Vestibular Rehabilitation Improves Gait Quality and Activities of Daily Living in People with Severe Traumatic Brain Injury: A Randomized Clinical Trial

Enhanced prognostic accuracy in severe TBI: a comprehensive nomogram analysis

OBJECTIVE

This study aims to enhance prognostic accuracy in severe traumatic brain injury (STBI) by developing a novel nomogram that integrates clinical and paraclinical data.

METHODS

Data from 263 STBI patients were analyzed, focusing on critical variables such as age, Glasgow Coma Scale scores, pupil responsiveness, CT findings, and blood markers. A rigorous regression analysis was conducted to identify significant predictors. The nomogram underwent internal and external validation, and its predictive performance was compared with existing models through a meta-analysis.

RESULTS

The novel nomogram demonstrated superior predictive accuracy for STBI outcomes compared to traditional models. Key predictors, including age, Glasgow Coma Scale scores, pupil responsiveness, CT findings, and specific blood markers, were harmonized to provide a more precise prognostic tool. Validation processes confirmed the robustness and reliability of the nomogram.

CONCLUSION

The developed nomogram represents a significant advancement in STBI prognosis, offering clinicians a powerful tool to improve patient care strategies. By integrating CT imaging and blood parameters, the nomogram enhances the precision of outcome predictions, facilitating better-informed clinical decisions.

Preventing postoperative moderate- and high-risk pressure injuries with artificial intelligence-powered smart decompression mattress on in middle-aged and elderly patients: a retrospective cohort analysis

Aims/Background Artificial intelligence technology has attained rapid development in recent years. The integration of artificial intelligence applications into pressure reduction mattresses, giving rise to artificial intelligence-powered pressure reduction mattresses, is expected to provide personalised intelligent pressure reduction solutions, through automatic user's data-based adjustment of the patient's local pressure condition to prevent pressure injury. The purpose of this study was to investigate the effectiveness of artificial intelligence-powered smart decompression in the prevention of postoperative medium- and high-risk pressure injury in middle-aged and elderly patients. Methods A total of 400 middle-aged and elderly patients admitted to our hospital from June 2021 to December 2023 were selected as study subjects. Patients were categorised into observation and control groups according to the medical record system. General demographic data of the patients were collected. The propensity score matching method was used to balance the baseline data of the two groups of patients. The incidence, severity, complications and sleep quality in the matched study subjects were also compared. Results After matching, there were 96 patients in the two groups, and the differences in baseline data between the two groups were not statistically significant. Pressure injury and the total incidence of complications in the observation group were significantly lower than those in the control group (p < 0.05). Before treatment, there was no difference in the scores of all aspects of the Richards Campbell Sleep Questionnaire between the two groups (p > 0.05). After treatment, the scores of all aspects of Richards Campbell Sleep Questionnaire in the observation group were significantly lower than those in the control group (p < 0.05). Conclusion The artificial intelligence-powered smart decompression mattress can significantly prevent moderate- and high-risk pressure injury, effectively reducing the incidence of pressure injury and complications in postoperative long-term bedridden patients, alleviating the severity of pressure injury, relieving the pressure on various parts, and improving the sleep quality of patients.

Ameliorative properties of quercetin in the treatment of traumatic brain injury: a mechanistic review based on underlying mechanisms

Traumatic brain injury (TBI) is a leading cause of disability worldwide, with an estimated annual incidence of 27-69 million. TBI is a severe condition that can lead to high mortality rates and long-term cognitive, behavioral, and physical impairments in young adults. It is a significant public health concern due to the lack of effective treatments available. Quercetin, a natural flavonoid found in various fruits and vegetables, has demonstrated therapeutic potential with anti-inflammatory, antioxidant, and neuroprotective properties. Recently, some evidence has accentuated the ameliorating effects of quercetin on TBI. This review discusses quercetin's ability to reduce TBI-related damage by regulating many cellular and molecular pathways. Quercetin in vitro and in vivo studies exhibit promise in reducing inflammation, oxidative stress, apoptosis, and enhancing cognitive function post-TBI. Further clinical investigation into quercetin's therapeutic potential as a readily available adjuvant in the treatment of TBI is warranted in light of these findings. This review adds to our knowledge of quercetin's potential in treating TBI by clarifying its mechanisms of action.

Full-body kinematics and head stabilisation strategies during walking in patients with chronic unilateral and bilateral vestibulopathy

Chronic imbalance is a frequent and limiting symptom of patients with chronic unilateral and bilateral vestibulopathy. A full-body kinematic analysis of the movement of patients with vestibulopathy would provide a better understanding of the impact of the pathology on dynamic tasks such as walking. Therefore, this study aimed to investigate the global body movement during walking, its variability (assessed with the GaitSD), and the strategies to stabilise the head (assessed with the head Anchoring Index). The full-body motion capture data of 10 patients with bilateral vestibulopathy (BV), 10 patients with unilateral vestibulopathy (UV), and 10 healthy subjects (HS) walking at several speeds (slow, comfortable, and fast) were analysed in this prospective cohort study. We observed only a few significant differences between groups in parts of the gait cycle (shoulder abduction-adduction, pelvis rotation, and hip flexion-extension) during the analysis of kinematic curves. Only BV patients had significantly higher gait variability (GaitSD) for all three walking speeds. Head stabilisation strategies depended on the plan of motion and walking speed condition, but BV and UV patients tended to stabilise their head in relation to the trunk and HS tended to stabilise their head in space. These results suggest that GaitSD could be a relevant biomarker of chronic instability in BV and that the head Anchoring Index tends to confirm clinical observations of abnormal head-trunk dynamics in patients with vestibulopathy while walking.

Dynamic Stability, Symmetry, and Smoothness of Gait in People with Neurological Health Conditions

Neurological disorders such as stroke, Parkinson's disease (PD), and severe traumatic brain injury (sTBI) are leading global causes of disability and mortality. This study aimed to assess the ability to walk of patients with sTBI, stroke, and PD, identifying the differences in dynamic postural stability, symmetry, and smoothness during various dynamic motor tasks. Sixty people with neurological disorders and 20 healthy participants were recruited. Inertial measurement unit (IMU) sensors were employed to measure spatiotemporal parameters and gait quality indices during different motor tasks. The Mini-BESTest, Berg Balance Scale, and Dynamic Gait Index Scoring were also used to evaluate balance and gait. People with stroke exhibited the most compromised biomechanical patterns, with lower walking speed, increased stride duration, and decreased stride frequency. They also showed higher upper body instability and greater variability in gait stability indices, as well as less gait symmetry and smoothness. PD and sTBI patients displayed significantly different temporal parameters and differences in stability parameters only at the pelvis level and in the smoothness index during both linear and curved paths. This study provides a biomechanical characterization of dynamic stability, symmetry, and smoothness in people with stroke, sTBI, and PD using an IMU-based ecological assessment.

The efficacy of virtual reality technology for the postoperative rehabilitation of patients with cervical spondylotic myelopathy (CSM): a study protocol for a randomized controlled trial

BACKGROUND

Patients with cervical spondylosis myelopathy (CSM) may experience severe neurological dysfunction due to untimely spinal cord compression after surgery. These disorders may lead to sensory and motion disorders, causing considerable psychological distress. Recent studies found that virtual reality (VR) technology can be an effective tool for treating spinal cord injuries. Owing to this discovery, we developed an exploratory research project to investigate the impact of this intervention on the postoperative recovery of patients with CSM.

METHODS

The purpose of this randomized controlled trial was to evaluate the efficacy of combining VR technology with conventional rehabilitation strategies for the postoperative rehabilitation of patients with CSM. A total of 78 patients will be recruited and randomized to either the conventional rehabilitation group or the group subjected to VR technology combined with conventional rehabilitation strategies. The Japanese Orthopaedic Association (JOA) scale will be the main tool used, and secondary outcomes will be measured via the visual analogue scale (VAS), neck disability index (NDI), and functional MRI (fMRI). The data analysis will identify differences between the intervention and control groups as well as any relationship between the intragroup changes in the functional area of the brain and the subjective scale scores after the intervention.

DISCUSSION

The aim of this trial is to investigate the effect of VR training on the postoperative rehabilitation of patients with CSM after 12 intervention treatments. Positive and negative outcomes will help us better understand the effectiveness of the intervention and its neural impact. If effective, this study could provide new options for the postoperative rehabilitation of patients with CSM.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2300071544). Registered 17 May 2023, https://www.chictr.org.cn/ .

Cognitive-motor dual-task training improves dynamic stability during straight and curved gait in patients with multiple sclerosis: a randomized controlled trial

BACKGROUND

Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating, degenerative disease of the central nervous system and the second most frequent cause of permanent disability in young adults. One of the most common issues concerns the ability to perform postural and gait tasks while simultaneously completing a cognitive task (namely, dual-task DT).

AIM

Assessing cognitive-motor dual-task training effectiveness in patients with Multiple Sclerosis (PwMS) for dynamic gait quality when walking on straight, curved, and blindfolded paths.

DESIGN

Two-arm single-blind randomized controlled trial. Follow-up at 8 weeks.

SETTING

Neurorehabilitation Hospital.

POPULATION

A sample of 42 PwMS aged 28-71, with a score of 4.00±1.52 on the Expanded Disability Status Scale were recruited.

METHODS

Participants were randomized in conventional (CTg) neurorehabilitation and dual-task training (DTg) groups and received 12 sessions, 3 days/week/4 weeks. They were assessed at baseline (T0), after the treatment (T1), and 8 weeks after the end of the treatment (T2) through Mini-BESTest, Tinetti Performance Oriented Mobility Assessment, Modified Barthel Index, and a set of spatiotemporal parameters and gait quality indices related to stability, symmetry, and smoothness of gait extracted from initial measurement units (IMUs) data during the execution of the 10-meter Walk Test (10mWT), the Figure-of-8 Walk Test (Fo8WT) and the Fukuda Stepping Test (FST).

RESULTS

Thirty-one PwMS completed the trial at T2. Significant improvement within subjects was found in Mini-BESTest scores for DTg from T0 to T1. The IMU-based assessment indicated significant differences in stability (P<0.01) and smoothness (P<0.05) measures between CTg and DTg during 10mWT and Fo8WT. Substantial improvements (P<0.017) were also found in the inter-session comparison, primarily for DTg, particularly for stability, symmetry, and smoothness measures.

CONCLUSIONS

This study supports the effectiveness of DT in promoting dynamic motor abilities in PwMS.

CLINICAL REHABILITATION IMPACT

Cognitive-motor DT implemented into the neurorehabilitation conventional program could be a useful strategy for gait and balance rehabilitation.

Instrumental assessment of dynamic postural stability in patients with unilateral vestibular hypofunction during straight, curved, and blindfolded gait

PURPOSE

To characterise dynamic postural stability of gait in patients with vestibular hypofunction (PwVH) using a sensor-based assessment while performing dynamic tasks and to correlate the results of this evaluation with clinical scales.

METHODS

This cross-sectional study involved 22 adults between 18 and 70 years old from a healthcare hospital centre. Eleven patients suffering from chronic vestibular hypofunction (PwVH) and eleven healthy controls (HC) were evaluated through a combined inertial sensor-based and clinical scale assessment. Participants were equipped with five synchronised inertial measurement units (IMUs) (128 Hz, Opal, APDM, Portland, OR, USA): three IMUs were located on the occipital cranium bone, near the lambdoid suture of the head, at the centre of the sternum, and at L4/L5 level, just above the pelvis, and were used to quantify gait quality parameters, while the other two were located slightly above lateral malleoli and used to perform stride and step segmentation. Three different motor tasks were performed in a randomized order: the 10-m Walk Test (10mWT), the Figure of Eight Walk Test (Fo8WT) and the Fukuda Stepping Test (FST). A set of gait quality parameters related to stability, symmetry and smoothness of gait were extracted from IMU data and correlated with the clinical scale scores. PwVH and HC results were compared to test for significant between-group differences.

RESULTS

Significant differences were found for the three motor tasks (10mWT, Fo8WT and FST) when comparing PwVH and HC groups. For the 10mWT and the Fo8WT, significant differences between the PwVH and HC groups were found for the stability indexes. Considering the FST, significant differences between the PwVH and HC groups were also found in the stability and symmetry of gait. A significant correlation was found between the Dizziness Handicap Inventory and gait indices during the Fo8WT.

CONCLUSIONS

In this study, we characterized the dynamic postural stability alterations during linear, curved, and blindfolded walking/stepping in PwVH combining an instrumental IMU-based with traditional clinical scales approach. Combining instrumental and clinical evaluation for dynamic stability of gait alterations in PwVH is useful in thoroughly evaluating the effects of unilateral vestibular hypofunction.

Effects of shoulder brace usage on postural stability in stroke survivors: A pilot randomized controlled trial

BACKGROUND

Despite advances in stroke rehabilitation, challenges in upper limb motor recovery and postural stability persist, negatively affecting overall well-being. Arm slings and shoulder braces have been proposed to address these issues, but their efficacy in promoting postural stability remains unclear.

OBJECTIVE

This pilot randomized controlled study aimed to evaluate the impact of a new shoulder brace (N1-Neurosling) on trunk postural stability during walking, pain, and upper limb muscle strength in chronic stroke survivors.

METHODS

Twenty-four adult chronic stroke patients were involved and randomly assigned to the shoulder brace group (SBg) or control group (CTRLg). Were assessed at baseline (T0) and after 4 weeks (T1) through the Trunk Control Test, the Numerical Rating Scale, the Motricity Index, Manual Muscle Test, and instrumental wearable-based assessment.

RESULTS

After 4 weeks, the SBg showed significant improvement in Trunk Control Test scores (p = 0.020) and smoothness of gait measured by log dimensionless jerk along the Antero-Posterior axis (- 5.31±0.25 vs. - 5.18±0.27, p = 0.018) compared to the CTRLg. The SBg also demonstrated a reduction in pain in the shoulder girdle and enhanced upper limb muscle strength.

CONCLUSION

The use of the N1-Neurosling shoulder brace led to improvements in postural stability and smoothness of gait in stroke patients.