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Advances in Therapy Jul 2024Limitations in physical functioning are common in patients with late-stage chronic kidney disease (CKD) and can greatly affect their lives. Using patient interviews,...
INTRODUCTION
Limitations in physical functioning are common in patients with late-stage chronic kidney disease (CKD) and can greatly affect their lives. Using patient interviews, this study reports experiences associated with physical functioning limitations for patients with late-stage CKD.
METHODS
A preliminary conceptual model on concepts relevant to physical functioning limitations in patients with CKD was developed using data from a targeted literature review (patients with CKD stages IV-V) and previous interviews (patients with CKD stages IIIa-IIIb). The preliminary conceptual model informed a semi-structured interview guide designed to capture experiences of physical functioning limitations in patients with CKD. Patients with CKD stages IV-V who were not receiving dialysis were interviewed; their responses were used to develop a comprehensive conceptual model summarizing their experiences associated with physical functioning limitations.
RESULTS
A total of 25 patients with CKD stage IV (n = 19) or V (n = 6) were interviewed. Based on patient responses, the reported concepts were grouped into one of six categories: physical functioning limitations/difficulties, behavioural impacts, activity participation restrictions, symptoms attributed to physical functioning limitations, impacts on sleep and emotional functioning impacts related to physical functioning limitations. Twenty-three patients reported concepts associated with physical functioning limitations, most frequently 'walking up and down stairs' (83%) and 'walking distances' (74%). All 23 patients also reported behavioural impacts, including 'need to rest/subsequent periods of rest' (100%) and 'participation in fewer activities' (91%). As well as summarizing the reported concepts, the comprehensive conceptual model shows how concepts may relate to one another; for example, challenging symptoms or difficulty completing tasks can lead to changes in patient behaviour such as purposely reducing or avoiding activities.
CONCLUSIONS
This study found that patients with late-stage CKD not receiving dialysis who experience physical functioning limitations report a range of impacts on their daily lives. The comprehensive conceptual model summarizes the concepts reported and the relationships between them, providing a holistic understanding of how patients with late-stage CKD are affected by physical functioning limitations. Infographic available for this article. INFOGRAPHIC.
Topics: Humans; Male; Female; Aged; Renal Insufficiency, Chronic; Middle Aged; Qualitative Research; Activities of Daily Living; Aged, 80 and over; Interviews as Topic; Quality of Life; Severity of Illness Index
PubMed: 38722538
DOI: 10.1007/s12325-024-02853-6 -
Journal of Hazardous Materials Jul 2024High U concentrations (reaching up to 14,850 mg ⋅ kg), were determined in soils and sediments of a wetland downstream of a former U mine in France. This study aims...
High U concentrations (reaching up to 14,850 mg ⋅ kg), were determined in soils and sediments of a wetland downstream of a former U mine in France. This study aims to identify the origin of radioactive contaminants in the wetland by employing Pb isotope fingerprinting, (U/U) disequilibrium, SEM, and SIMS observations. Additionally, information about U and Ra transport processes was studied using U-238 series disequilibrium. The results of Pb fingerprinting highlighted inherited material inputs of different U-mines with mainly two types of U-ores: i) pitchblende (UO), and ii) parsonsite (Pb(UO)(PO)). Moreover, significant disequilibrium of (Th/U) and (Ra/Th) activity ratios highlighted the mobility of U and Ra in the wetland, primarily driven by the water table fluctuations. Finally, this work uncovered a limitation of Pb isotope fingerprinting in the case of parsonsite materials, as the high natural Pb content of this mineral may hide the uranogenic Pb signature in the samples.
PubMed: 38703677
DOI: 10.1016/j.jhazmat.2024.134416 -
BMC Musculoskeletal Disorders May 2024Recent advancements in and the proliferation of autonomous mobility technology, such as intelligent wheelchairs, have made it possible to provide mobility services for...
Safety and feasibility of in-hospital autonomous transportation using a driverless mobility for patients with musculoskeletal disorders: preliminary clinical study to achieve mobility as a service in medical care.
BACKGROUND
Recent advancements in and the proliferation of autonomous mobility technology, such as intelligent wheelchairs, have made it possible to provide mobility services for patients with reduced mobility due to musculoskeletal disorders. In the present study, we conducted a preliminary clinical study to assess the safety and feasibility of in-hospital autonomous transportation using a driverless mobility (wheelchair) for patients with musculoskeletal disorders.
METHODS
From January to February 2022, 51 patients with musculoskeletal disorders exhibiting gait disturbance who presented to our institution were included in the present study. Driverless mobility rides were conducted over a straight-line distance of 100 m from the orthopaedic outpatient reception to the payment counter after the outpatient consultation. We assessed the quality of life using an EQ-5D-5 L index and pain using a VAS score before riding the mobility to investigate the patient's condition. After the ride, a questionnaire survey was conducted to assess patient satisfaction on a 5-point scale. In addition, adverse events during the mobility ride were investigated.
RESULTS
Overall satisfaction levels showed that 44 out of 51 (86%) patients rated the level as 3 or higher. There were no significant differences in the level of satisfaction based on the cause of disorders or EQ-5D-5 L Index. Among 19 patients who rated the level of satisfaction as 2-3, the ratio of postoperative patients and those with pain tended to be higher (p < 0.05). While 26 of 51 (51%) patients reported moments of feeling unsafe during the mobility ride, no actual adverse events, such as collisions, were observed.
CONCLUSIONS
An in-hospital autonomous transportation service using a driverless mobility for patients with musculoskeletal disorders demonstrated high satisfaction levels and was safe with no severe adverse events observed. The expansion of autonomous mobility deployment is expected to achieve mobility as a service in medical care.
Topics: Humans; Male; Musculoskeletal Diseases; Female; Middle Aged; Feasibility Studies; Adult; Aged; Patient Satisfaction; Quality of Life; Wheelchairs; Transportation of Patients; Mobility Limitation; Surveys and Questionnaires; Aged, 80 and over
PubMed: 38702633
DOI: 10.1186/s12891-024-07417-x -
Journal of Sport Rehabilitation Jul 2024Sport-related dystonia is a rare form of activity-specific dystonia that can severely impair an athlete's ability to perform. Due to a lack of data on the condition, it...
CONTEXT
Sport-related dystonia is a rare form of activity-specific dystonia that can severely impair an athlete's ability to perform. Due to a lack of data on the condition, it is difficult to diagnose and often overlooked, and no gold standard treatment has yet been defined.
CASE PRESENTATION
We present a rare and challenging case of sport-related dystonia that affected a 24-year-old male professional soccer player. The patient presented with severe rigidity and dystonia of the right lower-extremity, particularly the ankle and foot. The symptoms set on >1 year prior to the presentation to our outpatient clinic. He began to complain of stiffness and difficulty moving his lower limbs, especially his right leg, initially when playing soccer, but then also when walking normally. On presentation, he was unable to run and walked with difficulty, supporting his body weight only on the outside of his right foot. He also reported a motor trick and reverse motor trick involving the oral musculature in order to move his lower limb more freely.
MANAGEMENT AND OUTCOMES
An integrated rehabilitation approach based on postural rehabilitation, neuromuscular rehabilitation, and dental intervention was used to successfully treat this condition. The approach included: (1) postural rehabilitation with the Mézières-Bertelè method to reduce muscular stiffness, (2) neuromuscular re-education with Tai Chi exercises and electromyography-guided biofeedback, and (3) dental intervention and swallowing rehabilitation to limit impaired oral habits (due to the relationship between his impaired lower limb movements and motor tricks of the oral musculature). After 7 months of integrated rehabilitation, the patient returned to professional soccer.
CONCLUSIONS
This case report highlights the potential efficacy of an integrative rehabilitation approach for sports dystonia, particularly in cases where traditional treatments may not be effective. Such an approach could be considered a valuable option in the management of this rare, but debilitating, condition in athletes. Further research is needed to assess the effectiveness of this approach in larger populations.
Topics: Humans; Male; Soccer; Young Adult; Dystonia; Lower Extremity
PubMed: 38702050
DOI: 10.1123/jsr.2023-0100 -
Frontiers in Psychology 2024The use of mobile exoskeletons as assistive walking devices has the potential to affect the biomechanics of the musculoskeletal system due to their weight and restricted...
BACKGROUND
The use of mobile exoskeletons as assistive walking devices has the potential to affect the biomechanics of the musculoskeletal system due to their weight and restricted range of motion. This may result in physical and cognitive load for the user. Understanding how lower extremity loading affects cognitive-motor interference is crucial for the design of wearable devices, including powered exoskeletons, and the development of effective training interventions.
OBJECTIVE
This study aims to examine the effects of modified leg mechanics on cognitive-motor interference in dual-task walking. Gait variability, as an indicator of motor control, was analyzed to investigate its relation to cognitive task difficulty and to determine whether lower extremity loading modifies this relationship. Additionally, the impact on the gait pattern, as represented by the mean values of spatio-temporal gait parameters were investigated.
METHOD
Fifteen healthy young adults walked on a treadmill with and without weight cuffs bilaterally attached to their thighs and shanks while performing a visual-verbal Stroop test (simple task) and a serial subtraction task (difficult task). Dependent variables include mean values and variability (coefficients of variation) of step length, step width, stride time and double support time. Additionally, secondary task performance as correct response rates and perceived workload were assessed.
RESULTS
Double support time variability decreased during dual-task walking, but not during walking with modified leg mechanics while performing the difficult secondary task. Walking with modified leg mechanics resulted in increased gait variability compared to normal walking, regardless of cognitive load. During walking with modified leg mechanics, step length, step width, and stride time increased, while double support time decreased. The secondary tasks did not affect the gait pattern.
CONCLUSION
The interplay between an external focus of attention and competition for attentional resources may influence the variability of double support time. The findings suggest that walking with modified leg mechanics could increase cognitive-motor interference for healthy young adults in demanding dual-task situations. Therefore, it is important to analyze the underlying mechanisms of cognitive-motor interference in the context of human-exoskeleton interaction.
PubMed: 38699569
DOI: 10.3389/fpsyg.2024.1375029 -
The Journal of Nutrition, Health & Aging May 2024Post-stroke fatigue (PSF) is an experience characterized by an early feeling of exhaustion with fatigue, a lack of energy, and difficulty in exertion, both motor and...
OBJECTIVES
Post-stroke fatigue (PSF) is an experience characterized by an early feeling of exhaustion with fatigue, a lack of energy, and difficulty in exertion, both motor and cognitive. To counteract fatigue and limit its effects on activities of daily living, the use of vitamins and minerals is known in addition to the pharmacological approach. However, few studies have evaluated the effect of vitamin and mineral supplementation on fatigue management. SiderAL® Med is a food for special medical purposes with a complete formulation containing vitamins, sucrosomal minerals, copper and algal calcium. The aim of the study is to evaluate whether nutritional supplementation with SiderAL® Med improves the symptom of fatigue and motor and cognitive function in stroke patients.
DESIGN
This is a pilot, randomized study with a control group.
SETTING
Post-Acute Rehabilitation Unit of the Fondazione Policlinico "A. Gemelli" IRCCS.
PARTICIPANTS
Twenty-four patients with stroke outcomes, admitted to rehabilitation, were recruited and randomized into the experimental group (Sid-G) and the control group (CG).
INTERVENTION
The Sid-G patients, in association with the pharmacological and rehabilitation therapy foreseen during hospitalization, took SiderAL® Med, one sachet per day for 8 weeks, while the CG patients underwent only the pharmacological and rehabilitation therapy foreseen in the daily routine.
MEASUREMENTS
All patients were assessed at baseline (T0), after 4 weeks (T1), after 8 weeks (T2) and after 12 weeks (T3) for motor and cognitive fatigue, balance, walking, functional capacity, cognitive performance, autonomy, quality of life and body composition.
RESULTS
Both Sid-G and CG patients showed significant improvement on most rating scales between T0-T1-T2-T3 (p = 0.0001). When comparing the two groups, a statistically significant difference emerged in favor of Sid-G with regard to motor fatigue (p = 0.007), cognitive fatigue (p = 0.009) and total fatigue (p = 0.034); balance (p < 0.001), functional capacity (p < 0.001); cognitive performance (p = 0.004); bone mineral content (p = 0.005), lean mass (p = 0.005), total mass (p < 0.001) and percentage of fat mass (p = 0.039).
CONCLUSION
Nutritional supplementation with SiderAL® Med, in concert with intensive rehabilitation treatment, appears to be effective in managing fatigue and improving motor and cognitive performance and body composition, representing a valuable tool to associate with rehabilitation treatment in stroke patients.
PubMed: 38696891
DOI: 10.1016/j.jnha.2024.100256 -
Orthopedics May 2024Multiligament knee injury (MLKI) is a severe subclass of orthopedic injury and can result in significant functional impairment. Novel MLKI graft constructs such as...
BACKGROUND
Multiligament knee injury (MLKI) is a severe subclass of orthopedic injury and can result in significant functional impairment. Novel MLKI graft constructs such as suture augmentation aim to enhance graft strength and optimize knee stability. The purpose of this study was to present patient-reported outcome measurements of a cohort at a minimum follow-up of 2 years after multiligament knee reconstruction (MLKR) with suture augmentation.
MATERIALS AND METHODS
A retrospective chart review was performed to identify patients who underwent MLKR with suture augmentation. Demographic and injury-specific variables were gathered preoperatively and postoperatively. Patients were contacted at a minimum of 2 years postoperatively to collect Patient-Reported Outcomes Measurement Information System, Multiligament Quality of Life, and Lysholm knee scores.
RESULTS
Twenty-seven patients underwent MLKR with suture augmentation, with 15 being female (55.6%) and 12 being male (44.4%). The mean pain score was 49.93±9.96, the mean physical function score was 49.56±10.94, and the mean mobility score was 47.56±8.58. The mean physical impairment score was 33.96±23.69, the mean emotional impairment score was 36.55±26.60, the mean activity limitation score was 28.00±25.61, and the mean societal involvement score was 30.09±27.45. The mean Lysholm knee score for the cohort was 67.93±22.36.
CONCLUSION
Patients who underwent MLKR with suture augmentation had satisfactory scores across all patient-reported outcome measurements. On the basis of these criteria, the average patient achieved an acceptable clinical outcome, demonstrating that MLKR with suture augmentation is a safe and efficacious surgical technique for the treatment of MLKI. [. 202x;4x(x):xx-xx.].
PubMed: 38690848
DOI: 10.3928/01477447-20240424-02 -
Journal of Orthopaedic Case Reports Apr 2024Atlanto-occipital assimilation is the most common osseous anomaly of the cervical-occipital junction. The incidence rate of occipitalization has been reported...
INTRODUCTION
Atlanto-occipital assimilation is the most common osseous anomaly of the cervical-occipital junction. The incidence rate of occipitalization has been reported 1.42.5/1000 children. Most of the patients are asymptomatic initially. Clinical features usually appear after 3rd decade depending on the level and degree of spinal cord compression with surrounding vital structures such as vertebral artery involvement. Hence, early definitive diagnosis and subsequent successful treatment are necessary in such cases to prevent life-threatening complications.
CASE REPORT
A 16-year-old male presented with neck pain and progressive weakness of the bilateral lower limb since the past 2 months suffering from difficulty in walking, giddiness, and numbness of his fingertips. Hoffman's sign was positive. Plain cervical spine radiography (AP and lateral) is falsely suggestive of the absence of an atlas. MRI revealed the tip of the dens projecting 1314 mm above the Chamberlains line suggestive of basilar invagination. Occipito-cervical fixation was planned with an occipital plate, laminar, pedicle screw, and rods. Occipital plate fixed with screws (6,8 mm). C2 vertebra fixation with pedicle screw and laminar screws and C3 vertebra with a lateral mass screw under C-arm guidance. The patient mobilized with a walker from post-operative day 2 and then he ambulated unaided.
CONCLUSION
Different types of atlanto-occipital assimilation have been reported. Treatment modality completely depends on neurological symptoms and instability.Although, different surgical options are available, occipito-cervical fixation with occipital plate, screws, and rod fixation is the most superior surgical technique for atlanto-occipital assimilation with atlanto-occipital instability.
PubMed: 38681935
DOI: 10.13107/jocr.2024.v14.i04.4356 -
Cureus Mar 2024Antineutrophil cytoplasmic antibody-related vasculitis (AAV), is a group of diseases marked by systemic symptoms and severe small vessel inflammation. The three subtypes...
Antineutrophil cytoplasmic antibody-related vasculitis (AAV), is a group of diseases marked by systemic symptoms and severe small vessel inflammation. The three subtypes of AAV are eosinophilic GPA (EGPA), Microscopic Polyangiitis (MPA), and Granulomatosis with Polyangiitis (GPA). The organs that get involved in the disease process are the kidneys and the upper and lower respiratory tracts, with a spectrum of neurological manifestations. Here, we present a case report of a 68-year-old man who came with complaints of tingling and numbness over bilateral lower limbs for two months accompanied by difficulty in walking and bilateral foot drop without any respiratory complaints or involvement of sensory or autonomic system who was diagnosed with AAV (c-ANCA +) on further workup. A sural Nerve biopsy was done for confirmation which was suggestive of chronic, asymmetrical axonal neuropathy with perivascular inflammation, suggestive of vasculitic neuropathy. The patient had no other organ involvement. The patient was started on glucocorticoids and cyclophosphamide therapy for 6 cycles after which his symptoms and quality of life improved drastically.
PubMed: 38681477
DOI: 10.7759/cureus.57046