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Gait & Posture Mar 2012Impairments in gait coordination may be a factor in falls and mobility limitations after stroke. Therefore, rehabilitation targeting gait coordination may be an... (Comparative Study)
Comparative Study Review
Impairments in gait coordination may be a factor in falls and mobility limitations after stroke. Therefore, rehabilitation targeting gait coordination may be an effective way to improve walking post-stroke. This review sought to examine current treatments that target impairments of gait coordination, the theoretical basis on which they are derived and the effects of such interventions. Few high quality RCTs with a low risk of bias specifically targeting and measuring restoration of coordinated gait were found. Consequently, we took a pragmatic approach to describing and quantifying the available evidence and included non-randomised study designs and limited the influence of heterogeneity in experimental design and control comparators by restricting meta-analyses to pre- and post-test comparisons of experimental interventions only. Results show that physiotherapy interventions significantly improved gait function and coordination. Interventions involving repetitive task-specific practice and/or auditory cueing appeared to be the most promising approaches to restore gait coordination. The fact that overall improvements in gait coordination coincided with increased walking speed lends support to the hypothesis that targeting gait coordination gait may be a way of improving overall walking ability post-stroke. However, establishing the mechanism for improved locomotor control requires a better understanding of the nature of both neuroplasticity and coordination deficits in functional tasks after stroke. Future research requires the measurement of impairment, activity and cortical activation in an effort to establish the mechanism by which functional gains are achieved.
Topics: Accidental Falls; Exercise Therapy; Female; Gait Disorders, Neurologic; Humans; Male; Mobility Limitation; Physical Therapy Modalities; Postural Balance; Prognosis; Psychomotor Performance; Randomized Controlled Trials as Topic; Recovery of Function; Stroke; Stroke Rehabilitation; Treatment Outcome; Walking
PubMed: 22094228
DOI: 10.1016/j.gaitpost.2011.10.355 -
Zeitschrift Fur Gerontologie Und... Dec 2022Life-space mobility (LSM), as the extent of mobility within one's environment, is a key for successful aging and has become a relevant concept in gerontology and... (Review)
Review
BACKGROUND
Life-space mobility (LSM), as the extent of mobility within one's environment, is a key for successful aging and has become a relevant concept in gerontology and geriatric research. Adequate assessment instruments are needed to identify older persons with LSM restrictions, and to initiate, adapt or evaluate intervention strategies.
OBJECTIVE
To systematically identify, describe and analyze the psychometric properties of LSM questionnaires, with a special focus on their availability in the German language.
METHODS
A systematic literature search was conducted in PubMed, PsycINFO, Cochrane Library, CINAHL, and Web of Science. Studies that examined at least one psychometric property of LSM questionnaires published up to August 2021 were included and evaluated based on the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines.
RESULTS
This study included 37 validation studies describing 13 different LSM questionnaires. Methodological quality and comprehensiveness of validations were heterogeneous. Based on comprehensive and high-quality results, four LSM questionnaires stood out: the University of Alabama at Birmingham life-space assessment (UAB-LSA), life-space assessment in persons with cognitive impairment (LSA-CI), interview-based and proxy-based versions of the life-space assessment in institutionalized settings (LSA-IS), all of them available in the German language.
CONCLUSION
This systematic review provides a concise overview of available LSM questionnaires and their psychometric properties to facilitate the selection for use in clinical practice and research. The UAB-LSA and LSA-CI for community settings and the interview-based or proxy-based LSA-IS for institutional settings were found to be the most appropriate LSM questionnaires.
Topics: Humans; Aged; Aged, 80 and over
PubMed: 35244765
DOI: 10.1007/s00391-022-02035-5 -
Journal of the Peripheral Nervous... Dec 2016Symptoms of Charcot-Marie-Tooth (CMT) disease typically arise in childhood or adolescence with gait difficulty most common. A systematic review was conducted to... (Review)
Review
Symptoms of Charcot-Marie-Tooth (CMT) disease typically arise in childhood or adolescence with gait difficulty most common. A systematic review was conducted to synthesise, review, and characterise gait in paediatric CMT. Health-related electronic databases were reviewed with search terms related to CMT and gait. Of 454 articles, 10 articles describing seven studies met eligibility criteria; samples ranged from 1 to 81, included mixed CMT sub-types and had a participant mean age of 13 years. Assessments included a variety of methods to examine only barefoot gait. Heterogeneity of gait patterns was noted. Children and adolescents with CMT walked slower, most likely due to shorter stride length. Common kinematic and kinetic abnormalities included significant foot drop during swing, reduced calf muscle power, and proximal compensatory mechanisms in the lower limb. Little data were found to inform typical functional gait characteristics or change over time. Of note, barefoot assessment does not reflect function in everyday life where footwear is commonly worn. With limited existing literature, future studies of gait in paediatric CMT need to evaluate the influence of diagnostic sub-types and disease progression; the effect of factors such as footwear and the environment; and to explore changes in gait and function throughout childhood and adolescence.
Topics: Adolescent; Biomechanical Phenomena; Charcot-Marie-Tooth Disease; Child; Databases, Factual; Gait Disorders, Neurologic; Humans
PubMed: 27513454
DOI: 10.1111/jns.12183 -
Manual Therapy Aug 2016In adolescent athletes, low back pain has a 1-year prevalence of 57% and causes include spondylolysis and spondylolisthesis. An accurate diagnosis enables healing,... (Comparative Study)
Comparative Study Review
BACKGROUND
In adolescent athletes, low back pain has a 1-year prevalence of 57% and causes include spondylolysis and spondylolisthesis. An accurate diagnosis enables healing, prevention of progression and return to sport.
OBJECTIVE
To evaluate the diagnostic utility of patient history and physical examination data to identify spondylolysis and/or spondylolisthesis in athletes.
DESIGN
Systematic review was undertaken according to published guidelines, and reported in line with PRISMA.
METHOD
Key databases were searched up to 13/11/15.
INCLUSION CRITERIA
athletic population with LBP, patient history and/or physical examination accuracy data for spondylolysis and/or spondylolisthesis, any study design including raw data. Two reviewers independently assessed risk of bias (ROB) using QUADAS-2. A data extraction sheet was pre-designed. Pooling of data and investigation for heterogeneity enabled a qualitative synthesis of data across studies.
RESULTS
Of the eight included studies, two were assessed as low ROB, one of which also had no concerns regarding applicability. Age (<20 years) demonstrated 81% sensitivity and 44% specificity and gender (male) 73% sensitivity and 57% specificity for spondylolysis. Difficulty falling asleep, waking up because of pain, pain worse with sitting and walking all have sensitivity >75% for spondylolisthesis. Step-deformity palpation demonstrated 60-88% sensitivity and 87-100% specificity for spondylolisthesis. The one-legged hyperextension test was not supported for spondylolysis (sensitivity 50-73%, specificity 0-87%).
CONCLUSION
No recommendations can be made utilising patient history data. Based on one low ROB study, step deformity palpation may be useful in diagnosing spondylolisthesis. No physical tests demonstrated diagnostic utility for spondylolysis. Further research is required.
Topics: Adolescent; Age Factors; Athletes; Athletic Injuries; Female; Humans; Low Back Pain; Lumbar Vertebrae; Male; Medical History Taking; Physical Examination; Sex Factors; Spondylolisthesis; Spondylolysis
PubMed: 27317501
DOI: 10.1016/j.math.2016.03.011 -
Age and Type of Task-Based Impact of Mental Fatigue on Balance: Systematic Review and Meta-Analysis.Journal of Motor Behavior 2024The role of cognition in balance control suggests that mental fatigue may negatively affect balance. However, cognitive involvement in balance control varies with the... (Meta-Analysis)
Meta-Analysis Review
The role of cognition in balance control suggests that mental fatigue may negatively affect balance. However, cognitive involvement in balance control varies with the type or difficulty of the balance task and age. Steady-state balance tasks, such as quiet standing, are well-learned tasks executed automatically through reflex activities controlled by the brainstem and spinal cord. In contrast, novel, and challenging balance tasks, such as proactively controlling balance while walking over rugged terrain or reacting to unexpected external perturbations, may require cognitive processing. Furthermore, individuals with preexisting balance impairments due to aging or pathology may rely on cognitive processes to control balance in most circumstances. This systematic review and meta-analysis investigated the effect of mental fatigue on different types of balance control tasks in young and older adults. A literature search was conducted in seven electronic databases and 12 studies met eligibility criteria. The results indicated that mental fatigue had a negative impact on both proactive (under increased cognitive load) and reactive balance in young adults. In older adults, mental fatigue affected steady-state and proactive balance. Therefore, mentally fatigued older individuals may be at increased risk of a loss of balance during steady-state balance task compared to their younger counterparts.
Topics: Young Adult; Humans; Aged; Postural Balance; Aging; Walking; Cognition; Mental Fatigue
PubMed: 38189442
DOI: 10.1080/00222895.2023.2299706 -
Journal of Clinical Medicine Dec 2023This systematic review with meta-analysis was conducted to evaluate the effectiveness of local anesthetic administration into temporomandibular joint cavities in... (Review)
Review
This systematic review with meta-analysis was conducted to evaluate the effectiveness of local anesthetic administration into temporomandibular joint cavities in relieving pain and increasing mandibular mobility. Randomized controlled trials were included with no limitation on report publication dates. Final searches were performed on 15 October 2023, using engines provided by the US National Library, Bielefeld University, and Elsevier Publishing House. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Articular pain and mandible abduction values and their mean differences were summarized in tables and graphs. Eight studies on a total of 252 patients evaluating intra-articular administration of articaine, bupivacaine, lidocaine, and mepivacaine were included in the systematic review. None of the eligible studies presented a high risk of bias in any of the assessed domains. An analgesic effect of intra-articular bupivacaine was observed for up to 24 h. In the long-term follow-up, there were no statistically significant changes in quantified pain compared to both the baseline value and the placebo group, regardless of the anesthetic used (articaine, bupivacaine, and lidocaine). There is no scientific evidence on the effect of intra-articular administration of local anesthesia on the range of motion of the mandible. Therefore, in the current state of knowledge, the administration of local anesthetics into the temporomandibular joint cavities can only be considered as a short-term pain relief measure.
PubMed: 38202113
DOI: 10.3390/jcm13010106 -
The Cochrane Database of Systematic... Jan 2009Post-stroke motor impairments cause difficulty controlling the joints of the affected limbs to produce useful movements. One way to manage this to use an orthosis to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Post-stroke motor impairments cause difficulty controlling the joints of the affected limbs to produce useful movements. One way to manage this to use an orthosis to control the movement of the affected joints but evidence for their benefit is lacking.
OBJECTIVES
To determine the effectiveness of upper or lower limb orthoses on activity and impairment in people with stroke and other non-progressive brain lesions.
SEARCH STRATEGY
In February 2007 we searched the trials registers of the Cochrane Stroke, Movement Disorders and Injuries Groups, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1983), AMED (from 1985), PsycINFO (from 1967) and RECAL (from 1990), and other databases and trials registers. We screened reference lists, contacted lead authors and other researchers in the field.
SELECTION CRITERIA
We included randomised controlled trials of orthoses applied to the upper or lower limb in people with stroke and other non-progressive brain lesions.
DATA COLLECTION AND ANALYSIS
Two review authors independently identified trials, extracted data, and assessed trial quality. Results for continuous outcomes were combined and analysed using mean difference or standardised mean difference, both with 95% confidence intervals and fixed-effect model.
MAIN RESULTS
We analysed 14 trials with 429 participants. The overall effect of lower limb orthoses on walking disability (speed), walking impairment (step/stride length) and balance impairment (weight distribution in standing) was significant and beneficial. There was no significant effect on postural sway (balance impairment) or mobility disability but the numbers of studies and participants were low. However, these were all cross-over trials that looked at the immediate effect while wearing the orthosis; they did not assess the effects of wearing an orthosis over the long term. Upper limb orthoses showed no effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain. However, this was based on only three trials.
AUTHORS' CONCLUSIONS
A lower limb orthosis can improve walking and balance but the included studies have only examined the immediate effects while wearing the orthosis; the effects of long-term use have not been investigated. An upper limb orthosis does not effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain, but this conclusion is based on only three trials.
Topics: Arm; Brain Diseases; Humans; Leg; Orthotic Devices; Randomized Controlled Trials as Topic; Stroke Rehabilitation; Walking
PubMed: 19160222
DOI: 10.1002/14651858.CD003694.pub2 -
Neurorehabilitation and Neural Repair Sep 2021. Ambulatory tasks are the important components of balance training which effectively improve postural stability and functional activities in persons with Parkinson's... (Meta-Analysis)
Meta-Analysis
. Ambulatory tasks are the important components of balance training which effectively improve postural stability and functional activities in persons with Parkinson's disease (PD). The difficulty level of an ambulatory task is usually set in the form of attention, direction, speed, or amplitude requirement. . This study aimed to explore the neural mechanisms of cerebral hemodynamic responses to the difficulty level of ambulatory tasks in persons with PD. . We included ten studies that examined cerebral hemodynamic responses during ambulatory tasks at different difficulty levels in persons with PD. The change in hemodynamic responses was synthesized and meta-analyzed. . Patients during "ON" medication had higher relative change in oxygenated hemoglobin (ΔHBO) in the prefrontal cortex in response to difficulty levels of ambulatory tasks, which is comparable to that in healthy elderly individuals. However, patients during "OFF" medication did not show cortical activation in response to difficulty levels. During the lower-difficulty tasks, patients during "ON" medication demonstrated higher ΔHBO than healthy elderly participants and patients during "OFF" medication. Factors found to significantly contribute to the heterogeneity across studies included subjects' type and cognitive status, task duration, setting, and filter used for functional near-infrared spectroscopy (fNIRS) data pre-processing. . The findings suggest that ambulatory task at a higher difficulty level could be necessary to train the cortical capacity of PD persons, which should be conducted during "ON" medication; meanwhile, the contributing factors to the heterogeneity of studies would be useful as a reference when designing comparable fNIRS studies.
Topics: Brain; Cerebrovascular Circulation; Functional Neuroimaging; Hemodynamics; Humans; Parkinson Disease; Posture; Spectroscopy, Near-Infrared; Walking
PubMed: 34171982
DOI: 10.1177/15459683211028548 -
The Cochrane Database of Systematic... Jul 2009Post-stroke motor impairments cause difficulty controlling the joints of the affected limbs to produce useful movements. One way to manage this to use an orthosis to... (Review)
Review
BACKGROUND
Post-stroke motor impairments cause difficulty controlling the joints of the affected limbs to produce useful movements. One way to manage this to use an orthosis to control the movement of the affected joints but evidence for their benefit is lacking.
OBJECTIVES
To determine the effectiveness of upper or lower limb orthoses on activity and impairment in people with stroke and other non-progressive brain lesions.
SEARCH STRATEGY
In February 2007 we searched the trials registers of the Cochrane Stroke, Movement Disorders and Injuries Groups, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1983), AMED (from 1985), PsycINFO (from 1967) and RECAL (from 1990), and other databases and trials registers. We screened reference lists, contacted lead authors and other researchers in the field.
SELECTION CRITERIA
We included randomised controlled trials of orthoses applied to the upper or lower limb in people with stroke and other non-progressive brain lesions.
DATA COLLECTION AND ANALYSIS
Two review authors independently identified trials, extracted data, and assessed trial quality. Results for continuous outcomes were combined and analysed using mean difference or standardised mean difference, both with 95% confidence intervals and fixed-effect model.
MAIN RESULTS
We analysed 14 trials with 429 participants. The overall effect of lower limb orthoses on walking disability (speed), walking impairment (step/stride length) and balance impairment (weight distribution in standing) was significant and beneficial. There was no significant effect on postural sway (balance impairment) or mobility disability but the numbers of studies and participants were low. However, these were all cross-over trials that looked at the immediate effect while wearing the orthosis; they did not assess the effects of wearing an orthosis over the long term. Upper limb orthoses showed no effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain. However, this was based on only three trials.
AUTHORS' CONCLUSIONS
A lower limb orthosis can improve walking and balance but the included studies have only examined the immediate effects while wearing the orthosis; the effects of long-term use have not been investigated. An upper limb orthosis does not effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain, but this conclusion is based on only three trials.
Topics: Arm; Brain Diseases; Humans; Leg; Orthotic Devices; Randomized Controlled Trials as Topic; Stroke Rehabilitation; Walking
PubMed: 19588345
DOI: 10.1002/14651858.CD003694.pub3 -
World Neurosurgery Mar 2024Intramedullary meningiomas are an exceptionally rare subtype of spinal tumors, accounting for only 5% of primary spinal neoplasms. Given their scarcity and unique... (Review)
Review
BACKGROUND
Intramedullary meningiomas are an exceptionally rare subtype of spinal tumors, accounting for only 5% of primary spinal neoplasms. Given their scarcity and unique characteristics, understanding optimal management approaches is crucial for improved clinical decision-making. This systematic review aims to consolidate existing literature and present a detailed case illustration to enhance understanding of this uncommon spinal tumor entity.
METHODS
A systematic search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Eligible studies included case reports, case series, cohort studies, reviews, and meta-analyses. Data extraction and synthesis focused on demographic characteristics, tumor location, clinical presentation, imaging findings, surgical interventions, histopathological features, and outcomes.
RESULTS
A total of 15 high-quality scientific articles were included in the systematic review, providing insights into various aspects of intramedullary meningiomas. Demographic analysis revealed a broad age distribution with an equal gender distribution among affected patients. Common clinical presentations included difficulty walking, sensory disturbances, spastic paraparesis, and urinary incontinence. Neuroimaging findings demonstrated heterogeneous signal intensity variations on T1- and T2-weighted images, with variable enhancement patterns on gadolinium-enhanced images. Surgical interventions, predominantly total resection, resulted in favorable postoperative outcomes in most cases.
CONCLUSIONS
Intramedullary meningiomas pose diagnostic and therapeutic challenges due to their rarity and unique characteristics. Tailored surgical approaches, incorporating techniques such as intraoperative neurophysiological monitoring and fluorescence-aided resection, are crucial for minimizing neurological deficits and optimizing patient outcomes. Despite their infrequency, recognizing intramedullary meningiomas in the differential diagnosis of spinal tumors is essential for prompt diagnosis and timely intervention, ultimately improving patient prognosis.
PubMed: 38548054
DOI: 10.1016/j.wneu.2024.03.124