Active-assisted Exercises Research Articles

Ab. No. 66 A Novel Medical Device Prototype, One Stop Solution For Shoulder Dysfunction: A Scientific Note

Introduction: The Shoulder is an unique anatomical structure with an extraordinary Range of Motion (ROM) that allows us to interact with our environment. Shoulder pain is the third most common musculoskeletal disorder, with incidents rate up to 2.5% and prevalence range from 6.9% to 26%, which rise up to 66.7% for lifetime prevalence in general population. Shoulder Rehabilitation includes Continuous passive movement, active assisted exercises and resisted exercises. There is no such device which includes all these type of exercise in a single unit. All the available devices are separate so requires more space in clinics and also the cost increases because one may need to purchase all these type of devices. Methods: The present prototype is designed to include continuous passive movement, active assisted and resisted exercises in a single unit. So it is a one stop solution for the shoulder rehabilitation. The newly designed device will be helpful to the physiotherapists working in the clinical setups, because it occupies less space in physiotherapy clinics and also cost effective. Conclusion: This novel device is one stop solution for shoulder rehabilitation which provides active assisted and resisted exercises and continuous passive movements in a single unit.

The management of a Bell's Palsy Diagnosis in a Geriatric Patient Following COVID-19 Vaccination

<h3>Research Objectives</h3> To educate health care professionals about and document the potential unique incidence of Bell's Palsy diagnosis following COVID-19 vaccination during the pandemic while documenting significance of high-volt pulsed electrical stimulation intervention strategies by a physical therapist. <h3>Design</h3> Single subject retrospective case study. <h3>Setting</h3> Private practice physical therapy out patient clinic. <h3>Participants</h3> Retrospective single subject case study, based on diagnosis. <h3>Interventions</h3> A 72-year-old female, independent in all activities of daily living, experienced significant symptoms of Bell's Palsy following a COVID-19 vaccine. Past medical history included idiopathic Bell's Palsy on the contralateral side. Functional difficulties were documented and Facial Disability Index scores obtained. Physical therapy was initiated and utilized electrical stimulation protocol, active and active assistive exercise, and patient education/support. Focus for electrical stimulation included Frontalis, Orbicularis Oculi, Zygomaticus Major and Orbicularis Oris. Significant improvement and a full return to function was documented in 7 weeks. <h3>Main Outcome Measures</h3> Functional tolerances (patient reported), visual/strength improvements, and Facial Disability Index scores. <h3>Results</h3> Patient participation in physical therapy for the treatment of Bell's Palsy following a first dose vaccine for COVIID-19 is documented, with the outcome being full return to function and all social activities. FDI scores improved significantly as well as patient satisfaction scales, and the patient reported full credit to the physical therapy for the recovery, while refusing other interventions that were offered. <h3>Conclusions</h3> This case study presents a unique onset and etiology for a Bell's Palsy in a geriatric patient and contributes to the literature by offering physical therapy interventions with outcome findings. Patient advocacy for obtaining physical therapy was critical and significantly meaningful. Given the unique case of a single subject control, this case may be valuable for clinicians who may be presented with cases in the clinic, or for educational purposes in the classroom. <h3>Author(s) Disclosures</h3> None.

Brachial Plexus Injury and Musculocutaneous Nerve Palsy During Prone Positioning in a Patient With COVID-19

Prone positioning is crucial in the respiratory management of patients with acute respiratory distress syndrome (ARDS) and reduces mortality. However, this may be complicated by compression-related peripheral nerve injury. We report the case of a male in his 80s with obesity admitted to the intensive care unit (ICU) with COVID-19 pneumonia who developed brachial plexus disorder in the right upper extremity and musculocutaneous neuropathy in the left. The patient’s cough, dyspnea, and fatigue did not improve; therefore, he was intubated and placed in the prone position for one week. The patient complained of bilateral upper limb weakness on regaining consciousness. We diagnosed left musculocutaneous nerve palsy and right brachial plexus palsy based on physical findings and needle electromyography (EMG). Physical therapy was initiated, including joint range-of-motion exercises focused on preventing contractures in the extremities and active assistive exercises. Motor impairment improved, and the patient was discharged from the rehabilitation center.

Impact of a 12-month multifaceted neurological physiotherapy intervention on gross motor function in women with Rett syndrome.

Rett syndrome is a rare genetic neurological syndrome that affects mostly females. The syndrome leads to severe impairments impacting all areas of the affected persons' life, including speech, mobility, eating, and breathing impairments. The most distinct symptoms include stereotyped hand movements, ataxia, and atrophy of the lower limbs, and signs of autism. According to the principle of convenience sampling, the quantitative research included five females diagnosed with Rett syndrome subject to their personalized goal oriented neurological physiotherapy. Changes in gross motor function were assessed by the Gross Motor Function Measure 88 and Rett syndrome Gross Motor Scale. It was found that the 12-month multifaceted neurological physiotherapy intervention had statistically significant improvements in both Gross Motor Function Measure 88 (p = 0.005) and Rett syndrome Gross Motor Scale (p = 0.012). Despite positive improvements, the absence of control group made it difficult for a comparative evaluation to determine what interventions had the best possible outcomes. The quantitative research demonstrates neuro-developmental treatment sessions, hippotherapy, hydrotherapy, physical therapy, a walking program, endurance exercises, active-assisted exercises, and coordination exercises, had a significant impact on improving gross motor function status. Current multifaceted intervention program leads to good improvement of gross motor skills above what can be expected from late motor deterioration.

Comparação da resposta hemodinâmica entre terapia convencional e realidade virtual em pacientes com insuficiência cardíaca internados na unidade de emergência

ABSTRACT This study aimed to evaluate and to compare the acute response, due to semi-immersive virtual reality (VR) and conventional therapies (CT), of hemodynamic parameters in hospitalized individuals admitted to an emergency unity for heart failure (HF). This is a viability study with 11 individuals subjected to sessions with and without VR. At CT, stretching, active or active-assisted exercises, and fractional inspiration were performed. In VR therapy (VRT), VR box glasses were used to promote VR relaxation associated with CT. The hemodynamic parameters evaluated were heart rate, systolic and diastolic blood pressure, oxygen saturation, and double product. To analyze them, Student’s t- and Mann Whitney tests were used (p&lt;0.05). Comparing baseline and final evaluations showed no significant differences in the hemodynamic parameters of both groups (p&gt;0.05). Comparing absolute variations between CT and VRT also produced no significant differences between hemodynamic responses (p&gt;0.05). Results showed that administering VRT and CT promoted physiological changes in the responses of hemodynamic parameters in individuals with HF hospitalized in an emergency unit without significant differences between the two interventions. This study suggests that VRT is a hemodynamically safe method for treating patients in emergency units.

Electromyographic Evaluation of Early-Stage Shoulder Rehabilitation Exercises Following Rotator Cuff Repair.

BackgroundElectromyography (EMG) is frequently used as a guide for exercise rehabilitation progression following rotator cuff repair. Knowledge of EMG activity during passive and active-assisted exercises may help guide clinicians when considering exercise prescription in the early post-operative period.PurposeThe purpose of this study was to investigate EMG activity of the rotator cuff and deltoid musculature during passive and active-assisted shoulder range of motion (ROM) exercises commonly performed in post-operative rehabilitation.Study DesignDescriptive cohort laboratory study using healthy subjects.MethodsIn sixteen active healthy volunteers, surface and fine-wire EMG activity was measured in the supraspinatus, infraspinatus, subscapularis, and anterior, middle and posterior deltoid muscles during eight common ROM exercises. Mean %MVIC values and 95% confidence intervals were used to rank exercises from the least to the most amount of muscular activity generated during the exercises.ResultsStandard pendulum exercises generated low levels of EMG activity in the supraspinatus and infraspinatus (≤15% MVIC), while active-assisted table slides, and the upright wall slide generated low levels of EMG activity in only the supraspinatus. No exercises were found to generate low levels of muscular activation (≤15% MVIC) in the subscapularis.ConclusionThis study found no clear distinctions between the EMG activity of the supraspinatus or the infraspinatus occurring during common passive and active-assisted ROM exercises. Subdividing ROM exercises based on muscle activity, may not be necessary to guide progression of exercises prior to commencing active motion after rotator cuff repair.Level of EvidenceLevel 3b

Adhesive Capsulitis of Shoulder Emphasising on Restorative and Compensatory Management: A Case Study

Adhesive capsulitis more commonly periarthritis of shoulder is a common condition characteristic by pain, stiffness and restricted range of motion leading to difficulty in household activities, overhead reach and complexity in daily activities. This condition affects around two million - mostly women between the ages of 40 and 60. Some experts say changing levels of hormones may be to blame for this connection between adhesive capsulitis and menopause. This is a case study of Mrs. R a 55-year-old female presenting complain of left-sided shoulder pain and restricted movement. These symptoms started gradually but over time they began to affect her general quality of life and morale. Pain increased, particularly at night leaving her extremely tired during the daytime and she started to experience problems especially when dressing. After conducting a thorough examination, which included assessment of active and passive range of movements (rom), x rays and diagnostic special tests we reached a diagnosis of adhesive capsulitis of left shoulder The conservative management remains the mainstay treatment of adhesive capsulitis&#x0D; With using soft tissue mobilization treatment techniques in combination with a home exercise programmed with active assisted exercise. Here in this case study, we are emphasizing on the restorative and compensatory management decreasing the hours of OPD visits and promoting home program

Analysis Of The Cortical Hemodynamic Responses To Active-assistive Exercise In Individuals With Parkinson’S Disease.

Background: Gait and motor impairments are common symptoms in people with Parkinson’s disease (PD). Previous studies found active-assistive exercise to be effective in improving PD symptoms. The underlying neural mechanism contributing to these improvements is currently unknown. No previous studies have investigated how the brain responds to active-assistive exercise in people with PD. PURPOSE: To investigate the cortical hemodynamic responses to active-assistive exercise in individuals with PD. METHODS: A total of 7 individuals with PD (70.29 ± 5.44) and 10 controls (58.71 ± 9.30) participated in this cross-sectional study. All participants completed three modes of exercise including active exercise (AE), passive exercise (PE), and active-assistive exercise (AAE) using computerized cycling equipment (MOTOmed viva 2, RECK MOTOmed, Betzenweiler, Germany, 2017). Each mode of exercise was performed at a predetermined pace for 10 minutes on three separate days while a neuroimaging device, functional near-infrared spectroscopy (NIR Sport, NIRx Medical Technology, Berlin, Germany, 2017) captured oxy-hemoglobin (HbO) levels in the prefrontal lobe. RESULTS: Repeated measures ANOVA showed no significant difference in 𝚫;;;;HbO among exercise modes. A trend showed that the PD group displayed the greatest level of 𝚫;;;;HbO during PE and minimum with AE. A 2x3 mixed model ANOVA revealed no significant group x mode interaction. However, a trend showed that the PD group displayed greater levels of 𝚫;;;;HbO during PE and AAE whereas the control group revealed greater levels during AE and AAE. Four representative channels were selected for regional comparison of brain activation during AAE between groups. They demonstrated significant differences in the middle frontal cortex (p<.049), orbital cortex (p<.039), intermediate frontal cortex (p<.033), and granular frontal cortex (p<.022). CONCLUSION: Our findings suggest that people with PD showed higher levels of brain activity during passive and active-assistive modes of exercise as compared to active cycling. Brain activity levels during active-assistive exercise can be different when compared to those without PD. The results may help understand the underlying neural mechanism associated with positive outcomes following active-assistive exercise in PD.

PENGARUH RANGE OF MOTION AKTIF-ASSISITIF: LATIHAN FUNGSIONAL TANGAN TERHADAP PENINGKATAN KEKUATAN OTOT PASIEN STROKE NON HEMORAGIC DI RSUP HAJI ADAM MALIK MEDAN

Introduction. Stroke is a central nervous system disorder that most often causes paralysis of the limbs, due to attacks on neuromuscular nerves that cause muscle weakness, so it takes practice that is ROM Active-Assistive hand-functional exercises. This study aims to determine the effect of Range Of Motion Active-Assistive Functional Exercise Hand on Increasing Muscle Strength In Non Hemorrhagic Stroke Patients at Haji Adam Malik General Hospital Medan.Method. research design was Quasi experimental with Pretest-posttest control group design approach. The number of samples was 30 respondents according to the inclusion criteria.Result. Wilcoxon statistical test results obtained the highest results on the pretest with the category of Fair (value 3) and postest with Good category (value 4) obtained p value = 0.001 where the value of p value α (≤0.05) so it can be concluded there is an effect Range Of Motion Active -Assistive Functional Hand Exercise on Increasing Muscle Strength in Non Hemorrhagic Stroke Patients and for the control group the results obtained p = 0.175, which means no increase in muscle strength before and after the study. Mann Whitney Test with p value of 0.001 where p value α (≤0,05)Duscussion. can be concluded that there is a significant difference between treatment group and control group. Subsequent studies are suggested to perform the same type of research on the range of motion of non hemorrhagic stroke patients.

Repositionstechniken bei minimal-invasiver Stabilisierung proximaler Humerusfrakturen

The aim of surgical stabilization of proximal humerus fractures is to restore the anatomical relations between the greater and lesser tubercle, to reconstruct the joint and preserve the vascular supply of the fragments. Approximately 80% of proximal humeral fractures can be treated conservatively. Surgical treatment is indicated based on the fracture pattern, patient-related factors and the risk of avascular head necrosis. Two-part fractures with ametaphyseal comminution zone and 3/4-part fractures can benefit from near to anatomic reconstruction depending on the patient's demands and bone quality. Minimally invasive stabilization procedures allow for an anatomical reconstruction in the majority of fresh proximal humeral fractures with or without aproximal shaft fracture, provided that intraoperative traction allows the fracture to be aligned axially in the image intensifier by ligamentotaxis. Indirect, combined with direct reduction maneuvers, allow for an almost anatomical reconstruction, despite minimal invasive approaches. Beach chair position. The arm is held in apneumatic articulating traction device. Evaluation of the indirect reduction potential by ligamentotaxis with visualization of the alignment of the head fragments in relation to the shaft by traction, abduction/adduction, flexion/extension and rotation. The traction device and afoam roll in the axilla to neutralize the tension of the pectoralis major and teres major muscles while simultaneously adducting the elbow hold the reduction. Insufficient reduction of the fragments requires additional direct reduction maneuvers. Opening of the bursa and fixation of the rotator cuff with sutures to adjust reposition. A2.5 mm-threaded K‑wire is inserted into the head fragment as ajoystick. Under protection of the axillary nerve, the plate is inserted under protection of the axillary nerve. Temporary fixation of the plate with Kirschner wires for positioning the plate 5-8 mm below the greater tubercle and 2-3 mm laterally of the sulcus of the long biceps tendon and subsequent radiographic control. Reduction of the shaft against the plate with acortex screw. The threaded K‑wire in the head can be used to adjust the varus and valgus alignment and to achieve adequate support of the calcar. Finally, complete the osteosynthesis with angular stable screws. Immediate active assisted exercise in the shoulder under physiotherapeutic supervision. Temporary immobilization for patient comfort. Standard active and resistive mobilization after the first clinical and radiological checkup 6weeks after surgery. Further radiological checks after 3and 6months and 1year. No routine plate removal.

Myoelectric control algorithm for robot-assisted therapy: a hardware-in-the-loop simulation study

BackgroundA direct blow to the knee is one way to injure the anterior cruciate ligament (ACL), e.g., during a football or traffic accident. Robot-assisted therapy (RAT) rehabilitation, simulating regular walking, improves walking and balance abilities, and extensor strength after ACL reconstruction. However, there is a need to perform RAT during other phases of ACL injury rehabilitation before attempting an advanced exercise such as walking. This paper aims to propose a myoelectric control (MEC) algorithm for a robot-assisted rehabilitation system, “Nukawa”, to assist knee movement during these types of exercises, i.e., such as in active-assisted extension exercises.MethodsSurface electromyography (sEMG) signal processing algorithm was developed to detect the motion intention of the knee joint. The sEMG signal processing algorithm and the movement control algorithm, reported by the authors in a previous publication, were joined together as a hardware-in-the-loop simulation to create and test the MEC algorithm, instead of using the actual robot.Experiments and resultsAn experimental protocol was conducted with 17 healthy subjects to acquire sEMG signals and their lower limb kinematics during 12 ACL rehabilitation exercises. The proposed motion intention algorithm detected the orientation of the intention 100% of the times for the extension and flexion exercises. Also, it detected in 94% and 59% of the cases the intensity of the movement intention in a comparable way to the maximum voluntary contraction (MVC) during extension exercises and flexion exercises, respectively. The maximum position mean absolute error was 0.1^{circ }, 6.3^{circ }, and 0.3^{circ } for the hip, knee, and ankle joints, respectively.ConclusionsThe MEC algorithm detected the intensity of the movement intention, approximately, in a comparable way to the MVC and the orientation. Moreover, it requires no prior training or additional torque sensors. Also, it controls the speed of the knee joint of Nukawa to assist the knee movement, i.e., such as in active-assisted extension exercises.

REHABILITATION AND KINESIOTHERAPEUTIC TREATMENT DURING SURGERY FOR HUMERUS FRACTURE WITH PSEUDOARTHROSIS – A CASE REPORT

The bone of the upper arm (humerus) is the third largest and strongest bone in the human body which is located between the shoulder joint and the elbow joint.The aim of this thesis is to present a multifragmental fracture of the humerus of a 69 year old woman with no neurovascular lesions, with nounion which was treated with an osteosynthesis-adapted plate and individually placed screws. With appropriate physical therapy, the patient has fully recovered and has successfully returned to her everyday activities.Material and methods After the surgical procedure, the 69 year old patient received treatment at the department for physical therapy within GOB 8-mi Septemvri in Skopje. As part of the physical therapy, she received electrotherapy with an IF current and magnetic therapy, kinesiotherapy with active and active assisted exercise, including hydrotherapy with active pool exercises. The success is measured in milimeteres, which often makes this procedure extremely hard for the patient and the therapist.Results The success of the physical treatment of the patient was shown month by month, namely in the first, second and third month of the treatment.Conclusion The Humerus bone must be strong enough to bear the load during lifting, pushing or pulling of objects. The bone of the upper arm is very important, because without this bone we would not be able to control or to use the other parts of the arm.

A Lower Limb Rehabilitation Robot in Sitting Position with a Review of Training Activities.

Robots for stroke rehabilitation at the lower limbs in sitting/lying position have been developed extensively. Some of them have been applied in clinics and shown the potential of the recovery of poststroke patients who suffer from hemiparesis. These robots were developed to provide training at different joints of lower limbs with various activities and modalities. This article reviews the training activities that were realized by rehabilitation robots in literature, in order to offer insights for developing a novel robot suitable for stroke rehabilitation. The control system of the lower limb rehabilitation robot in sitting position that was introduced in the previous work is discussed in detail to demonstrate the behavior of the robot while training a subject. The nonlinear impedance control law, based on active assistive control strategy, is able to define the response of the robot with more specifications while the passivity property and the robustness of the system is verified. A preliminary experiment is conducted on a healthy subject to show that the robot is able to perform active assistive exercises with various training activities and assist the subject to complete the training with desired level of assistance.

A Systematic Review of Electromyography Studies in Normal Shoulders to Inform Postoperative Rehabilitation Following Rotator Cuff Repair

Study Design Systematic review. Background Electromyography (EMG) has previously been used to guide postoperative rehabilitation progression following rotator cuff repair to prevent deleterious loading of early surgical repair. Objective To review the current literature investigating EMG during rehabilitation exercises in normal shoulders, and to identify exercises that meet a cut point of 15% maximal voluntary isometric contraction (MVIC) or less and are unlikely to result in excessive loading in the early postoperative stages. Methods An electronic search of MEDLINE via Ovid, Embase, CINAHL, SPORTDiscus, PubMed, and the Cochrane Library for all years up to June 2016 was performed. Studies were selected in relation to predefined selection criteria. Pooled mean MVICs were reported and classified as low (0%-15% MVIC), low to moderate (16%-20% MVIC), moderate (21%-40% MVIC), high (41%-60% MVIC), and very high (greater than 60% MVIC). Results A search identified 2159 studies. After applying the selection criteria, 20 studies were included for quality assessment, data extraction, and data synthesis. In total, 43 exercises spanning passive range of motion, active-assisted range of motion, and strengthening exercises were evaluated. Out of 13 active-assisted exercises, 9 were identified as suitable (15% MVIC or less) to load the supraspinatus and 10 as suitable to load the infraspinatus early after surgery. All exercises were placed in a theoretical-continuum model, by which general recommendations could be made for prescription in patients post rotator cuff repair. Conclusion This review identified passive and active-assisted exercises that may be appropriate in the early stages after rotator cuff repair. J Orthop Sports Phys Ther 2017;47(12):931-944. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7271.

Parkinson’s Disease Patients Show Long-term Gait Improvements After Active Assistive Forced Exercise Training

Forced exercise training - whether it is conducted active or passive assistive - improves Parkinsonian symptoms such as rigor, dyskinesia, tremor and gait disturbances directly after exercising. The long-term effects, especially for complex movements like walking, are unknown. Furthermore, brain imaging data of healthy adults indicate that active assistive exercise leads to a more prominent brain activation than passive assistive exercise. A comparison of active and passive assistive forced exercise training has not been done. PURPOSE: To compare active and passive assistive forced exercise and to determine its long-term adaptations. METHODS: 24 patients participated in either a passive or an active assistive forced exercise training for 12 weeks. The patients were bilaterally affected by Parkinson’s disease and had a disease classification between ≥ 2.5 ≤ 4.0 on the modified Hoehn & Yahr stage scale. Gait patterns were analyzed before the beginning of the intervention, upon completion of the intervention, and twelve weeks after completion of the intervention. RESULTS: Both exercise methods led to an accelerated gait velocity (0.5 km/h) and elongated single stride length (6 cm) significantly after the intervention. Furthermore, swing phase (2 %) and monopedal stance phase (2 %) were significantly increased. Long-term effects were only shown for active assistive forced exercise, because gait velocity was still increased (0.35 km/h) 12 weeks after the intervention in comparison to preexercise levels. CONCLUSION: Active assistive forced exercise should be the preferred method for future treatment for patients affected by Parkinson’s disease to improve Parkinsonian symptoms long-term.

Upper limb rehabilitation robot for physical therapy: design, control, and testing

In recent years, the treatment process of patients and disabled people who need rehabilitation and physical medicine has become more effective with the use of new devices and developing technology. The rehabilitation robot is one of the most important developments in new technology. The right therapeutic exercises and the objectivity of the evaluation of the range of motion (ROM; generated torque and muscular activation measurement of the patient) are extremely important factors during treatment. In this study, a lower limb rehabilitation robot was modified and controlled for upper limbs. The retrofitted robot system is able to do passive, active, and active-assistive therapeutic exercises. On the other hand, it performs active-assistive exercises using muscular activation. A web-based human machine interface, which can support home-care service, was developed to control the robotic system. This interface includes a performance evaluation unit, which is able to use not only ROM and torque, but also muscular activation of patients for the assessment of therapy results. Thanks to this system, assessment and physical therapy can be realized by a single robotic system for both upper and lower limbs using physical parameters such as ROM, generated torque, and muscular activation of the limbs. Satisfactory performance of the system is observed in the tests performed with a healthy subject.

Effects of Active Assistive Exercise in a Relief of Body Weight Condition on Electromyographic Activity of Hip Muscles in People with Severe Motor and Intellectual Disabilities(Reports Supported by JPTA Grant)

Effects of Active Assistive Exercise in a Relief of Body Weight Condition on Electromyographic Activity of Hip Muscles in People with Severe Motor and Intellectual Disabilities(Reports Supported by JPTA Grant)

Efeitos da Estimulação Podal no Equilíbrio em Hemiparéticos por Acidente Vascular Cerebral

Objective. To investigate the effects of foot stimulation in balance ofstroke patients. Method. Were conducted 24 sessions in each of the 56 patients with a diagnosis of ischemic or hemorrhagic stroke, of both sexes, aged 44-85 years, mean 67 years.The included patients presente4d unilateral sequelae of stroke, medical release, signs of weak&shy;ness and/or spasticity in affected hemibody be able to perform part or full motion involved in MI. We excluded patients with decompen&shy;sated blood pressure, associated neurological pathologies and those who were not faithful to the treatment. The motor stimulation of hemiparetic foot consisted of adeep manual massage sliding across the foot, leg slip with stimulation of the gastrocnemius and soleus muscles after passive mobilization and active-assisted exercises and contract relax. The intervention was evaluated with Berg Balance Scale. Re&shy;sults. The balanceshowed a significant improvement in scores before and after (14 to 53). Conclusion. The foot stimulation was effective for improving balance in hemiparetic patients with sequels of stroke, demonstratingant increase in active motion and conducting function&shy;al abilities with the upper and lower limbs affected.

Minimally displaced fractures of the greater tuberosity: outcome of non-operative treatment

Minimally displaced (<3 mm) and non-displaced fractures of the proximal humerus are a common source of disability; nevertheless, there is no agreement on the recommended rehabilitation program in these patients. The purpose of this study was to evaluate the outcome of this group of patients and describe the rehabilitation protocol we have used for the treatment of this injury. We retrospectively analyzed the records of patients diagnosed with minimally displaced (<3mm) fractures of the greater tuberosity who were admitted to our institute between June 2007 and May 2008. Patients were treated with a three-phase protocol. In the first phase, patients were immobilized in a sling for 3 weeks. In the second phase, pendular and active assisted exercises were begun 3 to 6 weeks after the injury. In the third phase, active exercises were commenced starting 6 weeks after injury. Sixty-nine patients matched our inclusion and exclusion criteria. At an average follow-up of 31months (range, 26-41 months), the average Constant score improved from 40 points (range, 33-58 points) to 95 points (range, 75-100 points). Average satisfaction score improved from 4.2 of 10 (range, 2-6) to 9.5 of 10 (range, 7-10). The reported average duration of pain and decreased range of motion from the time of injury was 8.1 months (range, 1-24 months). When the diagnosis of a minimally displaced fracture of the proximal humerus is made, the patient can be reassured that a favorable outcome is anticipated with a staged rehabilitation protocol. Nevertheless, clinicians and patients should be aware that full recovery from the injury may take an average of 8 months.

Rehabilitation After Shoulder Replacement: Be All You Can Be!

Rehabilitation after shoulder arthroplasty should reflect an understanding of the postsurgical phases of healing. The surgeon must balance the need to allow healing while gradually restoring flexibility, functional active motion, endurance, strength, and ultimately return to daily function at home, at workplace, and in participation of recreational activities. At the completion of the surgical procedure, the surgeon should provide an environment that will allow mobility, restore stability, and ultimately allow use of the surrounding and supportive musculature to attain functional goals. The stages of rehabilitation include early passive exercises followed gradually by active and active-assisted exercises, including the use of therapeutic aqua exercises. Gradually, progressive muscular endurance and strengthening exercises are added over time, specifically designed to achieve each individual's unique functional goals. Clearly, the physiological age, the general health quality, and the severity of the preexisting pathology will dictate the degree of activity that can be ultimately achieved. Essentially, patients want relief of pain and restoration of function. A detailed approach to the phases of rehabilitation, nuances based on the type of arthroplasty, and limitations based on the initial pathology and specifics of arthroplasty will be discussed.