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Healthcare (Basel, Switzerland) Jun 2024With the advent of global aging, the health of the older population has become a critical public health challenge. The purpose of this study was to investigate the...
BACKGROUND
With the advent of global aging, the health of the older population has become a critical public health challenge. The purpose of this study was to investigate the effect of dual-tasking on gait performance in patients with sarcopenia.
METHODS
Thirty participants with sarcopenia (age: 70.73 ± 4.12 yr, MMSE score: 26.90 ± 3.00), including 14 males and 16 females, were selected according to the diagnostic criteria of the Asian Working Group on Sarcopenia. All participants were instructed to perform the gait test in three modes: single task (ST), cognitive-motor dual task (CMDT), and motor-motor dual task (MMDT). Statistical analyses were performed using one-way ANOVA to evaluate the effects of different task types on gait parameters of the participants.
RESULTS
(1) Compared with ST walking, gait frequency, step length, and step speed decreased, and the gait cycle and double-support phase increased in patients with sarcopenia during dual-task walking ( < 0.05); (2) Compared with ST walking, gait variability indices such as stride frequency, stride length, and support period significantly increased in patients with sarcopenia during dual-task walking ( < 0.05).
CONCLUSIONS
The increased difficulty in postural control caused by dual-task interference may reduce the safety of motor strategies in patients with sarcopenia and increase the risk of falls. Future studies should focus on the effects of exercise interventions on multitasking patterns in people with sarcopenia to promote balance function in these populations.
PubMed: 38921320
DOI: 10.3390/healthcare12121206 -
Diseases (Basel, Switzerland) Jun 2024Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) frequently coexist, significantly impacting health-related quality of life (HRQoL). This...
Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) frequently coexist, significantly impacting health-related quality of life (HRQoL). This study evaluated HRQoL in patients with CHF, COPD, or both, three months post-COVID-19 discharge using EQ-5D and KCCQ questionnaires to guide targeted healthcare interventions. We conducted a cross-sectional study at "Victor Babes" Hospital in Timisoara, enrolling 180 patients who had recovered from COVID-19 (60 in each group including CHF, COPD, and both conditions). HRQoL was assessed via EQ-5D and KCCQ. Significant disparities in HRQoL measures were noted across the groups. Patients with both CHF and COPD reported the worst outcomes, especially in terms of hospital stay lengths due to COVID-19 (11.63 days) and initial oxygen saturation levels (88.7%). HRQoL improvements from discharge to three months post-discharge were significant, with EQ-5D mobility scores improving notably across all groups (CHF and COPD: 2.87 to 2.34, = 0.010). KCCQ results reflected substantial enhancements in physical limitation (CHF and COPD: 38.94 to 58.54, = 0.001) and quality of life scores (CHF and COPD: 41.38 to 61.92, = 0.0031). Regression analysis revealed that dual diagnosis (CHF and COPD) significantly impacted usual activities and quality of life (β = -0.252, = 0.048; β = -0.448, = 0.017), whereas the initial severity of COVID-19 was a significant predictor of worse HRQoL outcomes (β = -0.298, = 0.037; β = -0.342, = 0.024). The presence of both CHF and COPD in patients recovering from COVID-19 was associated with more severe HRQoL impairment compared with either condition alone. These findings emphasize the need for specialized, comprehensive post-COVID-19 recovery programs that address the complex interplay among chronic conditions to optimize patient outcomes and enhance quality of life.
PubMed: 38920556
DOI: 10.3390/diseases12060124 -
Journal of Neuroengineering and... Jun 2024Treadmill gait training has been shown to improve gait performance in People with Parkinson's Disease (PwPD), and in combination with Virtual Reality, it can be an...
BACKGROUND
Treadmill gait training has been shown to improve gait performance in People with Parkinson's Disease (PwPD), and in combination with Virtual Reality, it can be an effective tool for gait rehabilitation. The addition of gamification elements can create a more stimulating and adherent intervention. However, implementation of new technologies in healthcare can be challenging. This study aimed to develop and evaluate the feasibility of a treadmill rehabilitation program in a Gamified Virtual Reality Environment (GVRE) for PwPD.
METHODS
The GVRE was developed following a user-centered design approach, involving both PwPD and physiotherapists in the development and evaluation of the intervention. The intervention consisted of a walking simulation in three different environments (countryside, city, and park), which had a progressive increase in difficulty. To test its feasibility, three sessions were carried out with four PwPD and four physiotherapists. To assess the usability, the System Usability Scale (SUS), Assistive Technology Usability Questionnaire for people with Neurological diseases (NATU Quest) and Simulator Sickness Questionnaire (SSQ) were used. To assess the intervention's acceptability, feedback and in-game performance was collected from participants.
RESULTS
Results showed the feasibility of the intervention, with a SUS score of 74.82 ± 12.62, and a NATU Quest score of 4.49 ± 0.62, and positive acceptability feedback. Participants showed clear preferences for naturalistic environments, and gamification elements were seen as positive. Difficulty settings worked as intended, but lowered enjoyment of the experience in some cases.
CONCLUSIONS
This intervention was successfully shown as a feasible option for the training of gait under Dual Task conditions for PwPD. It offers a safe and replicable environment in which complex situations can be trained. However, further iterations of the intervention need to be improved in order to guarantee accurate tracking and a more realistic training progression.
TRIAL REGISTRATION NUMBER
NCT05243394-01/20/2022.
Topics: Humans; Parkinson Disease; Feasibility Studies; Male; Virtual Reality; Aged; Female; Middle Aged; Gait Disorders, Neurologic; Video Games; Exercise Therapy; Gait
PubMed: 38915103
DOI: 10.1186/s12984-024-01399-6 -
The Journal of Clinical and Aesthetic... Jun 2024Atopic dermatitis (AD) is an inflammatory skin condition affecting both mental and physical health. Although research has shown reduced physical activity levels among...
Association Between Atopic Dermatitis and Impaired Mobility among Adults in the United States: Findings from the 2001-2006 National Health and Nutrition Examination Survey.
OBJECTIVE
Atopic dermatitis (AD) is an inflammatory skin condition affecting both mental and physical health. Although research has shown reduced physical activity levels among patients with AD, there is a scarcity of studies examining baseline mobility, which refers to the standard level of functional ambulation or movement capability. We analyzed the relationship between AD and baseline mobility among U.S. adults ages 20 to 59, utilizing the National Health and Nutrition Examination Survey (NHANES).
METHODS
We merged three, 2-year cycles of NHANEs data (2001-2006). Patients were categorized as having "impaired mobility" by the following question: "Because of a health problem, do you have difficulty walking without using any special equipment?" Multivariable logistic regression analyses were performed using STATA/SE 18.0.
RESULTS
Our analysis included 6,540 participants. The prevalence of impaired mobility was 7.1 percent among patients with AD and 3.9 percent among those without AD. This difference was statistically significant among patients aged 20 to 59 after adjusting for potential confounding variables (adjusted odds ratio [AOR], 1.65; 95% CI, 1.19-3.25; =0.010). Subgroup analysis showed increased rates of impaired mobility among males with AD (AOR, 2.55; 95% CI, 1.21-5.40; =0.016), and among adults aged 40 to 59 (AOR, 1.94; 95% CI, 1.03-3.68; =0.042).
LIMITATIONS
Limitations to our study include lack of specificity in the survey questionnaire, self-reporting bias, and an age limit of 59 years old.
CONCLUSION
Our study demonstrated a statistically significant elevation in impaired mobility among individuals with AD compared to those without AD. This underscores the importance of comprehensive care for AD patients.
PubMed: 38912191
DOI: No ID Found -
SAGE Open Medicine 2024Ambulatory mobility aids are several devices the elderly may use in order to improve their walking pattern, balance, or safety while mobilizing independently.
INTRODUCTION
Ambulatory mobility aids are several devices the elderly may use in order to improve their walking pattern, balance, or safety while mobilizing independently.
OBJECTIVES
To assess the effect of ambulatory mobility aid devices on cardiovascular parameters, walking speed, perceived exertion, and balance of older adult men.
METHODS
A sample of 156 old men was studied. Data were obtained through measurement of the participants' walking speed (distance covered/second), cardiovascular parameters (blood pressure), perceived exertion (difficulty or ease in breathing), and balance (ease in standing) after walking with and without the selected walking aid devices. Analysis was done to compare the effect of the walking aid devices on the selected dependent variables.
RESULTS
Results showed ambulation with mobility aid devices resulted in increase in the heart rate and blood pressure with the greatest increase observed when walking with Zimmer frame. Ambulation with mobility aid devices resulted in decrease of the walking speed of the participants when compared to ambulation without devices. Perceived exertion of participants after using Zimmer frame and walking cane was within 4.06 ± 1.35 and 3.98 ± 1.26, respectively, as opposed to 3.08 ± 0.73 after ambulation without aid. Use of Zimmer frame provided enough balance for participants.
CONCLUSION
Ambulatory mobility devices caused difference in cardiovascular parameters when compared to ambulation at rest and without aid. It was recommended that selection of ambulatory mobility aid devices should depend on objective mobility assessments and periodical re-evaluation to ensure that it suits a person's functional requirements and physical capabilities.
PubMed: 38911443
DOI: 10.1177/20503121241262250 -
Journal of Orthopaedic Case Reports Jun 2024Intramedullary nailing is a commonly performed surgery for tibia diaphysis fractures. However, in selected cases, this procedure can get complicated with rotational...
INTRODUCTION
Intramedullary nailing is a commonly performed surgery for tibia diaphysis fractures. However, in selected cases, this procedure can get complicated with rotational malalignment if not checked carefully intra-operatively.
CASE REPORT
A 29 year-old male sustained polytrauma and was treated with intramedullary nailing for bilateral femur and right-side tibia fractures. Postoperatively, the patient noticed extreme in-toeing suggesting an internal rotation deformity, which caused great difficulty in walking. The patient was planned for a revision surgery to correct the internal rotation deformity, 6 months after the index surgery. A minimally invasive metaphyseal osteotomy was performed, away from his fracture site by drilling multiple holes. The distal locking bolts of the interlocking nail were removed, and two K wires used to achieve the desired correction angle. After rotating the distal fragment, locking bolts were reinserted in new holes. We kept the patient on our regular follow-up till he achieved sound union at the osteotomy site, after which we allowed him unrestricted activities.
CONCLUSION
The presence of an intramedullary nail can hence help the surgeon in correcting such isolated rotational deformities without getting into the hassle of implant removal to achieve the same.
PubMed: 38910987
DOI: 10.13107/jocr.2024.v14.i06.4490 -
Cureus May 2024Soft tissue inflammatory responses to metal debris from prostheses, categorised as adverse reactions to metal debris (ARMD), are frequent complications of total hip...
Soft tissue inflammatory responses to metal debris from prostheses, categorised as adverse reactions to metal debris (ARMD), are frequent complications of total hip arthroplasty (THA) and often result in implant failure. Introducing modular implant designs in modern orthopaedics has brought benefits to total hip replacements but has also increased patients' susceptibility to corrosion-related risks. ARMD can develop from various metal articulating surfaces, including ceramic-on-polyethylene (CoP), ceramic-on-ceramic (CoC), metal-on-metal (MoM), and metal-on-polyethylene (MoP) configurations. In this case study, a 68-year-old male who underwent a MoP implant for osteoarthritis of the right hip 16 years ago presented with pain and difficulty walking, exacerbated over the past three months. Clinical examination revealed tenderness around the implant and a limited range of motion. Imaging studies, including X-rays and ultrasound-guided aspiration, coupled with normal serum and urinary cobalt (Co) and chromium (Cr) levels, confirmed the diagnosis of ARMD. Given the severity of symptoms and radiographic findings, surgical intervention was warranted, leading to a two-stage revision with implant augmentation using a Burch-Schneider cage. Three months post operation, the patient experienced significant improvements in pain levels, range of motion (ROM), and hip function. This case underscores the importance of vigilant surveillance for ARMD in patients undergoing non-MoM THA, even years post surgery. Prompt recognition and management of ARMD are crucial to mitigate the risk of long-term complications and optimise patient outcomes. Further research is needed to understand the risk factors and mechanisms underlying ARMD in MoP THA, aiding in developing preventive strategies and refined treatment protocols.
PubMed: 38910664
DOI: 10.7759/cureus.60810 -
Journal of Infection and Public Health Jun 2024Toxoplasma gondii is an opportunistic pathogen that can intrude into the blood-brain barrier and reside in the brain only with low inflammatory reaction. When infected...
Toxoplasma gondii is an opportunistic pathogen that can intrude into the blood-brain barrier and reside in the brain only with low inflammatory reaction. When infected with HIV, the immune system becomes severely compromised and leads to the reactivation of latent toxoplasmosis infection, which can mimic the clinical manifestation of stroke. We report a case of a 65-year-old female patient who presented with sudden right limb weakness, walking difficulty, and numbness without other typical symptoms, raising suspicion of acute ischemic stroke. The HIV serology returned positive, which expedited the diagnostic workup for opportunistic infection. Combining imageological examination and metagenomics next-generation sequencing of cerebrospinal fluid, HIV-associated cerebral toxoplasmosis was confirmed. The patient underwent treatment for toxoplasmosis and HIV. Six months after onset, the patient can walk independently but still exhibits weakness in the right upper limb. In HIV-infected patients, cerebral toxoplasmosis, particularly presenting as isolated stroke-like episodes, poses a more significant challenge, emphasizing the need for more thorough investigations to reduce the potential for misdiagnosis.
PubMed: 38905925
DOI: 10.1016/j.jiph.2024.102477 -
The Journal of Arthroplasty Jun 2024Many patients report more difficulty when descending stairs compared to level walking after total knee arthroplasty (TKA). Different implant designs can affect knee...
Muscle Activity and Biomechanics While Descending a Staircase After Total Knee Arthroplasty: A Study Comparing Different Posterior Stabilized and Medial Ball-and-Socket Designs.
BACKGROUND
Many patients report more difficulty when descending stairs compared to level walking after total knee arthroplasty (TKA). Different implant designs can affect knee biomechanics and muscle activity during gait, but their effect during stair descent is unclear. The purpose of this study was to evaluate knee biomechanics and muscle activations of quadriceps, hamstrings, and gastrocnemius muscles during a stair descent task in patients who underwent TKA with either a posterior stabilized (PS) or medial ball-and-socket (MBS) implant and to compare them to a group of healthy controls.
METHODS
There were 28 TKA patients who were randomized to either an MBS (n = 14) or PS (n = 14) implant and were compared with 14 controls. Patients visited the biomechanics lab approximately 12 months after TKA, where knee biomechanics and muscle activity were measured as they descended a three-step staircase.
RESULTS
Compared to the MBS and control groups, the PS group descended the stairs with a reduced knee flexion angle and greater hamstring muscle activation throughout single limb support. Knee joint moments and power were similar between the MBS and PS groups, but neither reached the level of the control group.
CONCLUSION
Lower knee flexion angles and increased hamstring muscle activity indicated that the PS group descended the stairs with a stiffer knee gait pattern than the MBS group. The MBS implant design may provide additional stability as patients require less muscle activity than the PS group.
PubMed: 38901712
DOI: 10.1016/j.arth.2024.06.022 -
Clinical Medicine Insights. Case Reports 2024Cerebral infarct associated with varicella-zoster virus (VZV) has been reported in the literature, while isolated central dizziness due to lateral medullary infarct...
BACKGROUND
Cerebral infarct associated with varicella-zoster virus (VZV) has been reported in the literature, while isolated central dizziness due to lateral medullary infarct (LMI) following VZV infection is rarely reported.
CASE REPORT
We report the case of a 65-year-old man who presented to the neurology department because of herpes zoster on the right trigeminal nerve distribution. At 12 hours after admission, he developed transient vertigo along with nausea and unsteady walking and left-sided spontaneous horizontal nystagmus, gaze-evoked nystagmus, and upbeat nystagmus. The other usual signs of LMI including Horner syndrome, dysarthria, swallowing difficulty, and hemibody sensory change were absent. Video head impulse indicated decreased head impulse gain of the vestibulo-ocular reflex for the bilateral horizontal, anterior, and posterior semicircular canals with abnormal saccade waves. Suppression head impulse paradigm showed few downward saccades reflecting anti-compensatory saccades after the end of the head impulse back to the head-fixed target and decreased vestibulo-ocular reflex gain values of bilateral semicircular canals. Brain magnetic resonance imaging (MRI) showed a small infarct in the far dorsolateral portion of the left rostral medulla. The cerebrospinal fluid was positive for VZV DNA.
CONCLUSIONS
In patients with VZV infection who develop dizziness, the possibility of cerebral infarct should be considered. Patients with facial herpes zoster and neurological symptoms always be screened for stroke using MRI and lumbar puncture should be performed and acyclovir administered empirically.
PubMed: 38895742
DOI: 10.1177/11795476241262213