Results</h3><div>Approximately, 35% of our sample population did not receive any postacute care after hospitalization. For Hispanics and others, this rate was 46%. There were differences by race/ethnicity in types of postacute care settings. We also found variation in use of postacute care by region.</div></div><div><h3>Conclusions</h3><div>In the era of value-based payment models, it is important to examine long-term outcomes associated with postacute care transitions and develop care coordination models to eliminate disparities in access of postacute rehabilitation care.</div><div>Supported by the Commonwealth Neurotrauma Initiative (CNI): Transitions and Disparities in Care and Outcomes (TDCO) for Neurotrauma (Award # A262-90012).</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e21"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gait Training with Robotic Exoskeleton: A Case Report on the Treatment of Neurological Patients with Ataxia","authors":"Monnivon Morrow,&nbsp;Alivia Thorn,&nbsp;Monnivon Morrow","doi":"10.1016/j.apmr.2025.01.069","DOIUrl":"10.1016/j.apmr.2025.01.069","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess treatment of gait instability in the subacute and chronic phase after a cerebral infarction as well as chronic brain injury after tumor removal, by focusing on postural impairment and gait ataxia, with the use of robotic overground ambulation. Treatments such as virtual reality, biofeedback, and postural stability training have shown some promise to treat ataxia, but specific efficacy needs to be further investigated (Marquer, 2014). Santos et al looked at therapist-assisted gait training versus bodyweight supported robotic-assisted gait training, which concluded that one was not better than the other (Santos 2018). No current studies have looked at the efficacy of robotic-assisted overground gait training without body weight support when not done in the intensive (5d/wk) setting.</div></div><div><h3>Design</h3><div>This is a 2-subject qualitative case study. There was no follow-up after discharge.</div></div><div><h3>Setting</h3><div>Outpatient neurological physical therapy.</div></div><div><h3>Participants</h3><div>Two patients with subacute cerebral infarction and chronic brain injury participated in this observational study.</div></div><div><h3>Interventions</h3><div>Both patients participated in outpatient neurological physical therapy. Over the span of 12 weeks, patients underwent an Ekso training program that included 10 sessions walking with decreasing assistance levels followed by overground ambulation between 100 and 200 feet each session.</div></div><div><h3>Main Outcome Measures</h3><div>Ataxia deficits were quantified by ataxia scores on the scale for the assessment and rating of ataxia (SARA), performed at every 8th to 10th visit. Standing balance and gait were also assessed through the Berg Balance Scale (BBS), Six-Minute Walk Test (6MWT), and the Ten Meter Walk Test (10MWT).</div></div><div><h3>Results</h3><div>In the subacute and chronic phase, patients showed severe ataxia through the use of the SARA. Subject 2 was formally assessed and scored 21 of 50. Both subjects were initially nonambulatory, or required maximum assistance to stand and walk. After 12-weeks between the start of treatment with the exoskeleton and the re-evaluation of patients, the patients demonstrated meaningful improvement on the BBS, 6MWT, and 10MWT. Subject 1 improved his BBS from 16 of 56 to 23 of 56, meeting MDC of 4 points. Subject 2 did not meet MDC for the BBS (3-point improvement). However, subject 2 did increase 6MWT distance from 0 feet at initial evaluation to 198 feet. Both subjects discharged as household ambulators. SARA scores remained unchanged.</div></div><div><h3>Conclusions</h3><div>Although gait training with robotics for ataxia has promising preliminary results to decrease fall risk, future studies are needed to investigate efficacy of this treatment.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e27"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility Randomized Controlled Trial of the Toolkit for Optimal Recovery After Concussion: A Live Video Program to Prevent Persistent Concussion Symptoms in Young Adults With Anxiety","authors":"Jonathan Greenberg PhD ,&nbsp;Nadine S. Levey BA ,&nbsp;Molly Becker MS ,&nbsp;Gloria Y. Yeh MD, MPH ,&nbsp;Joseph T. Giacino PhD ,&nbsp;Grant Iverson PhD ,&nbsp;Noah D. Silverberg PhD ,&nbsp;Robert A. Parker ScD ,&nbsp;Ana-Maria Vranceanu PhD","doi":"10.1016/j.apmr.2024.10.011","DOIUrl":"10.1016/j.apmr.2024.10.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To assess the feasibility of the &lt;em&gt;Toolkit for Optimal Recovery after Concussion&lt;/em&gt; (&lt;em&gt;TOR-C&lt;/em&gt;), the first mind-body program aiming to prevent persistent concussion symptoms among young adults with anxiety, and an active control (&lt;em&gt;Health Enhancement after Concussion&lt;/em&gt; [&lt;em&gt;HE-C&lt;/em&gt;]). We also tested preliminary improvements in outcome measures and putative mechanistic targets.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Single-blind, 2-arm, randomized controlled trial (RCT).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Academic medical center in the US Northeast.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Fifty young adults (aged 18-35 years) with a recent concussion (3-10 weeks prior) and anxiety (≥5 on the Generalized Anxiety Disorder-7 [GAD-7] questionnaire).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Both interventions consisted of four 45-minute 1:1 sessions with a clinician over Zoom. &lt;em&gt;TOR-C&lt;/em&gt; (n=25) taught mind-body, cognitive-behavioral, and return-to-activity skills. &lt;em&gt;HE-C&lt;/em&gt; (n=25) taught health education (eg, sleep, nutrition) without skills.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Primary: feasibility outcomes (eg, recruitment, credibility, expectancy, acceptability, safety, feasibility of assessments, fidelity, satisfaction, and &lt;em&gt;TOR-C&lt;/em&gt; homework adherence) with a-priori-set benchmarks. Secondary: intervention outcomes were concussion symptoms (&lt;em&gt;Post-Concussion Symptom Scale&lt;/em&gt;), physical function (&lt;em&gt;World Health Organization Disability Assessment Scale&lt;/em&gt;), anxiety (GAD-7/anxiety subscale of the Hospital Anxiety and Depression Scale), depression (&lt;em&gt;depression subscale of the Hospital Anxiety and Depression Scale&lt;/em&gt;) and pain (&lt;em&gt;Numerical Rating Scale&lt;/em&gt;). &lt;em&gt;TOR-C&lt;/em&gt; mechanistic targets were pain catastrophizing (&lt;em&gt;Pain Catastrophizing Scale&lt;/em&gt;), mindfulness (&lt;em&gt;Cognitive and Affective Mindfulness Scale-Revised&lt;/em&gt;), fear avoidance (&lt;em&gt;Fear Avoidance Behavior after Traumatic Brain Injury&lt;/em&gt;), limiting behavior and all-or-nothing behavior (&lt;em&gt;Behavioral Response to Illness Questionnaire&lt;/em&gt;).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Both interventions met all feasibility benchmarks and were associated with significant improvements in outcomes (concussion symptoms, physical function, anxiety, depression, and pain; &lt;em&gt;d=&lt;/em&gt;0.44-1.21) and &lt;em&gt;TOR-C&lt;/em&gt; mechanistic targets (pain catastrophizing, mindfulness, fear-avoidance, and limiting behavior; Cohen's &lt;em&gt;d=&lt;/em&gt;0.41-1.24). Improvements in all-or-nothing behavior were only significant in &lt;em&gt;TOR-C&lt;/em&gt; (&lt;em&gt;d&lt;/em&gt;=0.52). Improvements in all mechanistic targets except all-or-nothing behavior after &lt;em&gt;TOR-C&lt;/em&gt; were significantly associated with improvements in at least one outcome.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Findings provide strong support for the feasibility of &lt;em&gt;TOR-C&lt;/em&gt; and &lt;em&gt;HE-C&lt;/em&gt;, and preliminary evidence for improvements in mechanistic targets and outcomes. Findings in","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Pages 527-536"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}