Effects of elastic band orthosis (aider) on balance and gait in chronic stroke patients

Daher, Noha,Lee, Seungjun,Yang, You Jin korean Academy of Physical Therapy Rehabilitation 2013 Physical therapy rehabilitation science Vol.2 No.2

Objective: The objective of this study was to investigate the feasibility and effects of balance training using a newly developed elastic band orthosis (aider) for improvement of mobility and balance in chronic stroke patients. Design: Cross-sectional study. Methods: Ten patients with chronic hemiplegia participated in this study. There were six males and four females; two patients had right hemiplegia and eight had left hemiplegia. This study investigated the effect of the elastic band orthosis on balance and gait ability compared with bare foot condition. Gait parameters were measured using the opto-gait system for analysis of the spatial and temporal parameters of walking in stroke patients. In addition, balance ability in stroke patients was evaluated using the Timed Up and Go (TUG) and Berg Balance Scale (BBS). Results: This study investigated the effect of the elastic band orthosis on balance compared with bare foot condition. The TUG and BBS showed significant improvement with use of the elastic band orthosis (p<0.05). Use of the Elastic band orthosis resulted in significantly improved velocity, cadence, less-affected step length, less-affected stride length, and less-affected single limb support in stroke patients (p<0.05). Conclusions: We demonstrated a significant improvement in dynamic balance and gait ability in chronic stroke patients using the elastic band orthosis. This orthosis may aid in prevention of spastic foot drop, leading to improvement of walking ability.

Original Article : Effects of elastic band orthosis (aider) on balance and gait in chronic stroke patients

( Noha Daher ),( Seung Jun Lee ),( You Jin Yang ) 물리치료재활과학회 2013 Physical therapy rehabilitation science Vol.2 No.2

Objective: The objective of this study was to investigate the feasibility and effects of balance training using a newly developed elastic band orthosis (aider) for improvement of mobility and balance in chronic stroke patients. Design: Cross-sectional study. Methods: Ten patients with chronic hemiplegia participated in this study. There were six males and four females; two patients had right hemiplegia and eight had left hemiplegia. This study investigated the effect of the elastic band orthosis on balance and gait ability compared with bare foot condition. Gait parameters were measured using the opto-gait system for analysis of the spatial and temporal parameters of walking in stroke patients. In addition, balance ability in stroke patients was evaluated using the Timed Up and Go (TUG) and Berg Balance Scale (BBS). Results: This study investigated the effect of the elastic band orthosis on balance compared with bare foot condition. The TUG and BBS showed significant improvement with use of the elastic band orthosis (p<0.05). Use of the Elastic band orthosis resulted in significantly improved velocity, cadence, less-affected step length, less-affected stride length, and less-affected single limb support in stroke patients (p<0.05). Conclusions: We demonstrated a significant improvement in dynamic balance and gait ability in chronic stroke patients using the elastic band orthosis. This orthosis may aid in prevention of spastic foot drop, leading to improvement of walking ability.

Management of Extra-articular Scapular Fractures: A Narrative Review and Proposal of a Treatment Algorithm

Mohammad Daher,Sami Abi Farraj,Bassem El Hassan 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.5

The management of scapular fractures can be either conservative or operative, but it is still unclear how to choose the treatment option. Scapular fractures can be classified anatomically into four types: scapular spine, scapular body, and scapular neck where the treatment is conservative most of the time except for certain indications that are specific to each one, and inferior angle of the scapula where the operative treatment yields the best results but conservative treatment can be contemplated in some cases.

InSpace Balloon for the Management of Massive Irreparable Rotator Cuff Tears: A Systematic Review and Meta-Analysis

Mohammad Daher,Adam Pearl,Zalaquett Ziad,Bassem T. Elhassan,Joseph A. Abboud,Mohamad Y. Fares,Khaled J. Saleh 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.5

Background: The best course of action for massive irreparable rotator cuff tears (MIRCTs) is not universally agreed upon. Numerous surgical techniques have been discussed. The implantation of a biodegradable spacer into the subacromial area has been documented since 2012 by several authors. The implantation method is touted as being simpler, repeatable, and less invasive than other solutions that are now available. The purpose of this systematic review and meta-analysis, being the first of its kind, was to evaluate the literature to see the efficacy of InSpace balloon (ISB) implantation in the management of MIRCTs. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and with 2 researchers assessing and analyzing each study separately, an extensive electronic search of the literature was conducted in the PubMed database from 1961 until July 27, 2022. Results: Fourteen studies were included in this systematic review and three in the meta-analysis. Eleven out of fourteen studies favored ISB use for MIRCTs, while only three were against its use. All spacers were arthroscopically implanted in the subacromial space. Three studies were included in the meta-analysis. The differences in the compared outcomes were statistically insignificant. Conclusions: A controversy about the use of ISB remains in patients with MIRCTs. Both good and bad outcomes were reported. However, the majority of patients had good clinical outcomes across several grading scales, radiographic evidence of improved impingement, and self-report that they would redo the procedure in hindsight. To draw more solid conclusions and have statistically significant results in the meta-analysis, more randomized controlled trials and comparative studies comparing this device to other treatments are needed.

The impact of mental health on shoulder arthroplasty and rotator cuff repair: a meta-analysis

Mohammad Daher,Ryan Lopez,Peter Boufadel,Oscar Covarrubias,Jack C. Casey,George A. Casey,Mohamad Y. Fares,Joseph A. Abboud 대한견주관절학회 2024 대한견주관절의학회지 Vol.27 No.3

Background: The aim of this study was to evaluate the impact of mental health attributes, such as the presence of psychiatric comorbidities or psychological comorbidities (low resilience), on outcomes after rotator cuff repair (RCR) and total shoulder arthroplasty (TSA). Methods: PubMed, Cochrane, and Google Scholar (results pages 1–20) were searched up to November 2023. Mental health problems of interest included the presence of psychiatric comorbidities (depression, anxiety) or indicators of poor psychological functioning, such as low resilience or the presence of distress. Patients were assigned to poor or good mental health groups in this study based on their grouping in the original study. Results: Fourteen studies were included in the meta-analysis. Patients with good mental health had greater improvements in postoperative American Shoulder and Elbow Surgeons and Simple Shoulder Test scores in the TSA cohort (P=0.003 and P=0.01), RCR cohort (P<0.001), and the combined TSA and RCR cohort (P<0.001). No difference was found in visual analog scale score, satisfaction, external rotation, or flexion between the two mental health groups. Patients with poor mental health undergoing RCR experienced higher rates of adverse events and transfusions (P<0.001). Patients with poor mental health also had greater rates of revision and emergency department visits in the TSA cohort (P<0.001), RCR cohort (P=0.05 and P=0.03), and combined cohort (P<0.001). Patients with poor mental health undergoing TSA had a higher rate of re-admission (P<0.001). Conclusions: Patients with poor preoperative mental health showed inferior patient-reported outcome scores and increased rates of adverse events, revisions, and re-admissions. Level of evidence: III.

Non-alcoholic fatty liver disease-related hepatocellular carcinoma

Darine Daher,Karim Seif El Dahan,Amit G. Singal 대한간암학회 2023 대한간암학회지 Vol.23 No.1

Non-alcoholic fatty liver disease (NAFLD), one of the most common causes of liver disease, is an increasingly common cause of hepatocellular carcinoma (HCC). Several demographic, clinical, and genetic factors contribute to HCC risk in NAFLD patients, which may inform risk stratification scores. Proven efficacious approaches to primary prevention approach in patients with non-viral liver disease remain an area of need. Semi-annual surveillance is associated with improved early tumor detection and reduced HCC-related mortality; however, patients with NAFLD have several challenges to effective surveillance, including under-recognition of at-risk patients, low surveillance utilization in clinical practice, and lower sensitivity of current tools for early-stage HCC detection. Treatment decisions are best made in a multidisciplinary fashion and are informed by several factors including tumor burden, liver dysfunction, performance status, and patient preferences. Although patients with NAFLD often have larger tumor burden and increased comorbidities compared to counterparts, they can achieve similar post-treatment survival with careful patient selection. Therefore, surgical therapies continue to provide a curative treatment option for patients diagnosed at an early stage. Although there has been debate about the efficacy of immune checkpoint inhibitors in patients with NAFLD, current data are insufficient to change treatment selection based on liver disease etiology.

Bilateral reverse shoulder arthroplasty versus bilateral anatomic shoulder arthroplasty: a meta-analysis and systematic review

Mohammad Daher,Mohamad Y. Fares,Jonathan Koa,Jaspal Singh,Joseph Abboud 대한견주관절학회 2024 대한견주관절의학회지 Vol.27 No.2

Background: As the population is aging and indications are expanding, shoulder arthroplasty is becoming more frequent, especially bilateral staged replacement. However, surgeons are hesitant to use bilateral reverse prostheses due to potential limitations on activities of daily living. Methods: This meta-analysis was conducted to compare bilateral anatomic to bilateral reverse shoulder implants. PubMed, Cochrane, and Google Scholar (pages 1–20) were searched until April 2023. The clinical outcomes consisted of postoperative functional scores (American Shoulder and Elbow Surgeons [ASES], Single Assessment Numeric Evaluation [SANE], Physical Component Score [PCS], Mental Component Score, and Simple Shoulder Test), pain, and range of motion (external rotation and forward elevation). Three studies were included in this meta-analysis. Results: Bilateral anatomic implants had better postoperative functional outcomes and range of motion, but no significant difference was seen in postoperative pain when compared to the reverse prosthesis. Better ASES score, SANE score, and PCS as well as better external rotation and forward elevation were seen in the bilateral anatomic shoulder replacement group, but no significant difference in pain levels was seen between the two groups. Conclusions: The results may be explained by the lower baseline seen in the reverse prosthesis group, which may be due to an older population and different indications. Nevertheless, more randomized controlled studies are needed to confirm these findings. Level of evidence: III.

Surgical management of biconcave glenoids: a scoping review

Mohamad Y. Fares,Mohammad Daher,Joseph Mouawad,Emil R. Haikal,Jean Paul Rizk,Peter Boufadel,Joseph A. Abboud 대한견주관절학회 2024 대한견주관절의학회지 Vol.27 No.3

Biconcave (B2) glenoids, characterized by significant posterior glenoid bone loss and a biconcave wear pattern, are a challenging pathology in shoulder surgery. Significant bone defects present in B2 glenoids increases the risk of complications and rates of failure for operative patients with glenohumeral osteoarthritis. Diagnosing this entity is of pivotal importance, and can be accomplished with imaging and a comprehensive clinical investigation. There are no clear-cut guidelines for management, but options include hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse shoulder arthroplasty. In recent years, modern techniques such as corrective reaming, bone grafts, and the use of augmented components have improved patient outcomes. Educating prospective patients is essential for reaching a shared management decision, setting appropriate expectations, and optimizing prognostic outcomes.

Outcome of Breast Cancer Screening: A Lebanese Single Institution Experience

Kourie, Hampig Raphael,Daher, Alain,Matar, Dany,Antoun, Joelle,Salloum, Lony,Kattan, Joseph Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.21

Background: Since 2002, from October till December of each year, the Lebanese Ministry of Public Health conducts a mammogram based breast cancer screening campaign in the whole country for women over 40 years of age. These mammograms are performed free of charge in governmental hospitals or for reduced fees in private hospitals. The aim of this study is to analyze the direct impact of this campaign on cancer detection and subsequent treatment. Materials and Methods: Radiologic records of women screened with a mammogram during the campaign period from October till December 2012 at Saint Joseph Hospital, Baouchrieh, Beirut, were reviewed. Results of mammograms were reported using the ACR score. Women with ACR score ${\geq}4$ were tracked and investigated. Results: 900 screening mammograms were performed; median age was 55.2 years (range:31-81 years). Some 826 (91.8%) had an ACR score of ${\leq}2$; 66 (7.3%) an ACR =3 and only 8 (0.89%) an ACR=4. Thus, less than 1% (8/900) of all screened women were considered at high risk and needed a close follow-up. Among these 8 women, 4 underwent surgery for an early breast cancer, one had synchronous metastatic breast cancer and two were lost to follow-up. Conclusions: To coclude, Among 900-screened women for BC, less than 1 % (8 out of 900) were at high risk of hiding a BC (ACR=4), half of them benefited from early therapy (4 women out of 900) and one was a false positive. Larger studies on national level should be accomplished to have a complete data on breast cancer screening in Lebanon. The results of these studies can affect the Lebanese health policy regarding BC.

Arthroscopic remplissage: history, indications, and clinical outcomes

Mohamad Y. Fares,Mohammad Daher,Peter Boufadel,Emil R. Haikal,Jonathan Koa,Jaspal Singh,Joseph A. Abboud 대한견주관절학회 2024 대한견주관절의학회지 Vol.27 No.2

Several surgical procedures have been proposed to address anterior glenohumeral instability, which is one of the most common complaints in the general population. The remplissage, first described in early 2000s, is a procedure performed simultaneously with the arthroscopic Bankart repair to correct large, engaging Hill-Sachs lesions (HSLs). This procedure stabilizes the joint by tenodesing the infraspinatus tendon into the HSL to fill and disengage the defect. This procedure gained popularity because it has relatively low risk and is able to improve shoulder stability while being less invasive than other bone-blocking procedures. The remplissage has become a valuable add-on technique that can substantially improve outcomes in unstable patients undergoing arthroscopic Bankart repair. Nevertheless, several studies in the literature have raised concerns regarding its efficacy in critically unstable patients and the potential range of motion limitations that can arise postoperatively. Additional comparative studies and trials should be conducted to appropriately establish the role of remplissage in treating anterior instability, especially in patients with critical bone loss.