- Email: [email protected]
without functional electrical stimulation improves lower limbs disability in patients post-stroke: A systematic review with meta-analysis
e390
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
and to perform a genetic study based on Next-Generation Sequencing (NGS). Material and method This was a single-centre, prospective, observational study. Patients included were a Haemophilia Centre (HC) for bleeding symptoms of unknown cause (normal or abnormal haemostatic tests not explaining the bleeding phenotype) and having joint laxity and Musculoskeletical Rehabilitation Unit (RHB) for joint laxity and reporting bleeding symptoms. Bleeding severity was assessed by the haematologist using the ISTH Bleeding assessment tool (ISTHBAT) and joint hyperlaxity by the physiatrist by the Beighton score. Molecular analysis was performed using TruSight One Sequencing Panel Kit (Illumina). Quality and population frequency filters were applied and the search was limited to 78 genes related with Heritable Disorders of Connective Tissue (HDCT). Results Forty-three patients were included between June 2016 and January 207. All were females; median age was 38.6 years (range 17–62 years). Median ISTH-BAT score was 8 (range 3–17) and Beighton score 7 to 9 (range 3–9). ISTH-BAT score was abnormal in 77% and Beighton score in 80%. In 25 patients, both scores were abnormal. A total of 175 potential mutations were identified in HDCT related genes for all except one patient. In 46.5% a direct correlation between the identified mutation and the clinical phenotype could be established. In 10 patients, mutations in COL5A1, COL5A2, COL1A1 and COL1A2 genes were identified and validated by Sanger sequencing. Conclusion Clinical assessment for symptomatic joint hypermobility should be considered in patients with significant bleeding history of unknown cause. NGS could be a useful tool for the study of the responsible genes and the classification of patients. Keywords Hipermobility; Bleeding Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.907 ISPR8-1060
Role of O-C2 angle in the development of dysphagia in patients with halo-vest fixation M. Miyagi 1,∗ , H. Takahashi 2 , K. Tsuchiya 2 , H. Sekiya 3 , S. Ebihara 1 1 Toho University Graduate School of Medicine, Department of Rehabilitation Medicine, Tokyo, Japan 2 Toho University Omori Medical Center, Department of Orthopaedic Surgery, Tokyo, Japan 3 Toho University Omori Medical Center, Department of Oral Surgery, Tokyo, Japan ∗ Corresponding author. E-mail address: [email protected] (M. Miyagi) Introduction/Background The halo-vest brace has been a common mode for immobilization of the cervical spine. The incidence of complications such as pin loosing and infection are known in patients with halo-vest fixation. Dysphagia is one of the most serious complications seen with the use of a halo-vest brace. The aim of this study was to elucidate factors associated with the incidence of dysphagia in patients treated using a halo-vest brace in terms of not only demographic data, but also radiological findings of the cervical spine. Material and method We retrospectively reviewed medical records and radiological measurements using lateral plain X-rays of the cervical spine in patients who had undergone halo-vest fixation in our institute between January 2006 and August 2016. Severity of dysphagia was assessed using the Food Intake Level Scale (FILS) from medical records. Patients were classified into non-dysphagia (FILS level: 10) and dysphagia (FILS level: 1–9) groups. Results Forty-three patients were attributed for analysis. Twenty-eight patients were classified into non-dysphagia group, 15 patients were classified into dysphagia group. Mean age was
grater (P = 0.041), length of ICU stay was longer (P = 0.002), and frequency of tracheostomy was larger (P = 0.043) in the dysphagia group. Mean O-C2 angle was smaller in the dysphagia group (P = 0.027). Body mass index [odds ratio (OR) = 0.522, 95% confidence interval (CI) = 0.377–0.934, P = 0.024], ICU stay (OR = 1.302, 95% CI = 1.272–10.624, P = 0.016), and O-C2 angle (OR = 0.911, 95% CI = 0.833–0.996, P = 0.041) remained independent risk factors related to incidence of dysphagia. Spearman rank correlation showed a negative linear correlation between ICU stay and FILS level (r = 0.476, P = 0.001) and a positive linear correlation between O-C2 angle and FILS level (r = 0.385, P = 0.011). Conclusion This study suggested the significance of O-C2 angle as well as ICU stay for incidence and severity of dysphagia in patients with halo-vest fixation. Keywords Dysphagia; Halo-vest; O-C2 angle Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.908 ISPR8-0236
Cycling with/without functional electrical stimulation improves lower limbs disability in patients post-stroke: A systematic review with meta-analysis A. Shariat 1,∗ , N. Nakhostin Ansari 1,2 , J.A. Cleland 3 , M. Ghayour Najafabadi 4,5 , A.H. Memari 1 , R. Kordi 1 , M. Kargarfard 6,7 , P. Noormohammadpour 1 , S. Naghdi 1,2 1 Tehran University of Medical Sciences, Sports Medicine Research Center, Neuroscience Institute, Tehran, Iran 2 Tehran University of Medical Sciences, Department of Physiotherapy, School of Rehabilitation, Tehran, Iran 3 Franklin Pierce University, Manchester, New Hampshire, USA 4 Faculty of Physical Education, University of Tehran, Tehran, Iran 5 Department of Motor behaviour, Tehran, Iran 6 Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran 7 Department of Exercise Physiology, Isfahan, Iran ∗ Corresponding author. E-mail address: [email protected] (A. Shariat) Introduction/Background Cycling with or without functional electrical stimulation (FES) is an effective way to rehabilitate patients with lower limb disability. The purpose of this systematic review and meta-analysis was to quantify the effectiveness of different protocols of cycling with/without FES on lower limbs after stroke. Material and method The following databases were searched: PubMed, Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index of Nursing and Allied Health Literature, Ovid EMBASE, Physiotherapy Evidence Database (PEDro), and Occupational Therapy Systematic Evaluation of Effectiveness, by means of words relevant to randomized and stroke, cycling and lower limbs disability. Randomized-controlled trials from 1990 to July 2017 were included following predetermined search and selection criteria. Data extraction was performed using a predetermined data collection form. Results A total of 15 trials satisfied eligibility criteria for this review. Cycling had a positive effect on 6 meter walking test performance [30.4 s; −1.9 to 62.6 (standardized mean difference; 95% confidence interval)] compared with no or placebo intervention (control). Cycling had a positive effect on walking speed (0.10 m/s; 0.1–0.2), based on the results of 10 meter walking test, compared with control. Cycling had a positive effect on balance based on Berg score (0.25; −0.44 to 0.94) compared with control. Cycling with FES had a positive effect on balance (1.95; 1.33–2.52) compared with cycling alone. Conclusion Although cycling alone has a positive effect on walking ability, walking speed, and balance the effects are small and variable. In terms of balance, positive effects substantially smaller
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
when compared with concurrent effect of FES with cycling with low evidence. It appears that cycling with or without functional electrical stimulation has positive effects on walking ability walking speed and balance, but further research is needed to confirm the clinical utility of these modalities for stroke patients. Keywords Meta-analysis; Stroke; Lower limb disability Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.909 ISPR8-1135
Screening water test for aspiration
P. Kittipanya-Ngam ∗ , P. Wattanapan Khon Kaen University, Physical Medicine and Rehabilitation, Muang, Thailand ∗ Corresponding author. E-mail address: [email protected] (P. Kittipanya-Ngam) Introduction/Background One of the basic needs in life is eating. Swallowing problem is caused by a lot of diseases whose common complication is aspiration pneumonia. Physical examination, such as Modified Water Swallowing test (MWST), can detect aspiration but not silent aspiration. The videoendoscope (VE)/videofluoroscope (VF) are able to find out all aspirations but it is more complicated. Therefore this paper aims to study the capability of MWST to detect all aspirations. Material and method The demographic data, swallowing physical examination, MWST and videoendoscope (VE)/videofluoroscope (VF) test were recorded. Normal MWST scores 4 and 5. Abnormal MWST scores between 1 to 3. Aspiration with chocking or wet voice and silent aspiration were reported in percentage. Chi2 test was used to detect the different between normal and abnormal MWST. Results There were 60 patients who accessed the dysphagia clinic, MWST was used in 55 patients and VE/VF were done in 40 patients. There were only 36 patients who had done both MWST and VE/VF. From 22 abnormal MWST patients, 6 patients (27%) had aspiration with choking or wet voice and 2 patients (9%) had silent aspiration from VE/VF. From 14 normal MWST patients, 3 patients (21%) had silent aspiration. Therefore, the MWST can detect aspiration 36%. Moreover, the MWST showed no significantly different between normal and abnormal group (P-value 0.34). Conclusion The MWST detected aspiration at 36% which was quite low. Further study with a large number of patients or other screening tests should be done. Keywords Screening water test; Aspiration; Swallowing problem Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.910
e391
ISPR8-0528
Comparison of home-based modified self-Epley manoeuvre and Brandt-Daroff exercise on the posterior canal benign paroxysmal positional vertigo symptoms: A randomized single-blind controlled trial Dr. N.H. Mohamad Hanapi 1 , M. Mazlan (Associate Professor) 2,∗ , A.R. Abdul Rahman 3 , Dr. T.Y. Chung 2 , M.Z. Abu Bakar (Associate Professor) 4 1 Department of Rehabilitation Medicine, Ministry of Health, Kelantan, Malaysia 2 Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 3 Department of Rehabilitation Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia 4 Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia ∗ Corresponding author. E-mail address: [email protected] (M. Mazlan) Introduction/Background Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder in adults and the treatment of choice is by particle repositioning manoeuvres (PRM). This study compares the effects of two home-based exercises, self-Epley manoeuvre (SEM) and Brandt-Daroff exercise (BDE) in patients with posterior canal BPPV. Material and method This is a single-blinded prospective randomized-controlled trial on 50 patients suffering from unilateral posterior canal BPPV with a documented positive Dix-Hallpike test and symptoms of vertigo for at least 1 week. Both groups (25 in SEM and 25 in BDE) performed the home-based exercise for a total of 2-weeks duration. The primary outcome was vertigo resolution at 1 month and 6 months. Secondary outcomes were conversion of a positive to a negative Dix-Hallpike test at 1 month, reduction of vertigo intensity and the Dizziness Handicap Inventory (DHI) scores at 1 month and 6 months. Results Vertigo resolution was achieved in 40% of patients at 1 month and 48% of patients at 6 months for both groups. Conversion rate from positive to negative Dix–Hallpike test at 1 month was 92% in the SEM group and 84% in the BDE group (P = 0.38). From repeated assessments at 1 and 6 months, significant reduction in vertigo intensity, F(1.6, 78.4) = 84.6, P < 0.001 and improvement in the mean DHI scores, F(1.7, 85.1) = 74.3, P < 0.001 was seen within groups. There were no significant differences in vertigo intensity and mean DHI scores between the two groups. Both SEM and BDE were well-tolerated with few minor complications reported, such as transient dizziness and nausea. Conclusion Both the SEM and BDE are effective in treating posterior canal BPPV. Although there was no significant vertigo resolution, there was a reduction in vertigo intensity, and perceived negative impact on daily life from the improvement in the mean DHI scores Keywords Vertigo; Benign paroxysmal positional vertigo; Particle repositioning manoeuvre Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.911
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
and to perform a genetic study based on Next-Generation Sequencing (NGS). Material and method This was a single-centre, prospective, observational study. Patients included were a Haemophilia Centre (HC) for bleeding symptoms of unknown cause (normal or abnormal haemostatic tests not explaining the bleeding phenotype) and having joint laxity and Musculoskeletical Rehabilitation Unit (RHB) for joint laxity and reporting bleeding symptoms. Bleeding severity was assessed by the haematologist using the ISTH Bleeding assessment tool (ISTHBAT) and joint hyperlaxity by the physiatrist by the Beighton score. Molecular analysis was performed using TruSight One Sequencing Panel Kit (Illumina). Quality and population frequency filters were applied and the search was limited to 78 genes related with Heritable Disorders of Connective Tissue (HDCT). Results Forty-three patients were included between June 2016 and January 207. All were females; median age was 38.6 years (range 17–62 years). Median ISTH-BAT score was 8 (range 3–17) and Beighton score 7 to 9 (range 3–9). ISTH-BAT score was abnormal in 77% and Beighton score in 80%. In 25 patients, both scores were abnormal. A total of 175 potential mutations were identified in HDCT related genes for all except one patient. In 46.5% a direct correlation between the identified mutation and the clinical phenotype could be established. In 10 patients, mutations in COL5A1, COL5A2, COL1A1 and COL1A2 genes were identified and validated by Sanger sequencing. Conclusion Clinical assessment for symptomatic joint hypermobility should be considered in patients with significant bleeding history of unknown cause. NGS could be a useful tool for the study of the responsible genes and the classification of patients. Keywords Hipermobility; Bleeding Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.907 ISPR8-1060
Role of O-C2 angle in the development of dysphagia in patients with halo-vest fixation M. Miyagi 1,∗ , H. Takahashi 2 , K. Tsuchiya 2 , H. Sekiya 3 , S. Ebihara 1 1 Toho University Graduate School of Medicine, Department of Rehabilitation Medicine, Tokyo, Japan 2 Toho University Omori Medical Center, Department of Orthopaedic Surgery, Tokyo, Japan 3 Toho University Omori Medical Center, Department of Oral Surgery, Tokyo, Japan ∗ Corresponding author. E-mail address: [email protected] (M. Miyagi) Introduction/Background The halo-vest brace has been a common mode for immobilization of the cervical spine. The incidence of complications such as pin loosing and infection are known in patients with halo-vest fixation. Dysphagia is one of the most serious complications seen with the use of a halo-vest brace. The aim of this study was to elucidate factors associated with the incidence of dysphagia in patients treated using a halo-vest brace in terms of not only demographic data, but also radiological findings of the cervical spine. Material and method We retrospectively reviewed medical records and radiological measurements using lateral plain X-rays of the cervical spine in patients who had undergone halo-vest fixation in our institute between January 2006 and August 2016. Severity of dysphagia was assessed using the Food Intake Level Scale (FILS) from medical records. Patients were classified into non-dysphagia (FILS level: 10) and dysphagia (FILS level: 1–9) groups. Results Forty-three patients were attributed for analysis. Twenty-eight patients were classified into non-dysphagia group, 15 patients were classified into dysphagia group. Mean age was
grater (P = 0.041), length of ICU stay was longer (P = 0.002), and frequency of tracheostomy was larger (P = 0.043) in the dysphagia group. Mean O-C2 angle was smaller in the dysphagia group (P = 0.027). Body mass index [odds ratio (OR) = 0.522, 95% confidence interval (CI) = 0.377–0.934, P = 0.024], ICU stay (OR = 1.302, 95% CI = 1.272–10.624, P = 0.016), and O-C2 angle (OR = 0.911, 95% CI = 0.833–0.996, P = 0.041) remained independent risk factors related to incidence of dysphagia. Spearman rank correlation showed a negative linear correlation between ICU stay and FILS level (r = 0.476, P = 0.001) and a positive linear correlation between O-C2 angle and FILS level (r = 0.385, P = 0.011). Conclusion This study suggested the significance of O-C2 angle as well as ICU stay for incidence and severity of dysphagia in patients with halo-vest fixation. Keywords Dysphagia; Halo-vest; O-C2 angle Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.908 ISPR8-0236
Cycling with/without functional electrical stimulation improves lower limbs disability in patients post-stroke: A systematic review with meta-analysis A. Shariat 1,∗ , N. Nakhostin Ansari 1,2 , J.A. Cleland 3 , M. Ghayour Najafabadi 4,5 , A.H. Memari 1 , R. Kordi 1 , M. Kargarfard 6,7 , P. Noormohammadpour 1 , S. Naghdi 1,2 1 Tehran University of Medical Sciences, Sports Medicine Research Center, Neuroscience Institute, Tehran, Iran 2 Tehran University of Medical Sciences, Department of Physiotherapy, School of Rehabilitation, Tehran, Iran 3 Franklin Pierce University, Manchester, New Hampshire, USA 4 Faculty of Physical Education, University of Tehran, Tehran, Iran 5 Department of Motor behaviour, Tehran, Iran 6 Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran 7 Department of Exercise Physiology, Isfahan, Iran ∗ Corresponding author. E-mail address: [email protected] (A. Shariat) Introduction/Background Cycling with or without functional electrical stimulation (FES) is an effective way to rehabilitate patients with lower limb disability. The purpose of this systematic review and meta-analysis was to quantify the effectiveness of different protocols of cycling with/without FES on lower limbs after stroke. Material and method The following databases were searched: PubMed, Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index of Nursing and Allied Health Literature, Ovid EMBASE, Physiotherapy Evidence Database (PEDro), and Occupational Therapy Systematic Evaluation of Effectiveness, by means of words relevant to randomized and stroke, cycling and lower limbs disability. Randomized-controlled trials from 1990 to July 2017 were included following predetermined search and selection criteria. Data extraction was performed using a predetermined data collection form. Results A total of 15 trials satisfied eligibility criteria for this review. Cycling had a positive effect on 6 meter walking test performance [30.4 s; −1.9 to 62.6 (standardized mean difference; 95% confidence interval)] compared with no or placebo intervention (control). Cycling had a positive effect on walking speed (0.10 m/s; 0.1–0.2), based on the results of 10 meter walking test, compared with control. Cycling had a positive effect on balance based on Berg score (0.25; −0.44 to 0.94) compared with control. Cycling with FES had a positive effect on balance (1.95; 1.33–2.52) compared with cycling alone. Conclusion Although cycling alone has a positive effect on walking ability, walking speed, and balance the effects are small and variable. In terms of balance, positive effects substantially smaller
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
when compared with concurrent effect of FES with cycling with low evidence. It appears that cycling with or without functional electrical stimulation has positive effects on walking ability walking speed and balance, but further research is needed to confirm the clinical utility of these modalities for stroke patients. Keywords Meta-analysis; Stroke; Lower limb disability Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.909 ISPR8-1135
Screening water test for aspiration
P. Kittipanya-Ngam ∗ , P. Wattanapan Khon Kaen University, Physical Medicine and Rehabilitation, Muang, Thailand ∗ Corresponding author. E-mail address: [email protected] (P. Kittipanya-Ngam) Introduction/Background One of the basic needs in life is eating. Swallowing problem is caused by a lot of diseases whose common complication is aspiration pneumonia. Physical examination, such as Modified Water Swallowing test (MWST), can detect aspiration but not silent aspiration. The videoendoscope (VE)/videofluoroscope (VF) are able to find out all aspirations but it is more complicated. Therefore this paper aims to study the capability of MWST to detect all aspirations. Material and method The demographic data, swallowing physical examination, MWST and videoendoscope (VE)/videofluoroscope (VF) test were recorded. Normal MWST scores 4 and 5. Abnormal MWST scores between 1 to 3. Aspiration with chocking or wet voice and silent aspiration were reported in percentage. Chi2 test was used to detect the different between normal and abnormal MWST. Results There were 60 patients who accessed the dysphagia clinic, MWST was used in 55 patients and VE/VF were done in 40 patients. There were only 36 patients who had done both MWST and VE/VF. From 22 abnormal MWST patients, 6 patients (27%) had aspiration with choking or wet voice and 2 patients (9%) had silent aspiration from VE/VF. From 14 normal MWST patients, 3 patients (21%) had silent aspiration. Therefore, the MWST can detect aspiration 36%. Moreover, the MWST showed no significantly different between normal and abnormal group (P-value 0.34). Conclusion The MWST detected aspiration at 36% which was quite low. Further study with a large number of patients or other screening tests should be done. Keywords Screening water test; Aspiration; Swallowing problem Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.910
e391
ISPR8-0528
Comparison of home-based modified self-Epley manoeuvre and Brandt-Daroff exercise on the posterior canal benign paroxysmal positional vertigo symptoms: A randomized single-blind controlled trial Dr. N.H. Mohamad Hanapi 1 , M. Mazlan (Associate Professor) 2,∗ , A.R. Abdul Rahman 3 , Dr. T.Y. Chung 2 , M.Z. Abu Bakar (Associate Professor) 4 1 Department of Rehabilitation Medicine, Ministry of Health, Kelantan, Malaysia 2 Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 3 Department of Rehabilitation Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia 4 Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia ∗ Corresponding author. E-mail address: [email protected] (M. Mazlan) Introduction/Background Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder in adults and the treatment of choice is by particle repositioning manoeuvres (PRM). This study compares the effects of two home-based exercises, self-Epley manoeuvre (SEM) and Brandt-Daroff exercise (BDE) in patients with posterior canal BPPV. Material and method This is a single-blinded prospective randomized-controlled trial on 50 patients suffering from unilateral posterior canal BPPV with a documented positive Dix-Hallpike test and symptoms of vertigo for at least 1 week. Both groups (25 in SEM and 25 in BDE) performed the home-based exercise for a total of 2-weeks duration. The primary outcome was vertigo resolution at 1 month and 6 months. Secondary outcomes were conversion of a positive to a negative Dix-Hallpike test at 1 month, reduction of vertigo intensity and the Dizziness Handicap Inventory (DHI) scores at 1 month and 6 months. Results Vertigo resolution was achieved in 40% of patients at 1 month and 48% of patients at 6 months for both groups. Conversion rate from positive to negative Dix–Hallpike test at 1 month was 92% in the SEM group and 84% in the BDE group (P = 0.38). From repeated assessments at 1 and 6 months, significant reduction in vertigo intensity, F(1.6, 78.4) = 84.6, P < 0.001 and improvement in the mean DHI scores, F(1.7, 85.1) = 74.3, P < 0.001 was seen within groups. There were no significant differences in vertigo intensity and mean DHI scores between the two groups. Both SEM and BDE were well-tolerated with few minor complications reported, such as transient dizziness and nausea. Conclusion Both the SEM and BDE are effective in treating posterior canal BPPV. Although there was no significant vertigo resolution, there was a reduction in vertigo intensity, and perceived negative impact on daily life from the improvement in the mean DHI scores Keywords Vertigo; Benign paroxysmal positional vertigo; Particle repositioning manoeuvre Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.911