Dual-Task Obstacle Crossing Training Could Immediately Improve Ability to Control a Complex Motor Task and Cognitive Activity in Chronic Ambulatory Individuals With Spinal Cord Injury.

Background: The effectiveness of dual-task training has been reported in individuals with cognitive impairments. To date, there is no clear evidence on the incorporation of dual-task training in ambulatory individuals with spinal cord injury (SCI) who have intact cognitive functions but have various degrees of sensorimotor dysfunction. Objectives: To compare the immediate effects of dual-task obstacle crossing (DTOC) and single-task obstacle crossing (STOC) training on functional and cognitive abilities in chronic ambulatory participants with SCI. Methods: This is a randomized 2 × 2 crossover design with blinded assessors. Twenty-two participants were randomly trained using a 30-minute DTOC and STOC training program with a 2-day washout period. Outcomes, including 10-Meter Walk Tests (single- and dual-task tests), percent of Stroop Color and Word Test task errors, Timed Up and Go Test (TUG), and five times sit-to-stand test, were measured immediately before and after each training program. Results: Participants showed significant improvement in all outcomes following both training programs (p < .05), except percent of Stroop Color and Word Test task errors after STOC training. Obvious differences between the training programs were found for the percent of Stroop task errors and TUG (ps = .014 and .06). Conclusion: Obstacle crossing is a demanding task, thus the obvious improvement was found immediately after both training programs in participants with long post-injury time (approximately 5 years). However, the findings primarily suggest the superior effects of DTOC over STOC on a complex motor task and cognitive activity. A further randomized control trial incorporating a complex dual-task test is needed to strengthen evidence for the benefit of DTOC for these individuals.

Various surfaces challenge gait characteristics of ambulatory patients with spinal cord injury.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To assess the influence of various surfaces on the gait characteristics of ambulatory participants with incomplete spinal cord injury (SCI) as compared to data from able-bodied participants. SETTING: A tertiary rehabilitation center and communities. METHODS: Seventy participants (35 ambulatory individuals with incomplete SCI and 35 able-bodied individuals with gender- and age-matched) were assessed for their spatiotemporal gait variables while walking over a 10-m walkway of different surfaces (including hard, artificial grass, soft, and pebble surfaces) at a self-selected and fastest speed. The findings were analyzed using the method of manual digitization. The data among the surfaces were compared using Kruskal-Wallis test and Mann-Whitney U test, with a level of statistical significance at P < 0.05. RESULTS: Participants with incomplete SCI could safely walk over every surface without any adverse events. Their average stride length, cadence, and walking speed, but not percent step length symmetry, were significantly decreased while walking on the artificial grass, soft, and particularly pebble surfaces as compared to those found on a hard surface. These changes were found particularly in those with SCI, resulting in a walking speed decreased from 0.11 to 0.35 m/s, whereas the reduction of walking speed of able-bodied participants ranged from 0.04 to 0.20 m/s. CONCLUSIONS: The spatiotemporal characteristics of ambulatory participants with SCI were dramatically affected by the surfaces as compared to the data found in able-bodied participants. The findings have potential clinical implications for the incorporation of various surfaces to promote the functional outcomes and safety for ambulatory individuals with SCI.

Failures in dual-task obstacle crossing could predict risk of future fall in independent ambulatory individuals with spinal cord injury.

OBJECTIVE:: To determine whether cognitive-motor interference using ability of dual-task obstacle crossing could predict a risk of fall in 90 ambulatory individuals with spinal cord injury. DESIGN:: Six-month prospective study. SETTING:: A rehabilitation center and community hospitals. SUBJECTS:: Independent ambulatory individuals with spinal cord injury. MAIN OUTCOME MEASURES:: Subjects were interviewed and evaluated for personal characteristics, dual-task obstacle crossing ability, and functional ability using the 10 Meter Walk Test, Timed Up and Go Test, and Five Times Sit-to-Stand Test. Then they were prospectively monitored for fall data every month for six months in total. RESULTS:: A total of 90 chronic ambulatory individuals with spinal cord injury with an average age of 52.51 ± 13.43 years, who mostly had mild lesion severity ( n = 71, 79%) and walked with a walking device ( n = 54, 60%) completed in the study. More than one-third of the subjects ( n = 32, 36%) failed in dual-task obstacle crossing. The failures were obviously associated with the fall (unadjusted odds ratio = 7.07, P < 0.002, power = 1.000). CONCLUSION:: Cognitive-motor interference is important for ambulatory individuals with spinal cord injury, as it could detect those with low functional ability and risk of future falls.

Effects of dual- and complex-task on walking ability of ambulatory individuals with spinal cord injury.

BACKGROUND: Attempting to perform dual- and complex-tasks obviously reduces the walking ability of individuals with impaired cognitive functions. However, there is no clear evidence describing the effects of dual- and complex-tasks on the walking ability of ambulatory individuals with a spinal cord injury (SCI) who have intact cognitive functions, but suffer from various degrees of sensorimotor deterioration. AIM: To primarily investigate the effects of dual- and complex-task on the walking ability of ambulatory subjects with SCI as compared to healthy individuals. In addition, the study secondarily compared the effects in subgroups of subjects with SCI, including different age groups, lesion severity and level of ability. DESIGN: Cross-sectional design. SETTING: A major tertiary referral and community hospitals in Thailand. POPULATION: Thirty-seven ambulatory individuals with SCI and 13 healthy subjects. METHODS: All subjects were evaluated for outcomes while they walked under four conditions, including single-task overground walking (ST-OG), dual-task overground walking (DT-OG) using a color word Stroop task, single-task obstacle crossing (ST-OC) and dual-task obstacle crossing (DT-OC). The outcomes were compared among the conditions and between the groups of subjects in terms of walking time, obstacle crossing ability and percent of Stroop task errors. RESULTS: With the increasing complexity of the tasks, both SCI and healthy subjects walked significantly slower (P<0.001 for those with SCI and P<0.05 for healthy subjects), but not when compared between the ST-OC and DT-OG conditions (P>0.05). Subjects also showed a greater percentage of cognitive task errors when they encountered a dual- and complex-task, particularly those with SCI who were over 50 years old, had mild lesion severity or walked with a walking device (P<0.001). CONCLUSIONS: The incorporation of dual- and complex-task challenged cognitive-motor interference of ambulatory individuals with SCI. CLINICAL REHABILITATION IMPACT: The application of such tasks may benefit rehabilitation outcomes in a real-world situation for patients, especially for those who are older than 50, have mild lesion severity or use a walking device.

Medical complications and falls in patients with spinal cord injury during the immediate phase after completing a rehabilitation program.

BACKGROUND/OBJECTIVES: Complications and falls are crucial problems in patients with spinal cord injury (SCI). However, existing evidence on complications comes from data from hospital records over a long period of time, and falls were mostly reported retrospectively in patients with incomplete SCI. This study prospectively explored the occurrence of complications and falls, and associated factors in patients with SCI during the 6 months after discharge. METHODS: One hundred subjects with SCI (50 wheelchair-bound (WB) and 50 ambulatory (AM) subjects) from a tertiary rehabilitation center completed the study. Every month, subjects were monitored for data on medical complications and falls. Descriptive information is provided for each group. RESULTS: Every WB subject had complications and 14 subjects were re-hospitalized. The most frequent complications found in these subjects were neurogenic pain (36 subjects), urinary tract infection (UTI) (25 subjects), and pressure ulcers (21 subjects). In AM subjects, 38 subjects (76%) experienced complications and 3 subjects needed re-hospitalization. The most frequent complications included neurogenic pain (35 subjects) and UTI (11 subjects). Eighteen WB subjects (36%) and 27 AM subjects (54%) experienced falls. WB subjects had significantly increased odds for incidence of UTI and pressure ulcers, whereas AM subjects had significantly greater odds for falls (P < 0.05). CONCLUSION: A number of subjects with SCI experienced complications and falls after completing a rehabilitation program. The findings add to our knowledge about complications and falls after SCI, and confirm the importance of effective strategies to minimize the occurrence of complications and falls in these individuals.

The effect of six-weeks of sauna on treatment autonomic nervous system, peak nasal inspiratory flow and lung functions of allergic rhinitis Thai patients.

BACKGROUND: Allergic rhinitis is a chronic respiratory disease. Sympathetic hypofunction has been identified in allergic rhinitis patients. OBJECTIVE: To investigate the effects of six weeks of repeated sauna treatment on the autonomic nervous system, peak nasal inspiratory flow (PNIF) and lung functions in Thai patients with allergic rhinitis. METHODS: Subjects were diagnosed with allergic rhinitis clinically by an attending physician based on history, physical examination and positive reactions to a skin prick test. Subjects were randomly assigned to two groups. Controlsubjects received education and maintained a normal life. The sauna group received sauna treatment over a six-week period, 3 days per week, with 6 sets of 5 minutes per set per day, totaling 30 minutes. Each 5 minute set alternated with a 5 minute period of rest. Heart rate variability (HRV), peak nasal inspiratory flow and lung function were measured at the beginning and after three and six weeks of sauna treatment. The HRV measurement is composed of three components, including low frequency (indicating sympathetic function in normal units or n.u.), high frequency (indicated parasympathetic function in n.u.), and the ratio of LF/HF (indicating the balance of the autonomic system). RESULTS: Twenty-six allergic rhinitis patients, 12 males and 14 females participated in this study, 13 in the control group and 13 in the sauna treatment group; there were 6 males in each group. Baseline characteristics for the control and sauna treatment groups were comparable. There were significant changes in the HRV after six weeks of sauna treatment. The high frequency component was significantly lower in sauna treatment group (51.8 vs 35.4), while the low frequency component and LF/HF ratio were significantly higher in sauna treatment group than in the control group (48.1 vs 64.5 and 0.9 vs 2.5, respectively). The PNIF and the forced expiratory volume in one second, or FEV1, were also significantly higher in sauna treatment group (103.0 vs 161.9 and 80.1 vs 95.6, respectively). CONCLUSION: The six weeks of repeated sauna treatment can increase sympathetic activity, PNIF, and FEV1 in Thai patients with allergic rhinitis.

Age-related rehabilitation outcome in stroke patients.

BACKGROUND: Patients who survive a stroke usually have residual neurological deficits. Consequently, a rehabilitation program is valuable for improving their quality of life (QOL). However, age is a known factor that needs qualification vis-à-vis rehabilitation outcomes among Thai patients. OBJECTIVE: To study the functional and psychological outcomes and the QOL before and after rehabilitation program among three age groups of Thai stroke patients (< or = 44, 45-64 and > or = 65 years of age). STUDY DESIGN: Prospective, analytical study. MATERIAL AND METHOD: Three hundred and twenty seven stroke patients were measured using the Barthel index, the Hospital Anxiety and Depression scale (HADS) and the WHO QOL BREF questionnaire before and after undergoing an in-patient rehabilitation program. Data were collected from nine sites around Thailand. RESULTS: Functional and psychological outcomes and the quality of life score improved after the rehabilitation program. The youngest group of stroke victims showed the greatest improvement in functional outcome and QOL score in both the physical and social domains. No significant difference was found regarding anxiety and depression among the three groups. CONCLUSION: An in-patient rehabilitation program was of benefit to Thai stroke patients but age significantly determined rehabilitation outcomes.