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BACKGROUND: Recent research recommends physical exercise rather than rest following a mild traumatic brain injury (mTBI). OBJECTIVE: To determine the effect of physical exercise on persistent symptoms in people with mTBI. METHODS: A search of randomized controlled trials was conducted in CINAHL, Cochrane Library, EMBASE, MEDLINE, SportDiscus and Web of Science, from 2010 to January 2021. Studies were included if they described the effects of a physical exercise intervention in people with mTBI on persistent symptoms. Study quality, intervention reporting, and confidence in review findings were assessed with the CASP, TIDieR and GRADE respectively. RESULTS: 11 eligible studies were identified for inclusion. Study interventions broadly comprised of two categories of physical exercise, i.e., aerobic (n = 8) and vestibular (n = 3). A meta-analysis (n = 3) revealed the aerobic exercise group improvement was significantly larger compared to the usual care group –0.39 (95% CI: –0.73 to –0.05, p = 0.03). Only three studies using vestibular exercise reported on persistent symptoms and yielded mixed results. CONCLUSIONS: This study demonstrated that the use of aerobic exercise is supported by mixed quality evidence and moderate certainty of evidence, yet there is limited evidence for the use of vestibular exercise for improving persistent symptoms in people with mTBI. [ABSTRACT FROM AUTHOR]

Background The frequency and impact of undiagnosed benign paroxysmal positional vertigo (BPPV) in people identified with high falls risk has not been investigated. Objective To determine the frequency and impact on key psychosocial measures of undiagnosed BPPV in adult community rehabilitation outpatients identified with a high falls risk. Design A frequency study with cross-sectional design. Setting A Community Rehabilitation Program in Melbourne, Australia. Subjects Adult community rehabilitation outpatients with a Falls Risk for Older People in the Community Screen score of four or higher. Methods BPPV was assessed in 34 consecutive high falls risk rehabilitation outpatients using the Dix–Hallpike test and supine roll test. Participants were assessed for anxiety, depression, fear of falls, social isolation and loneliness using the Hospital Anxiety and Depression Scale, Falls Efficacy Scale-International and De Jong Gierveld 6-Item Loneliness Scale. Results A total of 18 (53%; 95% confidence interval: 36, 70) participants tested positive for BPPV. There was no significant difference between those who tested positive for BPPV and those who did not for Falls Risk for Older People in the Community Screen scores (P  = 0.555), Hospital Anxiety and Depression Scale (Anxiety) scores (P  = 0.627), Hospital Anxiety and Depression Scale (Depression) scores (P  = 0.368) or Falls Efficacy Scale-International scores (P  = 0.481). Higher scores for the De Jong Gierveld 6-Item Loneliness Scale in participants with BPPV did not reach significance (P  = 0.056). Conclusions Undiagnosed BPPV is very common and associated with a trend towards increased loneliness in adult rehabilitation outpatients identified as having a high falls risk. [ABSTRACT FROM AUTHOR]

Introduction: This exploratory descriptive case-control study examined gait characteristics during sand walking in people with unilateral transtibial amputation, comparing patterns between everyday prosthesis with shoe, everyday prosthesis without shoe (EPWS), and a water-activity prosthesis (WAP), and evaluated how users experience the use of the WAP. Materials and Methods: Three-dimensional gait analysis, using an eight-camera Vicon motion capture system, was completed for 16 participants (mean age, 51.4 ± 5.5; 75% male, amputation etiology 63% trauma) when walking independently over level ground (baseline) and sand (gait adaptation response). Outcome variables were spatiotemporal data and kinematic data for the hip, knee, and ankle, and additionally, a purposefully designed Water Activity Prosthesis Survey was completed. Results: The results demonstrated cautious gait with reduced walking speed (P < 0.05) and decreased ankle range of motion (<0.05) in the prosthetic limb when walking with the EPWS and WAP. Using the WAP resulted in most prominent kinematic adaptational changes on sand. When comparing differences between the EPWS and WAP, significantly less hip extension (−2.92°; 95% confidence interval, −5.56 to −0.28; P = 0.02) and significantly less movement at the ankle (P < 0.05) occurred in the prosthetic limb in walking trials with the WAP. Nevertheless, more than 80% of the participants used the WAP at least twice a week for shower, pool, and beach activities. Conclusions: This study suggests that, although important for participation in ADL and leisure activities and supporting higher quality of life, the use of the WAP leads to unfavorable biomechanical gait alterations. Therefore, when prescribing the WAP, this trade-off should be taken into consideration. [ABSTRACT FROM AUTHOR]

Purpose:To assess the orthotic and therapeutic effects of prolonged use of functional electrical stimulation (FES) on fatigue induced gait patterns in people with Multiple Sclerosis (MS).Method:Thirteen people with MS completed 3D gait analysis with FES off and on, before and after a fatiguing 6-minute walk, at baseline and after 8 weeks of use of FES.Results:Eleven participants completed all testing. An orthotic effect on gait was not evident on first use of FES. However, therapeutic effects on gait after 8 weeks use were generally positive, including increases in walking speed due to improved neuromuscular control and power generated at the hip and ankle of the more affected limb. The action of FES alone was not sufficient to overcome all fatigue related deficits in gait but there was evidence 8 weeks use of FES can ameliorate some fatigue effects on lower limb kinetics, including benefits to ankle mechanics involved in generating power around push-off during stance.Conclusions:Eight-weeks of FES can benefit the gait pattern of people with MS under non-fatigued and fatigued conditions.Implications for rehabilitationIn some people with MS prolonged use of FES may be necessary before observing positive orthotic effects.Improvements in the neuromuscular control of the more affected lower limb may develop with prolonged use of FES in people with MS.Only some therapeutic benefits of FES are maintained during fatigued walking in people with MS.FES may be considered as a gait retraining device as well as an orthotic intervention for people with MS. [ABSTRACT FROM PUBLISHER]

Background/aim Home visits, used by occupational therapists to facilitate independence and enhance safety, are effective but costly and time consuming. This research aims to establish the level of agreement in equipment prescribed by occupational therapists using: digital photographs only, and using home visits and digital photographs, respectively. Method Quasi-experimental methodological design conducted in private dwellings in the community in Adelaide with rehabilitation patients and their family members. The equipment recommended by occupational therapists for the toilet and bathroom using similar methods (both digital photographs from previous data; n = 5) was compared with equipment recommended using different methods (conventional home visits vs. digital photographs; n = 14). Results Percent agreement for equipment prescribed between groups, that is digital only and home visit/photography, respectively, were: 72.5/83.9% for toilet; 87.4/88.3% for bathroom and 83/87% for toilet and bathroom. Variability of agreement in the equipment prescribed showed that some items of equipment were incongruently prescribed, by both methods for toilet and bathroom areas. Conclusion Using digital photographs taken by family members, patient information, and an equipment list is a reliable method of making accurate equipment prescriptions in the toilet and bathroom areas. To enhance accuracy, in-depth patient information via face-to-face interview and measurements of physical environment should be included. [ABSTRACT FROM AUTHOR]

Abstract: Critical cellulase and hemicellulase activities are identified for hydrolysis of ionic liquid (IL) pretreated poplar and switchgrass; hemicellulase rich substrates with largely amorphous cellulose. Enzymes from Aspergillus nidulans were expressed and purified: an endoglucanase (EG) a cellobiohydrolase (CBH), an endoxylanase (EX) and an acetylxylan esterase (AXE). β-Xylosidase (βX) from Selenomonas ruminantium and a commercial β-glucosidase (βG) from Novozyme 188 were admixed with the A. nidulans enzymes. Statistical analysis indicates that βG and βX activities are significant for both glucose and xylose yields for the two substrates. EG is a significant factor for glucan hydrolysis while EX is significant for xylan hydrolysis of the substrates. The CBH, which has activity on crystalline cellulose and negligible activity on amorphous cellulose, was not a significant factor in glucan hydrolysis. EX is significant in glucan hydrolysis for poplar. The addition of AXE significantly improves xylan hydrolysis for poplar but not switchgrass. [Copyright &y& Elsevier]

Primary objective: To investigate if patients with traumatic brain injury, who are discharged to the community before emergence from post-traumatic amnesia (PTA), experience more adverse outcomes than those discharged after emergence from PTA.Research design: A retrospective review of previously collected data and medical records.Methods and procedures: Occurrences of adverse events including hospital readmissions, disengagement from follow-up services, non-compliance with discharge precautions, support system breakdown or undue carer strain at the post-discharge clinic review were recorded. The Glasgow Outcome Scale – Extended (GOS-E) and Supervision Rating Scale (SRS) were completed, retrospectively. Twenty-seven patients discharged to the community, prior to emergence from PTA, were compared to 20 patients discharged within seven days of emergence from PTA.Main outcomes and results: Patients discharged prior to emergence from PTA did not experience an increase in adverse outcomes and showed a higher level of engagement in follow-up services (p= 0.015). There was no difference between groups in the improvements from discharge to clinic review on the GOS-E (p= 0.113) and SRS (p= 0.165).Conclusions: Patients can be discharged prior to emergence from PTA, if all other discharge criteria have been met, without an increase in adverse outcomes. [ABSTRACT FROM PUBLISHER]

Objective. The aim of the present study was to investigate a change in physiotherapy provision from a 5- to 7-days-a-week service on both physiotherapy and hospital length of stay (LOS) after total knee (TKR) and total hip (THR) replacement. Methods. A retrospective analysis of a clinical database was conducted for patients who received either a TKR or THR between July 2010 and June 2012 in one regional hospital. Results. There was a significant decrease in physiotherapy LOS from 5.0 days (interquartile range (IQR) 5.0-6.0 days) for a 5-day physiotherapy service, to 5.0 days (IQR 4.0-5.0 days) for 7-day physiotherapy service (U = 1443.5, z = -4.62, P = 0.001). However, hospital LOS was not reduced (P = 0.110). For TKR, physiotherapy LOS decreased significantly by 1 day with a 7-day physiotherapy service (U = 518.0, z = -4.20, P = 0.001). However, hospital LOS was again no different (P = 0.309). For THR there was no difference in physiotherapy LOS (P = 0.060) or hospital LOS (P = 0.303) between the 5- and 7-day physiotherapy services. Where physiotherapy LOS was less than hospital LOS, delayed discharge was due primarily to non-medical issues (72%) associated with hospital organisational aspects. Conclusions. Increasing the provision of physiotherapy service after TKR provides an increase in physiotherapy sessions and has the potential to reduce hospital LOS. To be effective this must align with other administrative aspects of hospital discharge. [ABSTRACT FROM AUTHOR]

Objective: To assess (1) step count accuracy of the Fitbit Zip, compared to manual step count, in people receiving outpatient rehabilitation, in indoor and outdoor conditions, and (2) impact of slow walking speed on Fitbit accuracy. Design: Observational study. Setting: A metropolitan rehabilitation hospital. Subjects: Adults (n = 88) attending a subacute rehabilitation outpatient clinic with walking speeds of between 0.4 and 1.0 m/s. Interventions: Two 2-minute walk tests, one indoors and one outdoors, completed in random order. Main measures: Step count recorded manually by observation and by a Fitbit Zip, attached to the shoe on the dominant or non-affected side. Subgroup analysis included assessment accuracy for those considered limited community walkers (slower than 0.8 m/s) and those considered community walkers (faster than 0.8 m/s). Results: The Fitbit significantly (P < 0.05) undercounted steps compared to manual step count, indoors and outdoors, with percentage agreement slightly higher outdoors (mean 92.4%) than indoors (90.1%). Overall, there was excellent consistent agreement between the Fitbit and manual step count for both indoor (ICC 0.83) and outdoor (ICC 0.88) walks. The accuracy of the Fitbit was significantly (P < 0.05) reduced in those who walked slower than 0.8 m/s outdoors (ICC 0.80) compared to those who walk faster than 0.8 m/s (ICC 0.90). Conclusions: The Fitbit Zip shows high step count accuracy with manual step count in a mixed subacute rehabilitation population. However, accuracy is affected by walking speed, with decreased accuracy in limited community walkers. [ABSTRACT FROM AUTHOR]

The article discusses the impact of global total joint replacement (TJR) registry. An overview on the essential of several levels of data including patient, surgeon, and hospital identifiers to monitor the revision rates after TJR, is provided. Also emphasized is the aim to TJR to collect all TJR procedures maintained by the national orthopaedic society and financed by the government.