Correlations between ankle–foot impairments and dropped foot gait deviations among stroke survivors

BackgroundThe purpose of this paper is to 1) evaluate the relationship between ankle kinematics during gait and standardized measures of ankle impairments among sub-acute stroke survivors, and 2) compare the degree of stroke-related ankle impairment between individuals with and without dropped foot gait deviations.MethodsFifty-five independently ambulating stroke survivors participated in this study. Dropped foot was defined as decreased peak dorsiflexion during the swing phase and reduced ankle joint motion in stance. Standardized outcome measures included the Chedoke–McMaster Stroke Assessment (motor impairment), Modified Ashworth Scale (spasticity), Medical Research Council (muscle strength), passive and active range of motion, and isometric muscle force.FindingsFoot impairment was not related to peak dorsiflexion during swing (r = ? 0.17, P = 0.247) and joint motion during stance (r = 0.05, P = 0.735). Active (r = 0.45, P < 0.001) and passive (r = 0.48, P < 0.001) range of motion was associated with stance phase joint motion. Peak dorsiflexion during swing was related to isometric dorsiflexor muscle force (r = ? 0.32, P = 0.039). Individuals with dropped foot demonstrated greater motor impairment, plantarflexor spasticity and ankle muscle weakness compared to those without dropped foot.InterpretationOur investigation suggests that ankle–foot impairments are related to ankle deviations during gait, as indicated by greater impairment among individuals with dropped foot. These findings contribute to a better understanding of gait-specific ankle deviations, and may lead to the development of a more effective clinical assessment of dropped foot impairment.     

Transcranial direct current stimulation as an adjunct to cognitive training for older adults with mild cognitive impairment: A randomized controlled trial

BackgroundCognitive training (CT) for individuals with mild cognitive impairment (MCI) may not be optimal for enhancing cognitive functioning. Coupling CT with transcranial direct current stimulation (tDCS) may maximize the strength of transmission across synaptic circuits in pathways that are stimulated by CT. The synergistic effects arising from this combination could be superior to those with administration of CT alone.ObjectivesTo investigate whether the receiving tDCS combined with CT is superior to CT alone on domain-specific and task-specific cognitive outcomes in older adults with MCI.MethodsThis double-blind, sham-controlled randomized trial included 67 older adults with MCI assigned to 3 groups: 1) tDCS combined with CT (tDCS + CT), 2) sham tDCS combined with CT (sham tDCS + CT) and 3) CT alone. Nine sessions of computerized CT were administered to the 3 groups for 3 weeks. In addition, tDCS and sham tDCS was delivered to the left dorsolateral prefrontal cortex to the tDCS + CT and sham tDCS + CT groups, respectively, simultaneously with CT. Standardized cognitive assessments were performed at baseline, post-intervention, and at 6-week follow-up. Participants’ performance in the CT tasks was rated every session.ResultsThe 3 groups showed improvements in global cognition and everyday memory (P < 0.017) after the intervention and at follow-up, with larger effect sizes in the tDCS + CT than other groups (d > 0.94) but with no significant differences between groups. Regarding CT outcomes, the groups showed significant differences in favour of the tDCS + CT group in decreasing the completion and reaction times of working memory and attention activities (P < 0.017).ConclusionstDCS combined with CT was not superior to sham tDCS with CT and CT alone in its effects on domain-specific cognitive outcomes, but it did provide comparatively larger effect sizes and improve the processing speed of task-specific outcomes.ClinicalTrials.govNCT03441152.     

The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis

BackgroundThe association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis.MethodsSixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n = 18), mild pain (n = 27), or moderate/severe pain (n = 22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified.FindingsThe moderate/severe pain group demonstrated worse global pain (P < 0.01) and physical function scores (P < 0.01) compared to the no pain and the mild pain groups. The moderate/severe pain group also walked with greater knee flexion moments during the midstance phase of gait compared to the no pain group (P = 0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P = 0.009), which was associated with higher weight acceptance peak knee adduction moments (P = 0.003) and worse global pain (P = 0.003) and physical function scores (P = 0.006).InterpretationGreater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait.     

Validation of the Arm Profile Score in assessing upper limb functional impairments in people with multiple sclerosis

BackgroundAlthough upper limb (UL) impairments are widespread in people with Multiple Sclerosis (pwMS), there is limited quantitative evidence concerning their specific features. The aim of this study is to validate a synthetic measure based on kinematic data to define the degree of deviation from a physiologic pattern during the “hand to mouth” (HTM) task.MethodsTwenty pwMS (mean age 51.2 SD 11.1) years, Expanded Disability Status Scale (EDSS) score in the range 2–6.5, underwent a kinematic analysis of the HTM task using a motion capture system. Spatio-temporal parameters and synthetic indexes (Arm Variable Score, AVS and Arm Profile Score, APS) were calculated and compared with those of age-matched healthy individuals. Kinematic data were correlated with the EDSS score and clinical tests such as the Nine Hole Peg Test (NHPT) and hand-grip strength (HGS).FindingsPwMS exhibit reduced velocity, increased movement duration, sway of adjusting and frequency of direction changes as well as higher APS values (15.4° vs. 8.6°, P < 0.001) with respect to controls due to alterations in trunk flexion-extension, shoulder abduction-adduction, flexion-extension and rotation and elbow flexion-extension. Moderate-to-large correlations were found between APS and EDSS (rho = 0.609, P < 0.001), NHPT (rho = 0.468, P = 0.03) and HGS (rho = − 0.627 P < 0.001).InterpretationThe kinematic analysis of HTM provides useful information in quantifying UL impairments in pwMS. The APS index appears suitable to represent UL movement deviations from the physiological pattern in pwMS and to assess disease progression or effectiveness of pharmacologic and rehabilitative treatments effectiveness.     

Neuromuscular rate of force development deficit in Parkinson disease

BackgroundBradykinesia and reduced neuromuscular force exist in Parkinson disease. The interpolated twitch technique has been used to evaluate central versus peripheral manifestations of neuromuscular strength in healthy, aging, and athletic populations, as well as moderate to advanced Parkinson disease, but this method has not been used in mild Parkinson disease. This study aimed to evaluate quadriceps femoris rate of force development and quantify potential central and peripheral activation deficits in individuals with Parkinson disease.MethodsNine persons with mild Parkinson Disease (Hoehn & Yahr ≤ 2, Unified Parkinson Disease Rating Scale total score = mean 19.1 (SD 5.0)) and eight age-matched controls were recruited in a cross-sectional investigation. Quadriceps femoris voluntary and stimulated maximal force and rate of force development were evaluated using the interpolated twitch technique.FindingsThirteen participants satisfactorily completed the protocol. Individuals with early Parkinson disease (n = 7) had significantly slower voluntary rate of force development (p = 0.008; d = 1.97) and rate of force development ratio (p = 0.004; d = 2.18) than controls (n = 6). No significant differences were found between groups for all other variables.InterpretationsPersons with mild-to-moderate Parkinson disease display disparities in rate of force development, even without deficits in maximal force. The inability to produce force at a rate comparable to controls is likely a downstream effect of central dysfunction of the motor pathway in Parkinson disease.     

Lumbar extensor muscle force control is associated with disability in people with chronic low back pain

BackgroundThe ability to control lumbar extensor force output is necessary for daily activities. However, it is unknown whether this ability is impaired in chronic low back pain patients. Similarly, it is unknown whether lumbar extensor force control is related to the disability levels of chronic low back pain patients.MethodsThirty-three chronic low back pain and 20 healthy people performed lumbar extension force-matching task where they increased and decreased their force output to match a variable target force within 20%–50% maximal voluntary isometric contraction. Force control was quantified as the root-mean-square-error between participants' force output and target force across the entire, during the increasing and decreasing portions of the force curve. Within- and between-group differences in force-matching error and the relationship between back pain group's force-matching results and their Oswestry Disability Index scores were assessed using ANCOVA and linear regression respectively.FindingsBack pain group demonstrated more overall force-matching error (mean difference = 1.60 [0.78, 2.43], P < 0.01) and more force-matching error while increasing force output (mean difference = 2.19 [1.01, 3.37], P < 0.01) than control group. The back pain group demonstrated more force-matching error while increasing than decreasing force output (mean difference = 1.74, P < 0.001, 95%CI [0.87, 2.61]). A unit increase in force-matching error while decreasing force output is associated with a 47% increase in Oswestry score in back pain group (R² = 0.19, P = 0.006).InterpretationLumbar extensor muscle force control is compromised in chronic low back pain patients. Force-matching error predicts disability, confirming the validity of our force control protocol for chronic low back pain patients.     

Effectiveness and Tolerability of Amidotrizoate for the Treatment of Constipation Resistant to Laxatives in Advanced Cancer Patients

ContextConstipation is a common problem for advanced cancer patients, and is generally inadequately treated.ObjectivesThe aim of this study was to prospectively evaluate the effectiveness and tolerability of amidotrizoate (AM) in patients unresponsive to current laxatives.MethodsA consecutive sample of advanced cancer patients was surveyed. Inclusion criteria were no bowel movements for three days despite receiving regular doses of senna or lactulose. AM 50 mL was administered orally; the dose could be repeated the day after, based on clinical judgment and/or patients’ preference. Age, sex, primary tumor, previous abdominal surgery, chemotherapy and radiotherapy performed in the previous month, and the use of opioids were recorded. Nausea, the presence of early satiety, and fluid and food intake also were measured. Time to first bowel movement was recorded, and adverse effects attributable to AM.ResultsNinety-nine patients were surveyed (36 women/63 men). The mean age was 65.7 years (SD ± 12.2) and the mean Karnofsky score was 46.8 (SD ± 9.4). Patients had no bowel movement for a mean of four days (SD ± 1.8, range 3–15 days). A total of 80.8% of patients were receiving opioids in doses of mean daily oral morphine equivalents of 164 mg (SD ± 235). After AM administration (mean 9.9 ± 6.5 hours), 44.4% of patients had a bowel movement within 24 hours. This effect was associated with significant improvement of other symptoms and was independent of age (P = 0.513), gender (P = 0.090), Karnofsky status (P = 0.979), days of constipation (P = 0.198), concomitant chemotherapy (P = 0.098) or radiotherapy (P = 0.414), the use of opioids (P = 0.361), opioid doses (P = 0.420), and primary tumor (P = 0.231). The treatment was more effective in patients who had previous abdominal surgery (HR = 3.33).ConclusionAM was found to be an easy and inexpensive breakthrough medication to induce a bowel movement in about 45% of advanced cancer patients not responsive to common laxatives, with limited and acceptable adverse effects.     

Improvements in kinematics,muscle activity and pain during functional tasks in females with patellofemoral pain following a single patterned electrical stimulation treatment

BackgroundIndividuals with patellofemoral pain present with altered hip muscle activation, faulty movement patterns, and pain during functional tasks. Examining new treatment options to address these impairments may better treat those with patellofemoral pain. The purpose of this study was to determine if patterned electrical stimulation to the lower extremity affects muscle activity, movement patterns, and pain following a single treatment.MethodsFifteen females with patellofemoral pain were randomized to receive a single 15-minute treatment of either a patterned electrical neuromuscular stimulation or a sham. Peak kinematics of the knee, hip, and trunk, electromyography and pain were examined pre and post-intervention during a single leg squat and lateral step-down task. Group means and pre/post reduced kinematic values were also plotted during the entire task with 90% confidence intervals to identify differences in movement strategies.FindingsNo baseline differences were found in peak kinematics between groups. No pre to post-intervention differences in peak knee, hip and trunk kinematics were found, however differences were seen when the quality of movement across the entire tasks was assessed. The electrical stimulation group had improved knee flexion and hip abduction during the lateral step-down. A significant improvement in gluteus medius activation following patterned electrical neuromuscular stimulation occurred during the step-down (P = 0.039). Significant pain improvements were also seen in both the single leg squat (P = 0.025) and lateral step-down (P = 0.006).InterpretationA single treatment of patterned electrical neuromuscular stimulation improved muscle activation, lower extremity kinematics during functional tasks, and pain.     

The scale for retropulsion: Internal consistency,reliability and construct validity

BackgroundRetropulsion is an impairment of body orientation against gravity in the sagittal plane. In a Delphi study, the Scale for Retropulsion (SRP) was developed with a high level of expert agreement.ObjectiveTo assess the clinimetric properties of the German SRP in patients with neurological disorders.MethodsThe SRP was applied to 70 hospitalized patients with neurological disorders (stroke, critical illness neuropathy and/or myopathy, Parkinson syndromes). Internal consistency was determined with the Cronbach ɑ. Test–retest and interrater reliabilities were evaluated with the weighted kappa, intraclass correlation coefficient (ICC), and Bland–Altman plots. The construct validity was evaluated with Spearman correlation.ResultsThe median (interquartile range) SRP score was 5 (3–8) and ranged from 0 to 22 (total scale range: 0 to 24). The SRP had excellent internal consistency (Cronbach ɑ = 0.875) and good to excellent test–retest reliability (weighted kappa = 0.957, ICC = 0.957) and interrater reliability (weighted kappa = 0.837, ICC = 0.837). Analysis of construct validity resulted in good correlations with other clinical balance scales (r_Sp > 0.80), and fair to moderate correlations with posturographic measures (r_Sp = 0.27–0.56) and the subjective postural vertical error in the sagittal plane (r_Sp = ?0.325, P = 0.012) as well as the range in the frontal plane (r_Sp = 0.359, P = 0.007). The SRP discriminated between patients classified with and without retropulsion by an independent clinical expert (P < 0.001).ConclusionThe SRP provides a valid and reliable bedside test to quantify retropulsion in individuals with neurological disorders.     

Factores predictores del deterioro cognitivo en personas mayores de 60 años

ObjectiveTo determine the relationship of depressive symptoms, sleep hygiene, nutritional status and gait speed with cognitive impairment in people over 60 years.MethodCross-sectional, correlational design with a non-probability convenience sampling. The population was made up of people over 60 years of age belonging to recreational stays in an urban area of Tamaulipas, Mexico. Criterion measures included three neuropsychological tests (Stroop Test, Trail Making Test and Digit Span Subtest) the Geriatric Depression Scale, Pittsburgh Sleep Quality Index, Mini Nutritional Assessment and the Short Physical Performance Battery.ResultsThe final sample was of 108 participants. Regarding the influence of risk factors to predict cognitive impairment a significant model was observed (F = 12.914, gl = 4, P ≥ .001), showing a variance explained of 33.4%, where depressive symptoms (β = .205, P = .048), sleep (β = –.322, P = .001), nutritional status (β = –.336, P = .001) and gait speed (β = .244, P = .004) were associated with cognitive impairment.ConclusionsHigh levels of depressive symptoms, prolonged sleep duration, a malnutrition status and a slow gait speed predict cognitive impairment of the people over 60 years, this provides knowledge for the implementation of interventions aimed at preventing the risk factors that predict cognitive decline in order to delay its appearance.     

Prevalence and patterns of subclinical motor and cognitive impairments in non-disabled individuals with early multiple sclerosis: A multicenter cross-sectional study

BackgroundMotor and cognitive disorders appear early in the course of multiple sclerosis (MS) and develop gradually over time.ObjectiveTo study the frequency and pattern of subtle functional disorders in people with MS (PwMS) with no overt signs of disability in an early phase of the disease and their association with walking impairments in daily activities.MethodsIn this cross-sectional study, we recruited PwMS with an Expanded Disability Status Scale (EDSS) score ≤ 2.5 and disease duration ≤ 5 years. Participants were assessed with functional scales rating walking endurance (6-Min Walk Test), perceived walking ability (Twelve-item Multiple Sclerosis Walking Scale), balance (Fullerton Advanced Balance scale_short), manual dexterity (Nine Hole Peg Test), fatigue (Fatigue Severity Scale), and cognitive impairments (Brief International Cognitive Assessment).ResultsAbout 90% of the 82 PwMS (mean [SD] EDSS score 1.5 [0.7] and disease duration 2.2 [1.7] years) showed endurance values below the expected score; almost 30% showed impairment, and for 57%, perceived walking ability score was abnormal. Balance was impaired in 48% of participants, as was manual dexterity (29%) and fatigue (24%), but only a few showed cognitive impairments. Only 11% of PwMS had no abnormal score on the scales used in the assessment. As compared with EDSS score 0 to 1.5, with EDSS score 2 to 2.5, performance was worse for endurance (difference ± 61.0 m, P = 0.016), perceived walking ability (?11 points, P = 0.002), balance (+1.9 points, P = 0.005), manual dexterity (?2.8 s, P = 0.004), and fatigue (?1.3 points, P = 0.013). Factors that predicted perceived walking ability were balance (B = ?1.37, P < 0.001) and fatigue (B = 5.11, P < 0.001) rather than endurance (B = ?0.01, P = 048).ConclusionEven PwMS with no clinical disability and classified as having “no problem walking” present walking and other functional deficits when assessed with specific functional tests. The addition of specific tools could better identify subtle motor and cognitive deficits. Finally, the assessment of balance disorders and fatigue is important to understand individuals’ perceived walking impairments in daily activities.     

The effect of total hip and hip resurfacing arthroplasty on vertical ground reaction force and impulse symmetry during a sit-to-stand task

BackgroundThe aim of this study was to determine the influence of total hip arthroplasty and hip resurfacing arthroplasty on limb loading symmetry before, and after, hip reconstruction surgery during a sit-to-stand task.MethodsFourteen patients were recruited that were about to receive either a total hip prosthesis (n = 7) or a hip resurfacing prosthesis (n = 7), as well as matched controls. Patients performed a sit-to-stand movement before, 3 months after, and 12 months after surgery. Peak vertical ground reaction force and impulse were measured for each leg, from which ground reaction force and impulse symmetry ratios were calculated.FindingsBefore surgery, hip resurfacing patients showed a small asymmetry which was not different to normal for ground reaction force (0.88(0.28) vs. 1.00(0.11); p = 0.311) or impulse (0.87(0.29) vs. 0.99(0.09); p = 0.324) symmetry ratios. Total hip patients offloaded their affected hip by 30% in terms of impulse symmetry ratio (0.71(0.36) vs. 0.99(0.23); p = 0.018). At 3 months following surgery asymmetries were seen that were different to normal in both hip resurfacing patients for ground reaction force (0.77(0.16); p = 0.007), and total hip patients for ground reaction force (0.70(0.15); p = 0.018) and impulse (0.72(0.16); p = 0.011) symmetry ratios. By 12 months after surgery total hip patients regained a symmetrical loading pattern for both ground reaction force (0.95(0.06); p = 0.676) and impulse (1.00(0.06); p = 0.702) symmetry ratios. Hip resurfacing patients, however, performed the task by overloading their operated hip, with impulse symmetry ratio being larger than normal (1.16(0.16); p = 0.035).InterpretationPhysiotherapists should appreciate the need for early recovery of limb loading symmetry as well as subsequent differences in the responses observed with different prostheses.     

(Re)organisation of the somatosensory system after early brain lesion: A lateralization index fMRI study

ObjectiveTo evaluate the relationship between neural (re)organization of the somatosensory cortex and impairment of sensory function (2-point discrimination [2PD]) in individuals with unilateral cerebral palsy.MethodsWe included 21 individuals with unilateral cerebral palsy. 2PD thresholds were evaluated on thumb pads, and activation of the somatosensory cortex was recorded by functional MRI (fMRI) during passive movements of the affected hand. A lateralization index (LI) was calculated for the primary sensory (S1) and secondary sensory (S2) cortices and the correlation between the LI and 2PD thresholds was analysed.ResultsWe found a significant negative correlation between the 2PD thresholds and the S2 LI (r = −0.5, one-tailed P-value = 0.01) and a trend towards a negative correlation with the S1 LI (r = −0.4, one-tailed P-value = 0.05).ConclusionHigh levels of activation in the contralesional hemisphere were associated with high levels of sensory impairment in individuals with unilateral cerebral palsy. The interhemispheric (re)organization of the somatosensory system may not effectively compensate for somatosensory impairment.     

Effect of a high-intensity interval training on serum microRNA levels in women with breast cancer undergoing hormone therapy. A single-blind randomized trial

BackgroundThe role of microRNAs (miRs) in hormone therapy (HT) is of keen interest in developing biomarkers and treatments for individuals with breast cancer. Although miRs are often moderate regulators under homeostatic conditions, their function is changed more in response to physical activity.ObjectiveThis single-blind randomized trial aimed to explore the effect of high-intensity interval training (HIIT) on serum levels of miRs in individuals with early-stage breast cancer undergoing HT.MethodsHormone receptor-positive women with breast cancer and healthy women were randomly assigned to a healthy control group (n = 15), healthy group with HIIT (n = 15), breast cancer group with HT (HT, n = 26), and breast cancer group with HT and HIIT (HT + HIIT, n = 26). The exercise groups underwent interval uphill walking training on a treadmill 3 times a week for 12 weeks. At the end of the study, we analyzed changes in levels of cancer-related miRs (oncomiRs) and tumour suppressor miRs (TSmiRs) in response to the HT and HIIT.ResultsIn women with breast cancer versus healthy controls, the expression of some oncomiRs was significantly increased — miR-21 (P < 0.001), miR-155 (P = 0.001), miR-221 (P = 0.008), miR-27a (P < 0.001), and miR-10b (P = 0.007) — and that of some TSmiRs was significantly decreased — miR-206 (P = 0.048), miR-145 (P = 0.011), miR-143 (P = 0.008), miR-9 (P = 0.020), and let-7a (P = 0.005). Moreover, HT considerably downregulated oncomiRs and upregulated TSmiRs. HIIT for 12 weeks with HT significantly decreased the expression of the oncomiRs and significantly increased that of the TSmiRs as compared with HT alone.ConclusionsHITT could amplify the decrease and/or increase in expression of miRs associated with HT in women with breast cancer. A prospective trial could determine whether the use of circulating miRs for monitoring treatment can be useful in therapy decisions.Trial registrationIranian Registry of Clinical Trials (No.: IRCT201202289171N1).     

Management of Moderate-to-Severe Dyspnea in Hospitalized Patients Receiving Palliative Care

ContextBenzodiazepines (BZDs) are commonly prescribed for relief of dyspnea in palliative care, yet few data describe their efficacy.ObjectivesTo describe the management of moderate-to-severe dyspnea in palliative care patients.MethodsChart review of inpatients with moderate or severe dyspnea on initial evaluation by a palliative care service. We recorded dyspnea scores at follow-up (24 hours later) and use of BZDs and opioids.ResultsThe records of 115 patients were reviewed. The mean age of patients was 64 years and primary diagnoses included cancer (64%, n = 73), heart failure (8%, n = 9), and chronic obstructive pulmonary disease (5%, n = 6). At initial assessment, 73% (n = 84) of the patients had moderate and 27% (n = 31) had severe dyspnea. At follow-up, 74% (n = 85) of patients reported an improvement in their dyspnea, of which 42% (n = 36) had received opioids alone, 37% (n = 31) had BZDs concurrent with opioids, 2% (n = 2) had BZDs alone, and 19% (n = 16) had received neither opioids nor BZDs. Logistic regression analysis identified that patients who received BZDs and opioids had increased odds of improved dyspnea (odds ratio 5.5, 95% CI 1.4, 21.3) compared with those receiving no medications.ConclusionMost patients reported improvement in dyspnea at 24 hours after palliative care service consultation. Consistent with existing evidence, most patients with dyspnea received opioids but only the combination of opioids and BZDs was independently associated with improvement in dyspnea. Further research on the role of BZDs alone and in combination with opioids may lead to better treatments for this distressing symptom.     

Recovery of balance and gait after stroke is deteriorated by confluent white matter hyperintensities: Cohort study

BackgroundWhite matter hyperintensities (WMHs) are well known to affect post-stroke disability, mainly by cognitive impairment. Their impact on post-stroke balance and gait disorders is unclear.ObjectivesWe aimed to test the hypothesis that WMHs would independently deteriorate post-stroke balance and gait recovery.MethodsThis study was performed in 210 individuals of the cohort Determinants of Balance Recovery After Stroke (DOBRAS), consecutively enrolled after a first-ever hemisphere stroke. Clinical data were systematically collected on day 30 ± 3 (D30) post-stroke and at discharge from the rehabilitation ward. WMHs were searched on MRI, graded with the Fazekas scale, and dichotomized as no/mild (absence/sparse) or moderate/severe (confluent). The primary endpoint was the recovery of the single limb stance, assessed with the Postural Assessment Scale for Stroke (PASS). The secondary endpoint was the recovery of independent gait, assessed with the modified Fugl–Meyer Gait Assessment (mFMA). The adjusted hazard ratios (aHRs) of achievements of these endpoints by level of WMHs were estimated by using Cox models, accounting for other relevant clinical and imaging factors.ResultsIndividuals with moderate/severe WMHs (n = 86, 41%) had greater balance and gait disorders and were more often fallers than others (n = 124, 59%). Overall, they had worse and slower recovery of single limb stance and independent gait (P < 0.001). Moderate/severe WMHs was the most detrimental factor for recovery of balance (aHR 0.46, 95% confidence interval [CI] 0.32–0.68, P < 0.001) and gait (0.51, 0.35–0.74, P < 0.001), along with age, stroke severity, lesion volume and disrupted corticospinal tract. With cerebral infarct, endovascular treatments had an independent positive effect, both on the recovery of balance (aHR 1.65, 95% CI 1.13–2.4, P = 0.009) and gait (1.78, 1.24–2.55, P = 0.002).ConclusionsWMHs magnify balance and gait disorders after stroke and worsen their recovery. They should be better accounted for in post-stroke rehabilitation, especially to help establish a prognosis of mobility.ClinicalTrials.gov registrationNCT03203109.     

A Pilot Cluster-Randomized Trial of a 20-Week Tai Chi Program in Elders With Cognitive Impairment and Osteoarthritic Knee: Effects on Pain and Other Health Outcomes

ContextBecause Tai Chi (TC) is beneficial to elders without cognitive impairment (CI), it also may benefit elders with CI. But elders with CI have generally been excluded from TC studies because many measurement tools require verbal reports that some elders with CI are unable to provide.ObjectivesTo test the efficacy of a TC program in improving pain and other health outcomes in community-dwelling elders with knee osteoarthritis (OA) and CI.MethodsThis pilot cluster-randomized trial was conducted between January 2008 and June 2010 (ClinicalTrials.gov Identifier: NCT01528566). The TC group attended Sun style TC classes, three sessions a week for 20 weeks; the control group attended classes providing health and cultural information for the same length of time. Measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, physical function and stiffness subscales; the Get Up and Go test; the Sit-to-Stand test; and the Mini-Mental State Examination (MMSE), administered at baseline, every four weeks during the intervention and at the end of the study (post-test).ResultsEight sites participated in either the TC group (four sites, 28 participants) or control group (four sites, 27 participants). The WOMAC pain (P = 0.006) and stiffness scores (P = 0.010) differed significantly between the two groups at post-test, whereas differences between the two groups in the WOMAC physical function score (P = 0.071) and the MMSE (P = 0.096) showed borderline significance at the post-test. WOMAC pain (P = 0.001), physical function (P = 0.021), and stiffness (P ≤ 0.001) scores improved significantly more over time in the TC group than in controls. No adverse events were found in either group.ConclusionPracticing TC can be efficacious in reducing pain and stiffness in elders with knee OA and CI.     

Impacto de una intervención educacional sobre la calidad de la dieta mediterránea,la actividad física y el estado ponderal en adolescentes: ensayo clínico aleatorizado

ObjectiveTo analyse the impact of an educational intervention on the quality of the Mediterranean diet, physical activity and weight status in adolescents.MethodRandomised clinical trial (RCT), controlled with a multimodal educational intervention (control group [n = 36] and experimental group [n = 46]). Data collection at the beginning and end of the study, in teenagers from Cáceres, Spain. In both groups anthropometric measurements and sociodemographic data were determined. The quality of the Mediterranean diet was assessed through the KIDMED test, the degree of physical activity through the PAQ-A questionnaire and weight status with the growth charts of the Faustino Orbegozo Eizaguirre Foundation.ResultsWe obtained a significant increase in the experimental group in the PAQ-A questionnaire that assesses physical activity (P = .029). No significant differences were observed between groups in the weight status (P = .916). When comparing the quality of the Mediterranean diet (high vs moderate or low quality) with physical activity (P control = .730; experimental P = .495) and with weight status (P control = .838; experimental P = .372), No significant differences are observed.ConclusionsThe educational intervention did not improve the quality of the Mediterranean diet or physical activity, although most of our sample had normal weight and acceptable physical activity. We must continue to improve the healthy eating pattern of our adolescents, to ensure an adequate state of health in the future.