Purpose: Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care. Methods: Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle-Ottawa Scale was used to assess validity. Results: A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care. Conclusions: People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings.Key Words: dementia; geriatrics; hip fractures; rehabilitation. RÉ SUMÉObjectif : Il n'y a pas de pratiques exemplaires d'é tablies pour la ré adaptation aprè s une fracture de la hanche chez les personnes aux prises avec la dé mence. Nous avons procé dé à une revue systé matique en vue de recueillir les faits cliniques relatifs à la ré adaptation chez ce segment de la population, y compris les personnes en soins prolongé s. Mé thode : Une mé thodologie d'examen de documents normalisé e a é té utilisé e pour effectuer une recherche dans huit bases de donné es afin de recueillir de la documentation sur la ré adaptation aprè s une fracture de la hanche chez les personnes souffrant de dé mence. Les é tudes admissibles traitaient de patients avec dé mence qui avaient subi une fracture de la hanche; auprè s de qui on avait procé dé à une intervention en ré adaptation; et où au moins une fonction, la marche, le site du congé ou les risques de chutes avaient é té é valué s. L'é chelle de Newcastle-Ottawa a é té utilisé e aux fins d'é valuation de la validité de ces é tudes. Ré sultats : Au total, 13 é tudes ont é té ré pertorié es; cinq essais contrô lé s randomisé s (ECR), sept é tudes de cohorte prospective et une é tude de cohorte ré trospective. La qualité moyenne des ECR et des é tudes de cohortes é taient respectivement bonne à moyenne. Les participants avec dé mence lé gè re à modé ré e qui recevaient des traitements de ré adaptation ont dé montré des gains relatifs de fonction similaires à ceux qui ne souffraient pas de dé mence. Un...

Although retinal bipolar cells represent a morphologically well defined population of retinal interneurons, very little is known about the developmental mechanisms that regulate their processing. Furthermore, the identity of specific bipolar cell types that function in distinct visual circuits remains poorly understood. Here, we show that the homeobox gene Vsx1 is expressed in Type 7 ON bipolar cells. In the absence of Vsx1, Type 7 bipolar cells exhibit proper morphological specification but show defects in terminal gene expression. Vsx1 is required for the repression of bipolar cell-specific markers, including Calcium-binding protein 5 and Chx10. This contrasts its genetic requirement as an activator of gene expression in OFF bipolar cells. To assess possible ON signaling defects in Vsx1-null mice, we recorded specifically from ON-OFF directionally selective ganglion cells (DSGCs), which cofasciculate with Type 7 bipolar cell terminals. Vsx1-null ON-OFF DSGCs received more sustained excitatory synaptic input, possibly due to Type 7 bipolar cell defects. Interestingly, in Vsx1-null mice, the directionally selective circuit is functional but compromised. Together, these findings indicate that Vsx1 regulates terminal gene expression in Type 7 bipolar cells and is necessary for proper ON visual signaling within a directionally selective circuit.

Current research in LTC facilities is very sparse and little is known about the rehabilitation care provided in these facilities. Further research is needed to determine the most effective rehabilitation interventions following hip fractures for residents of LTC facilities with dementia.