Age-based prediction of incidence of complications during inpatient stroke rehabilitation: a retrospective longitudinal cohort study.

BACKGROUND: Stroke complications can occur not only in the acute ward but also during the subsequent rehabilitation period. However, existing studies have not adequately addressed the incidence of various complications among stroke in patients undergoing rehabilitation using a longitudinal method. We aimed to investigate the longitudinal impact of age on complication rates in patients undergoing inpatient stroke rehabilitation at different disease stages. METHODS: Five hundred and sixty-eight first-time stroke patients transferred to the rehabilitation ward between July 2002 and June 2012 were included in the study. Patients were stratified into age groups for comparison: <65 years (young), 65 years to <75 years (younger old), and ≥75 years (older old). In total, 30 different complication types were recorded for analysis. RESULTS: Constipation, shoulder pain, symptomatic urinary tract infection (UTI), and fever were common complications during initial stay in the rehabilitation ward, and incidence was >10% in all three age groups. The frequency of incidence of upper gastrointestinal bleeding (UGIB) was higher in the younger old (17.9%) and older old (20.6%) groups than in the young group (4.1%) during initial stay in the rehabilitation ward (p < 0.001). The incidence of UGIB was higher in the younger old (8.04%) and older old (8.33%) groups than in the young group (0.19%) during subsequent stay in the rehabilitation ward (p = 0.011). The incidence of symptomatic UTI was higher in the younger old (21.0%) and older old (20.0%) groups than in the young group (11.5%) during initial stay in the rehabilitation ward (p = 0.019). The incidence of symptomatic UTI was higher in the older old group (29.17%) than in the younger old (9.21%) and young (3.14%) groups during subsequent stay in the rehabilitation ward (p < 0.001). CONCLUSIONS: Age does not affect every complication type. UGIB and symptomatic UTI occurred more frequently in stroke patients aged ≥65 years during their stay in the rehabilitation ward.

Remote effect of lower limb acupuncture on latent myofascial trigger point of upper trapezius muscle: a pilot study.

Objectives. To demonstrate the use of acupuncture in the lower limbs to treat myofascial pain of the upper trapezius muscles via a remote effect. Methods. Five adults with latent myofascial trigger points (MTrPs) of bilateral upper trapezius muscles received acupuncture at Weizhong (UB40) and Yanglingquan (GB34) points in the lower limbs. Modified acupuncture was applied at these points on a randomly selected ipsilateral lower limb (experimental side) versus sham needling on the contralateral lower limb (control side) in each subject. Each subject received two treatments within a one-week interval. To evaluate the remote effect of acupuncture, the range of motion (ROM) upon bending the contralateral side of the cervical spine was assessed before and after each treatment. Results. There was significant improvement in cervical ROM after the second treatment (P = 0.03) in the experimental group, and the increased ROM on the modified acupuncture side was greater compared to the sham needling side (P = 0.036). Conclusions. A remote effect of acupuncture was demonstrated in this pilot study. Using modified acupuncture needling at remote acupuncture points in the ipsilateral lower limb, our treatments released tightness due to latent MTrPs of the upper trapezius muscle.

Follow-up of developmental profiles in children with spastic quadriplegic cerebral palsy.

BACKGROUND: The aim of this study was to investigate longitudinal changes in the developmental profiles of children with spastic quadriplegic (SQ) cerebral palsy (CP). Additionally, the relationship of developmental functions between the initial and final stages was determined. METHODS: This prospective study enrolled forty-six children with SQ CP between 2-6 years old and assessed their developmental profiles using the Chinese Child Developmental Inventory on the initial and final assessments. The interval between two assessments was 1.0 +/- 0.3 years. Eight developmental domains, including gross motor, fine motor, expressive language, concept comprehension, situation comprehension, self help, personal social and general development, were evaluated and qualified by the development quotient (DQ). The DQ change index (%) was calculated to evaluate the differences in each domain between the two assessments. The paired t test was used to compare differences in each domain between the two assessments. Pearson's correlation was used to analyze the relationship of each domain between the final and initial assessments. RESULTS: Children with SQ CP had lower DQs than normal children in all developmental functions on both assessments (23 - 66%). The DQ distributions were lowest in the gross motor and self help domains, higher in the fine motor, situation comprehension, and personal social domains, and highest in the expressive language, concept comprehension, and general development domains. Except for the fine motor and concept comprehension domains, the DQs of the developmental functions were significantly decreased on the final assessment (p < 0.05). CONCLUSION: These findings suggest preschool children with SQ CP had impairments in the full spectrum of developmental profiles. The course of developmental profiles evolves with age. Most developmental functions did not increase proportionally with increasing age in children with SQ CP.

Measurement of forefoot varus angle by laser technology in people with flexible flatfoot.

OBJECTIVE: The purpose of this study was to measure the forefoot varus angles in subjects with and without flexible flatfoot (FF) by using laser foot-scanning technology. DESIGN: In the rehabilitation laboratory of a tertiary medical center, 70 subjects with FF, ranging in age from 10 to 50 yr, were recruited. The control group consisted of 30 volunteers without clinical evidence of FF. A total of 100 positive casts were obtained by having their subtalar joints kept in a neutral position. The plantar surface of the positive cast was scanned by a Yeti 3D Foot Scanner. A straight line was drawn between the first and fifth metatarsophalangeal joints. The forefoot varus angle was measured from this line in relation to the line parallel to the ground. RESULTS: The mean forefoot varus angle was calculated to be 5.01 +/- 4.51 degrees in our FF subjects, and 1.23 +/- 1.96 degrees in the control group. Significant statistical difference in forefoot varus angle was noted between these two groups. CONCLUSIONS: The laser foot-scanning technique offers fast and accurate measurement of the forefoot varus angles. An average forefoot varus angle of approximately 5 degrees was observed in subjects with FF, which was significantly greater than the subjects without FF. Therefore, we recommend the concept of incorporating adequate forefoot posting at the medial forefoot area of an insole in treating people with FF.