Search

BACKGROUND: Accurate prediction of recovery is essential to determine whether a knee-ankle-foot orthosis (KAFO) is required in the subacute phase of stroke. However, there are currently no reliable methods to predict such recovery. OBJECTIVE: This study aimed to determine whether muscle strength of the affected lower limb (affected side LL strength) in stroke patients in the subacute phase who cannot walk without a KAFO can be used to predict the continuous need for a KAFO, using a hand-held dynamometer. METHODS: We enrolled patients with severe hemiplegia (n = 51) who were unable to walk without a KAFO for 10 days after stroke onset. They were divided into two groups depending on the continuous need for a KAFO at 1 month after onset; the KAFO and non-KAFO groups. Logistic regression analysis was used to investigate whether the affected side LL strength was a predictor of the continuous need for a KAFO at 1 month after onset. In addition, significant predictors were analyzed using receiver operating characteristic (ROC) curves. RESULTS: The KAFO and non-KAFO groups included 23 (45.10%) and 28 (54.90%) patients, respectively. The affected side LL strength and pusher syndrome severity were identified as predictors of the continuous need for a KAFO. The predictor with the highest predictive ability was the affected side LL strength, with an area under the ROC curve of 0.80 (95% CI, 0.68–0.93). CONCLUSIONS: Affected side LL strength may be a highly accurate predictor of the need for a KAFO in the subacute phase of stroke. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore the use of Complete Vocal Technique (CVT) voice therapy in acquired brain injury (ABI) patients Study: This study is an exploratory retrospective study. Method: Five ABI patients (two female and three male) with an average age of 20.6 years (SD = 3.5) received CVT voice therapy from an authorized CVT teacher at a neurorehabilitation facility in conjunction with physical rehabilitation therapy and speech and language therapy. Pre- and postmeasures included Voice Handicap Index, Maximum Phonation Time, electroglottography, and acoustic measures. Results: All voice measures improved for all five patients after receiving CVT voice therapy. Voice Handicap Index scores decreased from an average of 48.4 to 22.8. Maximum Phonation Time improved while the electroglottography and acoustic data showed improved phonation stability in jitter and shimmer measures. Overall, following the intervention, patients demonstrated improved loudness range, improved range in contact quotient for different sound conditions, faster-paced speech, extended functional pitch range, and decrease in unwanted creaking and breathiness. Conclusions: The findings suggest that CVT may be used as therapy in ABI populations with promising results. Both patient self-assessment and objective voice measures demonstrate improved voice function. Given the longitudinal nature of recovery in ABI patients, more studies are needed to qualify at which stage(s) of recovery the CVT interventions are most effective and beneficial. Randomized controlled trials for specific patient populations of ABI are needed to assess the interventions' effectiveness in specific ABI diagnoses. [ABSTRACT FROM AUTHOR]

Patients with Ehlers-Danlos Syndrome (EDS) frequently suffer from severe chronic pain. We carried out an observational cohort study to assess the effectiveness of compression garments (CGs) for reducing this pain. Patients with non-vascular EDS were given custom-made Cerecare® CGs during a visit to a specialist clinic (visit V0). They were followed up over 2 years with visits every 6 months (V1–V4). At each visit, pain was assessed for the joints treated with CGs using a visual analogue scale (VAS; 0–100 mm). Additional measures were obtained to assess neuropathic pain (painDETECT questionnaire), proprioception/balance (Berg Balance Scale), and functional independence, amongst others. Data were analyzed for 67 patients with EDS (hypermobile: 91%; classical: 6%; kyphoscoliotic: 3%). For the most painful joint, the mean VAS rating was 71.5 ± 22.8 mm at V0; this decreased to 53.5 ± 25.5 mm at V1 and 45.7 ± 29 mm at V4 (t-tests: p < 0.0001). From V0 to V4, improvements were also seen for pain at the other joints, neuropathic pain, functional independence, proprioception/balance, and the incidence of sprains and dislocations/subluxations, although not all comparisons were statistically significant (p < 0.05 level). These results indicate that CGs may effectively reduce the pain and joint instability in non-vascular EDS patients. [ABSTRACT FROM AUTHOR]

Engagement in leisure is difficult for many communitydwelling adults post-stroke, resulting in increased sedentary and solitary leisure activity, and reduced leisure engagement and satisfaction. This, in turn, impacts long-term recovery, health, and quality of life. The aim of this study was to review the efficacy of in-home and community-based leisure education and leisure counseling on meaningful activity engagement and health outcomes for this population. A systematic review of the literature from 2005-2020 resulted in 2,017 references of which three met the inclusion criteria. Findings indicate that leisure education and leisure counseling improved quality of life, leisure satisfaction, autonomous leisure engagement, and leisure competence, as well as reduced depression and perceived barriers. Clinical implications and future research recommendations are provided. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients exhibit considerable variations in gait patterns especially in knee hyperextension in the stance phase after stroke. If knee hyperextension is untreated it may lead to pain, reduced independence in activities of daily living, deformities and instability. OBJECTIVE: The aim of this study was to investigate the immediate effects of a buffered knee orthosis on gait of stroke patients with knee hyperextension. METHODS: A total of nine patients with knee hyperextension after stroke were selected to wear buffered knee orthosis developed by Zhongshan Traditional Chinese Medicine Hospital and Ruike Medical Technology (Shanghai) Co., Ltd during walking training and daily walking. Then the gait analysis system of Motionanalysis was used to analyze and evaluate kinematic and spatiotemporal parameters of the gait in patients with independent walking or walking with a buffered knee orthosis. RESULTS: After wearing the buffered knee brace, initial contact, maximum and minimum angles of support phase, the toe off the ground, maximum and minimum angles of swing phase on the injured side of knee and ankle increased. Minimum angle of support phase and maximum angle of swing phase on the uninjured side of ankle decreased, while the toe off the ground and minimum angles of swing phase increased significantly (all P < 0.05); There was no significant difference in other kinematics, in parameters between time and space, in walking speed among subjective gait parameters (P > 0.05). Walking distance, confidence, sense of security, and the feeling of walking hyperextension were all improved. In addition, the number of asymmetric kinematic parameters and spatiotemporal parameters decreased. CONCLUSION: The buffered knee orthosis can effectively prevent knee hyperextension after stroke, improve the knee and ankle sagittal motion, gait asymmetry, gait subjective feeling, and does not affect gait space-time parameters. [ABSTRACT FROM AUTHOR]

Abstract: Background: A knee–ankle–foot orthosis may be prescribed for the prevention of genu recurvatum during the stance phase of gait. It allows also to limit abnormal plantarflexion during swing phase. The aim is to improve gait in hemiplegic patients and to prevent articular degeneration of the knee. However, the effects of knee–ankle–foot orthosis on both the paretic and non-paretic limbs during gait have not been evaluated. The aim of this study was to quantify biomechanical adaptations induced by wearing a knee–ankle–foot orthosis, on the paretic and non-paretic limbs of hemiplegic patients during gait. Methods: Eleven hemiplegic patients with genu recurvatum performed two gait analyses (without and with the knee–ankle–foot orthosis). Spatio-temporal, kinematic and kinetic gait parameters of both lower limbs were quantified using an instrumented gait analysis system during the stance and swing phases of the gait cycle. Findings: The knee–ankle–foot orthosis improved spatio-temporal gait parameters. During stance phase on the paretic side, knee hyperextension was reduced and ankle plantarflexion and hip flexion were increased. During swing phase, ankle dorsiflexion increased in the paretic limb and knee extension increased in the non-paretic limb. The paretic limb knee flexion moment also decreased. Interpretation: Wearing a knee–ankle–foot orthosis improved gait parameters in hemiplegic patients with genu recurvatum. It increased gait velocity, by improving cadence, stride length and non-paretic step length. These spatiotemporal adaptations seem mainly due to the decrease in knee hyperextension during stance phase and to the increase in paretic limb ankle dorsiflexion during both phases of the gait cycle. [Copyright &y& Elsevier]

Introduction: The Ankle Lunge Test (ALT) is a reliable method of measuring weight bearing ankle dorsiflexion range, a key component of gait, in healthy ankles and a range of musculoskeletal conditions. The aim of this study is to evaluate the reliability and concurrent validity of the ALT in people with stroke and investigate whether change in ALT is observed following treatment of spasticity with Botulinum Toxin. Methodology: Repeated Measure Design: Forty stroke survivors were recruited for reliability testing. Twenty three stroke survivors were evaluated with the ALT before and after treatment of the lower limb with Botulinum Toxin. Measurement with the ALT was performed for all participants. For the reliability group, two physiotherapists evaluated the ALT on Day 1 and one therapist re‐evaluated the ALT one to 5 days later. For the change evaluation group, the ALT was tested prior to and six to eight weeks after intervention. Other measures evaluated were velocity, the Functional Ambulation Category, Timed Up and Go and the Modified Tardieu Scale. Results: Intra‐rater, inter‐rater and test‐retest reliability yielded intra‐class correlation coefficients at or above 0.92. Moderate correlations were found between the ALT and velocity r = 0.605 (p < 0.01), the Timed Up and Go r = −0.598 (p < 0.01) and the Functional Ambulation Category r = 0.380 (p < 0.05). Following intervention with Botulinum Toxin, there was significant (p < 0.02) improvement in the ALT; pre‐median 20 mm (IQR −25 to 35) to post‐median 21 mm (IQR 0 to 40) and the Timed Up and Go; pre‐median 21.40 s (IQR 13.43 to 28.82) to post‐median 20.08 s (IQR 14.06 to 28.47). Conclusion/Significance: The ALT is a reliable and valid measure which may be applied in clinical practice to evaluate change in weight bearing ankle dorsiflexion in people with stroke. [ABSTRACT FROM AUTHOR]

To investigate criteria acute care interdisciplinary providers use to select discharge destination for patients with traumatic brain injury (TBI). Cross-sectional, exploratory survey study. Data were collected from interdisciplinary providers at a U.S. Level I trauma centre via electronic survey. We invited 199 providers to participate and 27 responded (13.5% response rate). Responses were received from physicians and physical, occupational, and speech therapists. Findings showed variability in standard criteria and clinical judgment criteria providers used to select discharge destination for patients with TBI receiving acute care. There was limited agreement on standard criteria used to select discharge destination. Findings showed some agreement between providers on clinical judgment criteria used to select home as discharge destination and to prevent discharge to home. Most common clinical judgment criteria included therapists' recommendations on discharge location, patient's level of independence in activities of daily living, planned family support and ventilator dependence. Agreement on clinical judgment criteria became more limited when stratifying by discipline, frequency of patient care and experience. Findings on clinical judgment criteria providers use to select acute care discharge destination for patients with TBI are inconclusive. [ABSTRACT FROM AUTHOR]

Introduction: The present study is an examination of possible subclinical involvement of lower motor neuron (LMN) in patients with primary lateral sclerosis (PLS) and hereditary spastic paraparesis (HSP) electrophysiologically. Methods: Nine PLS patients and 5 HSP patients were prospectively analyzed. Jitter measurement with concentric needle electrode (25 mm, 30 G) (CN-jitter) recorded from right extensor digitorum muscle during voluntary contraction with 1 kHz high-pass frequency filter set. European Myelopathy Score (EMS) was used to evaluate disability. The relationship between disability score and jitter values was investigated. Results: HSP patients had suffered from the disease for longer period of time (p<0.001). Mean jitter values of patients with PLS and HSP were 26.5±12.1 µs and 30.8±34.8 µs, and the number of individual high jitters (>43 microseconds) observed in the PLS and HSP groups was 16/180 and 9/100, respectively without a significant intergroup difference. The ratio of patients with an abnormal jitter study were higher in HSP group (60%) compared to PLS (22%) (p<0.05). Potential pairs with blocking were present in HSP group (7 of 100 potential pairs) but not seen in PLS patients. EMS values were significantly lower in patients having potential pairs with high jitter and blocking compared to those without high jitter and blocking. Conclusion: The present study has demonstrated that early signs of LMN dysfunction can be detected electrophysiologically by CN-jitter in patients with UMN involvement. These electrophysiological findings in these patients with longer disease duration and lower clinical scores may be explained by spreading of the disease to LMNs or transsynaptic degeneration and its contribution in disease progression. [ABSTRACT FROM AUTHOR]

Purpose:Our aim was to describe the changes in the functional outcome at the early phase of rehabilitation following severe brain injury and to identify the factors associated with faster recovery. Methods:This retrospective analysis included 182 patients who were transferred from the intensive care unit (ICU) to a post-ICU neurorehabilitation unit following traumatic brain injury (TBI) (n = 82) or cerebrovascular accident (CVA) (n = 100). Admission, discharge and changes in scores were calculated for the Functional Independent Measurement (FIM) and the Wessex Head Injury Matrix (WHIM). Patients with high dynamics of clinical recovery were defined by delta FIM scores ≥22. Results:Upon admission to the neurorehabilitation unit, 97% of patients had a FIM score <50 and 41% a WHIM score <32. Patients showed significantly improved FIM (+17 points; 7–37) and WHIM (+11 points; 3–19) scores with an over 22-day stay (14–38). Those with faster recovery (45%) were more likely those with high FIM and WHIM scores at admission. The nature and severity of the brain insult were not associated with the dynamics of recovery. Conclusions:Within a 2–6 week stay in a post-ICU neurorehabilitation unit, patients with severe disability could achieve partial functional independence and showed cognitive improvements. [ABSTRACT FROM PUBLISHER]

Background and Purpose In Greece, as in many countries, there is a scarcity of evidence in the type of physiotherapy services offered for the rehabilitation of total knee replacement (TKR). Despite the number of TKRs annually performed in Greece (over 10,000), there are no available clinical guidelines as to the content of best physiotherapy practice. The aim of this nationwide survey undertaken by physiotherapists treating TKR patients post-operatively was to record standard practice and services available in Greece. Methods Design: cross-country survey Ten per cent of all registered physiotherapists working in public/private sectors were recruited. The developed survey comprised of questions regarding therapists' profile, protocols implemented at different stages of rehabilitation and the aims and modalities used. Results A 58.7% response rate was achieved, where 36% (47/132) of respondents were treating patients in the inpatient phase and 64% (85/132) after hospital discharge. Patients in Greece are discharged with a home-based exercise program (56.7%) and, to a lesser extent, are referred to rehabilitation centres (13.3%). Strengthening, range of movement and functionality seemed to be the primary goals especially in the inpatient phase, whereas in the outpatient phase, apart from the larger differences identified, functionality and balance training were more frequently reported. Conclusions No significant variations in practice were found during inpatient rehabilitation, whilst there seemed to be diversity across outpatient physiotherapy programs. The current survey suggests that patient's general health and psychological and behavioural issues are the criteria by which physiotherapists select the volume of implemented exercise and progression. However, no specific guidelines were followed. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective. The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma. Methods. A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews. Results. Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients' requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer. Conclusions. The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making. [ABSTRACT FROM AUTHOR]

Objectives: To assess predictors and indicators of disability and quality-of-life 4 years after severe traumatic brain injury (TBI), using structural equation modelling (SEM). Methods: The PariS-TBI study is a longitudinal multi-centre inception cohort study of 504 patients with severe TBI. Among 245 survivors, 147 patients were evaluated upon 4-year follow-up, and 85 completed the full assessment. Two outcome measures were analysed separately using SEM: the Glasgow Outcome Scale-extended (GOS-E), to measure disability, and the QOLIBRI, to assess quality-of-life. Four groups of variables were entered in the model: demographics; injury severity; mood and cognitive impairments; somatic impairments. Results: The GOS-E was directly significantly related to mood and cognition, injury severity, and somatic impairments. Age and education had an indirect effect, mediated by mood/cognition or somatic deficiencies. In contrast, the only direct predictor of QOLIBRI was mood and cognition. Age and somatic impairments had an indirect influence on the QOLIBRI. Conclusion: Although this study should be considered as explorative, it suggests that disability and quality-of-life were directly influenced by different factors. While disability appeared to result from an interaction of a wide range of factors, quality-of-life was solely directly related to psycho-cognitive factors. [ABSTRACT FROM PUBLISHER]

Copyright of Fisioterapia e Pesquisa is the property of Universidade de Sao Paulo, Faculdade de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To describe the discharge destination of patients with severe traumatic brain injury (sTBI) after acute care. To identify predictors associated with inpatient rehabilitation (vs discharge home) and to identify predictors associated with neurorehabilitation (vs general rehabilitation). Methods: A national, multi-centre, prospective study with adult survivors after sTBI (abbreviated injury scale head score > 3). Univariate and multivariate logistic regression models included patient characteristics, pre-injury conditions, initial neuro-physiological assessment, trauma mechanisms, severity of TBI and pre-hospital conditions to find predictors of discharge destination. Results: Out of the 566 included patients, 341 (60%) were referred to inpatient rehabilitation, thereof 249 (73%) to neurorehabilitation; 225 (40%) were discharged home or to a nursing home. Lower scores on the Glasgow Coma Scale at admission/at 14 days, higher injury severity scores and older age were predictors for inpatient rehabilitation. Younger age and male gender were predictors for neurorehabilitation. Conclusions: Patients’ pathways after acute care are not only determined by the severity of their brain injury, but also by their overall injury severity and socio-biological factors. More than half of the patients after sTBI are not discharged to specialized inpatient neurorehabilitation and, therefore, efforts should be taken to optimize post-acute care. [ABSTRACT FROM PUBLISHER]

Objective: The first aim of this study was to estimate the prevalence of TBI and epilepsy in a French prison population and to study variables known to be associated with TBI. The second aim was to compare prisoners with and without a history of TBI. Participants: All offenders (females, males and juveniles) admitted consecutively to Fleury-Mérogis prison over a period of 3 months were included in the study. Design: During the admission procedure, offenders were interviewed by healthcare staff using a self-reported questionnaire. Results: In all, 1221 prisoners were included. The rates of TBI and epilepsy were high, with a prevalence of 30.6% and 5.9%, respectively. Psychiatric care, anxiolytic and antidepressant treatment, use of alcohol and cannabis were all significantly higher among offenders with a history of TBI. Moreover, the number of times in custody and the total time spent in jail over the preceding 5 years were significantly higher among offenders with a history of TBI. Conclusions: These results provide further evidence that specific measures need to be developed such as, first of all, screening for TBI upon arrival in prison. [ABSTRACT FROM PUBLISHER]

Primary objective: To determine the features of stroke-related HO in a large sample of patients and to assess if HO risk is increased by haemorrhagic stroke. Research design: A case control study (risk factor of a rare event using retrospective analysis). Methods and procedures: Sixty-one patients with stroke-81 troublesome HOs-were included, each was matched with four controls, i.e. 244 patients with no HO after stroke. Matching criteria were age (±3.5 years) and sex. Data recorded were time from stroke to surgery, ischaemic or haemorrhagic stroke and presence of HO risk factors. Main outcomes and results: Mean age at time of stroke = 46.02 ± 11.4 years (15.9-76.3) for the case sub-group. Time from stroke to surgery = 23.4 ± 27.8 months (3.6-150.0). There was a significant relationship between haemorrhagic stroke and HO development (OR = 3.01; 95% CI = 1.14-7.98; p < 0.05), but not for ischaemic stroke. This became non-significant when all matching and risk factors were included in the model (adjusted OR = 1.98; 95% CI = 0.60-6.54; p = 0.26). Conclusion: Haemorrhagic stroke appears to increase the risk of HO development. Further studies are required to determine if this risk factor is independent from other comorbid factors. [ABSTRACT FROM AUTHOR]

Objective: To assess brain injury services utilization and their determinants using Andersen's model. Methods: Prospective follow-up of the PariS-TBI inception cohort. Out of 504 adults with severe traumatic brain injury (TBI), 245 survived and 147 received a 4-year outcome assessment (mean age 33 years, 80% men). Provision rates of medical, rehabilitation, social and re-entry services and their relations to patients' characteristics were assessed. Results: Following acute care discharge, 78% of patients received physiotherapy, 61% speech/cognitive therapy, 50% occupational therapy, 41% psychological assistance, 63% specialized medical follow-up, 21% community re-entry assistance. Health-related need factors, in terms of TBI severity, were the main predictors of services. Provision of each therapy was significantly associated with corresponding speech, motor and psychological impairments. However, care provision did not depend on cognitive impairments and cognitive therapy was related to predisposing and geographical factors. Community re-entry assistance was provided to younger and more independent patients. Conclusions: These quantitative findings illustrate strengths and weaknesses of late brain injury care provision in urban France and highlight the need to improve treatment of cognitive impairments. [ABSTRACT FROM AUTHOR]

Study design:Review of the literature.Objectives:It is widely believed that the timing of surgery and the size of the initial Neurological Heterotopic Ossification (NHO) affect the recurrence risk of NHO after SCI. A large number of studies were published in the 80s and the 90s, mostly of poor quality despite the fact that they were carried out by experienced surgical teams. The aim of this study was to suggest recommendations relating to the timing of excision of heterotopic ossification after SCI following the analysis of a recent review of the literature.Setting:France.Methods:A systematic literature search was performed in the PubMed Embase from January 2002 until June 2014 using the MESH headings 'spinal cord injury', 'paraplegia', 'heterotopic ossification' and 'surgery'. Results were compared with results from epidemiological studies based on the BANKHO database (patients who underwent surgery for troublesome HO after central neurological system (CNS) lesions in our center (357 patients, 539 surgeries)).Results:Few studies were found in the literature, results were sometimes contradictory and practices heterogeneous. Results from the BANKHO database showed that troublesome recurrence of NHO was not associated with 'early' surgery (before 6 months), and no association was found between recurrence and the size of the NHO around the joint (Brooker status).Conclusion:We suggest that surgical excision of the NHO should be carried out when it begins to be troublesome, as soon as comorbid factors are under control and the HO is sufficiently constituted for excision. [ABSTRACT FROM AUTHOR]

Primary objective: To determine the pathways of care within the first year after traumatic brain injury (TBI) and to explore whether provided care is related to residual impairments. Research design: Retrospective study of 343 patients with moderate and severe TBI admitted to a Level-1 trauma centre. Methods and procedures: Discharge destinations from hospital to home and frequency of outpatient visits were determined. Outcome was defined 1 year after injury by the Extended Glasgow Outcome Scale and Return to Work. Results: Most (94%) patients had returned home 1-year after injury despite cognitive (76%), behavioural (67%) and physical (55%) impairments. One in four patients was severely disabled and 32% had resumed work on a previous level. Two-thirds of all patients went home as secondary discharge destination and 50% needed inpatient rehabilitation. Almost half of patients needed outpatient care, mostly for behavioural and cognitive impairments. One in 10 patients consulted a psychiatrist, with 55% unfavourable outcome. Of those patients initially discharged to home without follow-up, eventually 10% needed outpatient rehabilitation. Conclusions: One-year after injury most patients had returned home with residual impairments and frequent medical consultations. This finding warrants further investigation to define appropriate aftercare by various medical specialists aimed at long-term community integration. [ABSTRACT FROM AUTHOR]

Objectives: To assess outcome and predicting factors 1 year after a severe traumatic brain injury (TBI). Methods: Multi-centre prospective inception cohort study of patients aged 15 or older with a severe TBI in the Parisian area, France. Data were collected prospectively starting the day of injury. One-year evaluation included the relatives-rating of the Dysexecutive Questionnaire (DEX-R), the Glasgow Outcome Scale-Extended (GOSE) and employment. Univariate and multivariate tests were computed. Results: Among 257 survivors, 134 were included (mean age 36 years, 84% men). Good recovery concerned 19%, moderate disability 43% and severe disability 38%. Among patients employed pre-injury, 42% were working, 28% with no job change. DEX-R score was significantly associated with length of education only. Among initial severity measures, only the IMPACT prognostic score was significantly related to GOSE in univariate analyses, while measures relating to early evolution were more significant predictors. In multivariate analyses, independent predictors of GOSE were length of stay in intensive care (LOS), age and education. Independent predictors of employment were LOS and age. Conclusions: Age, education and injury severity are independent predictors of global disability and return to work 1 year after a severe TBI. [ABSTRACT FROM AUTHOR]

Background and Purpose Despite a successful surgical procedure, deficits in muscle strength and physical function are documented 1-2 years after total hip replacement (THR). There is a lack of evidence concerning which rehabilitation strategy is the most effective after THR. The purpose of this pilot study was to investigate the feasibility of an early-initiated intensified, home-based training regime and to form the basis of future studies with regard to exercises, outcome measures and power calculations. Methods The trial is a single-blinded, cluster-randomized controlled trial performed at an orthopaedic physiotherapy department in a public hospital in Denmark. A consecutive sample of 46 patients undergoing primary THR surgery for osteoarthritis between September 2008 and January 2009 was included. Forty-four patients completed the trial (96% follow-up). Participants were randomly assigned to an intervention group (IG, n = 23) receiving 12 weeks of intensified exercises (e.g. rubber band resistance) or a control group (CG, n = 21) receiving standard rehabilitation exercises without external resistance. The outcome measurements were maximal gait speed, isometric hip abductor muscle strength, one-legged stance, health-related quality of life (EuroQol-5 Dimensions), patient satisfaction, and patient-evaluated function, stiffness and pain (Western and Ontario McMasters University Osteoarthritis Index). Results There were significant increases in both groups in all the measurements during the 12 weeks of exercises. All participants in the IG were satisfied or very satisfied with the exercises compared with 85% in the CG ( P = 0.095). In the IG, four participants (17.4%) had difficulties when performing the intensified exercises at home. Hip abduction strength was significantly weaker in the leg operated compared with the leg not operated on after the intervention in both groups ( P < 0.01). Conclusion This pilot study indicates that the majority of THR patients tolerated early-initiated intensified exercises without additional pain and with high patient satisfaction. It seems that some of the patients need supervision to perform intensified exercises. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]