Special Issue:
Challenges and Opportunities in Rehabilitation
Abstract
Cognitive rehabilitation is a critical component of intervention for many individuals with both short- and long-term impairments associated with traumatic brain injury (TBI). By focusing on major cognitive domains, emotional processing, and behavioral strategies, clinicians use cognitive rehabilitation to improve cognitive related functional outcomes, quality of life, and social relationships. Cognitive rehabilitation is traditionally divided into restorative and compensatory approaches, though increasingly combined approaches within the larger medical, multidisciplinary team are being incorporated and explored. Literature related to cognitive rehabilitation within the TBI population continues to be needed in order to assist clinicians in developing evidence-based intervention protocols and therapy plans. This paper details current approaches to cognitive rehabilitation and provides an updated review of the literature associated with the efficacy of cognitive rehabilitation. Reviewed evidence supports the use of cognitive rehabilitation to improve multiple cognitive domains, including attention, memory, executive function, and metacognitive skills. The long-term outcomes of continued cognitive rehabilitation services post-TBI are not as comprehensively documented as the relative short-term outcomes. The efficacy of cognitive rehabilitation is impacted by patient-specific variables, timing and intensity of treatment. This paper concludes with noted information related to the limitations of the current evidence of cognitive rehabilitation, including study design concerns, and reduced generalizability of the relevant research.
Sheer Shabat
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Anat Marmor
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Jeanna Tsenter
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Isabella Schwartz
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Zeev Meiner
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Shimon Shiri
Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
Abstract
Background and aims: Emotional distress is widespread among individuals recovering from COVID-19. The present study examined the relationships between illness severity and emotional distress and the outcomes of a general and cognitive rehabilitation program.
Methods: Participants were 61 post-acute COVID-19 patients who participated in a multidisciplinary rehabilitation program. Data were collected at admission and discharge, 6 months later. Medical evaluations and self-reported emotional, neuropsychological and functional measures were used.
Results: Mild illness was associated with higher levels of self-reported anxiety and depression and with lower self-reported executive functioning. Elevated anxiety levels and lower cognitive profile at admission were significantly linked to poorer cognitive outcomes, but not to motor or general functioning level at discharge.
Conclusions: The results of the study indicate the significance of monitoring emotional characteristics, particularly anxiety, in post-COVID-19 individuals during multidisciplinary rehabilitation.
Moon Fai Chan
Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University
Senthilkumar Ravindran
Department of Physiotherapy & Rehabilitation, Sultan Qaboos University Hospital, Oman
Hammad Al-Subhi
Department of Physiotherapy & Rehabilitation, Sultan Qaboos University Hospital, Oman
Saif Al-Riyami
Department of Physiotherapy & Rehabilitation, Sultan Qaboos University Hospital, Oman
Abstract
Rehabilitation training for stroke patients is mostly based on face-to-face contact. This affects the routine training during the coronavirus disease outbreak in many hospitals worldwide, including Oman. Perhaps, this problem can be overcome using a virtual reality system. This protocol study aims to compare the outcome measures of the two groups of stroke patients (virtual reality intervention vs. conventional control) on these two modes of rehabilitation training. A randomized controlled trial with pre-/post-study of 42 stroke patients (21 control vs. 21 intervention) with upper limb motor impairments, aged 18-65 years old, newly admitted to the rehabilitation clinic in Oman, will be recruited. Basic demographic data and three major outcome assessments will be collected pre-/post-period. Baseline assessment (pre) on admission to the stroke rehabilitation program and after completion (post). Participants will be assessed by Barthel Index, Action Research Arm scale, and time spent per session with costs involved by the workforce in training. Repeated measures general linear model will examine the within, between, and interaction effects while adjusted by demographic data. All analyses will use IBM SPSS software, and a statistical significance level of p<0.05 will be employed. This research protocol aims to evaluate the feasibility and effectiveness of VR in improving motor control in stroke patients with upper limb weakness by comparing a low-cost VR platform with face-to-face training. If the proposed training protocol is helpful and easy to use, it could become a reliable tool to assist healthcare professionals for stroke patients during their rehabilitation training. This protocol will contribute to the theoretical discussion of integrating high-tech equipment with healthcare theory for stroke patients with learning disabilities. Also, adopting a virtual reality system could aid if a sudden pandemic outbreak. It could continue offering its services while maintaining a high standard of care for stroke sufferers.
Mellanie Geijen
Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands
Rob Smeets
Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands
Eugene Rameckers
Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands; Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands; Rehabilitation Science, Pediatric Physical Therapy, Hasselt
Andrew Gordon
Department of Biobehavioral Science, Teachers College, Columbia University, New York, NY, USA
Caroline Bastiaenen
Department of Epidemiology, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, the Netherlands
Abstract
Aim: Investigate aspects of construct validity of parameters “mean peak force” and “number of successful attempts” of the press button task using the Task-oriented Arm-hAnd Capacity (TAAC) in children with unilateral cerebral palsy (CP) by comparing them to outcomes of comparative measures using Consensus-based Standards for the selection of health Measurement INstruments guidelines.
Methods: 118 children with unilateral CP (mean age 1 year 2 months, standard deviation 3 year 5 months) were included. Fourteen a priori hypotheses were formulated for each parameter of the TAAC. Strength and direction of the relationship between the TAAC and comparative measures were investigated by calculating Pearson correlation coefficients.
Results: For the parameter “mean peak force” 8/14 (57%) hypotheses could be supported. For the parameter “number of successful attempts” 13/14 (93%) hypotheses could be supported.
Conclusion: The hypothesized construct of the parameter “mean peak force” is only partially in line with our idea about the potential relationship of the compared constructs. The relationship needs to be reconsidered to some extent. The hypothesized construct of the parameter “number of successful attempts” is in line with our idea about the potential relationship of the compared constructs and can be considered to have good validity compared to the other measures. Thus, the construct of this parameter adds new and meaningful information as an outcome measure for functional strength measurements.
Eleni A. Kortianou
Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Greece.
Aspasia S. Mavronasou
Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Greece; 1st Department of Critical Care and Pulmonary Medicine, Pulmonary Rehabilitation Unit, National and Kapodistrian University of Athens, Evangelismos General Hospital, Greece
Vaia Sapouna
Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Greece.
Abstract
Many COVID-19 survivors worldwide suffer from persistent symptoms, impaired functional capacity and quality of life. Rehabilitation exercise interventions for the long-term physical consequences of coronavirus disease 2019 (COVID-19) are currently being reported. As a result, the clinical practice and research focus on interventions that support recovery from ongoing symptomatology, independently to hospitalization. To date, the outpatient rehabilitation programs offer various exercise modes and training intensities for people recovering from long-term symptomatology of COVID-19.
This narrative review summarizes previous studies that used exercise training protocols at the outpatient rehabilitation setting, presents the effectiveness of training on the functional outcomes and provides practical issues of the application of exercise training which overcome possible respiratory and peripheral muscle limiting factors of exercise and functional capacity for patients with Long-COVID-19. To this end we make recommendations on how better to implement exercise training in future studies so as to maximize training effects.
Due to lack of randomized trials, more research is needed in the field of the exercise training modalities that are more effective and in parallel more tolerable for patients with persistent post-COVID-19 symptoms. In this context, interval training mode with short exercise periods can prevent high lactate accumulation and allow more intense exercise stimuli to the deconditioned peripheral muscles with minimal cardiac strain and exercise-induced hyperventilation, thus improving exercise capacity in this patients’ population.
Amy J. Armstrong
Department of Rehabilitation Counseling, College of Health Professions, Virginia Commonwealth University, VA, USA.
Carolyn E. Hawley
Department of Rehabilitation Counseling, College of Health Professions, Virginia Commonwealth University, VA, USA.
Ya Su
Department of Statistical Sciences and Operations Research, College of Humanities and Sciences, Virginia Commonwealth University
Anat Marmor
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hebrew, University of Jerusalem, Jerusalem, Israel.
Sigal Sviri
Internal Medicine Intensive Care Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
Isabella Schwartz
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hebrew, University of Jerusalem, Jerusalem, Israel.
Shimon Siri
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hebrew, University of Jerusalem, Jerusalem, Israel.
Zeev Meiner
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hebrew, University of Jerusalem, Jerusalem, Israel.
Abstract
While COVID-19 has had a detrimental impact on most of the world’s population, it has especially affected health care workers (HCWs) who are on the front lines fighting the virus. How HCWs cope with the pandemic have recently been explored. Differences across cultural and health care system settings related to fear of COVID 19 and measures of wellbeing may provide further insight to the coping mechanisms and experiences of HCWs during this worldwide pandemic. The overall subjective well-being and meaning in life scores are noticeably higher for the American participants whereas the fear of COVID and resilience scores are close in both studies, with slightly higher resilience and lower fear in the Israeli HCWs. Age, ethnicity and lower resilience were found to be significantly associated with higher fear of COVID-19 in both cohorts. In the Israeli participants, education level and life satisfaction were also associated with lower fear of COVID19 whereas in the American cohort, gender and relationship were also associated. These results suggest that albeit the cultural differences, similar mechanisms namely age and resilience, are important in coping with fear of the COVID-19 pandemic among both cohorts of HCWs. Therefore, it is important to enhance resilience in order to reduce the psychological burden of the pandemic among HCWs. This study was conducted prior to the availability of a vaccine.
Eugene Rameckers, Ph.D., pediatric PT
Adelante, Centre of Expertise, pediatric Rehabilitation, The Netherlands; Department of Rehabilitation, Maastricht University, The Netherlands; Rehabilitation Science and Physical Therapy, Hasselt University, Belgium
Coen de Haan, pediatric PT
Adelante, Centre of Expertise, pediatric Rehabilitation, The Netherlands
Ingrid Meeuwsen, paediatric PT
Adelante, Centre of Expertise, pediatric Rehabilitation, The Netherlands
Abstract
Objective: To compare the effectiveness of Task-Oriented Arm Strength training in children with Cerebral Palsy (TOAST-CP), using Progressive Resistance Exercise principles with manual skill learning in improving the performance of manual daily activities in children with spastic Cerebral Palsy.
Methods/Design: This multicenter randomized controlled trial investigates the effectiveness of TOAST-CP in children with spastic Cerebral Palsy, involving 50 participants aged 8-18 years. Participants are recruited from rehabilitation centers. Eligible participants are randomly allocated to either TOAST-CP or usual care related to manual skill learning.
Intervention: The participants of the intervention group performed a TOAST-CP program, based on individual goals and guided by a progressive resistance exercise algorithm. The control group receives the usual care related to the manual skill learning program. TOAST-CP consists of an individual-based 30-minute session, three times a week over 16 weeks. A specific exercise program is developed.
Outcome: Outcome is measured at baseline at eight weeks, 16 weeks (end of training), three, and six months after training.
As a primary outcome, the Assisting Hand Assessment is used. Secondary outcomes are task-oriented strength measures and muscle strength measures of the upper limb. The Observation and Scoring of Arm Hand Skills (performance and amount of use of both hands), the ABILHAND (-Kids), and the Jebsen Taylor Hand Function test (speed of hand use) are measured. The most important needs and goals for the child and his/her parents are scored by Canadian Occupational Performance Measure and Goal Attainment Scaling.
George W. Kukurin
KCANN
Corissa D. Audren
Abstract
The number of literature reports suggesting that various types of electrical, optokinetic, caloric, and mechanical vestibular stimulation may enhance recovery of function in patients suffering from traumatic and degenerative brain disorders is growing. This case report describes the integration of vestibular stimulation techniques into a rehabilitation treatment plan of a traumatically brain injured 16-year-old patient who had failed to sustain recovery after a course of standard care. His intractable signs and symptoms included headache, brain fog/mild cognitive impairment and disequilibrium which made participation in his chosen sport, hockey, virtually impossible. His symptoms developed following a concussion while playing hockey. He was treated by the team’s designated sports specialist and eventually cleared to return to play, however he was rapidly re-concussed. At the time he presented for evaluation, a battery of tests was conducted and clearly supported the reoccurrence of his symptoms. His baseline scores were Graded Symptom Checklist symptom severity 46, Standard Assessment of Concussion 25/30, BESS Balance Score 14, Trails Test A 15.0, Trails Test B 27.4, Processing Speed Task 63, Reaction time simple 255 and Reaction time choice 469. Standard methods of rehabilitation including Gaze Stabilization Exercises and Progressive Balance Exercises were augmented with vestibular stimulation through the use of skull vibrations and optokinetic stimulation. After 18 treatments over approximately six weeks of rehabilitation augmented with vestibular stimulation, findings associated with mTBI normalized and he was able to resume his full participation in sporting activities. His post treatment scores were. Graded Symptom Checklist symptom severity 1, Standard Assessment of Concussion 24/30, BESS Balance Score 5, Trails Test A 12.4, Trails Test B 34.0, Processing Speed Task 64, Reaction time simple 245 and Reaction time choice 385. He remained asymptomatic at 4 months follow-up post discharge and is participating fully in team hockey activities. This case report describes the integration of vestibular stimulation into neurorehabilitation protocols which appeared to be associated with sustained reduction in disability and improved treatment-refractory symptoms in a patient with traumatic brain injury. It adds to the growing knowledgebase supporting the role of vestibular stimulation as an adjunct modality in the rehabilitation of brain disorders.
Ellen Ricke, PhD
Longfonds, Amersfoort, The Netherlands
Abstract
Chronic obstructive pulmonary disease is one highly prevalent chronic disease that demands increasing care; it is already the third leading cause of death worldwide. There is accumulating evidence that in patients with chronic obstructive pulmonary disease pulmonary rehabilitation is effective in improving the prognostic risk factor profile and in delaying mortality. In order to benefit from pulmonary rehabilitation, exercise adherence plays a crucial role. The present review discusses the current evidence on exercise adherence in chronic obstructive pulmonary disease and provides practical tips for assessing and adopting strategies to improve adherence in the Dutch context.
Studies from the Netherlands identify varying rates of exercise adherence depending on the complexity of the disease, such as comorbidities, and its treatment. Multiple factors determine exercise adherence in chronic obstructive pulmonary disease. In the Netherlands, factors such as perceived behavioral control, self-efficacy, exercise history, motivation, education, physical health, comorbidities, depressive symptoms and fatigue determine exercise adherence.
The Dutch version of the Rehabilitation Adherence Measure for Athletic training and a prediction model, the Predicting Adherence in paTients with CHronic diseases tool, can be used to identify poor adherence. Improving exercise adherence requires a multifaceted approach with strategies targeting healthcare providers, patients and healthcare systems. In the Dutch context, raising awareness of the patient’s context, emphasizing the importance of the patient-therapist relationship, providing clearer information, and enhancing social support within the patient’s environment are essential for improving exercise adherence and chronic obstructive pulmonary disease control.
Jan Kersschot
Private Practice, Lindelei 38, Aartselaar, Belgium
King Hei Stanley Lam
The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong
Teinny Suryadi
Department of Physical Medicine and Rehabilitation, Hermina Podomoro Hospital. Jakarta, Indonesia
Lisa Nurhasanah
Physical Medicine and Rehabilitation, Diponegoro University, Indonesia
Tanti Atjoe Kesoema
Physical Medicine and Rehabilitation, Diponegoro University, Indonesia
Abstract
Failed back surgery syndrome is a chronic pain condition that persists despite or after surgical intervention. It presents a disabling condition that is difficult to manage. Over the last decade, regional sugar water injections have become popular for the treatment of musculoskeletal and neuropathic pain syndromes. This article describes the case of a patient with persistent pseudo-sciatica despite surgery who underwent multiple sessions of sugar water injections. This study aimed to share this experience with the global medical community. Further clinical investigations are required to confirm whether this novel approach can effectively treat patients with this condition.
Matteo Varini
Centro Puzzle, Turin, Italy, ; Department of Psychology, University of Turin, Turin, Italy
Marina Zettin
Centro Puzzle, Turin, Italy, Department of Psychology, University of Turin, Turin, Italy
Marta Gai
Centro Puzzle, Turin, Italy,
Danilo Dimitri
Centro Puzzle, Turin, Italy; Department of Psychology, University of Turin, Turin, Italy
Abstract
Background. One of the most used non-invasive brain stimulation (NIBS) techniques in aphasia rehabilitation is Anodal Transcranial Direct Current Stimulation (A-tDCS). Its application is supported by the fact that brain plasticity, when facilitated by language intervention, can be improved by non-invasive brain stimulation. The effects of neuromodulation combined with various language and communication therapies have led to promising results in the rehabilitation of patients presenting with acquired aphasia. An Action Observation Therapy such as IMITAF seems to contribute to improvements in language skills, mainly in naming. This experimental clinical protocol aims to investigate the rehabilitative potential of A-tDCS on perilesional areas, combined with computerized neuropsychological training.
Method. Participant: Mr. V., 66-year old right-handed male, Italian native speaker. The patient suffered an ischemic stroke due to left carotid artery dissection which resulted in right hemiparesis, mixed transcortical aphasia, characterized by non-fluent speech and dysarthric and disfluent speech. Treatment: The subject underwent unipolar montage stimulation, with anode placed in F5 and intra-cephalic reference on Fp2. For safety reasons, a stimulation intensity of 1.5 mA was applied for 20 minutes once a day in combination with IMITAF level I, which required the subject to repeat bisyllabic words.
Procedure: The stimulation protocol lasted a total of 4 weeks and was divided into 2 different modes. Clinical Training: 40-minute treatments (no.10 sessions) and involved the combined administration of a-tDCS (20-minute online mode) and 40-minute training. Home-Based Training: 40-minutes trainig carried out at the patient’s home, via PC (no. 8 sessions). Results. Mr. V. completed the protocol treatment sessions without reporting any adverse effects, such as scalp redness, tingling or headache. The results showed an improvement in the auditory/visual comprehension of words/sentences after A-tDCS and Action Observation Therapy, which has maintained one month after treatment.
Conclusions. Together with IMTAF neuropsychological training, the constant and repeated use of A-tDCS, on the perilesional areas, contributed to improvements in language skills thus promoting an overall recovery of communicative skills in an individual with chronic post-stroke non-fluent aphasia.
Vasiliki S. Raidou
School of Medicine, National and Kapodistrian University of Athens, Greece
Stilliani Andreadou
General Hospital of Chalkida, Greece
Anna Christakou
Biomechanics Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Peloponnese, Greece
Eleni A. Kortianou
Clinical Exercise Physiology and Rehabilitation Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Greece
Abstract
The coronavirus disease 2019 pandemic increased the need for alternative disease monitoring, medication management, and rehabilitation approaches. During this period, significant adjustments were made to integrate telemedicine into various aspects of healthcare.
This critical review describes the use and effectiveness of digital health approaches adopted for the care of people with chronic respiratory diseases during and beyond the COVID-19 pandemic. A thorough search was conducted in the PubMed database from January 2020 up to December 2022. A total of thirty studies were retrieved and reviewed for the utilization of telehealth services for education, monitoring, assessment, self-management, and rehabilitation in comparison to standard care or not.
During the lockdown patients with chronic obstructive pulmonary disease, asthma, cystic fibrosis, interstitial lung diseases, lung cancer, and neuromuscular disorders indicated positive perception towards remote healthcare delivery. They expressed high levels of satisfaction and achieved self-management in chronic obstructive pulmonary disease and asthma. Remote visits decreased exacerbations of asthma and reinforced smoke cessation in patients with chronic obstructive pulmonary disease. Teleassessment and monitoring increased the percentage of cystic fibrosis and Duchenne Muscular Dystrophy patients seen via telemedicine. Web platforms and mobile applications supported telehealth interventions to reduce stress, depression, and anxiety in patients with cystic fibrosis, assessed the quality of life and physical activity of patients with sarcoidosis, and pursued health education in adolescents with asthma. A few studies carried out telerehabilitation programs in patients with chronic obstructive pulmonary disease, cystic fibrosis, Duchenne Muscular Dystrophy, and sarcoidosis. Findings advocate the feasibility of online exercises, the improvement of exercise capacity, muscle strength, respiratory muscle strength, and the reduction of dyspnea and fatigue.
Ellen Ricke
Department of Social Psychology, University of Groningen, Groningen, The Netherlands
Arie Dijkstra
Department of Social Psychology, University of Groningen, Groningen, The Netherlands
Abstract
Introduction: Pulmonary rehabilitation is considered an important method of improving health-related quality of life in patients with chronic obstructive pulmonary disease. A critical component to the success of pulmonary rehabilitation is exercise adherence, which is often lower than 50%. When there is a better understanding on the psychological determinants of adherence, theory-informed interventions can be developed to improve adherence. Therefore, the aim of this study was to examine the utility of the Theory of Planned Behavior in combination with the therapeutic alliance in explaining exercise adherence in a prospective cohort study of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease to ultimately increase adherence with psychological interventions. In addition, we examined the influence of the Theory of Planned Behavior determinants and alliance in combination with clinical determinants on adherence.
Methods: At baseline, 196 patients from 53 physiotherapy practices in the Netherlands and Belgium completed measures of the Theory of Planned Behavior, and disease and demographic characteristics. After three months they completed measures of alliance. Their physiotherapist provided exercise adherence measures after 12 months. Data were analyzed using Spearman’s correlations, hierarchical linear multiple regression analyses and mediation analysis.
Results: Hierarchical linear multiple regression analyses indicated that intention (b = 0.72; p < 0.001) and alliance (b = 0.26; p < 0.001) explained 24.8% of the variance in exercise adherence. After adding Medical Research Council dyspnea score and depression to the model, 35.6% of the variance could be explained. Perceived behavioral control, attitude, and alliance, explained 37.9% of variance in exercise intention. The effect of alliance on adherence was partially mediated by intention.
Conclusion: Extending the Theory of Planned Behavior with the concept of alliance is a promising innovation to understand exercise adherence of patients who are coached by a health care professional. Healthcare providers should obtain information about their patients’ attitudes, perceived behavioral control, and alliance, to inform their coaching and further psychosocial interventions. Concrete recommendations are provided for effectively addressing these psychosocial determinants of adherence within the patient-coaching relationship.
Challenges in the Evaluation of the Patient Presenting with Isolated Neurological Hand Dysfunction: A Case Series
Edward Soriano, , D.O.
Medical Director, Integrative Pain Management Garrett Regional Medical Center, Oakland, MD – West Virginia University of Medicine Board Certified Physical Medicine and Rehabilitation Board Certified Pain Management
Abstract
Isolated neurological hand dysfunction including symptoms of weakness, numbness, clumsiness and dystonia are not uncommon complaints presenting to physicians in primary care as well as to neurologists, physiatrists, orthopedists and neurosurgeons. Etiologies of neurological hand dysfunction range from lesions of the central and peripheral nervous system pathways as well as the neuromuscular junction and muscle. In this article we present a series of four patients referred to a rural Physical Medicine & Rehabilitation presenting with similar symptoms of neurological hand dysfunction that ultimately had very different diagnoses. The goal of this article is to review the appropriate history, physical and examination findings and pertinent neuroanatomy needed to direct the clinician towards the workup needed to accurately diagnose and treat neurological hand dysfunction.
H. Livneh
Clinical Rehabilitation Counseling Program, Portland State University
Phillip Rumrill
Human Development Institute, University of Kentucky
Malachy Bishop
Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison
Abstract
The second law of thermodynamics, also known as the law of entropy, posits that all physical processes, in a closed system, will evolve over time toward a state of higher disorderliness and randomness. Isolated efforts to explore and examine the application of this law to human psychosocial processes (psychological entropy) have been undertaken only since the middle of the 20th century and have been limited in scope. In this article, the authors explore several domains where psychological entropy (PE) may be helpful in elucidating the nature, structure, and processes inherent in psychosocial adaptation to chronic illness and disability (CID). This article is devoted to providing the reader with a brief outline of the scope of the law of physical entropy through highlighting its historical milestones, and examining its relationships with such concepts as chaos, flow of time, informational systems, the dynamics underlying denial, and finally, its link to a selected group of psychodynamic and cognitive perspectives. In a companion article, we explore potential clinical applications.
Neslihan Aksu, M.D.
Demiroğlu Bilim University, Faculty of Medicine, Department of Orthopedics and Traumatology, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Tomris Duymaz, Pt.
Demiroğlu Bilim University, Faculty of Medicine, Department of Physıcal Theraphy and Rehabilitation, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Vefa Atansay, M.D.
Demiroğlu Bilim University, Faculty of Medicine, Department of Orthopedics and Traumatology, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Büşra Akgönül, Pt.
Istanbul Florence Nighingale Hospital, Department of Physıcal Theraphy and Rehabilitation Department, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Ayhan Nedim Kara, M.D.
Demiroğlu Bilim University, Faculty of Medicine, Department of Orthopedics and Traumatology, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Azmi Hamzaoğlu, M.D.
Istanbul Florence Nightingale Hospital, Orthopaedics and Spine Center, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Abstract
Background: Due to risks of reinjury and osteoarthritis, the timing of return to sports after surgery is important. Although there are numerous studies on the return to sports (RTS) criteria in athletes who have undergone knee surgery, there are no studies on the return to dance (RTD) criteria after knee surgery in dancers. In this retrospective clinical study, we investigated the rates of osteoarthritis and reinjury after arthroscopic knee surgery and the criteria for RTD.
Materials and Methods: In a professional dance group consisting of 84 members (mean age: 29.8 ± 9.2 range: 18 to 49 years), during an 11 year period (between January 2009 and January 2020), 14 dancers (mean age 29.1±5.7 (20-38) years) sustained knee injuries (3 meniscus tears, 4 Anterior Cruciate Ligament (ACL) tears, 1 Posterior Cruciate Ligament (PCL), 1 patellar dislocation, 1 infrapatellar bursitis, 2 Hoffa’s fat pad syndromes, 2 symptomatic medial plicas) that required arthroscopic surgery. The RTD times after surgery, follow up lenghts, clinical and functional tests used for deciding on RTD were recorded.
Result: The postoperative follow up period was 56.7± 23 (26-108) months. The rate of reinjury was 7.14% after knee surgery. All dancers who underwent knee surgery were evaluated for osteoarthritis according to the Kellgren Lawrence classification, and the ostearthridites were classified as G:0 in 7 patients, G:1 in 3 patients, and G:2 in 4 patients on final knee radiographs.
Conclusion : In dancers who have undergone arthroscopic surgery, the return to dance criteria should assess painless repeated turnout after meniscus repair, and also safe landing and postural contol after ACL reconstruction or PCL reconstruction.
Paba Dotes Ana Belen
Physical Medicine and Rehabilitation Department, Hospital Regional Universitario de Málaga, Spain.
De Torres-Garcia Irene
Physical Medicine and Rehabilitation Department, Hospital Regional Universitario de Málaga, Spain. Civil Hospital, Plaza del Hospital Civil, s/n, 29009, Malaga, Spain
Abstract
Case: Acquired brain damage is one of the most complex pathologies that affect the central nervous system, there is great variability in its pathophysiology, from traumatic focal injuries to diffuse axonal injuries, including spasticity. It supposes a great comorbidity and functional repercussion in patients, hindering their subsequent recovery. We report a case of a young patient with a history of quadriplegia due to acquired brain damage secondary to thrombosis of the dural sinus. The patient presented sensorimotor deficit, restricted function, and a great situation of dependency. He required three cycles of high doses of incobotulinumtoxinA (IncoBoNT) according to his specific need, the first infiltration was 800 U, the second 800 U, and the last 500 U over a period of 14 weeks. Thanks to the previous objectives agreement with the patient the results were satisfactory and relevant for him, presenting a great functional improvement of spasticity and associated pain, as assessed by the visual analog scale score.
Conclusion: IncoBoNT at high doses and short intervals has been shown to be an effective and valuable tool for personalized treatment adapted to the needs of severely affected neurological patients.
Jae-kook Yoo
Department of Neurolgy, The Rodem Hospital, Incheon, Korea.
Soon-Hee Kwon
Department of Neurolgy, The Rodem Hospital, Incheon, Korea.
Jong-Eun Jeon
Department of Neurolgy, The Rodem Hospital, Incheon, Korea.
Sul-Hee Yoon
Department of Internal medicine, The Rodem Hospital, Incheon, Korea.
Jung-Eun Lee
Department of Rehabilitation medicine, The Rodem Hospital, Incheon, Korea.
Sang-Yoon Lee
Department of Rehabilitation medicine, The Rodem Hospital, Incheon, Korea.
Abstract
This case report from the Rodem Hospital introduces a pioneering intervention for muscle rigidity in Amyotrophic Lateral Sclerosis (ALS), featuring a unique placental extract injection and glucose injection therapy combined with lidocaine. This novel approach has demonstrated significant muscle regeneration and sustained relaxation in 47 ALS patients. Unlike traditional treatments, this protocol offers a more sustainable and regenerative outcome. The treatment involved injections of a mixture containing glucose, lidocaine, and placental extract, targeting severely rigid muscles. Remarkably, 42 of the 47 patients showed considerable improvements in knee flexion and a dramatic reduction in pain. The other two also experienced notable progress. This method stands out for its cost efficiency, impact on muscle suppleness, and reduced pain, suggesting a potential paradigm shift in ALS management. This case series highlights the importance of continued innovation and personalized treatment strategies in ALS care, aiming to improve patient quality of life and functional abilities.
This case report from the Rodem Hospital introduces a pioneering intervention for muscle rigidity in Amyotrophic Lateral Sclerosis (ALS), featuring a unique placental extract injection and glucose injection therapy combined with lidocaine. This novel approach has demonstrated significant muscle regeneration and sustained relaxation in 47 ALS patients. Unlike traditional treatments, this protocol offers a more sustainable and regenerative outcome. The treatment involved injections of a mixture containing glucose, lidocaine, and placental extract, targeting severely rigid muscles. Remarkably, 42 of the 47 patients showed considerable improvements in knee flexion and a dramatic reduction in pain. The other two also experienced notable progress. This method stands out for its cost efficiency, impact on muscle suppleness, and reduced pain, suggesting a potential paradigm shift in ALS management. This case series highlights the importance of continued innovation and personalized treatment strategies in ALS care, aiming to improve patient quality of life and functional abilities.
Cholid Tri Tjahjono
Division of Cardiac Prevention and Rehabilitation, Dept of Cardiology and Vascular Medicine Universitas Brawijaya-Saiful Anwar General Hospital Malang
Astrid Pramudya
Division of Cardiac Prevention and Rehabilitation, Dept of Cardiology and Vascular Medicine Universitas Brawijaya-Saiful Anwar General Hospital Malang
Abstract
Background: In the entire world, cardiovascular diseases (CVD) are primarily brought on by hypertension, or elevated blood pressure. From 4.5% (0.9 billion adults) in 2000 to 7% (1.6 billion adults) in 2010, the prevalence of hypertension has increased in relation to the global burden of diseases. Comprehensive management including non-pharmacological and pharmacological strategies of hypertension.
Healthy lifestyle choices can lower cardiovascular risk and postpone or prevent the onset of high blood pressure. Additionally, the first line of antihypertensive therapy is lifestyle change. One of the best way of life adjustments for lowering blood pressure is weight loss. Physical activity on a regular basis can reduce high blood pressure by 5 to 8 mm Hg. Every day, try to engage in at least 30 minutes of moderate exercise, such as walking, running, cycling, swimming, or dancing. High-intensity interval training is an alternative option. Short bursts of intense exercise are interspersed with slower intervals of activity during this form of training. A diet low in saturated fat, salt, and cholesterol and high in whole grains, fruits, vegetables, and low-fat dairy products can reduce high blood pressure by up to 11 mm Hg. It is possible to reduce blood pressure by roughly 4 mm Hg by limiting alcohol consumption to fewer than one drink per day for women and two drinks per day for males. Quitting smoking can potentially extend life by lowering blood pressure, lowering the risk of heart disease, and improving general health. The quality of your sleep can affect your blood pressure. Chronic (long-term) emotional stress may be a factor in high blood pressure. Controlling blood pressure also requires taking it at home and going to the doctor frequently. Strong social networks of family and friends are crucial for health. Following lifestyle changes, pharmacological therapy should be started. The choice of medication is based on the patient’s age, general cardiovascular risk, and co-morbidities. The pharmaceutical treatment plans suggested here are generally in line with the most recent US and European recommendations.
Conclusion: The optimal initial treatment strategy for hypertension should be comprehensive hypertension management, which focuses on lowering total cardiovascular risk through lifestyle changes, BP lowering, and lipid management.
David Civitarese
Shirley Ryan AbilityLab/Northwestern McGaw Medical Center, Chicago, IL
Michael A Downing
Albany Medical Center Physical Medicine and Rehabilitation Residency, Albany, NY
Michael O Bazzi
University of California, Irvine Physical Medicine and Rehabilitation Residency, Irvine, CA
Glenn Flanagan
Naples Regenerative Institute, Naples, FL
Joshua B Rothenberg
Sports Medicine, Baptist Health North Orthopedic Care, Boca Raton Regional Hospital, Boca Raton, FL
Abstract
Introduction: Achilles tendon rupture is one of the most common adult tendon injuries and continues to increase in incidence. This case report outlines a comprehensive approach for stand-alone leukocyte-poor platelet-rich plasma treatment of a partial subacute Achilles tendon rupture in a professional athlete who had received prior autologous conditioned serum injections with an interleukin-1 receptor antagonist.
Patient History: A 32-year-old male professional ice hockey player presented with persistent left ankle pain approximately seven months after suffering a partial acute Achilles tendon tear. Imaging confirmed a subacute partial Achilles tendon rupture.
Injection: Following local anesthesia, a 25-gauge 1.5-inch needle was advanced to the target structure under ultrasound guidance and 3 mL of autologous platelet-rich plasma was divided amongst several areas of the patient’s Achilles tendon, while simultaneously tenotomizing the tendon. No complications were observed.
Imaging: Follow-up magnetic resonance imaging approximately 9 months after platelet-rich plasma injection revealed complete resolution of the Achilles tendon rupture.
Conclusion: Ultrasound-guided leukocyte-poor platelet-rich plasma injection could be considered an effective treatment option for acute Achilles tendon rupture during the subacute stages of tendon healing, leading to complete radiographic resolution of the tear and enabling a return to high-level athletics
Velin Stratev
Department of pulmonary rehabilitation and lifestyle medicine, Cathinka Guldbergs Hospital, Norway
Odd-Magne Fjeldstad
Department of pulmonary rehabilitation and lifestyle medicine, Cathinka Guldbergs Hospital, Norway
Abstract
Chronic obstructive pulmonary disease (COPD) is chronic disease that affects mostly the lungs but there is growing evidence that it is also a systemic condition associated with a number of accompanying diseases known as comorbidities. Chronic inflammation and oxidative stress are the highlight pathogenic processes that interrelate COPD and comorbidities with additional disease specific risk factors and mechanisms. Through complex interactions COPD increases the risk for certain comorbidities and they in turn have negative impact on health status and contribute to mortality in COPD patients. Treatment of comorbidities in terms of coexistence with COPD may require more specific personalized therapeutic approach. Here we review the pathogenic mechanisms which define COPD as a systemic disease; the most common comorbidities of COPD: cardiovascular disease, diabetes and metabolic syndrome, cachexia, osteoporosis, depression/anxiety and obstructive sleep apnea; the pathways which connect these diseases with COPD and the latest treatment approaches.
Abstract
Substantial scientific evidence has been gathered on the pathophysiology of dystonia, leading to proposed theoretical treatment protocols for rehabilitating patients with this disorder. This study aimed to assess patient outcomes following the application of novel functional neurology treatment protocols based on basic neuroscience research. A consecutive case series of patients diagnosed with dystonia and treated in a private practice setting was studied for their response to neural rehabilitation techniques based on published basic neuroscience research. Sensory stimulation techniques including non-invasive spinal cord stimulation, vestibular nerve neuromodulation based on targeted skull vibration and stimulation of reciprocal inhibitory nerve activity of dystonic muscles was used as novel add on therapy to standard care. The subjects included 6 cases of cervical dystonia and 3 cases of more generalized dystonia. The proposed rehabilitation procedures were explained in detail to the patients, including the investigational nature of these procedures, and written informed consent was obtained from each patient prior to treatment. Based on the comparison of total dystonia scores upon admission and prior to treatment with total dystonia scores at the completion of a course of care, all 9 patients in this case series demonstrated improvement in their dystonic symptoms after treatment. The group average pre-treatment dystonia score was 11.4, while the post-treatment group averaged dystonia score was 5.2 points. This represents a moderate, but clinically important improvement in global dystonia scores in a series of 9 patients treated in a private practice setting. Considering that dystonia is highly resistant to treatment, the improvement seen in this case series suggests that the methods involved warrant further investigation in a more formal research setting. The clinically meaningful improvements (approximately 50% for the group average) seen in these cases argue for more research into the role of the sensory systems in both the pathophysiology and treatment of dystonic conditions.
Mehak Swami, DO
VA Western New York Healthcare System at Buffalo; Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Division of Geriatrics and Palliative Medicine
Karin Provost, DO, PhD
VA Western New York Healthcare System at Buffalo; Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Division of Pulmonary, Critical Care and Sleep Medicine
Abstract
Breathlessness is a distressing symptom, uniformly faced at some point in the disease process in all patients with Chronic Obstructive Pulmonary Disease (COPD). Despite maximal medical therapy and pulmonary rehabilitation, patients with COPD continue to experience refractory dyspnea, pain, poor appetite, limitations of physical activity, emotional distress, depression and overall poor health-related quality of life. Our current GOLD ABE pharmacologic treatment algorithm provides maximal disease specific therapy directed at optimization of physiologic airflow obstruction and exacerbation frequency, however leaving a gap in how best to approach the complex and multifactorial symptom of refractory breathlessness that occurs despite these pharmacologic interventions and pulmonary rehabilitation. The comprehensive and multidisciplinary approach of specialty palliative care may well fill this gap in our treatment algorithms. In this review, we will review the growing body of literature on the definitions and role of primary and specialty palliative care in the treatment of patients with COPD, review the components of a structured palliative care intervention in advanced lung disease, review the current pharmacologic and non-pharmacologic treatments for breathlessness, the identified barriers to palliative care intervention and consider the future direction of palliative care engagement in patients with COPD.
Marina Lancaster D. de Moraes Salles
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Nataly Garcia
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Lucas Fornari Laurindo
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Angiseli Damaceno Scanavacca
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Karla Regina Ezídio
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Ricardo José Tofano
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Cláudia Rucco Penteado Detregiachi
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil; Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Jesselina F. dos Santos Haber
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Mara Silva Foratto Marconatto
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Sandra Maria Barbalho
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil; Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil; Department of Biochemistry, School of Food and Technology of Marilia (FATEC), Avenida Castro Alves, 62, Marília, São Paulo 17500-000, Brazil
Karina Quesada
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil; Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Abstract
Poor sleep quality can affect cardiovascular health and is considered a significant risk factor for the development of risk factors for Metabolic syndrome (MetS). This study aimed to investigate possible associations between sleep quality measured by the Pittsburgh Sleep Quality Index and the MetS. This was a cross-sectional that comprised data from 208 patients. Biochemical and anthropometric parameters were assessed. The identification of MetS was performed according to the International Diabetes Federation guidelines. The quantitative variables were described with the support of the BioEstat 5.3 software. To assess the association of the studied variables with the diagnosis of MetS, the Mann-Whitney and Chi-square (n x n) statistical tests were used. The level of significance considered was 5%. According to the International Diabetes Federation criteria, 111 (53,36%) men and women presented MetS. There were no statically significant differences between the groups with or without sleep disorders and the values of waist circumference (p=0.6996), high-density lipoprotein cholesterol levels (p=0.7940), triglycerides levels (p=0.8703), blood pressure values (p= 0.9851, and p=0.9795 for systolic and diastolic blood pressure, respectively), and glycemia (p=0.5351). Eighty-eight volunteers (42%) presented sleep quality dysfunction, with the highest proportion observed among individuals affected by MetS (p=0.0019). Our results indicate an association between sleep quality and the prevalence of MetS . Therefore, sleep quality could be evaluated in patients with MetS so that the therapeutic strategy would not be limited to the intervention in biochemical and anthropometric factors.
