Effectiveness of Early Mobilization in Hospitalized Patients with Deep Venous Thrombosis

Deep venous thrombosis (DVT) is a common problem among hospitalized patients. It places the patient at risk for pulmonary embolism (PE), recurrent thrombosis, and post-thrombotic syndrome (PTS). In particular, up to 50% of patients with proximal DVT of the lower extremity develop PE. Because of the high mortality rate, there is a great concern from physiotherapists and physicians regarding patient’s treatment in the hospital setting. Thus, the purpose of the present review is to examine the effectiveness of early mobilization on acute leg DVT of lower extremity in hospitalized patients. Current evidence showed that early mobilization, i.e., walking and/or exercising, with anticoagulation and leg compression may be encouraged in patients with acute DVT. Recent studies reported the benefits of reduction in pain and edema, with improvement in quality of life when using the therapeutic strategy of early mobilization in patients with DVT. Early mobilization does not appear to increase the risk of developing PE, progression of an existing DVT, or developing a new DVT. Further research with larger hospitalized patient samples is required to determine the appropriate time in which ambulation should initiate after DVT, and whether exercise (regular or vigorous) or not exercise is more effective for DVT, PE, and PTS

Therapeutic Applications of Neuromuscular Electrical Stimulation in Critical Care Patients

Neuromuscular Electrical Stimulation (NMES) is commonly used by physiotherapists for pain relief, stimulation of denervated or disused muscles, and the promotion of wound healing.  The purpose of this review is to discus the applications of NMES in Intensive Care Unit (ICU) patients according to the current research evidence. The first application is the neuromuscular electrical stimulation (NMES) in  ICU acquired weakness with research evidence indicating significant benefits such as preservation of  muscle mass, prevention of  polyneuromyopathy and improvement of muscle performance. Secondly, NMES has been proved to be effective in preventing pressure ulcers and accelerating wound healing through mechanisms which are clearly demonstrated by many experimental and clinical studies. However, very few studies have examined the effect of E.S. in pressure ulcers of long term hospitalized ICU patients. Lastly, NMES in ICU can be applied in the form of functional electrical stimulation (FES), a well known technique used to mobilize patients with permanent neurological deficits such as stroke and spinal cord injury. Current evidence in this area is reviewed and future research is proposed

Functional Assessment Scales in a General Intensive Care Unit

The aims of this study were to describe the functional assessment scales for intensive care unit patients, to examine the psychometric evidence for reliability and validity and to summarize the strengths and the weaknesses of them. Several instruments have been used so far for the assessment of functional ability, impairment and/or disability in ICU patients, but all of them have specific limitations. These measurement tools include: Barthel Index, Functional Independence Measure, Functional Status Score for the ICU, Physical Function ICU Test Modified Rankin Scale, Karnofsky Scale Index, 4P questionnaire, Glasgow Outcome Scale, and Disability Rating Scale. The choice of the most appropriate assessment tool will depend on the specific patient population, its diagnosis and rehabilitation phase and the psychological properties of the available measurement. Future studies should examine additional types of reliability and validity with more sophisticated statistical analyses and to assess whether the tool is used for research and/or for clinical purposes

The Effectiveness of Inspiratory Muscle Training in Weaning Critically Ill Patients from Mechanical Ventilation

BACKGROUND: Inspiratory muscle weakness is a consequence of mechanical ventilation that contributes to weaning failure in critical ill patients. Since 1980, case reports of inspiratory muscle training (IMT) in ventilated, difficult to be weaned patients have proposed that this training strategy is associated with successful weaning. OBJECTIVE: We evaluated the efficacy of the inspiratory muscle training on the weaning process. METHODS: We conducted a literature search in the following databases: PubMed, EMBASE, Scopus and Google scholar. Selected keywords included inspiratory/ respiratory muscle training, weaning/failure, mechanical ventilation, critically ill, threshold load, intubated/ tracheostomy. RESULTS: In our analysis we included three randomized control trials involving 150 patients. The studies used different devices of training and training protocols. Inspiratory muscle training significantly increased inspiratory muscle strength in relation to sham or no training. CONCLUSION: Although IMT leads to significant increase of respiratory muscle strength, it has not yet been clearly demonstrated that this also leads to successful weaning. Further large randomized studies are needed to determine the beneficial effect of IMT in weaning patients from ventilatory support

Methylphenidate Normalizes Fronto-Striatal Underactivation During Interference Inhibition in Medication-Naïve Boys with Attention-Deficit Hyperactivity Disorder

Youth with attention deficit hyperactivity disorder (ADHD) have deficits in interference inhibition, which can be improved with the indirect catecholamine agonist methylphenidate (MPH). Functional magnetic resonance imaging was used to investigate the effects of a single dose of MPH on brain activation during interference inhibition in medication-naïve ADHD boys. Medication-naïve boys with ADHD were scanned twice, in a randomized, double-blind design, under either a single clinical dose of MPH or placebo, while performing a Simon task that measures interference inhibition and controls for the oddball effect of low-frequency appearance of incongruent trials. Brain activation was compared within patients under either drug condition. To test for potential normalization effects of MPH, brain activation in ADHD patients under either drug condition was compared with that of healthy age-matched comparison boys. During incongruent trials compared with congruent–oddball trials, boys with ADHD under placebo relative to controls showed reduced brain activation in typical areas of interference inhibition, including right inferior prefrontal cortex, left striatum and thalamus, mid-cingulate/supplementary motor area, and left superior temporal lobe. MPH relative to placebo upregulated brain activation in right inferior prefrontal and premotor cortices. Under the MPH condition, patients relative to controls no longer showed the reduced activation in right inferior prefrontal and striato-thalamic regions. Effect size comparison, furthermore, showed that these normalization effects were significant. MPH significantly normalized the fronto-striatal underfunctioning in ADHD patients relative to controls during interference inhibition, but did not affect medial frontal or temporal dysfunction. MPH therefore appears to have a region-specific upregulation effect on fronto-striatal activation

Brain imaging of the cortex in ADHD: a coordinated analysis of large-scale clinical and population-based samples

Objective: Neuroimaging studies show structural alterations of various brain regions in children and adults with attention deficit hyperactivity disorder (ADHD), although nonreplications are frequent. The authors sought to identify cortical characteristics related to ADHD using large-scale studies. Methods: Cortical thickness and surface area (based on the Desikan–Killiany atlas) were compared between case subjects with ADHD (N=2,246) and control subjects (N=1,934) for children, adolescents, and adults separately in ENIGMA-ADHD, a consortium of 36 centers. To assess familial effects on cortical measures, case subjects, unaffected siblings, and control subjects in the NeuroIMAGE study (N=506) were compared. Associations of the attention scale from the Child Behavior Checklist with cortical measures were determined in a pediatric population sample (Generation-R, N=2,707). Results: In the ENIGMA-ADHD sample, lower surface area values were found in children with ADHD, mainly in frontal, cingulate, and temporal regions; the largest significant effect was for total surface area (Cohen’s d=−0.21). Fusiform gyrus and temporal pole cortical thickness was also lower in children with ADHD. Neither surface area nor thickness differences were found in the adolescent or adult groups. Familial effects were seen for surface area in several regions. In an overlapping set of regions, surface area, but not thickness, was associated with attention problems in the Generation-R sample. Conclusions: Subtle differences in cortical surface area are widespread in children but not adolescents and adults with ADHD, confirming involvement of the frontal cortex and highlighting regions deserving further attention. Notably, the alterations behave like endophenotypes in families and are linked to ADHD symptoms in the population, extending evidence that ADHD behaves as a continuous trait in the population. Future longitudinal studies should clarify individual lifespan trajectories that lead to nonsignificant findings in adolescent and adult groups despite the presence of an ADHD diagnosis

Subcortical brain volume, regional cortical thickness, and cortical surface area across disorders: findings from the ENIGMA ADHD, ASD, and OCD Working Groups

Objective Attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and obsessive-compulsive disorder (OCD) are common neurodevelopmental disorders that frequently co-occur. We aimed to directly compare all three disorders. The ENIGMA consortium is ideally positioned to investigate structural brain alterations across these disorders. Methods Structural T1-weighted whole-brain MRI of controls (n=5,827) and patients with ADHD (n=2,271), ASD (n=1,777), and OCD (n=2,323) from 151 cohorts worldwide were analyzed using standardized processing protocols. We examined subcortical volume, cortical thickness and surface area differences within a mega-analytical framework, pooling measures extracted from each cohort. Analyses were performed separately for children, adolescents, and adults using linear mixed-effects models adjusting for age, sex and site (and ICV for subcortical and surface area measures). Results We found no shared alterations among all three disorders, while shared alterations between any two disorders did not survive multiple comparisons correction. Children with ADHD compared to those with OCD had smaller hippocampal volumes, possibly influenced by IQ. Children and adolescents with ADHD also had smaller ICV than controls and those with OCD or ASD. Adults with ASD showed thicker frontal cortices compared to adult controls and other clinical groups. No OCD-specific alterations across different age-groups and surface area alterations among all disorders in childhood and adulthood were observed. Conclusion Our findings suggest robust but subtle alterations across different age-groups among ADHD, ASD, and OCD. ADHD-specific ICV and hippocampal alterations in children and adolescents, and ASD-specific cortical thickness alterations in the frontal cortex in adults support previous work emphasizing neurodevelopmental alterations in these disorders

Re-injury worries, self-confidence and attention as predictors of re-injury and sport performance

IntroductionThe purposes of the present study were: (a) to develop and validate the Re-Injury Worry Questionnaire (R-IWQ), the Sport Confident Questionnaire of Injured Athletes (SCQ- IA) and the Attention Questionnaire of Injured Athletes (AQ-IA), (b) to examine the correlations between the factors of the R-IWQ, SCQ- IA and AQ-IA during the athletic competitive season, (c) to compare between groups with different severity of musculoskeletal injury on the factors of the instruments during the competitive season, and (d) to investigate the proposed theoretical model, describing the predictive ability of the factors of the questionnaires to the total of the re-injuries and the athletic performance in the beginning, in the middle and in the end of the competitive season.MethodThree hundred seventy (n = 370) male and female active athletes completed the RIWQ, SCQ- IA and the AQ-IA to examine the internal consistency, the factor structure, the factorial validity and the concurrent and discriminant validity. All the subjects had an acute musculoskeletal sport injury in the last year and they had followed a physiotherapy program. The sample of the main study was 80 athletes of basketball, handball, and water polo, aged 18 to 40 years old (M = 27.35, SD = 4.43). Furthermore, the subjects had an athletic musculoskeletal injury 3.7 months prior to the collection of the data (SD = 1.69). The R-IWQ and SCQ- IA were completed before the beginning of the competition and the AQ-IA after the end of the competition. The scale of the athletic performance was completed by the coach and the athlete one day after the competition. The severity of the injury was assessed using the «Colorado Injury Reporting System». Furthermore, the present study used: (a) a demographicquestionnaire of athletes, (b) a form related to the previous injury, and (c) a form related to the new re-injuries during the new season. The main statistical analyses of the study were: (a) an exploratory factor analysis, confirmatory factor analyses, that is a first order and a second order confirmatoryfactor analyses, and correlations Pearson r to examine the factor structure, the factorial validity, the concurrent and discriminant validity of the R-IWQ, SCQ- IA Re-injury worries, self-confidence and attention as predictors of re-injury and sport performance and the AQ-IA, respectively, (b) correlations Pearson r between the factors of the questionnaires, (c) ANOVΑ analyses to compare the differences between the groups with different severity of injury to the factors of the questionnaires, and (d)hierarchical multiple regressions to investigate the predictive ability of the factors of the questionnaires to the total of re-injuries and athletic performance.ResultsThe results of the present study indicated that the R-IWQ and the SCQ- IA are consisted of 12 and 14 items, which examine two correlated factors. The AQ-IA is consisted of 10 items that investigate two uncorrelated factors. The internal consistency of the three questionnaires is very good. However, the single factor model for the three questionnaires and the hierarchical model for the R-IWQ andSCQ- IA did not indicate a good fit. Therefore, the items of each questionnaire do not examine a single factor and it is not possible to estimate a total score for each questionnaire. Also, the results showed a negative correlation of the re-injury worries to the sport self confidence and to the functional attention and a positive correlation to the disruptive attention. The sport self confidence correlated positively to the functional attention and negatively to the disruptive attention. Furthermore, the results of the study showed that the factors of the three instruments: (a) predict the total of the re-injuries at the beginning of the competitive season, (b) predict partly the total of the re-injuries at the middle of the competitiveseason, (c) do not predict the total of the re-injuries at the end of the competitive season, and (d) predict partly the athletic performance, as the coach had estimated it, during the competitive period. Only the factors of the R-IWQ predict the athletic performance, as the athlete had estimated at the three phases of the competitive season, except the first factor of the R-IWQ at the beginning of the competitive season. All the factors of the three questionnaires predict partly the athletic performance, as the athlete had estimated it, at the beginning of the competitive season. Finally, no significant statistical predictions of the athletic performance from the athlete observed to the other phases of the competitive season. DiscussionResearchers, using the R-IWQ, SCQ- IA and the AQ-IA can measure re-injury worries, sport self confidence and attention objectively and can predict the probability of a re-injury on contact sports; thus can enhance the athletic performance. The results of the study confirm partly the proposed theoretical model, that is, the factors of the questionnaires predict partly the total of the re-injuries andthe athletic performance, as coaches had appreciated it, during the competitive season. On the contrary, athletes had over-estimated their performance during competition, their effort on the training period and their participation’s frequency during the training period. As a result, the factors of the questionnaires predict partly the performance, as athletes had estimated it, only at the beginning of the competitive season. Future research should be conducted to confirm the structure of the threequestionnaires with larger sample from different contact sports.Σκοποί της παρούσας έρευνας ήταν: (α) η κατασκευή και ο έλεγχος ψυχομετρικών δεικτών του Ερωτηματολογίου Ανησυχιών Επανατραυματισμού (ΕΑΕ), του Ερωτηματολογίου Αγωνιστικής Αυτοπεποίθησης για Τραυματισμένους Αθλητές (ΕΑΑ-ΤΑ) και του Ερωτηματολογίου Προσοχής για Τραυματισμένους Αθλητές (ΕΠ-ΤΑ), (β) η εξέταση των συσχετίσεων μεταξύ των παραγόντων των τριών ερωτηματολογίων κατά τη διάρκεια της αγωνιστικής περιόδου, (γ) η σύγκριση μεταξύ ομάδων μεδιαφορετικό βαθμό σοβαρότητας τραυματισμού ως προς τους παράγοντες των τριών ερωτηματολογίων στην έναρξη, στο μέσο και στο τέλος της αγωνιστικής περιόδου (δ) η διερεύνηση ενός προτεινόμενου θεωρητικού μοντέλου, περιγράφοντας την ικανότητα πρόβλεψης των παραγόντων των τριών ερωτηματολογίων στο σύνολο των νέων τραυματισμών και την αθλητική απόδοση στην έναρξη, στο μέσο και στο τέλος της αγωνιστικής περιόδου.ΜέθοδοςΤριακόσιοι εβδομήντα (n = 370) εν ενεργεία αθλητές και αθλήτριες συμπλήρωσαν το ΕΑΕ, ΕΑΑ-ΤΑ και ΕΠ-ΤΑ για τον έλεγχο της εσωτερικής συνέπειας, της δομικής εγκυρότητας, της παραγοντικής δομής και της εγκυρότητας συγχρονικής και διακριτής συνάφειας. Όλοι οι δοκιμαζόμενοι προέρχονταν από αθλήματα επαφής, είχαν οξύ αθλητικό μυοσκελετικό τραυματισμό τους τελευταίους 12 μήνες και είχαν ακολουθήσει φυσικοθεραπευτικό πρόγραμμα αποκατάστασης. Το δείγμα της κυρίως μελέτης αποτελείτο από 80 αθλητές της καλαθοσφαίρισης, της χειροσφαίρισης και της υδατοσφαίρισης με μέσο όρο ηλικίας 27.35 έτη (SD = 4.43). Τα ΕΑΕ και ΕΑΑ-ΤΑ συμπληρώθηκαν πριν την έναρξη του πρώτου επίσημου αγώνα της αγωνιστικής περιόδου, ενώ το ΕΠ-ΤΑ μετά το τέλος του πρώτου επίσημου αγώνα. Η κλίμακα αξιολόγησης της ατομικής αθλητικής απόδοσης συμπληρώθηκε από τους προ-πονητές και αθλητές μια ημέρα μετά τον επίσημο αγώνα. Η σοβαρότητα του τραυματισμού αξιολογήθηκε με το «Σύστημα Αξιολόγησης Τραυματισμού του Colorado». Επίσης, χρησιμοποιήθηκαν έντυπα καταγραφής: (α) δημογραφικών στοιχείων, (β) στοιχείων του προηγούμενου τραυματισμού και (γ) νέων τραυματισμών των αθλητών κατά τη διάρκεια της νέας αγωνιστικής περιόδου.Οι κύριες στατιστικές αναλύσεις των δεδομένων περιλάμβαναν: (α) δείκτες συσχέτισης Pearson για τον έλεγχο της εγκυρότητας συγχρονικής και διακριτής συνάφειας, (β) διερευνητική παραγοντική ανάλυση για τον έλεγχο της παραγοντικής δομής, καθώς και επιβεβαιωτικές παραγοντικές αναλύσεις (λ.χ., πρωτογενής και δευτερογενής επιβεβαιωτική παραγοντική ανάλυση) για την περαιτέρω εξέταση τηςδομικής εγκυρότητας, (γ) δείκτη Cronbach a για τον έλεγχο της εσωτερικής συνέπειας, (δ) συσχετίσεις Pearson για την εξέταση των συσχετίσεων μεταξύ των παραγόντων των ερωτηματολογίων, (ε) ανάλυση ANOVΑ για την αξιολόγηση των διαφορών μεταξύ ομάδων διαφορετικής σοβαρότητας τραυματισμού ως προς τους παράγοντες των τριών ερωτηματολογίων και (στ) ιεραρχικές πολλαπλές γραμμικές παλινδρομίσεις για την εξέταση των σχέσεων μεταξύ των παραγόντων των ερωτηματολογίων με το σύνολο των νέων τραυματισμών και την αθλητική απόδοση στις τρεις φάσεις της αγωνιστικής περιόδου.ΑποτελέσματαΤα ΕΑΕ και ΕΑΑ-ΤΑ αποτελούνται από 12 και 14 ερωτήσεις, αντίστοιχα, οι οποίες εξετάζουν δύο συσχετιζόμενους παράγοντες. Το ΕΠ-ΤΑ αποτελείται από 10 ερωτήσεις, οι οποίες μετρούν δύο μη συσχετιζόμενους παράγοντες. Η εσωτερική συνέπεια των τριών ερωτηματολογίων είναι αρκετά καλή. Όμως, το μοντέλο του ενός παράγοντα στα τρία ερωτηματολόγια και τα ιεραρχικά μοντέλα των ΕΑΕ και ΕΑΑ-ΤΑ δεν εμφάνισαν αποδεκτούς στατιστικούς δείκτες. Συνεπώς, οι ερωτήσεις του κάθε ερωτηματολογίου δεν μελετούν μια ενιαία και κοινή έννοια και δεν είναι δυνατόν να υπολογιστεί μια συνολική τιμή των δύο παραγόντων στο κάθε ερωτηματολόγιο. Επιπλέον, η παρούσα έρευνα έδειξε την αρνητική συνάφεια των ανησυχιών επανατραυματισμού με την αγωνιστική αυτοπεποίθηση και τη λειτουργική προσοχή και τη θετική συνάφεια με τη διάσπαση της προσοχής. Η αγωνιστική αυτοπεποίθηση είχε θετική συσχέτιση με τη λειτουργική προσοχή και αρνητική με τη διάσπαση τηςπροσοχής.Tα αποτελέσματα της έρευνας έδειξαν ότι οι παράγοντες των τριών ερωτηματολογίων παρουσιάζουν διαφορετική πρόβλεψη στις τρεις αγωνιστικές περιόδους. Συγκεκριμένα: (α) προβλέπουν το σύνολο των νέων τραυματισμών στην έναρξη της αγωνιστικής περιόδου, (β) προβλέπουν μερικώς το σύνολο των νέων τραυματισμών στο μέσο της αγωνιστικής περιόδου, (γ) δεν προβλέπουν το σύνολο των νέων τραυματισμών στο τέλος της αγωνιστικής περιόδου και (δ) προβλέπουν μερικώς την αθλητική απόδοση, όπως εκτιμήθηκε από τον προπονητή, στις τρεις φάσεις της αγωνιστικής περιόδου. Μόνο οι παράγοντες των ανησυχιών επανατραυματισμού προβλέπουν στατιστικώς σημαντικά την αθλητική απόδοση, όπως αυτή εκτιμήθηκε από τον ίδιο τον αθλητή στις τρεις φάσεις της αγωνιστικής περιόδου, με εξαίρεση τον 1ον παράγοντα των ανησυχιών επανατραυματισμού στην έναρξη της αγωνιστικής περιόδου. Οι παράγοντες των ανησυχιών επανατραυματισμού, της αγωνιστικής αυτοπεποίθησης και της προσοχής προβλέπουν μερικώς την αθλητική απόδοση στην έναρξη της αγωνιστικής περιόδου. Τέλος, καμία στατιστικώς σημαντική πρόβλεψη της απόδοσης από τον ίδιο τον αθλητή δεν παρατηρήθηκε στο μέσο και στο τέλοςτης αγωνιστικής περιόδου.Συζήτηση-ΣυμπεράσματαΗ χρησιμότητα του Ερωτηματολογίου Ανησυχιών Επανατραυματισμού, του Ερωτηματολογίου Αγωνιστικής Αυτοπεποίθησης για Τραυματισμένους Αθλητές και του Ερωτηματολογίου Προσοχής για Τραυματισμένους Αθλητές κρίνεται σημαντική επειδή ο ειδικός της αποκατάστασης θα έχει τη δυνατότητα να αξιολογήσει αντικειμενικά την ψυχολογική κατάσταση των αθλητών με προηγούμενο τραυματισμό, η οποία θα επηρεάσει την αθλητική απόδοση και θα συμβάλει στον επανατραυματισμό. Τα αποτελέσματα της έρευνας επιβεβαιώνουν μερικώς το προτεινόμενο θεωρητικό μοντέλο, δηλαδή, οι παράγοντες των τριών ερωτηματολογίων μερικώς προβλέπουν το σύνολο των νέων τραυματισμών και την αθλητική απόδοση, όπως αυτή εκτιμήθηκε από τους προπονητές στις τρεις φάσεις της αγωνιστικήςπεριόδου. Αντίθετα, οι αθλητές ενδεχομένως «υπερεκτίμησαν» την απόδοση τους στον αγώνα, την προσπάθεια που κατέβαλλαν στις προπονήσεις και τη συχνότητα συμμετοχής τους στις προπονήσεις, με αποτέλεσμα οι παράγοντες των ερωτηματολογίων μερικώς προβλέπουν την αθλητική απόδοση μόνο στην έναρξη της αγωνιστικής περιόδου. Περαιτέρω έρευνα απαιτείται να επαληθεύσει τη δομή των τριών ερωτηματολογίων με τη χρήση μεγαλύτερου δείγματος που προέρχεται από διαφορετικά ομαδικά αθλήματα επαφής