U-Rate-UE; Measuring Perceived Recovery of the Affected Upper Extremity in Adults Post-stroke.

OBJECTIVE: To establish initial validity of "U-Rate-UE", a single-question scale regarding perceived recovery of the stroke affected upper extremity (UE). DESIGN: A retrospective longitudinal study of data collected at rehabilitation admission, 6 weeks, and 6 months since stroke. SETTING: Stroke rehabilitation and community-based. PARTICIPANTS: A convenience sample of 87 individuals, median (interquartile range) age 71.5 (65-80) years, 15.0 (12-20) days post-stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The affected UE was assessed using the Fugl-Meyer Motor Assessment, grip strength, Action Research Arm Test, the Box and Block Test (BBT), and The Rating of Everyday Arm-Use in the Community and Home. Participants also rated how much they perceive that their affected UE recovered from the stroke using U-Rate-UE; 0-100 (no to full recovery). Longitudinal changes in U-Rate-UE ratings were assessed. In addition, at 6 weeks and 6 months post-stroke, the change in BBT was calculated and participants were grouped into achieved/did not achieve the minimal detectable change (MDC). Correlations between U-Rate-UE to the other UE assessments were assessed at all 3 timepoints. RESULTS: Significant changes in U-Rate-UE were seen over time (P<.05). At 6 weeks and 6 months, participants who achieved BBT-MDC rated their recovery significantly higher than participants who did not. U-Rate-UE was moderately-strongly significantly correlated to UE assessments (rho=.61-.85, P<.001). CONCLUSIONS: The U-Rate-UE is supported for use with UE assessments contributing to comprehensive clinical understanding of the recovery of the affected UE in adults post-stroke.

A digital exercise and augmented reality training system improved mobility among stroke patients: A randomized control trial.

BACKGROUND: The Selfit system was developed to improve the mobility and gait-related functions of stroke patients by providing digital exercises and augmented reality training system. OBJECTIVE: To evaluate the effects of a digital exercise and augmented reality training system on mobility, gait-related functions and self-efficacy outcomes in stroke patients. METHODS: A randomized control trial was conducted on 25 men and women diagnosed with an early sub-acute stroke. Patients were randomly assigned to either the intervention (N= 11) or the control groups (N= 14). Patients in the intervention group received a digital exercise and augmented reality training using the Selfit system in addition to the standard physical therapy treatment. Patients in the control group were treated with a conventional physical therapy program. Timed Up and Go (TUG) test, 10-meter walk test, the Dynamic Gait Index (DGI), and the Activity-specific Balance Confidence (ABC) scale were completed before and after the intervention. Feasibility and satisfaction among patients and therapists were also assessed after the completion of the study. RESULTS: The intervention group practiced proportionally more time per session than the control group with a mean change of 19.7% following 6 sessions (p= 0.002). The intervention group showed better improvement in post-TUG score compared to the control group (p= 0.04). ABC, DGI, and the 10-meter walk test scores were not significantly different between the groups. Both therapists and participants demonstrated high satisfaction with the Selfit system. CONCLUSION: The findings suggest that Selfit holds promise as an effective intervention for improving mobility and gait-related functions among patients with an early sub-acute stroke as compared to conventional physical therapy treatments.

Higher cognitive load interferes with head-hand coordination: virtual reality-based study.

Daily life activities often involve decision-based reaching movements in different contexts and circumstances. These activities span a wide array of cognitive load types we face while executing motor functions. Here we use a virtual reality-based neurocognitive testing platform to assess cognitive-induced changes in motor behavior as reflected by modulations in head-hand coordination. Our paradigm is based on the Color Trails Test (CTT), which is designed to assess two types of cognitive functions: Trails A-sustained visual attention (SVA), and Trails B-divided attention (DA). The virtual reality CTT adaptation (VR-CTT) requires execution of large multi-directional hand movements and head rotations. We employed a cross-correlation analysis on hand and head kinematics data collected from 122 healthy participants (ages: 20-90 years; divided as follows: young, middle-aged, and older adults) who completed the VR-CTT. The level of spatial coherence of head-hand movements was found to be high (R ≥ 0.76) in both Trails A and B, in all age groups. However, assessing head-hand phase shifts revealed longer time lags (i.e., in which head leads hand) in Trails B versus Trails A, in all age groups. We conclude that allocating cognitive resources to DA task reduces head-hand synchrony as compared to SVA conditions.

A randomized controlled trial of add-on naproxen, simvastatin and their combination for the treatment of schizophrenia or schizoaffective disorder.

This large randomized controlled trial examined the effect of naproxen, simvastatin or both on patients with schizophrenia. This was a large multi-center, twelve-week, randomized, double-blind, placebo-controlled, four-arm clinical trial administering naproxen, simvastatin or both to 232 subjects with schizophrenia or schizoaffective disorder. The primary outcome was change in PANSS total score. ANCOVA and mixed model analyses of the PANSS total score change showed no significant difference between naproxen and placebo (adjusted p = 0.78), simvastatin and placebo (adjusted p = 0.38) or the combination of naproxen and simvastatin compared to placebo (adjusted p = 0.72). No statistically significant drug-placebo differences were found in the PANSS subscales, CGI or BACS between all groups. There was a near significant improvement in negative symptoms (p = 0.06), and an analysis of the 5 factor PANSS factors analysis found a significant improvement in simvastatin above placebo in withdrawal (p = 0.03). These finding were not significant after correcting for multiple comparisons. A meta-analysis on changes in total PANSS scores in studies on statins in schizophrenia, including the present study together with six other studies showed a significant improvement for statins compared to placebo (Hedges' G of -0.245 (CI= -0.403, -0.086, p = 0.002). When one outlying study which showed particularly strong effects of statins was removed, part of the effect went away. In conclusion, in this study, naproxen and simvastatin alone or in combination were not efficacious in the treatment of symptoms in schizophrenia. However, the meta-analysis of all studies of simvastatin for schizophrenia indicates further research on this topic.

Determinants of Quality of Life in Individuals With Spinal Cord Injury Using Structural Equation Modeling.

OBJECTIVE: The objective of this study is to examine the interdependent associations between International Classification of Functioning, Disability and Health (ICF) domains and their relationship with environmental factors with regard to quality of life (QoL) in individuals with spinal cord injury (SCI). DESIGN: Survey, cross-sectional study, and model testing using structural equation modeling. SETTING: Two inpatient and outpatient SCI rehabilitation units, Sheba Medical Center and Loewenstein Hospital, Israel. PARTICIPANTS: Convenience sample of 156 individuals with SCI (N=156). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: QoL assessed by the World Health Organization Quality of Life Assessment-BREF. Neurological impairment after SCI reflected by lesion completeness and neurologic level of injury as measured by the International Standards for Neurological Classification of Spinal Cord Injury. The Spinal Cord Independence Measure to assess SCI-related task performance. ICF Brief Core Sets composition scores to assess impairment in body structure and function domains, limitations in activities, restriction in participation constructs, and the effect of environmental factors within the ICF model. RESULTS: Level of spinal cord injury and ICF Brief Core Sets composite score relating to activities and participation construct demonstrated a direct significant association with QoL. Moreover, a significant indirect association with QoL was found between the composite scores in ICF body structure and function and environmental factors, level of spinal cord injury, time since injury onset, and sex. Because the Spinal Cord Independence Measure was not related to QoL, we inferred that the categories related to instrumental activities of daily living and participation exert the most significant influence on QoL. CONCLUSIONS: In order to optimize improvements in quality of life, current rehabilitation programs should target limitations specifically related to instrumental activities of daily living and participation restrictions. It may serve as a focal point for further development of current therapeutic models and analytical methods that optimize rehabilitation planning and decision making among both health care professionals and patients.

Less-Affected Hand Function Is Associated With Independence in Daily Living: A Longitudinal Study Poststroke.

BACKGROUND AND PURPOSE: The upper extremity (UE) ipsilateral to the brain lesion is mildly affected poststroke. It is unclear whether patients perceive this, and the association between less-affected hand function and independence in activities of daily living (ADL) is unknown. We aimed to (1) assess longitudinal changes in function, dexterity, grip strength, and self-perception of the less-affected UE, (2) compare them to the normative data, and (3) determine the association of both UEs to ADL during the first 6 months poststroke. METHODS: Consecutive adults following a first stroke were assessed on rehabilitation admission (T1), 6 weeks (T2), and 6 months (T3) poststroke onset. Box and block test assessed function of both UEs. The functional dexterity test (FDT) and Jamar Dynamometer assessed dexterity and grip strength of the less-affected UE. The functional independence measure assessed ADL, and instrumental ADL was assessed at T3. Spearman correlations and multiple regression models were used. RESULTS: Participants were assessed at T1 (N=87), T2 (N=82), and T3 (N=68). At T1, less-affected UE deficits were apparent (median [interquartile range] box and block test-45 [35-53] blocks, FDT-44.5 [33.3-60.8] seconds, grip-25.5 [16.2-33.9] kilograms), but only 19.5% of the participants self-perceived this. Less-affected hand function significantly improved with 32% and 33% achieving a minimal clinically important difference for box and block test at T2 and T3, respectively. Dexterity improved significantly between T1 and T2 (P<0.001, no established minimal clinically important difference) and grip strength improved significantly between T2 and T3; 3.4% achieving a minimal clinically important difference (P<0.01). At T3, most participants did not reach the norms (box and block test-67.4 blocks, FDT-32.2 seconds, grip-40.5 kilograms). Both the less- and more-affected UEs explained a large portion of the variance of ADL at all time-points, after controlling for age, days-since-stroke-onset, stroke type, and cognition. CONCLUSIONS: Despite some improvement, the less-affected UE at 6 months poststroke remained below norms, explaining difficulties in ADL and instrumental ADL. Further research is needed.

Improvement of the Upper Extremity at the Subacute Stage Poststroke: Does Hand Dominance Play a Role?

BACKGROUND: The impact of hand dominance on the expected (motor and functional ability and daily use) improvement of the affected upper extremity (UE) in subacute stroke has not yet been investigated. OBJECTIVES: To compare between the affected dominant and affected nondominant UE (1) on rehabilitation admission (T1) for motor and sensory abilities, functional ability, and daily use and (2) 6 weeks poststroke onset (T2) and the UE recovery between T1 and T2 regarding percent change, improvement effect size, and percent of participants achieving minimal clinical important difference (MCID). METHODS: Multicenter longitudinal study. RESULTS: Thirty-eight participants with affected dominant and 51 participants with affected nondominant UE were recruited. On T1 and T2, between-group differences were not seen for all UE variables. Significant improvement in the motor and functional ability, daily use, and perceived recovery between T1 and T2 were seen for the affected dominant (z = -3.01 to -4.13, P < .01) and nondominant UEs (z = -4.59 to -5.32, P < .01). Effect size improvement values were moderate and large in the affected dominant and nondominant UE (respectively). In addition, 14% to 40% of the participants in both UEs achieved MCID. CONCLUSIONS: Significant and similar clinical meaningfulness in UE improvement can be expected during subacute rehabilitation; however, improvement magnitude and percent improvement is different for the UE domains of the affected dominant and the affected nondominant UEs. These findings highlight the distinct roles of the dominant and nondominant hands during bimanual daily activities, which can guide clinicians during stroke rehabilitation.

The Landing Error Scoring System Real-Time test as a predictive tool for knee injuries: A historical cohort study.

PURPOSE: To assess the value of the Landing error score system - real time test as a predictive tool for knee injuries among combat soldiers in the Israeli defense forces. METHODS: All 2474 Israeli defense forces' combat soldiers enrolled at the Israeli defense forces Injury Prevention and Rehabilitation Center were included. A retrospective cohort study was conducted. The predictive variable assessed was the landing error score system - real time score. The three main outcome variables were the incidence of overuse knee injuries, the meniscal injury, and the anterior cruciate ligament injury. Receiver operator characteristic analysis was performed to evaluate the test's potential as a predictive tool and in order to establish optimal cutoff scores. RESULTS: The area under the curve of the receiver operation curves demonstrated no predictive value of the landing error score system - real time test for all three outcome variables (knee injuries: area under the curve 0.526, 95% confidence interval 0.498, 0.554, anterior cruciate ligament injuries: area under the curve 0.496, 95% confidence interval 0.337, 0.656, meniscus injuries: area under the curve 0.515, 95% confidence interval 0.454, 0.576). INTERPRETATION: Based on the results of this study, the landing error score system - real time test has no predictive value for knee overuse injuries, meniscal injuries, and anterior cruciate ligament injuries. However, due to the small number of cases of anterior cruciate ligament injuries, the predictive value for anterior cruciate ligament injuries of this test should be further investigated.

The Association Between History of an Ankle Sprain and Traumatic Meniscal Injury Among Infantry Combat Soldiers in the Israeli Defense Forces: A Historical Cohort Study.

INTRODUCTION: The high frequency and number of ankle inversion injuries and meniscal injuries in military populations is an area of concern due to the debilitating effects and cumulative consequences of these particular injuries on the soldiers sustaining injury and the consequences on the operational effectiveness of the Israeli Defense Force (IDF). This study examines the possible relationship between ankle inversion injury and potential for subsequent meniscal injury in infantry soldiers in the IDF. MATERIAL AND METHODS: All 89,069 infantry combat soldiers (including special units), recruited to the IDF between 2007 and 2017 were included in this study. A historical cohort study was conducted. The cohort was divided into two groups: The exposure group included all participants that had suffered at least one ankle sprain in the past and the unexposed group that included all participants who did not suffer an ankle sprain in the past. A Cox proportional-hazards model (COX) model was used in order to obtain the adjusted to confounders association between exposure and outcome expressed in hazard ratio (HR). RESULTS: The crude association between ankle sprain in the past and the development of meniscal injury in this study was 0.87 (Relative risk = 0.87, P = 0.007). After adjusting for unit type, Body Mass Index (BMI), previous fracture of the lower limb, and the use of eyeglasses, using a COX model, the adjusted association between ankle sprain in the past and the development of meniscal injury was 0.8 (HR = 0.8, P = 0.001, confidence interval (95%) 0.74, 0.88). CONCLUSION: The results of this study indicate ankle sprains to be a protective factor for meniscal injury. Our main conclusion from the results of this study is that the assumption that those with previous leg injuries are at a greater risk for further leg injuries is questionable and cannot be generalized. Hence, the association between different types of injuries should be investigated separately.

Medical Attrition from Commanders Training in the Israeli Defense Forces (IDF): A Cross-sectional Study on 23,841 Soldiers.

INTRODUCTION: Attrition from training is associated with substantial financial and personnel loss. There is a plethora of medical literature and research of attrition rates related to initial/phase 1 training (basic combat training); however, the analysis of second phase training (commanders training, consisting of schools that qualify junior commanders and officers for infantry and non-infantry combat units) is limited. The purpose of this study is to perform a comprehensive survey regarding to medical attrition from commanders training in the IDF (Israeli Defense Forces) in order to present the commanders of the IDF a detailed situation report that will serve as an evidence-based platform for future policy planning and implementation. METHODS: A cross-sectional study including all soldiers (23,841) who participated in commanders training in the IDF in the period of 2012-2015 was performed. Soldiers for whom the attrition reason (medical or not medical) was missing were excluded from this study. Data were collected from the adjutancy-computerized system as well as the IDF's computerized medical consultation records package (CPR). Descriptive statistics were performed using mean, standard deviation, and median in order to express results. For the determination of statistical significance, chi-square test, Student's t-test, and Poisson regression models were used. RESULTS: Out of 23,841 soldiers that participated in this study, 75% (17,802) were males and 25% (6,039) were females. The overall attrition rate was 0.7% (164). The attrition rate for males was 0.86% (148 out of 17,082 males) and 0.26% (16 out of 6,039 females) for females. After adjusting for training unit, age, and BMI, the risk for attrition was 1.6 (160%) times higher for males as compared with females, and this result was statistically significant (IRR = 1.6, p = 0.01, CI 1.1, 2.2). The re-injury rate was 41% (68 out of 164 soldiers). The three most frequent diagnoses for attrition were orthopedics (66%), general surgery diagnoses (12%), and diagnoses related to internal medicine (11%). Out of 107 soldiers that attired due to orthopedic reasons, 36 (34%) suffered from calf and ankle injuries, 22 (21%) attired due to diagnoses related to the lower back, and 22 (21%) attired due to diagnoses related to the knee region. The highest attrition rate was encountered in the school for infantry junior command (2.2%) and the lowest rate was encountered in the officer training school for non-infantry units (0.11%). After adjusting for age and BMI, the risk for ankle injury was 2.55 (255%) times higher for soldiers in the school for infantry junior command as compared with soldiers in the officer school for infantry units (IRR = 2.55 p = 0.017, CI 1.18, 5.47). CONCLUSION: The attrition rate from commanders training in the IDF is low, and at this point, however, due to lack of uniform criteria for attrition, it cannot serve as an objective measure. We suggest measuring and discussing overuse injury rates (which is the most frequent cause of attrition), instead. Based on our results, we recommend an implementation of a better medical screening policy in order to reduce the re-injury rates during commanders training.

Overuse Injuries Among Female Combat Warriors in the Israeli Defense Forces: A Cross-sectional Study.

Introduction: Integration of females in combat units poses a unique challenge for army commanders around the world. The purpose of this study is to provide a detailed up-to-date situation report regarding overuse injuries among combat female warriors in the IDF (Israeli Defense Forces) in order to enable evidence-based decision-making, prevention policy, and further research of this highly significant military public health issue. Methods: A cross-sectional descriptive study was conducted including 2,519 females recruited to combat duties during the year of 2013. The main data source was the IDF's computerized medical consultation records package (CPR). Descriptive statistics was performed and some results were compared with males using data from other reports and studies of the IDF. Results: The overall injury rate was 28.3%. Of all injuries, 86% were in the ankle and calf (41%), the lower back (23%), and the knee (22%) regions. The average lost training days was 11 d for females as compared with 8 d for males. The overall rates of stress fractures and the rates of femur and femoral neck stress fractures were significantly higher among females as compared with males (11.2% vs. 2.5%, p = 0.0032, and 7.8% vs. 1.6% p = 0.00001, respectively). Conclusions: The overuse injury rates among females in the IDF are high and may be considered a significant military public health problem. In order to reduce the numbers of overuse injuries, which is expected to significantly increase after the IDF's policy change regarding to combat duties open for females, we recommend planning and implementation of policies and intervention programs and further research regarding to overuse injuries among female combat warriors with special focus on the calf and ankle, lower back, and knee regions and femoral stress fractures.

Overuse Injuries in the IDF's Combat Training Units: Rates, Types, and Mechanisms of Injury.

Introduction: Overuse injuries are responsible for most lost training days and attrition from combat training in the Israeli Defense Forces (IDF) as in armies around the world. The purpose of this study is to understand the rates, types, and mechanism of occurrence of overuse injuries in the IDF in order to provide the IDF's commanders a detailed updated situation report in order to enable commanders decision-making, prevention policy, and further research of this highly significant military public health issue. Methods: A cross-sectional study including 20,000 soldiers recruited to combat units during the year of 2013 was performed. Most of the data were collected from the IDF's computerized medical consultation records package. Descriptive statistics (percent, mean, standard deviation, and median) were used in order to express results. The study was approved by the IDF's institutional review board. Results: The overall injury rate was 24.5%. The total number of injuries was 6,393 with an average of 1.32 ± 0.22 injuries per injured soldier. The injury rate was 18.4% in the infantry units and 36.1% in non-infantry units. Of all injuries, 87% occurred in the lower back and lower limb regions. The most frequent injury sites were the calf and ankle (34%), the knee region (22%), and the lower back (19%). Of all injuries, 74% occurred during running (45%) or long-distance walking (29%). The average lost training days due to injuries was 9 d per soldier and 6.5 d per injury. The total number of stress fractures was 494-2.5% of all soldiers (four fractures per 100 person years). The calf and ankle region was the most frequent site of stress fractures and accounted for 84% of all stress fractures, the vast majority of them (95%) were fractures of the distal tibia. The average number of lost training days due to stress fractures was 16 ± 6.1 per fracture. Conclusions: As in other armies around the world, overuse injuries in the IDF are a major public health problem and poses a significant challenge to the IDF's commanders and the medical corps policy leaders. Further studies should be performed in order to identify the risk factors for these injuries especially in the lower back and the lower limb regions as part of the effort to try and reduce the rates of these injuries as much as possible. This study emphasizes the need for a continuous surveillance and monitoring system for overuse injuries as a significant and integral component of any intervention plan in the domain of overuse injuries.

Venous thromboembolism in patients with pemphigus: A cohort study.

BACKGROUND: Venous thromboembolism (VTE) has been reported to be a significant cause of death in patients with pemphigus. OBJECTIVE: We sought to assess the incidence and characteristics of VTE in patients with pemphigus. METHODS: A retrospective study following a cohort of 172 patients with newly diagnosed pemphigus for the development of VTE was conducted. RESULTS: Over a mean follow-up time of 4 years, 10 patients (6%) had development of VTE at a median of 4 months from pemphigus diagnosis. The highest risk was found in the first year, at 5 VTE events per 100 patient-years or a 5% VTE risk for that first year. Five patients had deep vein thromboses, 4 had pulmonary embolisms, and 1 had both. Age and gender were not related to the VTE risk. Most patients had VTE risk factors, either hereditary or acquired as the result of pemphigus treatments and their complications, including hospitalization, immobilization, and infections. LIMITATIONS: The use of existing health records limited the assessment of asymptomatic VTE and VTE risk factors; a matched control population was not studied. CONCLUSIONS: VTEs are not rare in patients with pemphigus, more so in the first year after diagnosis. VTE risk must be assessed in all patients, especially when hospitalized, and thrombo-prophylaxis should be initiated in qualifying cases.

Markers of muscle damage for comparing soft tissue injury following proximal femur nail and dynamic hip screw operations for intertrochanteric hip fractures.

BACKGROUND: Femoral neck fractures are the most common fractures among the elderly. The two operative approaches used for the treatment of AO/OTA 31 intertrochanteric fractures include an intramedullary device (proximal femoral nail [PFN]) or an extramedullary device (sliding/dynamic hip screw [DHS]). The aim of this study was to provide objective evidence of local soft tissue injury by measuring serum creatine phosphokinase (CPK), a biochemical marker, to quantify muscle damage and inflammation in patients treated by the two approaches. PATIENTS AND METHODS: Medical data of 359 patients operated for intertrochanteric fractures with PFN (156 patients) or DHS (193 patients) were retrospectively reviewed. The fractures were classified according to AO/OTA classification. Perioperative and radiographic data were collected to ensure cohorts with similar characteristics. Serum CPK and serum hemoglobin (Hb) levels were measured preoperatively and on postoperative day 1 (POD1). Independent predictors of elevation in the levels of markers of inflammation and muscle damage were determined by a multivariate linear regression model. RESULTS: The demographics were similar for the two groups. Our study population included 64.2% female patients. Preoperative serum CPK levels were available for 89 patients and POD1 serum CPK levels were available for all patients. One-hundred and thirteen of the 193 DHS patients (58%) and 14 of the 156 PFN patients (9%) had a stable fracture (AO/OTA 31A1, p<0.0001). The DHS patients had a greater increase between pre- and postoperative CPK levels compared to the PFN patients (DHS, δ=368 versus PFN, δ=65, p<0.0002). The PFN patients had a greater decrease in both the pre- and postoperative Hb levels compared to the DHS patients (Diff_Hb 0.27g/dl). The older the patient, the greater decreases in Diff_CPK compared to the younger ones. CONCLUSIONS: Implementation of POD1 CPK blood levels as a biochemical marker of soft tissue injury provided quantitative evidence that patients whose intertrochanteric fracture was stabilized by a DHS suffered greater soft tissue injury compared to patients whose fracture was stabilized by a PFN.

Tablet Apps and Dexterity: Comparison Between 3 Age Groups and Proof of Concept for Stroke Rehabilitation.

BACKGROUND AND PURPOSE: Touch screen tablet technology might be suitable for self-training of impaired dexterity poststroke. We compared performance of app-based hand activities in individuals without a disability from 3-age groups, and assessed the feasibility of using tablet apps in individuals with stroke. METHODS: Experiment I included 172 Individuals without a disability: 79 young adults (26.2 [3.9] years old), 61 middle-aged adults (55.9 [5.1] years old), and 32 older adults (68.7 [3.0] years old). Experiment II included 20 individuals with stroke, aged 59.3 ± 13.7 years with impairment of the upper extremity. All participants performed the app-based "Tap-it" (tapping) task twice and the Nine Hole Peg Test. The stroke group practiced with additional apps and underwent clinical assessments. RESULTS: Significant differences in the tapping task performance were found between the 3 age groups (dominant hand time: F(2,169) = 30.57; P = 0.0001; and accuracy F(2,169) = 25.20; P = 0.0001; nondominant hand time: F(2,169) = 35.09; P = 0.0001; and accuracy F(2,169) = 19.62; P = 0.0001). Of the 20 individuals with stroke, 15 were able to complete the 2 trials of the tapping task, but all participants reported enjoying the experience and thought the apps may have potential for stroke rehabilitation to improve performance of the stroke-affected hand. DISCUSSION AND CONCLUSIONS: Performance of tablet app-based hand activities was affected by impaired hand dexterity in older participants without a disability and in participants with stroke. Tablet apps may potentially provide a way to facilitate self-training of repetitive, task-oriented, isolated finger and hand movements to improve hand dexterity and function after stroke.Video abstract available for additional insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A118).

Locking versus standard screw fixation for acetabular cups: is there a difference?

INTRODUCTION: Total hip replacement has been established as a valid treatment option for displaced subcapital fractures. However, insufficient primary fixation may be the reason for early loosening in these osteoporotic patients. Primary fixation of the cup is usually achieved by press-fit fixation that can be enhanced using screws. Locking the screws into their respective cups may seem to improve the primary fixation of the construct, as locked plates proved superior fixation for osteoporotic fractures. METHODS: The study consisted of three groups: in each group, three cups were fixed into blocks of foam bone using press-fit technique. In the first group, no additional screws were used, in the second group two standard screws were inserted, while in the third group two acetabular screws were cemented into the cup to simulate locked screw fixation. Load was applied onto the rim of the acetabular component to cause shearing between the cup and the block. Cup fixation was examined by a loading machine that acquired load versus displacement. The stiffness (load vs. displacement) was calculated. RESULTS: Screws, either locked or non-locked, enhanced cup fixation by 26 % (p value <0.01). No significant changes were found between the locking and non-locking screws groups. DISCUSSION: These experimental results indicate that acetabular screws enhance primary cup fixation. This may become significant in conditions where the acetabular bone stock is suboptimal, such as when performing total hip arthroplasty after displaced subcapital fractures. However, there is no superiority for locked screws over standard screw fixation.

Rehabilitation outcome of post-acute lower limb geriatric amputees.

PURPOSE: To characterize the lower-limb elderly amputee patients admitted to a post-acute rehabilitation program, assess their 1-year survival rate, estimate rate of prosthetic fit and report rate and factors associated with 1-year post-discharge prosthetic use. METHODS: A cohort study performed in a post-acute rehabilitation department. Patients were evaluated by the Functional Independence Measure (FIM), motor FIM (mFIM), rate of prosthesis fit, length of stay (LOS), 1-year survival rate and long-term prosthetic use. RESULTS: One-hundred and seventeen lower limb elderly amputee patients consecutively admitted from January 2004 to June 2010 were enrolled in the study. Mean age was 74.7 ± 8.1; 56 patients (47.9%) had transtibial amputation (TTA); 46 (39.3%) transfemoral amputation (TFA) and 15 (12.8%) bilateral amputation. The main cause for amputation was diabetic foot (60.7%). Fifty-four (46.2%) patients died during first year post-admission. Twenty-seven patients (23.1%) were fitted with a prosthesis. When the bilateral amputees were considered separately, the rate of prosthetic fit among unilateral amputees was 24.5% (25/102) whereas among bilateral amputees it was 20% (3/15). Patients with prosthesis rehabilitation had a higher rate of TTA (p = 0.027), better metabolic status (p < 0.001), higher functional and cognitive levels (p < 0.001), and longer LOS (p < 0.001) compared with patients who received wheelchair rehabilitation. Twenty patients were contacted 1 year later: eight (40.0%) reported continuous functional prosthesis use, eight - partial prosthesis use and four (20%) did not use the prosthesis at all. The patient group with 1-year post-discharge prosthesis use had a significantly higher rate of TTA (p = 0.032), lower rate of congestive heart failure (CHF) (p = 0.014) and higher score changes on the FIM and mFIM (p = 0.043). CONCLUSIONS: Rehabilitation efforts should best be targeted depending on need. Rehabilitation professionals should make an educated estimate of outcomes at the beginning of rehabilitation based on the characteristics of the patients (level of amputation and functional level on admission).

Functional and environmental factors affecting work status in individuals with longstanding poliomyelitis.

INTRODUCTION: Remunerative employment is a major concern of individuals with chronic disabilities, among them, those with longstanding poliomyelitis (LSP). Although LSP is not rare there are almost no data related to work participation. PURPOSE: The aims of the current study were to determine the effects of a number of social and functional variables as barriers or facilitators to work participation in persons with LSP. PATIENTS AND METHODS: Charts of 123 LSP patients of working age that were seen in the post-polio outpatient clinic, between the years 2000 and 2005 were reviewed for the study. Data on age, gender, family status, level of function in activities of daily living, basic, and extended (B-ADL and E-ADL), and mobility were then analyzed for correlation to the vocational status. RESULTS: Seventy-two people (58.5%) were employed at the time of the survey. Gender and marital status were not found to significantly differ as regard to employment. Using assistive devices for mobility or being dependent for basic ADL were associated with lower levels of employment. Driving was positively associated with the employment status of the LSP individuals. CONCLUSION: Persons with LSP encounter important barriers to work participation, particularly on the International Classification of Functioning, Disability, and Health (ICF) components of activity and environment.