Rehabilitation Interventions for Gait Problems in Patients With Diabetic Peripheral Neuropathy: A Scoping Review
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Background and Objectives: Gait and balance disturbances are challenging conditions in patients with Diabetic Peripheral Neuropathy (DPN). The overall literary consensus is that rehabilitation interventions are effective in improving gait performance in this patient group. This review sought to highlight and assess the literature and provide a scoping review on the current knowledge gaps in the rehabilitation interventions for the gait problems of patients with DPN. Methods: An electronic databases search was done between 2001 and May 2020. Besides, a hand-search method was used for grey literature. Two experts reviewed the results and screened them based on the subject’s diagnosis with DPN and gait problems. Results: Of 87 studies obtained, nine met the inclusion criteria. The frequent components of the rehabilitation interventions included exercise therapy, dual-task intervention, and the use of assistive devices. The outcomes utilized most frequently included changes in balance and stability, muscle strength, proprioception, function, and gait parameters. Conclusion: Evidence was formed as a scoping review to guide rehabilitation for DPN patients with gait problems. Rigorous comparative studies with clearly defined interventions are needed.Background/Purpose: Multiple sclerosis (MS) is a progressive neurological disease that results in increased fatigue, decreased muscle function, and impaired gait and balance. The purpose of this study was to evaluate the relationship between lower leg muscle function and changes in gait and balance immediately and 20 minutes after 6mins walk-induced fatigue. Methods: Six persons with MS (Patient-Determined Disease Steps 3-5) participated in the study. Perceived fatigue and demographic information were taken at baseline. Muscle fatigability and mitochondria capacity was measured in the lower leg muscles before walking. Reported fatigue (VAFS, 0-10), gait variability, gait asymmetry, and static balance were measured before and immediately after a self-paced 6 minutes treadmill walk with slight elevation, and after 20 minutes of rest. Results: Participant’s baseline MFIS score ranged from 14 - 71. There was a 173% increase in reported fatigue scores after walking. Gait was impaired with a ~26% increase in gait variability and ~40% increase in gait asymmetry immediately after walking (Cohen’s D = 0.4, 0.3 respectively). There was also ~69% increase in balance postural sway with eyes opened and a ~20% increase with eyes closed (Cohen’s D = 0.5, 0.2 respectively). Gait and balance remained impaired after 20 minutes of rest. The decline in gait parameters after walking had a negative correlation with muscle endurance (r=-0.80, p=0.03), and mitochondrial capacity (r=-0.92, p<0.01). The changes in gait and balance were more evident in participants with a higher disability. Conclusions: Six minutes of self-paced walking with slight elevation worsened gait and balance among people with MS (PwMS), which did not completely recover after 20 minutes of rest. The changes in gait after walking were associated with lower leg muscle function. Lower leg muscle function might be an important intervention target to improve gait and balance fall risk among PwMS.
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We designed a rehabilitation program for patients with post-myocardial infarction by modifying the 14-step program of Emory University into a more suitable form for a Japanese. The usefulness of this rehabilitation program was evaluated by comparing the clinical course of our patients with that of the patients in our affiliated institutions, where patients had no systematic rehabilitation therapy. The following results were obtained: 1) Most patients of the rehabilitation-completed group were living a non-restricted life 6 months after discharge. The life style of the rehabilitation group even including the rehabilitation-non-completed group, was far better than that of the non-rehabilitation group. 2) Many patients of the rehabilitation group were working at the same job as before infarction 3 years after discharge, while a substantial number of the patients of the non-rehabilitation group had changed their job or retired within 3 years after discharge. 3) The reason for changing job or retiring was primarily subjective symptoms or objective findings in the rehabilitation-completed group, while it was mostly fear in the non-rehabilitation group. 4) Patients who could not complete our program were mainly old patients of over 70 years of age, patients with extensive anterior infarction and subendocardial infarction and ones with complications such as shock and cardiac failure.
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Objective To identify the current situation of rehabilitation awareness, demand for rehabilitation of stroke patients in the communities of Chinese cities, in order to provide reference for rehabilitation education and suitable rehabilitation programs. Methods This community-based survey involving 964 stroke patients from three metropolises assesses rehabilitation awareness, the status of rehabilitation and demands for rehabilitation for stroke patients. Results Of the 964 patients, 33.7%(325) reported that they had received information on stroke rehabilitation and only 10.4%(100) patients were well informed of the topic. Seven hundred and fourteen(74.1%) had been hospitalized and 30.4%(294/964) received acute rehabilitation during hospitalization. Of them, 198(20.5%) patients only received acupuncture and massage or manipulation; 178(18.5%) received physical therapy. After discharge, 35%(250/714) received continuous rehabilitation services. Among the reasons of not receiving rehabilitation services, Don't know rehabilitation therapy was placed on the first rank of all reasons. Most stroke patients(74.3%) preferred to receiving rehabilitation services in the centers of community health service. In fact, only 80(8.3%) received community-based rehabilitation(CBR) after discharge. Conclusion The status of rehabilitation is worse than expected. The lack of awareness is an important barrier to early rehabilitation therapy. The importance of establishing an effective education and rehabilitation program to improve status of rehabilitation for stroke survivors should be emphasized.
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70% of medication errors occurring in the hospitals are preventable. The study was aimed to document, classify and examine interventions and examine reasons as to why pharmacists initiate changes in drug therapy and the outcomes of interventions, also examine the acceptability of interventions to analyze if intervention study can be a reliable learning process and to identify the areas of weakness in case of ineffective interventions. Interventions were broadly classified into Reactive interventions and Passive interventions. The study was conducted for six months. A total of 470 interventions were recorded in this study. Out of these 470 interventions, 104 were reactive interventions and 366 were passive interventions. Out of 92 outcome assessed interventions, the outcomes were beneficial in (91.30%) and had no effect in (8.70%). Active involvement of clinical pharmacists in the wards helps physicians in taking better therapeutic decisions which highlights areas where clinical pharmacists could prove their skill and knowledge to achieve better patient outcomes.
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[Purpose] The aim of the study was to assess the effect of an 8-week balance exercise program for enhancement of gait function on temporal and spatial parameters of school aged children with intellectual disabilities. [Subjects] Forty young people with intellectual disabilities were assigned either to the balance exercise program for enhancement of gait function group (BG group, n=19) or the control group (n=21). [Methods] The BG group attended an 8-week balance exercise program for enhancement of gait function consisting of two sessions a week. Gait was assessed using temporal and spatial parameters. [Results] The balance exercise program resulted in significant improvements in participant performance in temporal and spatial parameters. [Conclusion] A balance exercise program for enhancement of gait function can be an effective intervention for improving functional outcomes and can be recommended as an alternative mode of physical activity programming for improving balance and gait.
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The article reviews a ten-year experience with rehabilitation of post-stroke patients accumulated at specialized in- and out-patient rehabilitation centers. The authors present the principles of structuring the recovery process, as well as the main components of rehabilitation programmes, individual methods, and their combination. The ultimate results of rehabilitation treatment are considerably better than those observed following the traditional chemo- and physiotherapy.
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老年者急性心筋梗塞例についてリハビリテーション (以下リハビリと略す) の効果, 影響を検討するため, 対照としてリハビリを施行していなかった期間の心筋梗塞群 (リハビリ(-)群) 53人平均77.1歳と, リハビリを組織的に開始後に入院した心筋梗塞群 (リハビリ(+)群) 84人平均76.1歳とに分け, 予後との関連を検討した. リハビリ(+)群を到達リハビリレベルにより分類すると, リハビリ不能群20人, 軽度リハビリ群15人, 歩行訓練群27人, リハビリ終了群22人であった. リハビリレベル別の合併症の頻度の比較では, リハビリ到達レベル高度の群に梗塞後狭心症が多かった. 心不全の有無, 梗塞再発に関しては各群間に有意差はなかった. 退院時運動レベルと梗塞後の合併症との関連を見ると, 狭心症を有する群に於いて有意に運動レベルが高かった. リハビリ(-), (+)の各群の平均3.5年の観察期間中に於いて, 心臓死は各々51%, 41%にのぼった. リハビリ(-)群の平均7.5年の観察期間中, 心臓死は62%であった. リハビリ(+)群の心臓死例26人について, リハビリレベルと生存年数の間にr=0.53 (p<0.01) の正相関が見られた. 梗塞後狭心症を両群で比較するとリハビリ (-) で13%, リハビリ(+)群で42%と, リハビリ(+)群で多かった. 退院時運動能力は, リハビリ (+) 群で高かった. 生命予後の検討では, リハビリ(+)群で生存率が高い傾向があり, 心死率は低い傾向があったが, 有意差は見られなかった.
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Gait and balance measures have particular potential as outcome measures in Multiple Sclerosis (MS) because, of the many hallmarks of MS disability, gait and balance dysfunction are present throughout the course of the disease, impact many aspects of a person’s life, and progress over time. To highlight the importance and relevance of gait and balance measures in MS, explore novel measurements of gait and balance in MS, and discuss how gait, balance, and fall measures can best be used and developed in clinical and research settings, the 1st International Symposium on Gait and Balance in Multiple Sclerosis was held in Portland, Oregon, USA on October 1, 2011. This meeting brought together nearly 100 neurologists, physiatrists, physical therapists, occupational therapists, nurses, engineers, and others to discuss the current status and recent advances in the measurement of gait and balance in MS. Presentations focused on clinician-administered, self-administered, and instrumented measures of gait, balance, and falls in MS.
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