Prediction of Gait without Physical Assistance after Inpatient Rehabilitation in Severe Subacute Stroke Subjects.

BACKGROUND: Gait recovery is one of the main therapeutic goals of the rehabilitation for patients after a stroke. OBJECTIVE: This study is aimed at describing the frequency of achievement of gait without physical assistance in poststroke subacute patients by the time of discharge from a rehabilitation hospitalized program. Secondarily, our goal is to identify gait without physical assistance predictors in this same population based on the admission's clinical and demographic conditions. METHODS: Data from 185 first unilateral hemispheric stroke patients that need physical assistance to walk at admission were analyzed. The sample was dichotomized into gait with physical assistance and gait without physical assistance to calculate the frequency of achievement of gait without assistance at discharge. Multivariate logistic modeling was applied to identify prognostic factors for regaining gait without physical assistance. RESULTS: Gait without assistance was achieved in 50.27% of the subjects. Five variables were identified for the prediction model: age (Odds ratio [OR] = .87, 95% confidence interval [CI] = .83-.92), gender (OR = .37, 95% CI = .14-.94), time between stroke and hospitalization (OR = .96, 95% CI = .94-.99), initial Berg Balance (OR = 1.52, 95% CI = 1.23-1.88), and initial lower limb Fugl Meyer (OR = 1.17, 95% CI = 1.07-1.27). CONCLUSIONS: Although discharge planning is complex, achievement of gait without physical assistance is undoubtedly a landmark to decide on hospitalization discharge. Half of this sample was able to walk without physical assistance at hospitalization discharge. Five clinical and demographic conditions at admission were found predictors of gait without physical assistance at inpatient discharge.

Fatigue level in spinal cord injury AIS D community ambulatory subjects.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: The objective of our study was to determine the level of fatigue in ASIA impairment scale (AIS) D spinal cord injury (SCI) in community ambulatory subjects and correlate fatigue with other clinical symptoms. SETTING: Outpatient Rehabilitation Unit, FLENI Institute, Escobar. Buenos Aires, Argentina. METHODS: We included twenty-six patients with AIS D SCI that attended therapies at FLENI Institute between 2002 and 2009. We measured the demographic and clinical characteristics of the subjects. All patients were administered the fatigue severity scale (FSS). A cut-score for over four was indicative of significant fatigue. We used the Spearman's coefficient correlation to analyze associations among the FSS with pain (Visual analog scale), depression (Beck depression inventory), and physical activity (hours per week). RESULTS: The median score of the FSS scale was 2.82 (1-5). Fatigue was found in 5 individuals (19.2%). There was a significant correlation between FSS scale and the Beck questionnaire. No association was found between FSS and pain or physical activity. CONCLUSION: The findings of this study suggest that fatigue is a relevant problem for people with SCI AIS D, and is a disabling symptom when present. There is a significant relationship between fatigue and depression. SPONSORSHIP: FLENI Rehabilitation Institute.

Traffic gridlock on a honeycomb city.

Inspired by an old and almost in oblivion urban plan, we report the behavior of the Biham-Middleton-Levine (BML) model-a paradigm for studying phase transitions of traffic flow-on a hypothetical city with a perfect honeycomb street network. In contrast with the original BML model on a square lattice, the same model on a honeycomb does not show any anisotropy or intermediate states, but a single continuous phase transition between free and totally congested flow, a transition that can be completely characterized by the tools of classical percolation. Although the transition occurs at a lower density than for the conventional BML, simple modifications, like randomly stopping the cars with a very small probability or increasing the traffic light periods, drives the model to perform better on honeycomb lattices. As traffic lights and disordered perturbations are inherent in real traffic, these results question the actual role of the square gridlike designs and suggest the honeycomb topology as an interesting alternative for urban planning in real cities.

Unraveling the puzzling intermediate states in the Biham-Middleton-Levine traffic model.

The Biham-Middleton-Levine (BML) traffic model, a cellular automaton with eastbound and northbound cars moving by turns on a square lattice, has been an underpinning model in the study of collective behavior by cars, pedestrians, and even internet packages. Contrary to initial beliefs that the model exhibits a sharp phase transition from freely flowing to fully jammed, it has been reported that it shows intermediate stable phases, where jams and freely flowing traffic coexist, but there is no clear understanding of their origin. Here, we analyze the model as an anisotropic system with a preferred fluid direction (northeast) and find that it exhibits two differentiated phase transitions: the system is either longer in the flow direction (longitudinal) or perpendicular to it (transversal). The critical densities where these transitions occur enclose the density interval of intermediate states and can be approximated by mean-field analysis, all derived from the anisotropic exponent relating the longitudinal and transversal correlation lengths. Thus, we arrive at the interesting result that the puzzling intermediate states in the original model are just a superposition of these two different behaviors of the phase transition, solving by the way most mysteries behind the BML model, which turns out to be a paradigmatic example of such anisotropic critical systems.

Strategies to improve recovery in acute ischemic stroke patients: Iberoamerican Stroke Group Consensus.

Stroke is not only a leading cause of death worldwide but also a main cause of disability. In developing countries, its burden is increasing as a consequence of a higher life expectancy. Whereas stroke mortality has decreased in developed countries, in Latin America, stroke mortality rates continue to rise as well as its socioeconomic dramatic consequences. Therefore, it is necessary to implement stroke care and surveillance programs to better describe the epidemiology of stroke in these countries in order to improve therapeutic strategies. Advances in the understanding of the pathogenic processes of brain ischemia have resulted in development of effective therapies during the acute phase. These include reperfusion therapies (both intravenous thrombolysis and interventional endovascular approaches) and treatment in stroke units that, through application of management protocols directed to maintain homeostasis and avoid complications, helps to exert effective brain protection that decreases further cerebral damage. Some drugs may enhance protection, and besides, there is increasing knowledge about brain plasticity and repair mechanisms that take place for longer periods beyond the acute phase. These mechanisms are responsible for recovery in certain patients and are the focus of basic and clinical research at present. This paper discusses recovery strategies that have demonstrated clinical effect, or that are promising and need further study. This rapidly evolving field needs to be carefully and critically evaluated so that investment in patient care is grounded on well-proven strategies.

Comparison of gait performance on different environmental settings for patients with chronic spinal cord injury.

STUDY DESIGN: Observational cross-section study. OBJECTIVES: The objective of our study was to determine if the influence of a community environment would impact on ASIA D spinal cord injured (SCI) gait performance patients. Our main hypothesis is that an outdoor community environment may influence gait speed and endurance on community ambulating patients. METHODS: Ten-Meter Walking (10MWT) and Six-Minute Walking (6MWT) tests were performed on community ambulating SCI research participants (n=18) in two different environmental conditions: (1) Experimental (indoors Gymnasium) and (2) Natural (community setting). Average gait speed and endurance values were obtained for the two different conditions and analyzed for statistical significance on the nonparametric two-tailed Wilcoxon signed rank test. RESULTS: While no difference was observed on the 10MWT we found an improvement on gait performance on the 6 MWT on a community setting. CONCLUSIONS: Our study showed mixed results on environmental influence on gait speed and endurance on ASIA D patient population. While there is no difference on the 10 MWT, there is an improvement on gait performance on the communitary 6MWT.