INTRODUCTION: Rehabilitation medicine in a tertiary care hospital involves attending to many patients affected by intensive care unit (ICU)-associated weakness (ICU-AW) and hospital-associated deconditioning (HAD). These conditions contribute to poor long-term functional outcomes and increased mortality. We explored the role of short-term adjunctive androgen therapy in this group of patients in improving the rehabilitative outcomes. METHODS: This was a retrospective analysis of five patients with either ICU-AW or HAD who were given testosterone replacement therapy (TRT) or oxandrolone for a total of 2 weeks during the period from April to November 2020 was undertaken. During the 2-week trial period, the subjects underwent standard rehabilitation therapy. RESULTS: Grip strength was used as the primary outcome measure, and the mean improvement was 4.2 kg (+24.9%), which is encouraging in a 2-week timeframe. This was matched with good functional recovery in terms of distance ambulated and less assistance needed for ambulation. Sex hormone analysis was also done before initiation of TRT, and it showed that four out of five of the subjects were biochemically hypogonadal. None of the subjects dropped out or experienced any significant adverse events over the 2-week trial period. All the subjects except one improved to full independence at 3 months post-discharge. CONCLUSION TRT has the potential to be used as a useful adjunct to standard rehabilitation in enhancing functional recovery in critically ill patients. A multidisciplinary approach would ensure that suitable patients benefit from optimal nutrition, optimal rehabilitation and synergistic testosterone therapy in a clinically sound and resource-efficient fashion.
Humans ; Testosterone/therapeutic use* ; Retrospective Studies ; Male ; Hormone Replacement Therapy/methods* ; Intensive Care Units ; Singapore ; Middle Aged ; Muscle Weakness/drug therapy* ; Aged ; Hospitals, General ; Hand Strength ; Androgens/therapeutic use* ; Treatment Outcome ; Critical Illness/rehabilitation* ; Female ; Recovery of Function

Introduction. Stroke continues to be a major cause of mortality and disability. Besides having residual motor, sensory, or language deficits, there is a need to identify cognitive and mood related issues as well. Stroke recovery may be best defined as improvement across a variety of outcomes, beginning with biological and neurologic changes that manifest as improvement in performance and activity based behavioural measures Alternatively, the broad definition of stroke rehabilitation is: any aspect of stroke care that aims to reduce disability and promote participation in activities of daily living. The objectives of this process are: to prevent deterioration of function; improve function; achieve the highest possible level of independence within the limits of the persistent stroke impairments. The three approaches of rehabilitation are that of restoration, compensation and modification. Four phases (1.hyperacute, 2.acute, 3.subacute and 4.community reintegration phase) are recognized during stroke rehabilitation, although there is no consensus for the duration of each phase. Specific conditions such as post stroke shoulder pain, depression and spasticity should be identified and appropriate treatment rendered to improve function and quality of life for the patient. Conclusion. Post-stroke patients are more and more likely to survive and progress to the chronic phase of rehabilitation. It is useful to understand the difference between stroke recovery and rehabilitation and to be aware of pathologies that may impede rehabilitation.

Introduction. Stroke continues to be a major cause of mortality and disability. Besides having residual motor, sensory, or language deficits, there is a need to identify cognitive and mood related issues as well.Stroke recovery may be best defined as improvement across a variety of outcomes, beginning with biological and neurologic changes that manifest as improvement in performance and activity based behavioural measures. Alternatively, the broad definition of stroke rehabilitation is: any aspect of stroke care that aims to reduce disability and promote participation in activities of daily living. The objectives of this process are: to prevent deterioration of function; improve function; achieve the highest possible level of independence within the limits of the persistent stroke impairments. The three approaches of rehabilitation are that of restoration, compensation and modification. Four phases (hyperacute, acute, subacute and community reintegration phase) are recognized during stroke rehabilitation, although there is no consensus for the duration of each phase. Specific conditions such as post-stroke shoulder pain, depression and spasticity should be identified and appropriate treatment rendered to improve function and quality of life for the patient.Conclusion. Post-stroke patients are increasingly likely to survive and progress to the chronic phase of rehabilitation. It is useful to understand the difference between stroke recovery and rehabilitation and to be aware of pathologies that may impede rehabilitation

INTRODUCTIONThis study aimed to evaluate the safety and efficacy of a combination of levodopa and virtual reality (VR)-based therapy for the enhancement of upper limb recovery following acute stroke.

METHODSThis was a pilot single-blinded case series of acute stroke patients with upper extremity hemiparesis. Patients were randomised to standard care with concomitant administration of either levodopa alone (control group) or combination therapy consisting of VR-based motivational visuomotor feedback training with levodopa neuromodulation (VR group). Main clinical outcome measures were the Fugl-Meyer Upper Extremity (FM-UE) assessment and Action Research Arm Test (ARAT). Kinematic measurements of affected upper limb movement were evaluated as a secondary measure of improvement.

RESULTSOf 42 patients screened, four patients were enrolled in each of the two groups. Two patients dropped out from the control group during the trial. Patients receiving combination therapy had clinically significant improvements in FM-UE assessment scores of 16.5 points compared to a 3.0-point improvement among control patients. Similarly, ARAT scores of VR group patients improved by 15.3 points compared to a 10.0-point improvement in the control group. Corresponding improvements were noted in kinematic measures, including hand-path ratio, demonstrating that the quality of upper limb movement improved in the VR group.

CONCLUSIONOur results suggest that VR-based therapy and pharmacotherapy may be combined for acute stroke rehabilitation. Bedside acquisition of kinematic measurements allows accurate assessment of the quality of limb movement, offering a sensitive clinical tool for quantifying motor recovery during the rehabilitation process after acute stroke.