Rehab Centers: Home Blood Pressure Variability as Cardiovascular Risk Factor in the Population of Ohasama.

Home Blood Pressure Variability as Cardiovascular Risk Factor in the Population of Ohasama.

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Hypertension. 2012 Nov 19;
Asayama K, Kikuya M, Schutte R, Thijs L, Hosaka M, Satoh M, Hara A, Obara T, Inoue R, Metoki H, Hirose T, Ohkubo T, Staessen JA, Imai Y

Blood pressure variability based on office measurement predicts outcome in selected patients. We explored whether novel indices of blood pressure variability derived from the self-measured home blood pressure predicted outcome in a general population. We monitored mortality and stroke in 2421 Ohasama residents (Iwate Prefecture, Japan). At enrollment (1988-1995), participants (mean age, 58.6 years; 60.9% women; 27.1% treated) measured their blood pressure at home, using an oscillometric device. In multivariable-adjusted Cox models, we assessed the independent predictive value of the within-subject mean systolic blood pressure (SBP) and corresponding variability as estimated by variability independent of the mean, difference between maximum and minimum blood pressure, and average real variability. Over 12.0 years (median), 412 participants died, 139 of cardiovascular causes, and 223 had a stroke. In models including morning SBP, variability independent of the mean and average real variability (median, 26 readings) predicted total and cardiovascular mortality in all of the participants (P?0.044); variability independent of the mean predicted cardiovascular mortality in treated (P=0.014) but not in untreated (P=0.23) participants; and morning maximum and minimum blood pressure did not predict any end point (P?0.085). In models already including evening SBP, only variability independent of the mean predicted cardiovascular mortality in all and in untreated participants (P?0.046). The R(2) statistics, a measure for the incremental risk explained by adding blood pressure variability to models already including SBP and covariables, ranged from <0.01% to 0.88%. In a general population, new indices of blood pressure variability derived from home blood pressure did not incrementally predict outcome over and beyond mean SBP. HubMed – rehab


Effect of powered gait orthosis on walking in individuals with paraplegia.

Filed under: Rehab Centers

Prosthet Orthot Int. 2012 Nov 21;
Arazpour M, Ahmadi Bani M, Vahab Kashani R, Tabatabai Ghomshe F, Mousavi ME, Hutchins SW

Background:The important purpose of a powered gait orthosis is to provide active joint movement for patients with spinal cord injury.Objectives:The aim of this study was to clarify the effect of a powered gait orthosis on the kinematics and temporal-spatial parameters in paraplegics with spinal cord injury.Study Design:Quasi-experimental.Methods:Four spinal cord injury individuals experienced gait training with a powered gait orthosis for a minimum of 6 weeks prior to participating in the following walking trials: walking with an isocentric reciprocating gait orthosis and walking with both separate and synchronized movements with actuated orthotic hip and knee joints in a powered gait orthosis. Specific parameters were calculated and compared for each of the test conditions.Results:Using separate and synchronized actuated movement of the hip and knee joints in the powered gait orthosis increased gait speed and step length and reduced lateral and vertical compensatory motions when compared to the isocentric reciprocating gait orthosis, but there were no significant differences in these parameters. Using the new powered gait orthosis improved knee and hip joint kinematics.Conclusions:The powered gait orthosis increased speed and step length as well as hip and knee joint kinematics and reduced the vertical and lateral compensatory motions compared to an isocentric reciprocating gait orthosis in spinal cord injury patients.Clinical relevanceThis new powered gait orthosis has the potential to improve hip and knee joint kinematics, the temporal-spatial parameters of gait in spinal cord injury patients walking.
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Risk for late-life re-injury, dementia and death among individuals with traumatic brain injury: a population-based study.

Filed under: Rehab Centers

J Neurol Neurosurg Psychiatry. 2012 Nov 21;
Dams-O’Connor K, Gibbons LE, Bowen JD, McCurry SM, Larson EB, Crane PK

OBJECTIVES: To determine the association of self-reported traumatic brain injury (TBI) with loss of consciousness (LOC) with late-life re-injury, dementia diagnosis and mortality. DESIGN: Ongoing longitudinal population-based prospective cohort study. SETTING: Seattle-area integrated health system. PARTICIPANTS: 4225 dementia-free individuals age 65 and older were randomly selected and enrolled between 1994 and 2010. Participants were seen every 2 years, with mean (range) follow-up of 7.4 (0-16) years. 606 (14%) participants reported a lifetime history of TBI with LOC at enrolment. 3466 participants provided information regarding lifetime history of TBI and completed at least one follow-up visit. MAIN OUTCOME MEASURES: Self-reported TBI with LOC after study entry, incident all-cause dementia and Alzheimer’s disease (AD), and all-cause mortality. RESULTS: There were 25 567 person-years of follow-up. History of TBI with LOC reported at study enrolment was associated with increased risk for TBI with LOC during follow-up, with adjusted HRs ranging from 2.54 (95% CI 1.42 to 4.52) for those reporting first injury before age 25 to 3.79 (95% CI 1.89 to 7.61) for those with first injury after age 55. History of TBI with LOC was not associated with elevated risk for developing dementia or AD. There was no association between baseline history of TBI with LOC and mortality, though TBI with LOC since the previous study visit (‘recent TBI’) was associated with increased mortality (HR 2.12, 95% CI 1.62 to 2.78). CONCLUSIONS: Individuals aged 65 or older who reported a history of TBI with LOC at any time in their lives were at elevated risk of subsequent re-injury. Recent TBI with LOC sustained in older adulthood was associated with increased risk for mortality. Findings support the need for close clinical monitoring of older adults who sustain a TBI with LOC.
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Isolated benign schwannoma of the supraorbital nerve presenting as an asymptomatic palpable mass.

Filed under: Rehab Centers

J Craniofac Surg. 2012 Nov; 23(6): 1929-30
Denadai R, Bastos EM, Raposo-Amaral CE

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