EFFECTS OF REHABILITATION PROGRAM FOCUSED ON IMPROVING REAL-LIFE DAILY ACTIVITIES OF PATIENTS WITH MILD COGNITIVE IMPAIRMENTS OR DEMENTIA AND THEIR CAREGIVERS.

Objective: To evaluate the effectiveness of a dyadic outpatient rehabilitation program focused on improving the real-life daily activities of patients with mild cognitive impairments or dementia and their caregivers. Design: Retrospective study. Subjects: Eight patients with mild cognitive impairments or dementia and their caregivers. Methods: The rehabilitation program comprised eight 1-hour sessions by occupational therapists with patients and his/her caregivers. Patients were assessed for motor function, cognitive function, and quality of life, and their caregivers were assessed for depression and caregiver burden. Participants were assessed at pre-program and post-program, and 3-month follow-up. Results: The scores of caregiver-assessed Quality of life in Alzheimer's disease scale in patients significantly improved at post-program (median [interquartile range], 30.0 [7.0]) compared with pre-program (27.0 [2.8], effect size = 0.77, p = 0.029). In caregivers, the Zarit Caregiver Burden Interview scores decreased significantly at post-program (16.5 [13.0]) compared with pre-program (22.0 [17.5], effect size = 0.72, p = 0.042). There were no significant differences in other assessments. Conclusions: The rehabilitation program focused on real daily activities and demonstrated to improve patients' quality of life and caregivers' depression and caring burden through patient-caregiver interaction. Future enhanced follow-up systems are warranted.

Poor walking ability outcome and activities of daily living improvement in patients undergoing cardiac rehabilitation during COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has had wide-ranging impacts across international healthcare systems and direct impacts on rehabilitation professionals. Few outcome data for cardiac patients undergoing rehabilitation programs during the COVID-19 pandemic are available. AIM: We conducted a study to compare the effect of modified rehabilitation therapies mainly performed in wards versus conventional therapies mainly performed in rehabilitation units in which exercise on a treadmill and cardiopulmonary exercise testing were available. DESIGN: Observational study. SETTING: University hospital. POPULATION: Fifty-five consecutive inpatients admitted to a university hospital and underwent a cardiac rehabilitation program from August 2019 to June 2020. METHODS: The patients were divided into two groups: those admitted during the COVID-19 outbreak (Group A, N.=28) and those admitted before the COVID-19 outbreak (Group B, N.=27). The evaluation included age, sex, duration of the rehabilitation intervention program, days before initiation of the rehabilitation program, functional status, and Functional Independence Measure (FIM) Score. RESULTS: A higher proportion of patients in Group A than B underwent a cardiac rehabilitation program provided in wards (88.5% vs. 48.8%, respectively). Group A showed a significantly lower 6-minute walking distance and walking speed than Group B at discharge (P=0.031 and 0.014, respectively). Group A showed a significantly shorter exercise time using an ergometer than Group B (P=0.028). CONCLUSIONS: The difference in the cardiac rehabilitation location during the COVID-19 pandemic may affect the rehabilitation contents and lead to less improvement in physical function. CLINICAL REHABILITATION IMPACT: A cardiac rehabilitation program was performed mainly in wards instead of in rehabilitation units during the COVID-19 pandemic. Walking abilities were adversely affected by the modified cardiac rehabilitation program.

Upper Limb Motor Function Affects the Outcome after Treatment with Botulinum Toxin A.

BACKGROUND: Treatment with Botulinum toxin A (BoNT-A) is effective in decreasing upper limb spasticity. OBJECTIVE: This study aimed to determine the differences in the outcome based on the upper limb motor function before BoNT-A treatment. METHODS: The subjects were 61 patients who underwent BoNT-A treatment for upper limb spasticity. Limb function was evaluated using the Fugl-Meyer Assessment upper extremity (FMA-UE), modified Ashworth scale, passive range of motion and disability assessment scale before treatment as well as 2, 6, and 12 weeks after treatment. We divided the total and each subscale of FMA-UE before BoNT-A administration into beyond-the-mean-score group (higher score group) and below-the-mean-score group (lower score group). RESULTS: In both the higher and lower score groups of the FMA-UE total and modified Ashworth scale scores improved significantly after treatment. In FMA-UE, the higher score group of subscale A improved significantly, but subscale C decreased significantly at 2 and 6 weeks after the administration. The lower score group of total, subscale A, and B improved significantly. In the disability assessment scale, the self-dressing capability at 6 weeks and limb position at 2, 6 and 12 weeks after the administration improved significantly in the higher score group. In the lower score group, the hygiene capability at 2 weeks as well as the dressing capability and limb position improved significantly at 2, 6 and 12 weeks after administration. CONCLUSIONS: The time course after administration of BoNT-A differed based on upper limb motor function before injection. When administering BoNT-A into the finger flexor muscles of a patient, we should carefully judge the indications for administration.