Recovery of walking ability using a robotic device in subacute stroke patients: a randomized controlled study

Purpose: This study investigates the effectiveness of Lokomat + conventional therapy in recovering walking ability in non-ambulatory subacute stroke subjects involved in inpatient rehabilitation. Method: Thirty first-ever stroke patients completed 8 weeks of intervention. One group (n = 16) received Lokomat therapy twice a week, combined with three times 30 min a week of conventional overground therapy. The second group (n = 14) received conventional assisted overground therapy only, during a similar amount of time (3.5 h a week). The intervention was part of the normal rehabilitation program. Primary outcome measure was walking speed. Secondary outcome measures assessed other walking- and mobility-related tests, lower-limb strength and quality of life measures. All outcome measures were assessed before and after the intervention and at wk 24 and wk 36 after start of the intervention. Results: Patients showed significant (p<0.05) gains in walking speed, other walking- and mobility related tests, and strength of the paretic knee extensors relative to baseline at all assessments. However, there were no significant differences in improvements in any of the variables between groups at any time during the study. Conclusion: These results indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as conventional therapy alone

Mortality in Robin sequence : identification of risk factors

Although Robin sequence (RS) is a well-known phenomenon, it is still associated with considerable morbidity and even mortality. The purposes of this study were to gain greater insight into the mortality rate and identify risk factors associated with mortality in RS. We retrospectively reviewed all RS infants followed at the Wilhelmina Children's Hospital from 1995 to 2016. Outcome measurements were death and causes of death. The authors identified 103 consecutive RS infants with a median follow-up of 8.6 years (range 0.1-21.9 years). Ten of the 103 infants (10%) died at a median age of 0.8 years (range 0.1-5.9 years). Nine of these ten infants (90%) were diagnosed with an associated syndrome. Of these, seven infants died of respiratory insufficiency due to various causes (two related to upper airway obstruction). The other two syndromic RS infants died of arrhythmia due to hypernatremia and of West syndrome with status epilepticus. One isolated RS infant died of brain ischemia after MDO surgery. Cardiac anomalies were observed in 41% and neurological anomalies in 36%. The presence of a neurological anomaly was associated with a mortality rate of 40% versus 7% in infants with no neurological anomaly (p = 0.016), with an odds ratio of 8.3 (95% CI 1.4-49.0) for neurological anomaly versus no neurological anomaly. Mortality was 15% in infants with syndromic RS versus 2% in infants with isolated RS (p = 0.044). Mortality was not significantly associated with the presence of a cardiac anomaly, surgical treatment for severe respiratory distress in the neonatal period, or prematurity. CONCLUSION: RS represents a heterogeneous patient population and is associated with a high level of underlying syndromes. The present study reports a mortality rate of 10% significantly associated with syndromic RS and the presence of neurological anomalies. A multidisciplinary approach in all infants born with RS, including genetic testing and examination of neurological anomalies in a standardized way, is crucial to identify infants with underlying syndromes potentially associated with increased mortality. What is Known: • Reported mortality rates in Robin sequence vary from 2% to 26%. • Clinicians mainly focus on the morbidity of Robin sequence that includes respiratory complications due to upper airway obstruction in the period after birth. • Robin sequence represents a heterogeneous patient population and is associated with a high level of underlying syndromes. What is New: • The present study reports a mortality rate of 10% significantly associated with syndromic Robin sequence and the presence of neurological anomalies. • A multidisciplinary approach in all infants born with Robin sequence, including genetic evaluation and standardized workup for neurological anomalies, is crucial to identify infants with underlying syndromes potentially associated with increased mortality

Health-Related Quality of Life 5 Years After Roux-en-Y Gastric Bypass in Young (18-25 Years) Versus Older (≥ 26 Years) Adults : a Scandinavian Obesity Surgery Registry Study.

BACKGROUND: To compare changes in health-related quality of life (HRQoL) in young (18-25 years) versus older (≥ 26 years) adults up to 5 years after Roux-en-Y gastric bypass (RYGB). METHODS: Data on Short Form-36 (SF-36) and obesity-related problems scale (OP) at baseline and 1, 2, and 5 years after RYGB were extracted from the Scandinavian Obesity Surgery Registry. Within-group changes and the effect of age group on 5-year changes in SF-36 and OP were analyzed. Effects sizes (ESs) were calculated. RESULTS: A total of 2542 young and 12,425 older adults were included at baseline, and 138 young (20.7% of those eligible) and 1021 older (31.8%) adults were followed-up 5 years post-RYGB. At this time, average to large improvements (ES ≥ 0.5) were observed in physical functioning, physical component score and OP in young adults, and in physical functioning, role physical, general health, physical component score, and OP in older adults (all, p ≤ 0.001). Both age groups displayed negligible to weak (ES &lt; 0.5) or no improvements in mental HRQoL (all, p &lt; 0.55). Older adults displayed greater 5-year improvements than their young counterparts in role physical, general health, vitality, social functioning, physical component score, and obesity-related problems scale (all, p &lt; 0.05). CONCLUSIONS: Both young and older adults displayed improvements in OP and physical HRQoL 5 years post-RYGB compared to baseline, while mental HRQoL did not improve to the same extent. Greater HRQoL-improvements could be expected in older patients why future research on HRQoL post-RYGB should stratify data on age groups