Rehabilitation Approaches Research Articles

Does a service provide safe, effective rehabilitation? An evaluation method for providers and purchasers

Background Independent organisations monitor the safety and governance of clinical services but do not assess specialist expertise. Peer review can assess service capability but is resource-intense and infeasible. The problem How can you ensure a service provides safe, effective rehabilitation? You ask them to provide data as evidence that they can be trusted to do so. This article suggests a structured approach to providing data on entrustability. An analogy How is the specialist skill of a doctor in training established? They provide evidence about high-level outcomes (capabilities in practice) related to their speciality. An educational supervisor assesses whether they can be trusted to perform safely and effectively without supervision. The capabilities in practice define their expertise. The solution A service can use seven high-level rehabilitation service capabilities, based on the clinical capabilities associated with medical training, with observable indicative descriptors, to collect evidence of their rehabilitation approach. A service must also select four to eight high-level competencies indicating they can rehabilitate their patient caseload safely and effectively. These competencies also need indicative descriptors as evidence of their performance in the service; 11 examples are given. Capabilities. The seven rehabilitation capabilities are: using the biopsychosocial model, having a multi-professional team, making a person-centred rehabilitation plan, working collaboratively across all boundaries, tailoring treatments to the patient's needs, ensuring staff have specific competencies required for their caseload, and acknowledging and managing uncertainty and complexity. Conclusion. Service providers could use this structured approach to develop and provide users with evidence of their rehabilitation expertise.

Interventional pain management practices in Pakistan: The role of Physical Medicine and Rehabilitation (PMR).

Chronic pain represents a complex, multifaceted challenge that surpasses the prevalence of commonly encountered disorders such as diabetes mellitus and hypertension. This condition exerts a substantial burden on healthcare systems due to its pervasive impact. While pain interventions and procedures constitute a crucial facet, they alone do not constitute a comprehensive solution. Nevertheless, the strategic and precise application of these procedures by well-trained and proficient physicians offers patients a swift route to resuming their normal activities, sparing them from protracted reliance on medications. Within the realm of Physical Medicine and Rehabilitation (PM&R), Interventional Pain Management (IPM) adopts a multidisciplinary rehabilitative approach, addressing all dimensions of pain syndromes. This approach culminates in enhanced functional outcomes and an improved quality of life. This concise review underscores the significance of this integrated approach, shedding light on various pain procedures routinely employed for diagnostic and therapeutic purposes. Within this context, we briefly explore the application of ultrasound and C-arm guided procedures. In conclusion, this review underscores the imperative nature of embracing a multidimensional approach to pain management, essential for seamlessly incorporating interventional pain management techniques into the broader domain of rehabilitation medicine.

A Wearable Personalised Sonification and Biofeedback Device to Enhance Movement Awareness.

Movement sonification has emerged as a promising approach for rehabilitation and motion control. Despite significant advancements in sensor technologies, challenges remain in developing cost-effective, user-friendly, and reliable systems for gait detection and sonification. This study introduces a novel wearable personalised sonification and biofeedback device to enhance movement awareness for individuals with irregular gait and posture. Through the integration of inertial measurement units (IMUs), MATLAB, and sophisticated audio feedback mechanisms, the device offers real-time, intuitive cues to facilitate gait correction and improve functional mobility. Utilising a single wearable sensor attached to the L4 vertebrae, the system captures kinematic parameters to generate auditory feedback through discrete and continuous tones corresponding to heel strike events and sagittal plane rotations. A preliminary test that involved 20 participants under various audio feedback conditions was conducted to assess the system's accuracy, reliability, and user synchronisation. The results indicate a promising improvement in movement awareness facilitated by auditory cues. This suggests a potential for enhancing gait and balance, particularly beneficial for individuals with compromised gait or those undergoing a rehabilitation process. This paper details the development process, experimental setup, and initial findings, discussing the integration challenges and future research directions. It also presents a novel approach to providing real-time feedback to participants about their balance, potentially enabling them to make immediate adjustments to their posture and movement. Future research should evaluate this method in varied real-world settings and populations, including the elderly and individuals with Parkinson's disease.

Value-consistent rehabilitation is associated with long-term psychological flexibility and quality of life after traumatic brain injury

ABSTRACT Meaningful steps have been taken toward using holistic approaches in outpatient rehabilitation for traumatic brain injury (TBI) (i.e., treating the whole individual); however, research and practice continue to disproportionately focus on adapting to physical and cognitive changes. Research suggests treatment focusing on individual values may be important for psychological adjustment after TBI. The current study sought to explore individual values across multiple life domains in those with TBI as well as what values outpatient rehabilitation was helpful for, and to examine discrepancies between these factors (i.e., value-consistent rehabilitation) in relation to important long-term treatment outcomes. 215 adults with a history of TBI who had participated in outpatient rehabilitation completed online surveys assessing how consistent outpatient rehabilitation was with individual values, psychological flexibility, and quality of life. The life domains with the greatest discrepancies between individual importance and rehabilitation helpfulness were spirituality, intimate relations, and family relations. Greater value-consistent rehabilitation was associated with higher levels of psychological flexibility and quality of life beyond demographics and injury characteristics. Our findings provide further support in favour of holistic, client-centred approaches that are facilitated by neurological rehabilitation programs.

Overarm Training Tolerance: A Pilot Study on the Use of Muscle Oxygen Saturation as a Biomarker.

Ulnar collateral ligament (UCL) tears occur due to the prolonged exposure and overworking of joint stresses, resulting in decreased strength in the flexion and extension of the elbow. Current rehabilitation approaches for UCL tears involve subjective assessments (pain scales) and objective measures such as monitoring joint angles and range of motion. The main goal of this study is to find out if using wearable near-infrared spectroscopy technology can help measure digital biomarkers like muscle oxygen levels and heart rate. These measurements could then be applied to athletes who have been injured. Specifically, measuring muscle oxygen levels will help us understand how well the muscles are using oxygen. This can indicate improvements in how the muscles are healing and growing new blood vessels after reconstructive surgery. Previous research studies demonstrated that there remains an unmet clinical need to measure biomarkers to provide continuous, internal data on muscle physiology during the rehabilitation process. This study's findings can benefit team physicians, sports scientists, athletic trainers, and athletes in the identification of biomarkers to assist in clinical decisions for optimizing training regimens for athletes that perform overarm movements; the research suggests pathways for possible earlier detection, and thus earlier intervention for injury prevention.

Exploring the Acute Effects of Immersive Virtual Reality Biking on Self-Efficacy and Attention of Individuals in the Treatment of Substance Use Disorders: A Feasibility Study.

The role of exercise programs during substance use disorder (SUD) treatment is considered particularly supportive in fostering positive psychological and behavioral changes. The treatment of SUD is a challenging and demanding process. Therefore, it is crucial to discover innovative methods to enhance and facilitate it. Integrating exercise into a virtual environment is an innovative approach for drug rehabilitation, offering multiple benefits to individuals undergoing treatment. The aim of this feasibility study was to explore the acute effects of cycling exercise in an immersive virtual reality (VR) environment on attentional control and self-efficacy expectations of individuals undergoing SUD treatment. A total of 20 individuals (mean age of 37.75 years) enrolled in a SUD treatment program participated in the study. They were instructed to complete a single session of cycling with a self-selected duration within the VR system. Following the cycling session, pre-post measures indicated a statistically significant improvement in self-efficacy expectations and attentional control measured with the Stroop test. The results revealed that participants expressed high levels of intention for future use, interest/enjoyment, and positive attitudes toward the VR exercise system. Qualitative data indicated that participants found the VR exercise system enjoyable, expressed a strong intention to use it, and did not encounter technical difficulties or negative emotions. In conclusion, it seems that engaging in a brief period of self-selected exercise within a virtual environment can result in temporary activation of cognitive changes, heightened self-efficacy expectations, and a motivating approach to increasing physical activity participation among individuals with SUD, thus suggesting the feasibility of this approach.

COVID-19-Associated Cerebellitis: A Case Report and Rehabilitation Outcome.

The COVID-19 pandemic has brought attention to neurological complications, including cerebellitis, characterized by inflammation of the cerebellum. Despite its rare occurrence, cerebellitis has been associated with COVID-19 infection, albeit the pathogenic mechanisms remain unclear. We present the case of a 22-year-old male with acute onset ataxia and dysarthria during a SARS-CoV-2 infection. Diagnostic evaluations ruled out other causes, confirming cerebellitis. Treatment included steroid therapy, vitamin supplementation, physiotherapy, and intravenous immunoglobulins. Rehabilitation focused on enhancing balance, coordination, and daily activities. The patient showed significant improvement in functional abilities, with increased autonomy in daily activities and improved ambulation. Despite persistent mild symptoms, the multidisciplinary rehabilitation approach led to remarkable progress. This case underscores the importance of recognizing and managing neurological complications, such as cerebellitis, in COVID-19 patients. A comprehensive approach combining medical treatment and rehabilitation is essential for optimizing outcomes. Further research is needed to elucidate the pathogenesis and optimal management strategies for such complications.

Is immediate dental implant in fibula free flap beneficial for implant survival and osteoradionecrosis in jaw reconstruction?

ObjectivesThis study aimed to compare the risk of osteoradionecrosis and implant survival in oral cancer patients undergoing immediate dental implants during jaw reconstruction, termed “Jaw in a Day” (JIAD), with those receiving no implants or delayed implants (non-JIAD). Patients & methodsClinicopathologic data were collected from prospectively enrolled JIAD patients (n = 10, 29 implants) and retrospectively from non-JIAD patients (n = 117, 86 implants). Survival analyses were performed to assess implant survival and osteoradionecrosis-free survival. ResultsOsteoradionecrosis occurred in 0 % of JIAD cases compared to 19.3 % in non-JIAD cases without implants and 71.4 % in non-JIAD cases with delayed implants (p = 0.008). Osteoradionecrosis-free survival was significantly better in the JIAD group than the non-JIAD group (p = 0.0059). Implants in the JIAD group all survived regardless of radiation therapy (29/29, 100 %) and 95.1 % (58/61) of implants survived in delayed implants in non-irradiated fibula without radiotherapy. Meanwhile, only 11 of 25 implants placed in irradiated fibula flaps survived, even when the implants were placed after a median time interval of 624 days after radiotherapy, and none of them were earlier than 360 days. The survival analysis revealed a significant difference (p < 0.0001). ConclusionJIAD appears to offer superior outcomes in terms of implant survival and osteoradionecrosis prevention compared to delayed implant placement. Placing implants in irradiated fibula, even after years, significantly poses high risk of implant failure and osteoradionecrosis. JIAD represents a promising approach for optimal rehabilitation, particularly in oral cancer patients requiring postoperative radiotherapy. Proper positioning and orientation of implants and flaps are crucial for implant survival.

Prognostic Factors in Idiopathic Sudden Sensorineural Hearing Loss: The Experience of Two Audiology Tertiary Referral Centres.

Background and Objectives: Although different hypotheses have been proposed over time, there is a dearth of information on factors able to predict the response to treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) and hearing recovery. The aim of this study was to apply univariate and multivariate statistical models in a retrospective clinical setting of patients given therapy for ISSNHL at our tertiary academic audiological centers to investigate the prognostic value of clinical signs, symptoms, and comorbidities in relation to hearing recovery. Materials and Methods: The inclusion criteria were: history of ISSNHL diagnosed and treated at the Padova or Modena tertiary academic audiological centers; age ≥ 18 years; availability of clinical and audiological outcome data. The exclusion criteria were: hearing loss in acoustic schwannoma, endolymphatic hydrops, meningitis, trauma (head trauma, temporal bone fracture, acoustic trauma), barotrauma, perilymphatic fistula; exposure to noise levels ≥ 80 dB in the work environment; any unilateral or bilateral hearing loss (except for presbycusis) prior to ISSNHL diagnosis; any disorders affecting the external or middle ear; any previous ear surgery; refusal to make medical data available for research purposes. Eighty-six consecutive patients (38 females, 48 males; median age: 58 years; interquartile range: 47.00-69.00 years) were included. A systemic steroid therapy was administered to all patients, either orally with prednisone or intravenously with methylprednisolone. Second-line therapy included intratympanic steroid injections and/or hyperbaric oxygen therapy. Results: A multivariate logistic regression model was used, including the non-multicollinear clinical and audiological variables, which showed a p-value < 0.10 at the univariate analyses (namely age at diagnosis, time to diagnosis, oral steroid dose, and PTA on the affected side). Only PTA on the affected side retained its statistical significance (OR: 1.0615, 95% CI: 1.0185-1.1063, p = 0.005). Conclusions: The analysis of our data showed an association between the hearing threshold before treatment and the recovery from ISSNHL. Further studies on larger cohorts (especially in a prospective setting) are needed to shed more light on the prognostic role of clinical parameters in patients with ISSNHL. In a correct counseling setting, with regard to the patient's concern about not being able to recover hearing, it is important to offer perspectives of appropriate hearing rehabilitation approaches.

Care Pathways in Rehabilitation for Children and Adolescents with Cerebral Palsy: Distinctiveness of the Adaptation to the Italian Context.

In 2020, a multiprofessional panel was set up in collaboration with the Italian FightTheStroke Foundation family association to produce evidence-based recommendations for the management and neuromotor rehabilitation of persons with cerebral palsy aged 2-18 years to implement in clinical practice in Italy. The recommendations of these care pathways were developed according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines for Care Pathways Development and the Grading of Recommendations Assessment Development and Evaluation working group for adoption, adaptation, or de novo development of recommendations from high-quality guidelines (GRADE-ADOLOPMENT). Four strong positive recommendations were developed regarding comprehensive management, and twenty-four addressed neuromotor treatment. A holistic, individualized approach was affirmed in terms of both multidimensional patient profile and interdisciplinary management in a network with the school where children and adolescents are integrated. It was defined that all motor rehabilitation approaches must be individually tailored considering age and developmentally appropriate activities as interventions and goals, in light of the reference curves addressing prognosis for Gross Motor Function and Manual Ability Classification Systems. Intervention must be structured with adaptations of the task and/or of the context (objects and environment) based on the analysis of the child's skills to support motivation and avoid frustration.

General Rehabilitation Principles for Patients with Cerebral Palsy After Single-Event Multilevel Surgery (SEMLS)

Single-Event Multilevel Surgery (SEMLS) is the standard for surgical correction of secondary orthopedic deformities in cerebral palsy (CP). SEMLS include simultaneous correction of soft tissue contractures, bone deformities, incomplete and complete joint dislocation to improve the gait and functional activity of patients with CP. The surgery volume determines the need for planned and long-term postoperative rehabilitation, however, there are no confirmed guidelines, neither Russian, nor foreign, on the patient’s management during postoperative period. This review provides an analysis of rehabilitation approaches after SEMLS at CP, offers recommendations on preparation and step-by-step postoperative restoration of motor function, and prevention of any associated complications.

Effect of telerehabilitation-based core-stability exercise on pain-related disability, pain self-efficacy, and psychological factors in individuals with non-specific chronic low back pain: a randomized controlled study

BackgroundCore-stability exercise is an exercise modality used in the management of patients with low back pain (LBP). Telerehabilitation is a new treatment approach that is gaining traction as an alternative rehabilitation approach. This study determined the effect of telerehabilitation-based core stability exercise (TCSE) and clinical-based core stability exercise (CCSE) on pain-related disability, pain self-efficacy, and psychological factors in patients with non-specific chronic low back pain (CLBP).Materials and methodsFifty participants (24 males and 26 females) with a mean age of 40.28 years participated in this randomized controlled study and were recruited from the out-patients physiotherapy clinic of 2 tertiary hospitals in Lagos State and were allocated into two groups (telerehabilitation-based core stability exercise group and clinical-based core stability exercise group which serves as the control) using computer-generated random number sequence. Pain-related disability, pain self-efficacy, and psychological status were assessed at baseline, and at the completion of the 4th and 8th week. Patients received supervised intervention protocols twice weekly for 8 consecutive weeks. Independent t-test, Mann–Whitney U test, and Friedman test were used in analyzing the data at an alpha level of 5%.ResultsThere was a statistically significant difference (P = 0.0001) noted within each group (telerehabilitation-based core stability exercise group and clinical-based core stability exercise group) in all the outcome measures assessed (Pain Disability Index, Pain Self-efficacy Questionnaire and Depression-Anxiety-Stress scale) but no group was superior to one another when compared.ConclusionTelerehabilitation-based core stability exercise was as efficacious as clinical-based core stability exercise in decreasing pain-related disability, improving pain self-efficacy and psychological factors, and should be incorporated as part of the treatment program in musculoskeletal rehabilitation for individuals with non-specific CLBP.Trial registrationPACTR202208607830603, 16th August 2022—retrospectively registered, https://pactr.samrc.ac.za/

Stochastic electrical stimulation of the thoracic or cervical regions with surface electrodes facilitates swallow in rats.

Aspiration pneumonia, a leading cause of mortality, poses an urgent challenge in contemporary society. Neuromuscular electrical stimulation (NMES) has been commonly used in dysphagia rehabilitation. However, given that NMES at motor threshold targets only specific muscles, it carries a potential risk of further compromising functions related to swallowing, respiration, and airway protection. Considering that the swallow motor pattern is orchestrated by the entire swallow pattern generator (the neural mechanism governing a sequence of swallow actions), a rehabilitation approach that centrally facilitates the entire circuit through sensory nerve stimulation is desirable. In this context, we propose a novel stimulation method using surface electrodes placed on the back to promote swallowing. The efficacy of the proposed method in promoting swallowing was evaluated by electrically stimulating sensory nerves in the back or neck. Probabilistic stimulus was applied to either the back or neck of male and female rats. Swallows were evoked by an oral water stimulus, and electromyographic (EMG) activity of the mylohyoid, thyroarytenoid, and thyropharyngeus muscles served as the primary outcome measure. Gaussian frequency stimulation applied to the skin surface of the thoracic back elicited significant increases in EMG amplitude of all three swallow-related muscles. Neck stimulation elicited a significant increase in EMG amplitude of the thyroarytenoid during swallow, but not the mylohyoid or thyropharyngeus muscles. While the targeted thoracic spinal segments T9-T10 have been investigated for enhancing respiration, the promotion of swallowing through back stimulation has not been previously studied. Furthermore, this study introduces a new probabilistic stimulus based on Gaussian distribution. Probabilistic stimuli have been reported to excel in nerve stimulation in previous research. The results demonstrate that back stimulation effectively facilitated swallow more than neck stimulation and suggest potential applications for swallowing rehabilitation.

Efficacy of rehabilitation interventions on functioning in patients with hemophilic arthropathy: A systematic review with meta-analysis.

Hemophilic arthropathy is a detrimental condition that crucially affects functional outcomes in hemophilic patients.In recent years, due to the advances in systemic therapies, growing attention has been raised in the rehabilitation field in order to improve functional outcomes of hemophilic patients. However, the optimal rehabilitation modalities in these patients are far from being fully characterized. The present study aimed to assess the effects of different rehabilitation interventions on physical functioning and health-related quality of life of hemophilic arthropathic patients. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Five databases were systematically searched for randomized controlled trials (RCTs) published until June 22nd, 2023. The selection criteria included adult patients with hemophilia A and B receiving rehabilitation interventions. The outcomes were muscle strength, physical function, pain intensity, physical performance, and health-related quality of life. Out of 1,743 identified records, 17 studies were included in the qualitative synthesis. Rehabilitation interventions were categorized into exercise intervention, fascial therapy, and multimodal intervention. The findings suggested positive outcomes in terms of muscle modifications, range of motion improvements, joint health enhancements, pain intensity reduction, and quality of life improvements. More in detail, meta-analyses showed significant improvements in pain intensity [ES: -1.10 cm (-1.37, -0.82), p< 0.00001], joint health [ES: -1.10 (-1.38, -0.82), p< 0.00001], In accordance, exercise interventions showed significant benefits in terms of joint health [ES: -2.54 (-3.25, -1.83), p< 0.00001)] and quality of life [ES: 1.17 (0.48, 1.86), p< 0.0000)]. Rehabilitation interventions have a positive impact on functional outcomes and health-related quality of life of hemophilic arthropathic patients. Further studies are needed to better elucidate the role of a comprehensive intervention combining different rehabilitation approaches to treat hemophilic arthropathy.

Avoiding the use of long-term parenteral support in patients without intestinal failure: A position paper from the European Society of Clinical Nutrition & Metabolism, the European Society of Neurogastroenterology and Motility and the Rome Foundation for Disorders of Gut-Brain Interaction.

The role of long-term parenteral support in patients with underlying benign conditions who do not have intestinal failure (IF) is contentious, not least since there are clear benefits in utilising the oral or enteral route for nutritional support. Furthermore, the risks of long-term home parenteral nutrition (HPN) are significant, with significant impacts on morbidity and mortality. There has, however, been a recent upsurge of the use of HPN in patients with conditions such as gastro-intestinal neuromuscular disorders, opioid bowel dysfunction, disorders of gut-brain interaction and possibly eating disorders, who do not have IF. As a result, the European Society of Clinical Nutrition and Metabolism (ESPEN), the European Society of Neuro-gastroenterology and Motility (ESNM) and the Rome Foundation for Disorders of Gut Brain Interaction felt that a position statement is required to clarify - and hopefully reduce the potential for harm associated with - the use of long-term parenteral support in patients without IF. Consensus opinion is that HPN should not be prescribed for patients without IF, where the oral and/or enteral route can be utilised. On the rare occasions that PN commencement is required to treat life-threatening malnutrition in conditions such as those listed above, it should only be prescribed for a time-limited period to achieve nutritional safety, while the wider multi-disciplinary team focus on more appropriate biopsychosocial holistic and rehabilitative approaches to manage the patient's primary underlying condition.

Restoration of coherent reach-grasp-pull movement via sequential intraneural peripheral nerve stimulation in rats

Objective. Peripheral nerve stimulation (PNS) has been demonstrated as an effective way to selectively activate muscles and to produce fine hand movements. However, sequential multi-joint upper limb movements, which are critical for paralysis rehabilitation, has not been tested with PNS. Here, we aimed to restore multiple upper limb joint movements through an intraneural interface with a single electrode, achieving coherent reach-grasp-pull movement tasks through sequential stimulation. Approach. A transverse intrafascicular multichannel electrode was implanted under the axilla of the rat’s upper limb, traversing the musculocutaneous, radial, median, and ulnar nerves. Intramuscular electrodes were implanted into the biceps brachii (BB), triceps brachii (TB), flexor carpi radialis (FCR), and extensor carpi radialis (ECR) muscles to record electromyographic (EMG) activity and video recordings were used to capture the kinematics of elbow, wrist, and digit joints. Charge-balanced biphasic pulses were applied to different channels to recruit distinct upper limb muscles, with concurrent recording of EMG signals and joint kinematics to assess the efficacy of the stimulation. Finally, a sequential stimulation protocol was employed by generating coordinated pulses in different channels. Main results. BB, TB, FCR and ECR muscles were selectively activated and various upper limb movements, including elbow flexion, elbow extension, wrist flexion, wrist extension, digit flexion, and digit extension, were reliably generated. The modulation effects of stimulation parameters, including pulse width, amplitude, and frequency, on induced joint movements were investigated and reach-grasp-pull movement was elicited by sequential stimulation. Significance. Our results demonstrated the feasibility of sequential intraneural stimulation for functional multi-joint movement restoration, providing a new approach for clinical rehabilitation in paralyzed patients.

Single-Sided Deafness at a Tertiary Care Rehabilitation Centre: A Cross-Sectional Retrospective Study.

To estimate the Single-sided deafness (SSD) among sensorineural hearing loss (SNHL) in Tertiary Care Rehabilitation Centre. To determine the audiological characteristics, associated and medical problems, and rehabilitative approaches among SSD. A retrospective study was conducted to report on demographic details, audiological evaluation, and hearing aid management among SSD clients. A total of 11,534 cases of SNHL were reported to the Audiology department at the tertiary care rehabilitative center at Mysuru between January 2014 and December 2017. A total of 225 were diagnosed as having SSD, accounting for approximately two cases of SSD in a cohort of 100 SNHL cases (225/11,534*100). In addition, males are affected more than females. SSD is found to have more in the right ear than the left ear. Their major complaints were tinnitus and vertigo, apart from reduced hearing sensitivity from the affected ear. In the side of the ear with profound hearing loss among SSD clients showed normal middle ear status with absent acoustic reflexes, otoacoustic emissions, and auditory brainstem response. Only 54 individuals (24%) out of 225 SSD clients underwent a hearing aid trial. Twenty-one (9%) SSD clients purchased a hearing aid, and a minuscule seven (3%) of 225 SSD clients are using a hearing aid. The preference for hearing aid uptake was low because of the experience of vibratory sensation and having near-normal hearing in one ear. Two cases of SSD were observed among SNHL and they are less likely to get benefits from the hearing aid.

Relationship between the Injury Location and Swallowing Difficulty among Stroke Patients, A Retrospective Cohort Study

Post-stroke dysphagia (PSD), a neurological or mechanical disorder that hinders food transport from the oral cavity to the stomach. It has been widely associated with severe complications with higher mortality and morbidity rates. Traditional therapies for the treatment of dysphagia mainly focused on compensatory methods and behavioural rehabilitation approaches. The retrospective cohort study aimed to determine the association and correlation between developments of dysphagia in relation to the location of the stroke and to identify the swallowing recovery period following the stroke. A retrospective cohort study investigated swallowing difficulties in 64 stroke patients at an ambulatory care centre over a year. Data collection involved reviewing medical records and imaging reports, with analyses conducted using SPSS software, ANOVA and chi-square methods to assess associations between injury location and swallowing difficulty. Hemorrhagic stroke was more prevalent (65.6%) than ischemic stroke (34.4%). A significant association was found between gender and stroke type, with males exhibiting a higher prevalence of ischemic strokes (71.4%) compared to females (29.8%). Age differences between stroke types, gender and affected swallowing phases and stroke type and affected swallowing phase revealed no significant associations. Distinct differences were noted in swallowing difficulties across stroke types. Furthermore, recovery time varied depending on the intervention method, with speech therapy linked to shorter recovery periods. The study underscores the importance of considering gender and stroke-type-specific differences in stroke prevalence, age distribution, and swallowing difficulties. These findings contribute valuable insights to understanding stroke characteristics and their implications for clinical management and rehabilitation strategies.

COVID-19 as a critical risk factor for osteonecrosis of the jaw: diagnostic challenge and surgical treatment

This case report describes a unique and complex presentation of osteonecrosis of the maxilla, complicated by Aspergillosis and Mucormycosis, developed in an immunocompetent patient recovering from COVID-19. The patient presented with a range of clinical symptoms, including facial pain, rhinorrhea, cacosmia, cough, and radiographic evidence of jaw involvement. Cytological and histological examinations revealed the presence of Aspergillus niger and mucormycosis-like fungal elements. Our report discusses the main diagnostic challenges, the different potential etiopathological hypotheses, and the alternative therapeutic and rehabilitative approaches. This atypical surgical case definitely highlights the need for heightened awareness among healthcare professionals, regarding the potential risk to discover severe opportunistic fungal infections also in COVID-19 patients; this case further sheds light on the importance of a multidisciplinary approach for an effective management of such intricate post-COVID-19 complications.

Health-related quality of life and participation after inpatient rehabilitation of sepsis survivors with severe sequelae: a cohort study.

To describe health-related quality of life and participation after rehabilitation of severely affected sepsis survivors. Cohort study. Patients with severe sequelae after sepsis treated in a multidisciplinary rehabilitation pathway were included. Patient characteristics at the time of diagnosis, and the outcome 3 months after discharge from rehabilitation are described. At that time, health-related quality of life, social participation, and the rate of living at home were measured. Of the 498 patients enrolled, 100 severely impaired patients were transferred for a multidisciplinary rehabilitation approach. Fifty-five of them were followed up at 3 months. Descriptive and inference statistics showed that 69% were living at home with or without care. Health-related quality of life and participation scores were 0.64 ± 0.32 for the EQ-5D utility index and 54.98 ± 24.97 for the Reintegration of Normal Living Index. A multivariate regression model explaining health-related quality of life at 3 months included age, lower limb strength, and walking ability during rehabilitation (r2 = 0.5511). Participation at 3 months was explained by age, body mass index, lower limb strength, and duration of tracheal intubation (r2 = 0.6229). Patients who have experienced serious sepsis with severe sequelae can achieve a moderate level of quality of life and participation within a multidisciplinary pathway.