Factors Associated With Time to Decannulation in Patients With Tracheostomy Following Severe Traumatic Brain Injury.

BACKGROUND: Prolonged tracheal tube placement following severe traumatic brain injury (TBI) can cause serious complications. Safe removal requires sufficient ability for independent breathing and airway protection. Thus, identifying important factors for time to removal of the tracheal tube (decannulation) is essential for safe and efficient weaning. This study aimed to identify significant factors for time to decannulation in a Danish population of subjects with tracheostomy after TBI. METHODS: This was a retrospective register-based cohort study. Subjects with moderate and severe TBI and a tracheal tube were selected from the Danish Head Trauma Database between 2011-2021. Time to decannulation was calculated as time from injury to decannulation. Associations between selected explanatory variables representing demographic and clinical characteristics and time to decannulation were analyzed using linear regression models. RESULTS: A total 324 subjects were included with a median of 44 d to decannulation. Primary analysis found that an improvement in swallowing ability during the initial 4 weeks of rehabilitation was associated with an 8.2 d reduction in time to decannulation (95% CI -12.3 to -4.2, P < .001). Change in overall sensorimotor ability reduced time to decannulation by 0.94 (95% CI -0.78 to -0.10, P = .03) d. Change in cognitive abilities from rehab admission to 4-week follow-up did not significantly affect the number of days to decannulation (P = .66). Secondary analysis showed pneumonia was associated with the largest estimated increase of 24.4 (95% CI 15.9-32.9, P < .001) d and that increased cognitive functioning at rehabilitation admission was associated with a significant reduction in time to decannulation. CONCLUSIONS: This study found that a change in swallowing ability is a potentially significant factor for reducing time to decannulation. Identifying factors that could explain differences in time to decannulation is essential for patient outcomes, especially if these factors are modifiable and could be targeted in rehabilitation and treatment.

Differences in Thigh Muscle Activation Between Standing and Landing Exercises for Knee Injury Prevention and Rehabilitation.

Background: In injury prevention or rehabilitation programs, exercises that facilitate enhanced hamstring activity may be beneficial when aiming to enhance knee joint stability during movements in sports with higher risk of acute knee injury. Information about neuromuscular activation of the hamstring muscles in commonly used exercises may improve exercise selection and progression in programs for knee injury prevention or rehabilitation. Purpose: To investigate (1) how balance devices with progressing degrees of instability influence the activity of muscles controlling the knee joint in typical balance exercises with different demands on postural control, and (2) if any between-sex differences exist. Study design: Cross-sectional study. Methods: Twenty habitually active healthy adults (11 males) participated in this cross-sectional study. Single-leg stance, single-leg squat and single-leg landing were performed on the floor and two different balance devices imposing various levels of challenge to postural control. Three-dimensional motion analysis was used to obtain hip and knee joint angles, and as primary outcomes, and peak normalized EMG activity from the hamstrings and quadriceps muscles was measured for comparison between exercises. Results: The more challenging in terms of maintaining stable balance the devices were, the higher hamstring muscle activity levels were observed. There was a clear progression across balance devices from single-leg stance to single-leg squat and further to single-leg landing displaying increasing hamstring activity levels. The change in medial hamstring activity across all devices when changing from single-leg squat to single-leg landing was significantly higher for the female participants than for the males reaching a higher level of activity. Conclusion: The muscle activity of the hamstrings and quadriceps increased when the motor task was more dynamic. Specifically, single-leg landings were effective in increasing the hamstring muscle activity over the single-leg stance to single-leg squat exercises, and muscle activity was significantly increased with the most unstable device. Increases in hamstring muscle activation was greater in female subjects than males with increasing instability of the balance devices. Trial identifier: Not registered. Level of evidence: 3.

Diet-induced ketosis in adult patients with subacute acquired brain injury: a feasibility study.

Background: Research in animal models on cerebral metabolism after brain injury highlights the potential benefits of ketosis in reducing secondary brain injury, but studies in humans are lacking. Aim: This study aimed to examine if a 6-week ketogenic diet intervention with added medium-chain triglycerides (MCT) was feasible in adult patients with acquired brain injury in the subacute phase, whether ketosis could be achieved and maintained, and to what extent serious adverse reactions, adverse reactions, serious adverse events, and adverse events occured. Methods: Patients ≥18 years of age diagnosed with subacute acquired brain injury and an expectation of hospitalisation ≥6 weeks were included in the intervention group. Patients not included in the intervention group were included in a standard care reference group. The intervention consisted of a ketogenic diet supplemented with MCT to obtain a plasma concentration of ß-hydroxybutyrate (BHB) ≥0.5 mmol/L. Patients who were enterally fed were given KetoCal® 2.5:1 LQ MCT Multi Fiber (Nutricia A/S, Allerød, Denmark), supplemented with Liquigen® (Nutricia A/S, Allerød, Denmark). Patients consuming oral nutrition were given KetoCal® 2.5:1 LQ MCT Multi Fiber supplemented with Liquigen®, in addition to ketogenic meals. Results: During a 13-week inclusion period, 12 of 13 eligible patients (92% [95% CI: 67% to 99%]) were included in the intervention group, and 17 of 18 excluded patients (94% [95% CI: 74% to 99%]) were included in the reference group. Eight patients (67%) completed the 6-week intervention. It took a median of 1 day to achieve ketosis from starting a 100% MCT ketogenic diet, and it was maintained for 97% of the intervention period after ketosis was obtained. There were no serious adverse reactions to the MCT ketogenic diet, and patients experienced adverse reactions not considered serious in 9.5% of days with the intervention. The MCT ketogenic diet was accepted by patients on all intervention days, and in the two patients transitioning from enteral feeding to oral intake, there were no complications related to transitioning. Conclusion: Intervention with MCT ketogenic diet is feasible and tolerated for 6 weeks in hospitalised adult patients with subacute acquired brain injury. Randomised controlled trials are needed to assess the benefits and harms of the MCT ketogenic diet and the effect on patients' recovery.Clinical trial registration: ClinicalTrials.gov, identifier [NCT04308577].

Local dynamic stability during treadmill walking can detect children with developmental coordination disorder.

OBJECTIVE: Developmental coordination disorder (DCD) is an innate impairment of motor coordination that affects basic locomotion and balance. This study investigated local dynamic stability of trunk accelerations during treadmill walking as an objective evaluation of gait stability and the sensitivity and specificity of this measure to discriminate children with DCD from typically developing children. METHOD: Eight children with DCD and ten age- and gender-matched typically developing children (TD) walked four minutes on a treadmill. Trunk accelerations in vertical, medio-lateral and anterior-posterior directions were recorded with a sternum mounted accelerometer at 256Hz. Short term local dynamic stability (λs), root mean square (RMS) and relative root mean square (RMSR) were calculated from measures of orthogonal trunk accelerations. Receiver operating characteristic curve (ROC) analysis was performed to discriminate between groups based on short term local dynamic stability. RESULTS: λs was significantly greater in children with DCD in the main movement direction (AP) (DCD: 1.69±0.17 λs; TD:1.41±0.17 λs; p=0.005), indicating reduced local dynamic stability. RMS and RMSR accelerations showed no difference between children with DCD and TD children in any direction. The ROC analysis of λs in separate directions and in two dimensions showed an excellent accuracy of discriminating between children with DCD and TD children. Anterior-posterior direction in combination with medio-lateral or vertical showed best performance with an area under the curve (AUC) of 0.91. CONCLUSION: We have shown that children with developmental coordination disorder have general reduced local dynamic stability and that the short term Lyapunov exponent has good power of discrimination between DCD and TD.

Impaired postural control in children with developmental coordination disorder is related to less efficient central as well as peripheral control.

BACKGROUND: Developmental coordination disorder (DCD) is a neurodevelopmental impairment that affects approximately 6% of children in primary school age. Children with DCD are characterized by impaired postural control. It has yet to be determined what effect peripheral and central neuromuscular control has on their balance control. OBJECTIVE: The aim of this study was to investigate the underlying mechanisms to impaired postural control in children with DCD using the rambling-trembling decomposition of the center of pressure (CoP). METHOD: Nine children with DCD (9.0±0.5years, 7 boys, 2 girls) and 10 age- and gender-matched typically developing children (TD) with normal motor proficiency (9.1±0.4years, 7 boys and 3 girls) performed 3×30s bipedal standing on a force plate in six sensory conditions following the sensory organization procedure. Sway length was measured and rambling-trembling decomposition of CoP was calculated in medio-lateral (ML) and anterior-posterior (AP) direction. RESULTS: Both rambling and trembling were larger for the children with DCD in AP (p=0.031; p=0.050) and ML direction (p=0.025; p=0.007), respectively. ML rambling trajectories did not differ in any conditions with fixed support surface. In ML direction children with DCD had a lower relative contribution of rambling to total sway (p=0.013). CONCLUSION: This study showed that impaired postural control in children with DCD is associated with less efficient supraspinal control represented by increased rambling, but also by reduced spinal feedback control or peripheral control manifested as increased trembling.