Clinical Rehabilitation Programs Research Articles

Body composition assessment using bioelectrical impedance analysis (BIA) in a wide cohort of patients affected with mild to severe obesity

Obesity is characterized by fat mass excess (FM), extra cellular water increase (ECW) and, with ageing, decrease in fat free mass (FFM). The validity of body impedance analysis (BIA) in patients with mild to severe obesity is still debated. The purpose of this study is to describe the Resistance (Rz) and Reactance (Xc) values obtained by Body Impedance Analysis (BIA) in a wide cohort of Italian patients with mild to severe obesity. The secondary endpoint is to describe the resulting body composition values (as percentage and indexes) in this population. The study enrolled adult in-patients with mild to severe obesity (classified with class I, II and III obesity) undergoing clinical care rehabilitation program for obesity complications and weight loss. BIA values were grouped by sex, BMI and age classes. A total of 8303 patients with obesity, aged 18 to 90y, were studied. The Resistance (Rz) and Reactance (Xc) were reported by sex, age and BMI classes. In women and men both, the phase angle (PhA) decreases with increasing BMI (kg/m2) and the resulting BIA vector was significantly shifted. The FM index (FMI) was higher (p<0.0001) in women while FFM index (FFMI) was higher in men (p<0.0001) and significantly associated with BMI. FFMI decreased with age in both sex (p<0.0001). Skeletal mass (SM) presents a progressive reduction in relation to age and gender both. The present BIA-based body composition analysis in a wide cohort of mild to severe obese patients revealed a significantly decreased Rz and Xc values with a consequent significant decrease of PhA in a BMI-dependent manner. The body compartments estimation with available equations was BMI, sex and age dependent. These observational results could be the basis for the development of new equations adapted for patients suffering from obesity.

Efficacy of lateral stair walking training in patients with chronic stroke: A pilot randomized controlled study.

Patients with chronic stroke have reduced capacity for performing activities of daily living (ADLs) and are at increased risk for falls during walking due to long-term changes to muscle tone and force, as well as movement control. To investigate the efficacy of lateral stair walking training on muscle strength of affected lower extremities, balance, ADLs, and gait ability in patients with chronic stroke. The experimental group received 15 min of lateral stair walking exercise along with 15 min of traditional physiotherapy, whereas the control group received only traditional physiotherapy for 30 min. Both groups received the intervention once a week for 12 weeks. Outcome measurements included muscle strength, postural assessment scale for stroke patients (PASS), Fugal-Meyer assessment for lower extremity (FMA-LE), Barthel index (BI), timed up and go test (TUG), and the gait parameters which were determined by the Reha-Watch system. A total of 24 participants completed the study. The experimental group showed significant improvements in hip extensor, flexor, and abductor strength of the affected limb, FMA-LE, BI, TUG, and gait parameters of stride length, velocity, and cadence. Significant differences in affected limb ankle plantar strength (p = 0.024), PASS (p = 0.017), BI (p = 0.039), TUG (p = 0.049), and gait velocity (p < 0.001) were observed between the 2 groups. Lateral stair walking training alongside physical therapy resulted in significant improvements in hip muscle strength and gait parameters in patients with chronic stroke. Our results support the incorporation of lateral stair walking training into clinical rehabilitation programs. Lateral stair walking training in patients with chronic stroke can be used as an effective treatment to improve gait, balance performance, and ADLs.

The Feasibility and Reliability of a Digits-in-Noise Test in the Clinical Follow-Up of Children With Mild to Profound Hearing Loss.

Speech perception in noise is an important aspect of the rehabilitation of children with hearing loss. We aimed to evaluate the feasibility and reliability of the Dutch digits-in-noise (DIN) test in the clinical follow-up of children with hearing aids (HAs) and/or cochlear implants (CIs). A second aim of the study was to gain insight in the speech perception in noise performance of children with different degrees of hearing loss. We retrospectively analyzed DIN test data of Dutch-speaking children with hearing loss (N = 188; 5 to 18 years old). A free-field version of the DIN-test was used. Children with open-set phoneme recognition in quiet of >70% at 65 dB SPL (best aided condition) were included. Ages ranged from 5 to 18 years old. All were experienced HA or CI users and had used their device(s) for at least 1 year before the measurement in the study. The DIN-test was performed in the framework of a clinical rehabilitation program. During testing, children wore their own devices with normal daily programs. The average speech reception threshold (SRT) was -3.6 dB (SD 3.6) for the first list and significantly improved to -4.0 dB (SD 3.1) for the second list. HA users had a 4-dB better SRT compared with CI users. The larger the child's hearing loss, the worse the SRT is. However, 15% of the children who completed a first list of 24 trials were unable to complete a second list. Mean adaptive staircase trajectories across trials suggested that learning occurred throughout the first list, and that loss of sustained attention contributed to response variability during the second list. The DIN test can be used to assess speech perception in noise abilities for children with different degrees of hearing loss and using HAs or CIs. The children with hearing loss required a higher signal-to-noise ratio (SNR) than did normal-hearing children and the required SNR is larger as the hearing loss increases. However, the current measurement procedure should be optimized for use in standard pediatric audiological care, as 15% of the children were unable to conduct a second list after the first list to reach a more stable SNR.

Physical Rehabilitation Outcomes in Patients with Dementia Following Hip Fracture Surgery: A Review

Background: Dementia patients were reported of having high risk for hip fracture. Rehabilitation programs were still being debated for this vulnerable population and the recovery outcomes in this frail elderly population are varied, thus evidenced-based outcomes for this issue are needed.Objective: To investigate rehabilitation programs, especially on physical function outcomes in patients with dementia following hip fracture surgery.Method: PubMed, Scopus and MEDLINE (EBSCO) databases were searched from January 2000 to June 2020 concerning rehabilitation intervention program in dementia patients who received hip surgical treatment. The studies included have the following criteria, (1) investigating physical outcomes of rehabilitation programs (2) Randomized controlled trials (RCTs) study design, (3) study involving dementia patients following hip fracture surgery (4) English full-text journal.Results: Six studies were included in this review. Most study focused on interdisciplinary or multidisciplinary rehabilitation program. Physical outcomes of rehabilitation programs seem to improve physical function, maintaining physical ability for ambulation, and decrease the risk of falls in mild or moderate dementia patients following hip fracture surgery. However, the physical function of older persons with dementia confirmed to be lower than those without dementia.Conclusion: Rehabilitation may show benefit for physical function in elderlywith mild or moderate dementia following hip fracture surgery, and this population needs to be included in the clinical rehabilitation program. Investigating and establishing the strategies to improve outcomes for dementia population is needed for future study.

Description of Unique Extensive Clinical Rehabilitation Program for Individuals with Spinal Cord Injury

Description of Unique Extensive Clinical Rehabilitation Program for Individuals with Spinal Cord Injury

Surgical Treatment of Persistent Contractures of the Interphalangeal Joints of the Fingers

Summary. Relevance. The treatment of the consequences of intraarticular injuries of fingers is still one of the problems that requires further solution. Objective: to improve the results of surgical treatment of post-traumatic persistent contractures of the interphalangeal joints of the fingers. Materials and Methods. To analyze the effectiveness of the proposed treatment approach The results of treatment of 77 patients with post-traumatic contractures of the joints of the fingers, distributed into clinical groups and subgroups, depending on the severity of the injuries and the type of applied clinical rehabilitation program, were analyzed. Patients of the main groups were treated according to the proposed clinical rehabilitation program, indicators were analyzed before treatment, 3 months and 1 year after treatment using a point system for assessing the functional state of the hand and the QuickDASH scale. Results. According to the results of the analysis of 77 patients with the consequences of injuries of the interphalangeal joints using 2 systems for assessing the function of the interphalangeal joints, it was found that treatment of severe and moderate arthrogenic contractures with the method of distraction arthroplasty and corrective osteotomy improves functional results by achieving congruent relationships in joints and mobilization of the ligamentous apparatus. Conclusions. Comprehensive treatment according to the proposed clinical rehabilitation program allows to increase the number of immediate positive results in the main subgroups of both groups to 22 (68.8%) versus 5 (11.1%) in the comparison subgroups (p&lt;0.001) on a rating scale, and excellent and good results on the QuickDASH scale up to 20 (62.5%) and 12 (37.5%) versus 1 (2.2%) and 41 (91.1%) cases, respectively (p&lt;0.001). When studying the long-term results of surgical treatment of arthrogenic contractures of the interphalangeal joints, positive results were obtained in 37 (63.8%) patients, satisfactory in 20 (34.5%) and unsatisfactory in 1 (1.7%) case according to the rating scale; 27 (46.6%) excellent, 30 (51.7%) good and 1 (1.7%) satisfactory results showed QuickDASH scale.

Marker-Based Movement Analysis of Human Body Parts in Therapeutic Procedure.

Movement analysis of human body parts is momentous in several applications including clinical diagnosis and rehabilitation programs. The objective of this research is to present a low-cost 3D visual tracking system to analyze the movement of various body parts during therapeutic procedures. Specifically, a marker based motion tracking system is proposed in this paper to capture the movement information in home-based rehabilitation. Different color markers are attached to the desired joints’ locations and they are detected and tracked in the video to encode their motion information. The availability of this motion information of different body parts during the therapy can be exploited to achieve more accurate results with better clinical insight, which in turn can help improve the therapeutic decision making. The proposed framework is an automated and inexpensive motion tracking system with execution speed close to real time. The performance of the proposed method is evaluated on a dataset of 10 patients using two challenging matrices that measure the average accuracy by estimating the joints’ locations and rotations. The experimental evaluation and its comparison with the existing state-of-the-art techniques reveals the efficiency of the proposed method.

Electrical Stimulation in Combating Pressure Ulcer for Immobilize Subjects: A Conceptual Framework

A paradigm shift in health system did intensify the need for research on wearable electronics. There are numerous reasons that could lead to skin ulcers. The most common are lesion due to constant pressure, incontinence control, excessive humidity and postural changes. Over the years, there have been numerous interventions ranging from specific skin treatment, introducing prevention programs as well as to mechanical intervention. On the rise in such clinical rehabilitation program is the use of electrical stimulation (ES) at a therapeutic level, wound care and muscle function restoration. This paper presents a concept development and implementation process of a new pressure ulcer intervention system which can be used for both chairbound and bedridden patients. The concept here is to integrate the use of electrical stimulation, interface pressure mapping and redistribution with antimicrobial protection not only to act as therapeutic but at the same time as a means of prevention of pressure ulcers by improving muscle tone and decreasing atrophy among immobilized subjects.

Feasibility, acceptability and efficacy of a text message-enhanced clinical exercise rehabilitation intervention for increasing \u2018whole-of-day\u2019 activity in people living with and beyond cancer

BackgroundExercise interventions are typically delivered to people with cancer and survivors via supervised clinical rehabilitation. However, motivating and maintaining activity changes outside of the clinic setting remains challenging. This study investigated the feasibility, acceptability and efficacy of an individually-tailored, text message-enhanced intervention that focused on increasing whole-of-day activity both during and beyond a 4-week, supervised clinical exercise rehabilitation program for people with cancer and survivors.MethodsParticipants (n = 36; mean ± SD age 64.8 ± 9.6 years; 44.1 ± 30.8 months since treatment) were randomized 1:1 to receive the text message-enhanced clinical exercise rehabilitation program, or the standard clinical exercise rehabilitation program alone. Activity was assessed at baseline, 4-weeks (end of the standard program) and 12-weeks (end of enhanced program) using both device (activPAL accelerometer; sitting, standing, light-stepping, moderate-stepping) and self-report [Multimedia Activity Recall for Children and Adults (MARCA); sedentary, light, moderate-to-vigorous physical activity (MVPA)] methods. The MARCA also assessed time use domains to provide context to activity changes. Changes and intervention effects were evaluated using linear mixed models, adjusting for baseline values and potential confounders.ResultsThe study had high retention (86%) and participants reported high levels of satisfaction [4.3/5 (±0.8)] with the intervention. Over the first 4 weeks, MARCA-assessed MVPA increased [+ 53.2 (95%CI: 2.9, 103.5) min/d] between groups, favoring the text message-enhanced program, but there were no significant intervention effects on sedentary behavior. By 12 weeks, relative to the standard group, participants in the text message-enhanced group sat less [activPAL overall sitting: − 48.2 (− 89.9, − 5.6) min/16 h awake; MARCA: -80.1 (− 156.5, − 3.8) min/d] and were participating in more physical activity [activPAL light stepping: + 7.0 (0.4, 13.6: min/16 h awake; MARCA MVPA: + 67.3 (24.0, 110.6) min/d]. The time-use domains of Quiet Time [− 63.3 (− 110.5, − 16.0) min/d] and Screen Time [− 62.0 (− 109.7, − 14.2) min/d] differed significantly between groups.ConclusionsResults demonstrate feasibility, acceptability and efficacy of a novel, text message-enhanced clinical exercise rehabilitation program to support changes in whole-of-day activity, including both physical activity and sedentary behavior. Changes were largely seen at 12-week follow-up, indicating potential for the intervention to result in continued improvement and maintenance of behavior change following a supervised exercise intervention.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000641493; date registered 17/5/16).

Evolution of gait parameters in individuals with a lower-limb amputation during a six-minute walk test

BackgroundA recent amputation leads to decreased functional capacities in the lower limb amputees (LLA), especially during walking. Assessments of LLA’s gait in clinical settings are used to provide feedback on their evolution without quantifying gait parameters distinctly, unlike new technologies, such as inertial sensors (IMUs), which have demonstrated their effectiveness in different environments and populations. Research questionHow do the spatial-temporal gait parameters and kinematics of the LLA evolve quantitatively over a six-minute walk test (6MWT) and is the use of inertial sensors relevant in clinical practice to quantify those parameters? MethodsFifteen LLA from a study cohort performed a 6MWT post-rehabilitation, wearing inertial sensors on both feet to provide gait parameters (i.e., minimum toe clearance (minTC), speed, cadence, stance time and foot flat ratio (FFr)) over this test. A non-parametric ANOVA was conducted comparing the evolution of each parameter over the 6MWT (12 intervals of 30 s). Significance level was set at P ≤ 0.05. Post-hoc Wilcoxon signed-rank tests were performed if a main effect was detected. ResultsMinTC and stance phase variability along the 6MWT were significantly different over time. Cadence variability and speed variation were significantly different between both feet (amputated and non-amputated leg). SignificanceThe increased variability in gait parameters along the 6MWT suggests a greater risk of future mobility problems following a return in community. The data provided by the IMUs reflect the potential of the clinical rehabilitation programme and could, therefore, help clinicians to refine their interventions.

Effect of an exercise rehabilitation program on physical function over 1 year in chronic kidney disease: an observational study.

BackgroundExercise rehabilitation may help maintain physical function in chronic kidney disease (CKD), but long-term clinical effectiveness is unknown. We evaluated the effect of an exercise rehabilitation program on physical function over 1 year in individuals with CKD.MethodsThis clinical program evaluation included adults with CKD (any stage) registered in a provincial renal program from 1 January 2011 to 31 March 2016. Attenders were referred to and attended a 10-week exercise rehabilitation program (n = 117). Nonattenders were referred, but did not attend the program (n = 133). Individuals enrolled in a longitudinal frailty study (n = 318) composed a second control group. Primary outcome: Change in physical function [short physical performance battery (SPPB) score]. Secondary outcomes included change in health-related quality of life, physical activity, exercise behaviour, hospitalization over 1 year. Predictors of improved SPPB were assessed using logistic regression.ResultsIn sum, 53, 40 and 207 participants completed 1-year follow-up in attender, nonattender and second control groups, respectively. Baseline median SPPB [interquartile range (IQR)] scores were 10.5 (9–12), 10 (8–12) and 9 (7–11) in attender, nonattender and second control groups, respectively (P = 0.02). Mean change in SPPB score over 1 year was not significantly different between groups (P = 0.7). Attenders with baseline SPPB score <12, trended toward increased likelihood of improved SPPB score at 1 year [odds ratio (OR) 2.18; 95% confidence interval (CI) 0.95–5.02; P = 0.07]. More attenders (60%) exercised regularly at 1 year than nonattenders (35%) (P = 0.03).ConclusionsThe impact of clinical exercise rehabilitation programs on physical function at 1 year needs further delineation. However, our observation of improved exercise behaviour at 1 year suggests sustained benefits with such programs in CKD.

Development and Validation of Ambulosono: A Wearable Sensor for Bio-Feedback Rehabilitation Training.

Wearable technology-based measurement systems hold potential for the therapeutic and rehabilitation management of patients with various chronic diseases. The purpose of this study was to assess the accuracy and test–retest reliability of a new-generation wearable sensor-based system, dubbed Ambulosono, for bio-feedback training. The Ambulosono sensor system was cross-validated by comparing its functionality with the iPod touch (4th generation) sensor system. Fifteen participants underwent a gait test to measure various gait parameters while wearing both the iPod-based and Ambulosono sensors simultaneously. The physically measured values (i.e., the true values) of step length, distance traveled, velocity, and cadence were then compared to those obtained via the two-sensor systems using the same calculation algorithms. While the mean percentage error was <10% for all measured parameters, and the intra-class correlation coefficient revealed a high level of agreement between trials for both sensor systems, it was found that the Ambulosono sensor system outperformed the iPod-based system in some respects. The Ambulosono sensor system possessed both reliability and accuracy in obtaining gait parameter measurements, which suggests it can serve as an economical alternative to the iPod-based system that is currently used in various clinical rehabilitation programs.

Social relationships in rehabilitation and their impact on positive outcomes among amputees with lower limb loss at Walter Reed National Military Medical Center.

To explore how the social context of the clinic influenced the way former patients with lower limb loss in the Military Advanced Training Center at Walter Reed National Military Medical Center evaluated their outcomes. Cross-sectional phenomenological-based interviews and observations. Twenty individuals with lower limb amputation were recruited from a multidisciplinary military treatment programme for patients with lower-extremity traumatic limb-loss injured in Afghanistan or Iraq. Lightly structured interviews were conducted either in person or over the telephone with former patients and clinical care-providers. Where possible, observation was conducted in conjunction with the interviews. The research team used content analysis of the data, consistent with ethnographic methods. Analysis of the therapeutic effect of social relationships developed in the clinical rehabilitation programme identified 3 areas of significance: enduring relationships with key care-providers, access to treatment team by patients, and peer support among patients. The social component of service delivery influences patients' outcomes from clinical care. These results could be translated across healthcare settings to improve patient outcomes.

Analysis of one repetition during biceps curl exercise among age-matched adult volunteers using endurance, curl speed and surface electromyography signals.

Exercises under isometric and dynamic contractions are influenced by the rate coding and recruitment strategies. The study of muscle strength under dynamic contraction is normally performed using one-repetition maximum (1-RM) method. There are several variants of deriving one repetition method using number of repetitions and load that are useful in physical fitness and clinical rehabilitation program. However, the factors of dynamic contractions such as endurance time, speed of muscle contractions and muscle activity are not considered in 1-RM methods. The muscular activities are analyzed using surface electromyography (sEMG) signals. Limited work has been reported on the relationship between the 1-RM method and factors such as endurance time, speed of contraction and sEMG activity. In this work, a modified 1-RM method is proposed, namely, N-RM, using load, number of repetitions, endurance time, speed of contraction and normalized sEMG activity. For this purpose, sEMG signals are recorded from 58 healthy subjects under standard dynamic contraction protocol involving curl exercise. Conventional 1-RM is computed by using Epley's method and compared with proposed method using correlation analysis. The results show that 1-RM increases linearly with number of curls (r=1) but has a poor correlation coefficient with sEMG (r=0.01) and endurance time (r =0.4). The curl speed for lower 1-RM and higher 1-RM did not show any statistical difference (p =0.2). The proposed N-RM is observed to have good correlation with endurance time (r=0.734), curl speed (r=0.893) and sEMG activity (r=0.8851). These results demonstrate that the proposed N-RM is highly correlated to factors influencing the dynamic contractions. This method can be further extended to assess muscles under various clinical disorders and sports training.

Outcomes of a 3-Month Clinical PAD Rehabilitation Program

Outcomes of a 3-Month Clinical PAD Rehabilitation Program

Association Between Sexual Problems and Relationship Satisfaction Among People With Cardiovascular Disease

BackgroundRelationship satisfaction is generally positively correlated with sexual satisfaction, but this relation has been poorly examined in people with cardiovascular disease who are at increased risk of sexual problems compared with the general population. AimTo document reported changes to sex after a diagnosis of cardiac disease and determine whether there is an association between sexual function and relationship satisfaction. MethodsSemistructured telephone interviews focused on relationship satisfaction and sexual problems were conducted with 201 people with cardiovascular disease who were currently in a sexual relationship with one main partner and were recruited from six hospital cardiac rehabilitation centers in Ireland. Comparisons between groups were conducted using t-tests and multivariate analysis of variance for continuous variables and χ2 tests for categorical variables. Predictors of relationship satisfaction were assessed using multiple linear regression analysis. OutcomesData were gathered on demographic and clinical variables, sexual problems, and relationship satisfaction, including satisfaction with the physical, emotional, affection, and communication aspects of relationships. ResultsJust less than one third of participants (n = 61, 30.3%) reported that sex had changed for the worse since their cardiac event or diagnosis, with approximately half of these stating that this was a serious problem for them. Satisfaction with relationships was high among patients surveyed; more than 70% of the sample reported being very or extremely satisfied with the physical and emotional aspects and showing affection during sex. Satisfaction with communication about sex was lower, with only 58% reporting being very or extremely satisfied. We did not find significant associations between reporting of sexual problems or deterioration of sex as a result of disease and relationship satisfaction. Clinical ImplicationsCardiac rehabilitation programs should address these sexual problems, potentially by enhancing communication within couples about sex. Strengths and LimitationsThe strength is that data are presented on the sexual experiences and relationship satisfaction of a relatively large sample of people diagnosed with cardiac disease, a relatively underexplored research area. Limitations include the possibility of selection bias of study participants and bias associated with self-report measurement. ConclusionsSexual problems were significant in this population but were not related to relationship satisfaction in this cross-sectional survey.Byrne M, Murphy P, D’Eath M, et al. Association Between Sexual Problems and Relationship Satisfaction Among People With Cardiovascular Disease. J Sex Med 2017;14:666–674.

Very short/short-term benefit of inpatient/outpatient cardiac rehabilitation programs after coronary artery bypass grafting surgery.

Exercise-based rehabilitation is an important part of treatment patients following coronary artery bypass graft (CABG) surgery. To evaluate effect of very short/short-term exercise training on cardiopulmonary exercise testing (CPET) parameters. We studied 54 consecutive patients with myocardial infarction (MI) treated with CABG surgery referred for rehabilitation. The study population consisted of 50 men and 4 women (age 57.72 ± 7.61 years, left ventricular ejection fraction 55% ± 5.81%), who participated in a 3-week clinical and 6-month outpatient cardiac rehabilitation program. The Inpatient program consisted of cycling 7 times/week and daily walking for 45 minutes. The outpatient program consisted mainly of walking 5 times/week for 45 minutes and cycling 3 times/week. All patients performed symptom-limited CPET on a bicycle ergometer with a ramp protocol of 10 W/minute at the start, for 3 weeks, and for 6 months. After 3 weeks of an exercise-based cardiac rehabilitation program, exercise tolerance improved as compared to baseline, as well as peak respiratory exchange ratio. Most importantly, peak VO2 (16.35 ± 3.83 vs 17.88 ± 4.25 mL/kg/min, respectively, P < 0.05), peak VCO2 (1.48 ± 0.40 vs 1.68 ± 0.43, respectively, P < 0.05), peak ventilatory exchange (44.52 ± 11.32 vs 52.56 ± 12.37 L/min, respectively, P < 0.05), and peak breathing reserve (52.00% ± 13.73% vs 45.75% ± 14.84%, respectively, P < 0.05) were also improved. The same improvement trend continued after 6 months (respectively, P < 0.001 and P < 0.0001). No major adverse cardiac events were noted during the rehabilitation program. Very short/short-term exercise training in patients with MI treated with CABG surgery is safe and improves functional capacity.

Profilul demografic al pacientului cu AVC

Aim. Spastic hemiparesis is part of a complex clinical manifestation associated with a pathology of the central nervous system in a context of an ischemic or hemorrhagic stroke or in connection with various structural and functional innate or acquired changes. Disabling both the functional and psychosocial areas, spastic hemiparesis is a major element for the patient-centered concerns in the last decades. The study aims to create a demographic profile of a patient with stroke. Material and methods. The present study took into account patients hospitalized for clinical and functional assessment and specific rehabilitation program within a period of 6 months. It has aimed the collection of the demographic data including age, gender, living environment, education, as well as of the clinical data (age of the disease, comorbidities, smoker profile, features of the cerebral pathology, cognitive level). Results. The data were grouped to outline the profile of a hemiplegic patient addressed to our clinic for diagnosis and therapy. Discussions. A descriptive study of the group using data collected by direct interview or from medical documents was done. The limitations of the study are the difficulties in addressability especially for the patients that live in the rural areas and the lack of centralized data from other recent studies nationwide. Conclusion. The resulting data is very close to those shown in similar studies conducted in Europe and suggests the need for further development of health policies focusing on the needs of the neurological patients.

Estimating oxygen uptake and energy expenditure during treadmill walking by neural network analysis of easy-to-obtain inputs.

The study of oxygen uptake (V̇o2) dynamics during walking exercise transitions adds valuable information regarding fitness. However, direct V̇o2 measurements are not practical for general population under realistic settings. Devices to measure V̇o2 are associated with elevated cost, uncomfortable use of a mask, need of trained technicians, and impossibility of long-term data collection. The objective of this study was to predict the V̇o2 dynamics from heart rate and inputs from the treadmill ergometer by a novel artificial neural network approach. To accomplish this, 10 healthy young participants performed one incremental and three moderate constant work rate treadmill walking exercises. The speed and grade used for the moderate-intensity protocol was related to 80% of the V̇o2 response at the gas exchange threshold estimated during the incremental exercise. The measured V̇o2 was used to train an artificial neural network to create an algorithm able to predict the V̇o2 based on easy-to-obtain inputs. The dynamics of the V̇o2 response during exercise transition were evaluated by exponential modeling. Within each participant, the predicted V̇o2 was strongly correlated to the measured V̇o2 ( = 0.97 ± 0.0) and presented a low bias (~0.2%), enabling the characterization of the V̇o2 dynamics during treadmill walking exercise. The proposed algorithm could be incorporated into smart devices and fitness equipment, making them suitable for tracking changes in aerobic fitness and physical health beyond the infrequent monitoring of patients during clinical interventions and rehabilitation programs.

Rehabilitation needs in oncological patients: the On-rehab project results on patients operated for musculoskeletal tumors.

Rehabilitation plays an important role in improving functional outcome in patients operated on musculoskeletal tumors. Literature in the field is scarce and the specific needs for rehabilitation of these patients are still unknown. To analyze the rehabilitation needs of patients with primary malignant musculoskeletal tumors. Observational, longitudinal study on both inpatient and outpatient operated on musculoskeletal tumors. Rehabilitation needs of oncological patients were explored by means of questionnaires administered by a physician. Demographic, oncological, psychological domains were also assessed. Twenty-nine patients were evaluated in the immediate post-operative period, 25 patients had a follow up at 6 months, and 11 patients at 12 months. Rehabilitation needs concerned essentially the neuromotor function and the improvement of independence at home/outside home. At first admission, support for occupational rehabilitation was also relevant, while its importance was reduced over the follow-up. Pain control need was greater at first admission (VAS over the follow-up 3.3, 0.52, and 1.09, respectively) and required treatment with painkillers. Quality of life (EORTC) increased over the three assessments (respectively 48.80; 71.42; 82.14). The Psychological Distress Inventory (PDI) scores were 26.23, 21.75, 23.6, and the Caregiver Needs Assessment (CNA) scores were 32.69, 27.95, and 31.7 respectively at the three follow up. The relevant domains in which rehabilitation needs emerged in up to 1 year follow up were the neuromotor area in order to gain independence at home and outside the home, pain control, particularly after surgery, nursing, psychological support of patients and caregivers, and occupational activities (personal, work, school, social). The findings of the present study suggest that: short and midterm clinical rehabilitation programs should be made available for patients operated on musculoskeletal tumors. Physical function recovery is only one aspect of rehabilitation, and psychosocial functioning must be taken into account and coordinated by a comprehensive team of specialists. Appropriate assessment tools should be used, and a continuum of care from the hospital to the patient's home should be promoted.