Postural Maintenance Is Associated With Walking Ability in People Receiving Acute Rehabilitation After a Stroke.

OBJECTIVES: The Postural Assessment Scale for Stroke Patients (PASS) assesses the ability of people post stroke to maintain or change a given posture from lying to standing, and the items on which people with different walking status perform differently may suggest potential interventions. The purpose of this study was to (1) examine the association of PASS scores at admission for acute rehabilitation with walking status at admission and 3 months post stroke (3 M), and (2) identify PASS items that discriminate walking status. METHODS: In this prospective observational study, 93 people post stroke were assessed with the PASS and a 2.44-m gait speed test at admission, with walking status assessed by telephone interview at 3 M. Those who could walk over a 2.44-m distance without the assistance of a walking aid or another person were considered to be independent in walking; others were considered to be dependent. Those who were dependent at admission were divided into the "regained independence" and "remained dependent" groups based on their status at 3 M. The association of the PASS at admission with 3 levels of walking status (independent at admission, regained independence, and remained dependent) was examined using the Kruskal-Wallis test. For those dependent at admission, the association of PASS score at admission with walking status at 3 M was examined using logistic regression and receiver operating curve analysis. RESULTS: PASS scores at admission differed significantly across the 3 walking status groups and were significantly associated with walking status at 3 M (odds ratio = 0.864; 95% CI = 0.798-0.935) over and above length of stay. People post stroke who were dependent at admission and had PASS scores ≥22 were more likely to regain independence at 3 M. Nine PASS items differed among the 3 groups. CONCLUSIONS: PASS score is significantly associated with walking status at admission and at 3 M. The identified 9 items suggest possible interventions for acute rehabilitation. IMPACT: This study identified 9 PASS items that could guide clinicians in selecting interventions for acute rehabilitation.

Early Rehabilitation in Acute Care Inpatient Wards May Be Crucial to Functional Recovery 3 Months After Ischemic Stroke.

OBJECTIVE: Early rehabilitation in acute care inpatient wards may maximize functional outcome at 3 months after stroke in survivors of stroke. It is unknown whether functional change during acute care hospitalization is significantly associated with functional recovery at 3 months in survivors of acute stroke. The purposes of this study were to examine the association of the Barthel Index (BI) at 3 months with functional change as measured with the Barthel Index (ΔBI) in an acute care inpatient ward and to identify the factors associated with ΔBI and who could benefit from an early rehabilitation program. METHODS: In this prospective longitudinal study, 76 patients with ischemic stroke in an acute care inpatient ward received early rehabilitation of up to 2 sessions per day for 5 d/wk during their stay. Therapy density was calculated as the proportion of total therapy sessions completed. At admission and discharge, they were assessed with the BI and the Postural Assessment Scale for Stroke Patients (PASS). Demographic and health-related information was also collected. The Barthel Index (BI) was reassessed at 3 months. RESULTS: ΔBI in the acute care inpatient ward significantly predicted the BI at 3 months, over and above the other significant variables; in addition, therapy density and change in PASS were significantly associated with ΔBI. Patients with moderate initial functional dependence had the largest ΔBI, followed by the group with a more severe condition. CONCLUSIONS: ΔBI in acute care inpatient wards may be an important predictor of the BI at 3 months. Therapy density and change in PASS were significantly associated with ΔBI. IMPACT: Survivors of acute stroke who receive up to 2 rehabilitation sessions per day for 5 d/wk early in their hospitalization have better functional recovery at 3 months after stroke.

The effect of insoles on symptomatic flatfoot in preschool-aged children: A prospective 1-year follow-up study.

Flatfoot is a common reason for parents to seek help from health care professionals, and limited evidence is available regarding the effects of insoles on preschool-aged children. This study mainly investigated the effect of insoles on symptomatic flatfoot in preschool-aged children and followed up the changes in footprints after 1 year.This study was a prospective, observational cohort study. Children aged 3 to 5 years old who exhibit the signs of flatfoot feet were recruited from the kindergartens in the central Taiwan between March 2010 and December 2013. The Chippaux-Smirak index (CSI) was used to determine whether the footprints of children were associated with flatfoot. The children were divided into an insole group and a no-insole group according to diagnoses by doctors. This study used the modified shoe insole as the intervention, and the CSI measured and followed up the changes in footprints after 1 year.A total of 466 preschool-aged children aged 3 to 5 years old with flatfoot completed the 1-year follow-up study. Of these, 123 children (men 77; women 46) were in the insole group and 343 children (men 187; women 156) were in the no-insole group. After the insoles were worn for 1 year, the CSI values of the children with symptomatic flatfoot decreased by 9.7%, and the 5-year-old children had the biggest change (effect size = 1.25). In the insole group, 34.1% of the footprints were determined as normal at 1-year follow-up, and CSI values decreased by 17.5%. High prevalence of joint laxity was found in both groups (insole group: 34.5%; no-insole group: 35.1%). Of the children in the insole group, the proportion of joint laxity was significantly higher in the flatfoot group (43.1%) than in the normal group (17.7%).This study showed that wearing insoles indeed can reduce the signs of flatfoot in preschool-aged children, and the effect is better in 5-year-old children. It is suggested that insoles can be provided as a conservative treatment for preschool-aged children with symptomatic flatfoot.

Using therapeutic ultrasound to promote irritated skin recovery after surfactant-induced barrier disruption.

BACKGROUND: Surfactant-induced skin barrier disruption can enhance blood flow and water content in the superficial skin. The effect of therapeutic ultrasound on accelerating the recovery of superficial skin after skin barrier disruption has seldom been studied. OBJECTIVE: To understand the effects of therapeutic ultrasound on barrier recovery, we used the sodium lauryl sulfate irritation model and treatment with ultrasound intervention. METHODS: The study allocated 30 healthy subjects into an ultrasound group (n = 15) and a control group (n = 15), each divided into three subgroups (sodium lauryl sulfate at concentrations of 1.0%, 0.5%, and 0%). Pulsed ultrasound (1 MHz, 0.3 W/cm2SATA) was applied to ultrasound subgroups. The treatment effect was evaluated by the recovery rate of enhanced blood flow and water content. RESULTS: The results indicated a surfactant dose-dependent effect on blood flow, but not on water content. The recovery rates of enhanced blood flow were higher in the 0.5% and 1.0% ultrasound subgroups than in the control subgroups throughout the experiment. However, recovery rates of water content were higher in the ultrasound subgroups than in the control subgroups only on Day2. CONCLUSIONS: Pulsed ultrasound accelerated the barrier recovery by reducing the enhanced blood flow and water content after skin barrier disruption.

Muscle oxygenation dynamics in response to electrical stimulation as measured with near-infrared spectroscopy: A pilot study.

Neuromuscular electrical stimulation (NMES) is used for preventing muscle atrophy and improving muscle strength in patients and healthy people. However, the current intensity of NMES is usually set at a level that causes the stimulated muscles to contract. This typically causes pain. Quantifying the instantaneous changes in muscle microcirculation and metabolism during NMES before muscle contraction occurs is crucial, because it enables the current intensity to be optimally tuned, thereby reducing the NMES-induced muscle pain and fatigue. We applied near-infrared spectroscopy (NIRS) to measure instantaneous tissue oxygenation and deoxygenation changes in 43 healthy young adults during NMES at 10, 15, 20, 25, 30, and 35 mA. Having been stabilized at the NIRS signal baseline, the tissue oxygenation and total hemoglobin concentration increased immediately after stimulation in a dose-dependent manner (P < 0.05) until stimulation was stopped at the level causing muscle contraction without pain. Tissue deoxygenation appeared relatively unchanged during NMES. We conclude that NIRS can be used to determine the optimal NMES current intensity by monitoring oxygenation changes.

Validating the 6-minute walk test as an indicator of recovery in patients undergoing cardiac surgery: A prospective cohort study.

The 6-minute walk test (6MWT) has been applied to assess postsurgical recovery in cardiac populations. This study mainly investigated whether the 6MWT could serve as an indicator for physical functioning in patients undergoing cardiac surgery.Participants completed the 6MWT and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at baseline, discharge, and 3 months postoperatively, in order to analyze the construct validity and responsiveness of the 6MWT. The participants in this study were 125 patients (92 males and 33 females) with an average age of 65.1 ±â€Š11.1 years. The mean 6MWT was 308.9 ±â€Š77.3 m in the preoperative phase, decreased to 277.3 ±â€Š85.7 m at discharge, and returned to 378.1 ±â€Š95.2 m at 3-month follow-up. The results showed that the 6-minute walk distances at baseline and at 3-month follow-up were moderately to highly correlated with the physical functioning subscale of the SF-36 (rs = .44 and .54, respectively) and had weak correlation with the nonphysical functioning subscales. The recovery level of physical functioning is meaningfully associated with the 6MWT change from baseline to discharge and from baseline to 3-month follow-up. Patients with higher New York Heart Association (NYHA) Functional Classification levels had lower 6MWT. Additionally, the 6MWT was sensitive to change during the perioperative period (effect sizes from -0.51 to 1.72).The supporting evidence includes the construct validity and responsiveness of the 6MWT. This study supports the feasibility of the 6MWT as an evaluation tool of physical functioning for assessment of postcardiac surgical recovery.

Characterization of the muscle electrical properties in low back pain patients by electrical impedance myography.

OBJECTIVES: This study aims to investigate the electrical properties of lumbar paraspinal muscles (LPM) of patients with acute lower back pain (LBP) and to study a new approach, namely Electrical Impedance Myography (EIM), for reliable, low-cost, non-invasive, and real-time assessment of muscle-strained acute LBP. DESIGN: Patients with muscle-strained acute LBP (n = 30) are compared to a healthy reference group (n = 30). Electrical properties of LPM are studied. BACKGROUND: EIM is a novel technique under development for the assessment of neuromuscular disease. Therefore, it is speculated that EIM can be employed for the assessment of muscle-strained acute LBP. METHODS: Surface electrodes, in 2-electrode configurations, was used to measure the electrical properties of patient's and healthy subject's LPM at six different frequencies (0.02, 25.02, 50.02, 1000.02, 3000.02, and 5000.02 kHz), with the amplitude of the applied voltage limited to 200 mV. Parameters of impedance (Z), extracellular resistance (Re), intracellular resistance (Ri), and the ratio of extracellular resistance to intracellular resistance (Re/Ri) of LBP patient's and healthy subject's LPM were assessed to see if significant difference in values obtained in muscle-strained acute LBP patients existed. RESULTS: Intraclass correlation coefficient (ICC) showed that all measurements (ICC>0.96 for all studying parameters: Z, Re, Ri, and Re/Ri) had good reliability and validity. Significant differences were found on Z between LBP patient's and healthy subject's LPM at all studying frequencies, with p<0.05 for all frequencies. It was also found that Re (p<0.05) and Re/Ri (p<0.05) of LBP patient's LPM was significant smaller than that of healthy subjects while Ri (p<0.05) of LBP patient's LPM was significant greater than that of healthy subjects. No statistical significant difference was found between the left and right LPM of LBP patients and healthy subjects on the four studying parameters. CONCLUSION: EIM is a promising technique for assessing muscle-strained acute LBP.

Gait speed measure: the effect of different measuring distances and the inclusion and exclusion of acceleration and deceleration.

The purposes of this study were to examine the effects of different distances and the inclusion and exclusion of acceleration and deceleration distances on the measurement of self-paced and fastest gait speeds in younger and older adults. The self-paced and fastest gait speeds of younger and older adults were measured over 4-m and 10-m walkways with the acceleration and deceleration distances included and excluded in the measuring distance. The results indicated gait speeds (both self-paced and fastest) measured over different distances were comparable only if a distance for acceleration and deceleration was excluded from the measuring distance to obtain stable and comparable gait speeds. Similar results were found for younger and older groups.

Intrarater reliability and the value of real change for waist and hip circumference measures by a novice rater.

Intrarater reliability and measurement error associated with waist and hip circumference measures performed by a novice rater with one measurement were examined and compared among Body Mass Index (BMI) subgroups in a convenience sample of 76 participants (25 men, 51 women; M age = 47.2 yr., SD = 14.2). A rater blinded to the purpose of the study, as well as to the tape measure results, received training and then performed hip and waist circumference measures twice with a 10-min. interval. Intrarater reliability of the measures was acceptable (ICC3,1 > .95) across the BMI subgroups; measurement error was found to be greater in the overweight and obese subgroups. If a test-retest change score is greater than 3.0 cm in waist circumference and 2.0 cm in hip circumference, it can be assumed to be a true change with 95% confidence.