Functional recovery priorities and community rehabilitation service preferences of spinal cord injury individuals and caregivers of Chinese ethnicity and cultural background.

Introduction: Spinal cord injury (SCI) causes significant and permanent disability affecting motor, sensory and autonomic functions. We conducted a survey on the priorities of functional recovery and preferences for community rehabilitation services in a cohort of Chinese individuals with SCI as well as the primary caregivers. The study also investigated their views on advanced technology and research. Methods: An online platform with a self-administered questionnaire was used to collect the opinions of clients that received services from an SCI follow-up clinic, a self-help association, or a non-government organization from 1 September-31 December 2021. Results: Eighty-seven subjects (74 individuals with SCI-48 tetraplegic, 26 paraplegic, and 13 caregivers) responded to the survey. Recovery of arm/hand function was given the highest priority among tetraplegics, followed by upper trunk/body strength and balance, and bladder/bowel function. Sexual function had a significant lower ranking than all priority areas except normal sensation (p < 0.05). Paraplegics viewed bladder/bowel function as the most important area of functional recovery, followed by walking movement, upper trunk/body strength and balance, elimination of chronic pain, and regaining normal sensation. There was no statistically significant difference among the top priority areas (p > 0.05). In contrast to previous studies done in Western populations, the study revealed that sexual function was ranked as the lowest by all 3 groups of respondents (tetraplegics, paraplegics, and caregivers). The majority of participants thought community rehabilitation services were inadequate. Most of the respondents were interested to try advanced technology which would facilitate their daily life and rehabilitation. About half of the individuals with SCI thought advance in technology and research could bring significant improvement in their quality of life in the coming 10 years. Conclusion: This survey is the first study specifically looking into the recovery and rehabilitation priorities of a Chinese population of individuals with SCI. This is also the first study to investigate the priorities of the primary caregivers of SCI individuals. The findings are useful as a reference for planning of future research and provision of rehabilitation services for the SCI community locally and in other parts of China.

Knowledge Gaps in Biophysical Changes After Powered Robotic Exoskeleton Walking by Individuals With Spinal Cord Injury-A Scoping Review.

In addition to helping individuals with spinal cord injury (SCI) regain the ability to ambulate, the rapidly evolving capabilities of robotic exoskeletons provide an array of secondary biophysical benefits which can reduce the complications resulting from prolonged immobilization. The proposed benefits of increased life-long over-ground walking capacity include improved upper body muscular fitness, improved circulatory response, improved bowel movement regularity, and reduced pain and spasticity. Beyond the positive changes related to physical and biological function, exoskeletons have been suggested to improve SCI individuals' quality of life (QOL) by allowing increased participation in day-to-day activities. Most of the currently available studies that have reported on the impact of exoskeletons on the QOL and prevention of secondary health complications on individuals with SCI, are of small scale and are heterogeneous in nature. Moreover, few meta-analyses and reviews have attempted to consolidate the dispersed data to reach more definitive conclusions of the effects of exoskeleton use. This scoping review seeks to provide an overview on the known effects of overground exoskeleton use, on the prevention of secondary health complications, changes to the QOL, and their effect on the independence of SCI individuals in the community settings. Moreover, the intent of the review is to identify gaps in the literature currently available, and to make recommendations on focus study areas and methods for future investigations.

Comparison between Accelerometer and Gyroscope in Predicting Level-Ground Running Kinematics by Treadmill Running Kinematics Using a Single Wearable Sensor.

Wearable sensors facilitate running kinematics analysis of joint kinematics in real running environments. The use of a few sensors or, ideally, a single inertial measurement unit (IMU) is preferable for accurate gait analysis. This study aimed to use a convolutional neural network (CNN) to predict level-ground running kinematics (measured by four IMUs on the lower extremities) by using treadmill running kinematics training data measured using a single IMU on the anteromedial side of the right tibia and to compare the performance of level-ground running kinematics predictions between raw accelerometer and gyroscope data. The CNN model performed regression for intraparticipant and interparticipant scenarios and predicted running kinematics. Ten recreational runners were recruited. Accelerometer and gyroscope data were collected. Intraparticipant and interparticipant R2 values of actual and predicted running kinematics ranged from 0.85 to 0.96 and from 0.7 to 0.92, respectively. Normalized root mean squared error values of actual and predicted running kinematics ranged from 3.6% to 10.8% and from 7.4% to 10.8% in intraparticipant and interparticipant tests, respectively. Kinematics predictions in the sagittal plane were found to be better for the knee joint than for the hip joint, and predictions using the gyroscope as the regressor were demonstrated to be significantly better than those using the accelerometer as the regressor.

One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry.

BACKGROUND: The purpose of this registry-based retrospective study was to investigate the risk factors related to one-year mortality in displaced intracapsular fragility hip fracture patients. METHODS: Patients were screened from the Fragility Fracture Registry. Inclusion criterion was displaced intracapsular hip fracture patients with atypical or pathological fractures excluded. One-year mortality was investigated against risk factors including age, gender, past medical history, pre-fracture mobility (PFM), pre-operation ASA grade, delayed surgery over 48 h, post-surgical complications, and length of stay at acute orthopedic ward (LOS). RESULTS: A total of 1050 patients were included for further analysis. Gross one-year mortality was 14.9%. One-year mortality was significantly higher in patients who received non-operative treatment and those who received surgery but delayed over 48 h after admission (both p <  0.001). Male gender (OR = 2.708), advanced age (OR = 1.359), higher risk ASA grades (III to V) (OR = 1.990), past history of gastrointestinal disease (OR = 1.671), and renal impairment (OR = 1.984) were related to higher one-year mortality. The mortality of patients in PFM grade 3 and LOS group 3 was significantly higher (OR = 2.240 and 1.722, respectively). CONCLUSIONS: Higher age, male gender, past gastrointestinal disease and renal impairment, ASA grade over 3, indoor confined pre-fracture ambulatory, and stay at hospital over 15 days were risk factors related to higher one-year mortality in surgically treated displaced intracapsular hip fracture patients. A multi-disciplinary approach is advised to patients identified with these risks factors and co-managed by orthopedic surgeons, geriatricians, and fracture liaison nurses.

Effect of load carriage on chronic low back pain in adults with cerebral palsy.

BACKGROUND: Chronic low back pain (LBP) is a common secondary musculoskeletal problem among adults with cerebral palsy (CP). This study investigated the feasibility of incorporating backpack carriage with daily production activities for relieving chronic LBP among adults with CP. OBJECTIVES: The effects of backpack carriage in relieving chronic LBP for adults with CP. STUDY DESIGN: A multiple bivariate approach with convenience sampling. METHODS: Nine adults with CP suffering from chronic LBP were scheduled to carry a 4 lb backpack at work for 60 minutes on weekdays for four consecutive weeks. The pain level was rated by the participants on an 11-point scale. Muscle activity of erector spinae was measured by surface electromyography. RESULTS: Significant improvement in back pain was found immediately after the backpack carriage with no adverse effect reported. It was accompanied with significantly reduced erector spinae activity. Although the overall change in pain ratings across the study period was not significant, a decreasing trend with time was observed. CONCLUSIONS: The loaded backpack has the potential to serve as an 'orthosis' for immediate back pain relief among adults with CP. Its underlying mechanism can be attributed to a reduction in back muscle tension during the load carriage.

Percutaneous transphyseal intramedullary Kirschner wire pinning: a safe and effective procedure for treatment of displaced diaphyseal forearm fracture in children.

Percutaneous transphyseal intramedullary Kirschner wire (K-wire) fixation was performed for diaphyseal fracture of the forearm in 84 children. In 60 patients (71%) closed reduction was performed, while in the remaining 24 (29%) closed reduction was supplemented with a mini-open reduction The K-wire was inserted transphyseally through the radial styloid or the Lister tubercle for the radius, and through the tip of the olecranon for the ulna. With an average follow-up of 70 months and a minimum follow-up of 2 years, all the patients reviewed were found to have good functional results; none had nonunion, deep infection, or premature physeal closure. Moreover, initial preoperative translation of the fracture of more than 100% displacement was found to be associated with a significantly higher chance of requiring a mini-open reduction. The authors concluded that percutaneous transphyseal intramedullary K-wire pining for forearm diaphyseal fracture in children is a convenient, effective, and safe operation, without any deleterious effects on subsequent growth of the distal radius.