Comprehensive Rehabilitation Program Research Articles

Mind–body exercise for patients with stable COPD on lung function and exercise capacity: a systematic review and meta-analysis of RCTs

Chronic Obstructive Pulmonary Disease (COPD) is a global health concern. Mind–body exercises like Tai Chi and Yoga are suggested as non-pharmacological interventions for COPD management. This meta-analysis evaluates mind–body exercises' impact on lung function and exercise capacity in stable COPD patients, aiming to assess their effectiveness in rehabilitation. A systematic search across various databases identified relevant randomized controlled trials until April 2024. Primary outcomes included lung function tests (FEV1, FVC, FEV1/FVC, FEV1%) and Six-Minute Walk Test (6MWT) results. The Standardized Mean Difference (SMD) measured intervention effects. Fifteen studies with 1047 participants were analyzed. Mind–body exercises significantly improved FEV1 (SMD = 0.87), FEV1/FVC (SMD = 0.19), FEV1% (SMD = 0.43), and 6MWT (SMD = 1.21) compared to standard care. Sensitivity and subgroup analyses confirmed result stability despite some heterogeneity.In conclusion, Mind–body exercises enhance lung function and exercise capacity in stable COPD patients. Integrating them into comprehensive rehabilitation programs is advisable. Further research should explore the specific impacts of different exercise types and intensities.

Quadriceps Activation After Anterior Cruciate Ligament Reconstruction: The Early Bird Gets the Worm!

Arthrogenic Muscle Inhibition (AMI) is a phenomenon observed in individuals with joint injury or pathology, characterized by a reflexive inhibition of surrounding musculature, altered neuromuscular control, and compromised functional performance. After anterior cruciate ligament reconstruction (ACLR) one of the most obvious consequences of AMI is the lack of quadriceps activation and strength. Understanding the underlying mechanisms of AMI is crucial for developing effective therapeutic interventions. The surgical procedure needed to reconstruct the ACL has biochemical et physiological consequences such as inflammation, pain, and altered proprioception. These alterations contribute to the development of AMI. Therapeutic interventions aimed at addressing AMI encompass a multidimensional approach targeting pain reduction, inflammation management, proprioceptive training, and quadriceps activation. Early management focusing on pain modulation through modalities like ice, compression, and pharmacological agents help mitigate the inflammatory response and alleviate pain, thereby reducing the reflexive inhibition of quadriceps. Quadriceps activation techniques such as neuromuscular electrical stimulation (NMES) and biofeedback training aid in overcoming muscle inhibition and restoring muscle strength. NMES elicits muscle contractions through electrical stimulation, bypassing the inhibitory mechanisms associated with AMI, thus facilitating muscle activation and strength gains. Comprehensive rehabilitation programs tailored to individual needs and stage of recovery are essential for optimizing outcomes in AMI. The objective of this clinical viewpoint is to delineate the significance of adopting a multimodal approach for the effective management of AMI, emphasizing the integration of pain modulation, proprioceptive training, muscle activation techniques, and manual therapy interventions. Highlighting the critical role of early intervention and targeted rehabilitation programs, this article aims to underscore their importance in restoring optimal function and mitigating long-term complications associated with AMI.

A multivariate regression analysis of a comprehensive rehabilitation program and performance improvement in young female volleyball players

Purpose: This study aimed to investigate the efficacy of a comprehensive rehabilitation program tailored for college female volleyball players in India, specifically focusing on its impact on vertical jump performance. Material and Methods: Twenty-seven female college volleyball players participated in the study, undergoing a preseason rehabilitation program comprising various exercises targeting strength, power, stability, agility, and flexibility. Pre- and post-rehabilitation assessments were conducted to evaluate changes in vertical jump height using a Vertec vertical jump measuring device. Statistical analysis included multivariate regression analysis and paired t-tests. Results: The multivariate regression analysis revealed significant positive associations between several rehabilitation components, including squats, depth jumps, and plyometric circuits, and improved vertical jump height (p < 0.01). Paired t-test results indicated a significant increase in vertical jump height post-rehabilitation (p < 0.0001), with a mean difference of 4.863 cm. Strong positive correlations were observed between baseline and post-rehabilitation vertical jump measurements (r = 0.9629). Conclusions: The findings demonstrate the effectiveness of the comprehensive rehabilitation program in enhancing vertical jump performance among college female volleyball players in India. By targeting multiple facets of physical fitness and movement quality, the program facilitated significant improvements in explosive lower body strength and power, essential for volleyball performance. These results underscore the importance of tailored rehabilitation interventions in optimizing athlete capabilities and achieving success on the volleyball court.

Analisis Anarkisme Remaja dalam Kejahatan Klitih di Kabupaten Bantul: Faktor, Karakteristik, dan Upaya Penegakan Hukum

The phenomenon of street violence that occurs in Bantul Regency, Yogyakarta, namely klitih, is a serious concern for the local community. This research aims to analyze the factors that influence juvenile involvement in crime, characteristics of perpetrators, crime patterns, and efforts to increase the effectiveness of law enforcement in dealing with these problems. The research method used is a normative approach with a qualitative descriptive approach. Secondary data was obtained from various literary sources and related legal documents. The results of the research show that social factors, the search for identity, hereditary school gangs, family, education, environment, as well as the influence of media and technology play a role in teenagers' involvement in klitih. The characteristics of the perpetrators include teenagers aged between 15 and 20 years, low educational background and a dysfunctional family environment. The klitih crime pattern involves acts of violence with the aim of showing courage in front of a peer group. Efforts to increase the effectiveness of law enforcement include improving coordination between law enforcement agencies, increasing security patrols, utilizing technology, and implementing comprehensive rehabilitation programs.

Variability of preoperative rehabilitation in preparation for primary arthroplasty in patients with osteoarthritis of the knee joint

Relevance. In the last decade, preoperative rehabilitation has attracted considerable attention from both domestic and foreign specialists, however, its effectiveness and impact on the early recovery of patients with osteoarthritis of the knee joint after primary arthroplasty causes many contradictions and remains controversial.Objective. To analyze the scientific literature and evaluate the results, potential advantages and disadvantages of using available and modern methods of preoperative rehabilitation in preparation for primary arthroplasty in patients with osteoarthritis of the knee joint.Materials and methods. In the course of this study, data was searched using Scopus, Web of Sciеnce, Pubmed, and RSCI databases for the period from 2009 to 2024.Results. As a result of the analysis, the key methods of preoperative rehabilitation used during the preparation for total knee arthroplasty were identified, and the effect of these methods on the restoration of functional parameters in patients, changes in pain and the duration of hospital stay after surgery was studied in comparison with the standard program of preparation for total knee arthroplasty.Conclusion. During the study, it was revealed that preoperative rehabilitation before total knee replacement can significantly reduce the duration of hospital stay, however, convincing evidence of improvement in postoperative functional parameters has not been established. To determine the real effectiveness of preoperative rehabilitation, clinical studies are needed to study the effect of comprehensive preoperative rehabilitation programs on the pathogenetic aspects of osteoarthritis, clinical symptoms and functional parameters in the postoperative period.

A brief report: A rehabilitation journey in a professional elite ballet dancer

Purpose:This brief report aims to present and reflect on the lessons learnt from practice with an individual case professional dancer who sought comprehensive psychological support as a result of a trauma-injury ruptured Achilles tendon during a live performance.Method & Results:A professional elite ballet dancer received a total of 12 sessions delivered weekly lasting 60 minutes each session. Rehabilitation post-surgery included physiotherapy, strength and conditioning, pilates, nutrition and psychological support as part of a comprehensive package. Quantitative data through the PANAS questionnaire (Watson et al., 1988) was administered at baseline, midpoint and at the end of the sessions. Three main themes emerged as acquired skills through psychological interventions: 1) self-confidence and self-esteem, 2) a renewed sense of belonging, and 3) a sense of autonomy.Discussion & Conclusions:A dancers’ centred approach in providing psychological support for a comprehensive rehabilitation program where transdisciplinary interlinked approaches benefited the recovery from injury to full recovery. Reflections highlight the importance of positive person-centred psychological models of practice, the Rogerian foundations of authenticity, non-judgemental and guiding principles of recovery and the clinician positionality, active listening and compassion.

Features of correction of disorders of the digestive system in children with reactive asthenic syndrome

Objective: to study the features of the digestive system in children with reactive asthenic syndrome and correction of disorders using a comprehensive integration program.Materials and methods: a prospective cohort non-randomized study of 419 children of primary school age was conducted. The main group consists of 128 children living in the territory of active hostilities. Control group — 291 children outside the zone of active hostilities. A full examination was carried out before and 6 months after the start of the comprehensive integration rehabilitation program. All children were collected complaints, anamnesis, analysis of outpatient records, objective examination, examination of the motor-evacuation function of the gastrointestinal tract.Results: all children of the main group had complaints from the digestive system. 97 (75.78%) children were concerned about decreased appetite; 79 (61.72%) — stool disorders. Functional disorders were registered in 80 (62.50%) children of the main group, organic pathology — in 62 (48.44%). Among functional abnormalities, functional disorders of the biliary tract were in the first place (in 65 (50.78%) people). Among the organic pathology — diseases of the stomach and 12-duodenum (in 59 (46.09%) children). Peripheral electrogastroenterography revealed in most children of the main group non-impulsive contractions and discoordination of motor skills of varying degrees of severity in all parts of the gastrointestinal tract.Conclusions: the implementation of complex rehabilitation measures optimized the studied indicators with more pronounced effectiveness in children evacuated from active combat zones.

Sexual relations and rehabilitation of injured athletes: A narrative review

Sexual health is a critical aspect of overall well-being, encompassing physical, mental, and emotional dimensions. For athletes, maintaining sexual health during injury rehabilitation can be particularly challenging. Injuries disrupt training, competition schedules, intimate relationships, and sexual health, impacting the psychological state, the recovery process, and overall quality of life. Athletes are highly attuned to their bodies, and any injury impeding physical performance can lead to significant stress and anxiety, affecting sexual health. Conversely, sexual activity and intimate relationships can influence the rehabilitation process both positively and negatively. Understanding this interplay is essential for holistic rehabilitation programs addressing all aspects of an athlete's well-being. Physiologically, sexual activity involves physical exertion, hormonal changes, and alterations in blood flow, impacting healing. Hormones released during sexual activity, such as oxytocin, endorphins, and dopamine, can provide pain relief and enhance mood, benefiting recovery. Testosterone, crucial for muscle repair and growth, is also influenced by sexual activity. However, physical exertion during sexual activity can strain injured areas, potentially exacerbating injuries if not managed carefully. Psychologically, injuries can impact an athlete’s self-esteem, body image, and mental health. Positive sexual relations offer emotional support, enhancing psychological resilience during recovery. Intimate relationships provide normalcy and help athletes maintain a positive body image, counteracting the negative psychological effects of injuries. Social support from intimate partners is vital for rehabilitation. Open communication about physical limitations and sexual needs can strengthen relationships and create a supportive environment for recovery. Comprehensive rehabilitation programs should address sexual health, providing education on safe practices, offering counseling services, and encouraging open dialogue between athletes, partners, and healthcare providers. Rehabilitation programs can enhance recovery and improve outcomes for injured athletes by integrating physiological, psychological, and social aspects.

Влияние рынка санаторно-курортных услуг на развитие экономики Казахстана

The purpose of writing the article was to consider the authors of the current state and development of the market of spa services in Kazakhstan, which has a significant impact on the sustainable development of the country's economy. Currently, in harsh market conditions, the level of competitiveness of spa services suffers first of all, that is, it means the possibility of these services to bring acceptable income to the company and has a significant impact on the sustainable development of this business. Materials and methods: within the framework of a systematic approach, when writing the article, the author applied the principles and methods of complex and comparative analysis, economic and statistical, including graphical, the principle of groupings, etc. Research results: today in the Republic of Kazakhstan there are all the economic prerequisites for the development of sanatorium-resort services, where natural resources and space have served as the basis for the development of the economy of sanatorium-resort tourism in the country. In the republic, you can find all the main types of sanatoriumresort institutions that use comprehensive rehabilitation, treatment, recovery and prevention programs. The authors analyzed and studied the main types of health resorts of the Republic of Kazakhstan, the economic component of the current state of the market of sanatorium-resort services in Kazakhstan, the structure of public spending on paid services in the field of sanatorium-resort organizations in Kazakhstan, determining the positions of the regions of Kazakhstan on sanatorium-resort organizations, etc. The main problems hindering the development of sanatorium-resort services were also highlighted and the characteristic features of the sanatorium-resort services market that distinguish it from other markets were highlighted. It is worth noting that the importance of modern activities of sanatoriumresort enterprises in tourism is due to the long and rich traditions of domestic balneology, based on strict scientific approaches to organization and high professionalism in the implementation of sanatoriumresort services.

Psychological state, self-assessment y emotional stability of a severely wounded combatant

The article presents a comprehensive analysis of the peculiarities of the psychological state, self-esteem and emotional stability of severely wounded combatants who returned from combat. The research is based on the study of the psychological well-being of this category of victims, their adaptation and rehabilitation after severe physical injuries. The main focus is on identifying the manifestations of post-traumatic stress disorder (PTSD), depressive and anxiety symptoms in severely wounded combatants. It was found that severe combat trauma significantly increases the risk of developing mental disorders in victims, significantly complicating their recovery and return to a full-fledged peaceful life.The main factors that affect the emotional stability and general psychological state of severely wounded combatants are analyzed. These factors include physical pain and limitations, loss of functional capabilities, psychological trauma, social isolation, feelings of loss and helplessness, as well as problems with employment and financial stability. The role and importance of family care in supporting the psychological well-being of severely wounded combatants is considered. It is noted that effective rehabilitation requires close cooperation between medical professionals, psychologists, social workers and families of the victims. An important aspect is raising public awareness of the problems faced by severely wounded combatants and developing social support and adaptation programs for this category of people. Based on the results obtained, the article outlines the main areas of psychological assistance to severely wounded combatants. The author emphasizes the need for a comprehensive psychological rehabilitation program aimed at processing traumatic experiences and restoring self-esteem.

An Evaluation of Phantom Pain among Traumatic Lower Limb Amputees in Lahore

Background: Amputation is the surgical removal of all or part of an irreparably damaged limb due to injury or disease. Trauma is the leading cause of lower limb amputation in Pakistan. Phantom limb pain (PLP) is a common and distressing complication following amputation, affecting the quality of life and functional outcomes. Objective: The primary objective of this study was to assess the occurrence and intensity of phantom limb pain in patients who had undergone lower limb amputation due to traumatic causes in Pakistan. Methods: A descriptive cross-sectional study was conducted over six months, involving 73 patients who had undergone lower limb amputation due to trauma. The study was carried out in Ghurki Trust Teaching Hospital, Sheikh Zayed Hospital, and Mayo Hospital. Patients aged 20-45 years, with amputations performed within one year, were included. Exclusion criteria were non-traumatic amputations and amputations older than one year. Non-probability convenience sampling was used. Participants were divided into three groups based on the level of amputation: hip disarticulation (n=12), transfemoral (n=28), and transtibial (n=33). Phantom limb pain was assessed using the Numeric Pain Rating Scale (NRPS), an 11-item scale ranging from 0 (no pain) to 10 (severe pain). Data were analyzed using SPSS version 25, and descriptive statistics were presented in tables and graphs. Ethical approval was obtained from the Ethics Committee of Lahore College of Physical Therapy (ERC-LCPT/298/2019). Written informed consent was obtained from all participants. Results: The study found that 83.6% of the participants experienced phantom limb pain. Among the hip disarticulation group, 91.7% reported PLP, with a mean NRPS score of 7.3. In the transfemoral group, 89.3% experienced PLP, with a mean NRPS score of 6.8. In the transtibial group, 75.8% reported PLP, with a mean NRPS score of 5.4. The association between the level of amputation and the presence of PLP was significant, with p-values of 0.003 for hip disarticulation, 0.000 for transfemoral, and 0.001 for transtibial amputations. Conclusion: Phantom limb pain is a prevalent and significant issue among patients with traumatic lower limb amputations in Pakistan, with varying intensity across different levels of amputation. These findings underscore the need for targeted pain management strategies and comprehensive rehabilitation programs to address PLP and improve the quality of life for amputees.

A New Approach to Postoperative Rehabilitation following Mosaicplasty and Bone Marrow Aspiration Concentrate (BMAC) Augmentation.

Chondral defects in the knee present a significant challenge due to their limited self-healing capacity, often leading to joint degeneration and functional disability. Current treatments, including surgical approaches like mosaicplasty and regenerative therapies such as bone marrow aspirate concentrate (BMAC) augmentation, aim to address these defects and improve patient outcomes. This study conducted a single-center, randomized controlled trial to evaluate the efficacy of different treatment approaches and rehabilitation protocols for chondral defects. Thirty-seven subjects presenting with symptomatic chondral or osteochondral defects (>3 cm2) in the weight-bearing region of the femoral condyle were partitioned into three groups, and underwent mosaicplasty with or without BMAC augmentation, followed by either a 6-week or 12-week rehabilitation program. Group 1 (n = 10) received mosaicplasty combined with BMAC augmentation and engaged in a twelve-week two-phase rehabilitation protocol. Group 2 (n = 15) underwent mosaicplasty alone and participated in the same twelve-week two-phase rehabilitation regimen. Meanwhile, Group 3 (n = 12) underwent mosaicplasty and underwent a shorter six-week one-phase rehabilitation program. Clinical assessments were performed using the visual analog scale (VAS) for pain, goniometry for the knee's range of motion (ROM), manual muscle testing (MMT) for quadricep strength, and the Western Ontario and McMaster University Arthritis Index (WOMAC) for functional evaluation in three test phases. Significant differences in WOMAC scale scores were observed between the three groups at the intermediate (F(2, 34) = 5.24, p < 0.010) and final (F(2, 34) = 111, p < 0.000) stages, with post hoc Tukey tests revealing variations shared among all three groups. The between-group analysis of the VAS scale demonstrated no statistically significant difference initially (F(2, 34) = 0.18, p < 0.982), but significant differences emerged following the intermediate (F(2, 34) = 11.40, p < 0.000) and final assessments (F(2, 34) = 59.87, p < 0.000), with post hoc Tukey tests revealing specific group variations, notably between Group 1 and both Group 2 and Group 3, and also between Group 3 and Group 2. The between-group analysis of quadricep muscle strength using MMT scores revealed no statistically significant differences initially (F(2, 34) = 0.376, p < 0.689) or following the intermediate assessment (F(2, 34) = 2.090, p < 0.139). The one-way ANOVA analysis showed no significant difference in the knee ROM initially (F(2, 34) = 1.037, p < 0.366), but significant differences emerged following intermediate (F(2, 34) = 9.38, p < 0.001) and final assessments (F(2, 34) = 11.60, p < 0.000). Post hoc Tukey tests revealed significant differences between Groups 1 and 2, Groups 1 and 3, and Groups 2 and 3 at intermediate and final assessments. The patients who received BMAC augmentation and completed a 12-week rehabilitation protocol had significantly better outcomes in pain relief, knee function, and ROM when compared to those who did not receive BMAC augmentation or those who completed a shorter rehabilitation period. Our findings suggest that combining mosaicplasty with BMAC augmentation and a comprehensive rehabilitation program can lead to superior clinical outcomes for patients with chondral defects in the knee.

Rehabilitation of cardiological patients with post-COVID syndrome: morphofunctional data report

INTRODUCTION. Post-COVID is a common complication of COVID-19, occurring in more than a third of patients, and condition will persist for more than 3 months after infection with the SARS-CoV-2. AIM. To evaluate impact and potential effectiveness of a comprehensive physical rehabilitation program on health of cardiac patients with complications of a previously suffered new coronavirus infection SARS-CoV-2 COVID-19. MATERIALS AND METHODS. The study involved 128 cardiology patients with post-COVID syndrome. The study participants comprised three groups depending on the 12-week physical rehabilitation program. The effectiveness of rehabilitation was assessed through parameters of cardiopulmonary testing, as well as the 6-minute walk exercise test and the degree of dyspnea according to modified mMRC dyspnea questionnaire. RESULTS. The mMCR index in CPR group was 1.0 [0.0–1.0] point, compared with 2.0 [1.0–2.0] in control and comparative groups (p 0.05); exercise tolerance VO2max increased by 8.3 ± 3.8 % (p 0.05); normalization of heart rate and blood pressure in response to physical activity after 12 weeks in intervention group was 5.0 ± 2.1 % compared to comparative and control groups; 6MWT test results 688 m, in the intervention group, versus 490 m, for participants in control group (p 0.05). DISCUSSION. A comparative analysis of previously conducted studies confirmed pattern between the inclusion of combined cardiorespiratory training in the protocol for 12-week rehabilitation of post-COVID complications among cardiac patients, and a decrease in the degree of shortness of breath, as well as an increase in exercise tolerance. CONCLUSIONS. Based on experimental data obtained, it is advisable to analyze the effects of Cardiopulmonary Physical Rehabilitation program in the framework of larger randomized clinical trials. This will allow a more detailed assessment of the clinical consequences, as well as the ability to adjust mode and dose of physical activity of proposed rehabilitation program.

The effect of audit and feedback and implementation support on guideline adherence and patient outcomes in cardiac rehabilitation: a study protocol for an open-label cluster-randomized effectiveness-implementation hybrid trial

Background Providing secondary prevention through structured and comprehensive cardiac rehabilitation programmes to patients after a myocardial infarction (MI) reduces mortality and morbidity and improves health-related quality of life. Cardiac rehabilitation has the highest recommendation in current guidelines. While treatment target attainment rates at Swedish cardiac rehabilitation centres is among the highest in Europe, there are considerable differences in service delivery and variations in patient-level outcomes between centres. In this trial, we aim to study whether centre-level guideline adherence and patient-level outcomes across Swedish cardiac rehabilitation centres can be improved through a) regular audit and feedback of cardiac rehabilitation structure and processes through a national quality registry and b) supporting cardiac rehabilitation centres in implementing guidelines on secondary prevention. Furthermore, we aim to evaluate the implementation process and costs.MethodsThe study is an open-label cluster-randomized effectiveness-implementation hybrid trial including all 78 cardiac rehabilitation centres (attending to approximately 10 000 MI patients/year) that report to the SWEDEHEART registry. The centres will be randomized 1:1:1 to three clusters: 1) reporting cardiac rehabilitation structure and process variables to SWEDEHEART every six months (audit intervention) and being offered implementation support to implement guidelines on secondary prevention (implementation support intervention); 2) audit intervention only; or 3) no intervention offered. Baseline cardiac rehabilitation structure and process variables will be collected. The primary outcome is an adherence score measuring centre-level adherence to secondary prevention guidelines. Secondary outcomes include patient-level secondary prevention risk factor goal attainment at one-year after MI and major adverse coronary outcomes for up to five-years post-MI. Implementation outcomes include barriers and facilitators to guideline adherence evaluated using semi-structured focus-group interviews and relevant questionnaires, as well as costs and cost-effectiveness assessed by a comparative health economic evaluation.DiscussionOptimizing cardiac rehabilitation centres’ delivery of services to meet standards set in guidelines may lead to improvement in cardiovascular risk factors, including lifestyle factors, and ultimately a decrease in morbidity and mortality after MI.Trial registrationClinicalTrials.gov. Identifier: NCT05889416. Registered 2023-03-23.

Clinical case of complex rehabilitation for post-traumatic myelopathy using Taraskul lake sapropels

BACKGROUND. Post-traumatic myelopathy (combat injury) is a serious condition that leads to severe functional impairment requiring complex rehabilitation based on assessment of functional impairment. The use of sulfide-silt mud is used in sanatoriums of the eastern military district for the rehabilitation of patients with pathology of the musculoskeletal system according to generally accepted methods. Lake Bolshoi Taraskul in the Tyumen region is a natural reservoir of sapropels with unique biological properties. AIM. Show on the example of a clinical case the results of an integrated approach in the rehabilitation of a patient with post-traumatic myelopathy as a result of combat trauma, implemented on the basis of an individual. CASE DESCRIPTION. Patient, 32 years old, with post-traumatic myelopathy due to spinal injury. Upon admission, the indicators: rehabilitation routing scale — 5 points, Revermid mobility index — 4 points, Ashforth spasticity scale — 3 points, ASIA scale — B, FIM functional independence scale 99 points. Initially, the patient is transferred from the chair to the couch with minimal support, sits without additional support for more than 5 minutes, verticalization of the patient only using high support (high walkers). The comprehensive rehabilitation program included physiotherapy, hydrokinesotherapy and peloidotherapy with Lake Taraskul sapropels. As a result of treatment, the patient walks with a support on a walker on a flat surface with rest, walks along the wall with a support on handrails. A patient supported by canes climbs a ladder. CONCLUSION. This clinical case discloses the effectiveness of comprehensive rehabilitation of a patient with post-traumatic myelopathy (combat trauma) with the inclusion of Lake Taraskul in the rehabilitation program for hydrokinesiotherapy and peloidotherapy with sapropels.

The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries.

Background: People with spinal cord injuries (SCIs) often have trouble remaining active because of paralysis. In the past, exercise recommendations focused on the non-paralyzed muscles in the arms, which provides limited benefits. However, recent studies show that electrical stimulation can help engage the paralyzed extremities, expanding the available muscle mass for exercise. Methods: The authors provide an evidence-based approach using expertise from diverse fields, supplemented by evidence from key studies toward the management of electrical stimulation therapies in individuals with SCIs. Literature searches were performed separately using the PubMed, Medline, and Google Scholar search engines. The keywords used for the searches included functional electrical stimulation cycling, hybrid cycling, neuromuscular electrical stimulation exercise, spinal cord injury, cardiovascular health, metabolic health, muscle strength, muscle mass, bone mass, upper limb treatment, diagnostic and prognostic use of functional electrical stimulation, tetraplegic hands, and hand deformities after SCI. The authors recently presented this information in a workshop at a major rehabilitation conference. Additional information beyond what was presented at the workshop was added for the writing of this paper. Results: Functional electrical stimulation (FES) cycling can improve aerobic fitness and reduce the risk of cardiovascular and metabolic diseases. The evidence indicates that while both FES leg cycling and neuromuscular electrical stimulation (NMES) resistance training can increase muscle strength and mass, NMES resistance training has been shown to be more effective for producing muscle hypertrophy in individual muscle groups. The response to the electrical stimulation of muscles can also help in the diagnosis and prognosis of hand dysfunction after tetraplegia. Conclusions: Electrical stimulation activities are safe and effective methods for exercise and testing for motor neuron lesions in individuals with SCIs and other paralytic or paretic conditions. They should be considered part of a comprehensive rehabilitation program in diagnosing, prognosing, and treating individuals with SCIs to improve function, physical activity, and overall health.

The Clinical Outcome of Cardiac Rehabilitation in Coronary Artery Disease Patients with Regard to the Presence of Left Ventricular Systolic Dysfunction.

Background: Despite the use of advanced treatment techniques, coronary artery disease (CAD) still remains the main cause of left ventricular (LV) dysfunction and heart failure. Participation in cardiac rehabilitation (CR) programs can lead to a number of beneficial effects, but some patients do not demonstrate the expected improvement. The aim of this study is to evaluate the impact of CR on changes in exercise capacity with regard to the presence of LV dysfunction. Methods: A group of 428 patients with CAD were consecutively admitted to an outpatient comprehensive cardiac rehabilitation program comprising 24 exercise sessions of interval training on cycle ergometers, three times a week for 45 min, and a health education. The patients were compared in two subgroups, i.e., with LV systolic dysfunction (LVEF < 50%, n = 175) and LVEF ≥ 50% (n = 253). Results: In the LVEF < 50% group, the exercise capacity improved by 1 ± 0.78 MET (median 1.15 MET), and 0.86 ± 0.77 MET (median 1.08 MET) in the LVEF ≥ 50% group. Women with LVEF < 50% demonstrated a significant increase in exercise capacity by 1.2 MET, while those with LVEF ≥ 50% did not display any such increase. All men, regardless of LVEF, exhibited a similar improvement in exercise capacity greater than 1 MET. Conclusions: An outpatient eight-week cardiac rehabilitation program based on 45 min aerobic interval training sessions three times a week appears less effective for women with CAD and EF ≥ 50%. In this group, the proposed training intervention is insufficient in improving exercise capacity to an extent that could indicate a reduction in mortality risk.

A Structured Literature Review on the Research and Design of Rehabilitation Environments.

This literature review is conducted to identify knowledge gaps and shape a framework for the development of guidelines and future research on programming and design of rehabilitation environments. Patients suffering from trauma, stroke, neurological or cardiopulmonary conditions, or recovering from surgery or cancer treatment require rehabilitation services. A comprehensive rehabilitation program can support continuum of care for inpatient and outpatient groups. However, within most facilities, rehabilitation environments are found to be outdated and undersized compared to other programs or lack the correct adjacencies within the facility. Unfortunately, this deficiency is echoed by limited guidelines on programming, planning, and design of these environments. General guidelines derived from healthcare environments research is not adaptable to rehabilitation environments, because the paradigm used in most healthcare environment research does not address specific needs of rehabilitation patients in regaining confidence or relearning daily life skills. We conducted a structured literature review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a basis for reporting the available body of work on evidence-based research in rehabilitation environments. Through analysis of the limited literature, specific mediators such as patient confidence and motivation were identified. An environment that creates a balance between privacy and social interaction can promote these mediators. Creating enriched environments through elements that engage the senses and encourage more social and physical interaction is essential for recovery. Finally, accessibility and wayfinding are of great importance in these environments due to potential limited mobility or cognitive impairments of patients.

New horizons in comprehensive rehabilitation of patients with melanoma: improved outcomes through an integrated approach to immunotherapy

Abstract. The article discusses issues of a comprehensive rehabilitation approach for patients with melanoma when treated with immunotherapy. By focusing on innovative treatments, the study highlights the need to integrate nutritional support, physical therapy, magnetic therapy and psychological support to improve quality of life and enhance the effectiveness of immunotherapy regimens. Purpose. The study aims to evaluate the impact of a multidisciplinary rehabilitation program on improving physiological functions, psychoemotional well-being and the impact on the overall antitumor response, which together can improve the quality of life of patients with melanoma. Materials and methods. The study included 135 patients diagnosed with melanoma who received a course of immunotherapy. In the study group (the main group), a complex of rehabilitation techniques was used (magnetic therapy, physical therapy, nutritional support, psychological support), while in the control group, patients did not undergo an accompanying comprehensive rehabilitation program. Treatment effectiveness was assessed in accordance with iRECIST 1.1 criteria. To assess the quality of life, the Russian version of the EORTC QLQ-C30 questionnaire was used. The severity of adverse events was assessed according to CTCAE 5.0 criteria. Results. Patients from the main group who received comprehensive rehabilitation support along with immunotherapy showed an improvement in their general physical condition and a decrease in the intensity of some side effects of treatment. Patients in the control group who received only standard immunotherapy also showed changes in their health status, but these changes were less pronounced compared to the main group. Adverse events during treatment occurred in 55 % of patients in the main group and in 74 % in the control group. Patients in the main group noted an improvement in quality of life by 25 %, while in patients in the control group this figure was 12 %. An 18 % improvement in general condition was noted by patients in the main group, while patients in the control group noted an 8 % improvement in general condition. Conclusion. Implementation of a multidisciplinary rehabilitation approach, including nutritional support, physical therapy exercises, magnetic therapy, and psychological support, demonstrates significant improvements in symptom management and quality of life in melanoma patients undergoing immunotherapy.

EVALUATION OF THE EFFECTIVENESS OF A COMPREHENSIVE PROGRAM OF REHABILITATION OFFERED ACCORDING TO DIFFERENT THERAPEUTIC PROTOCOLS IN REDUCING CHRONIC FRONTAL SYNDROME IN PATIENTS 10-YEARS FOLLOWING NEUROSURGERY FOR POST-TRAUMATIC INTRACEREBRAL HEMATOMA

The aim of the study was to evaluate the effectiveness of a Comprehensive Program of Rehabilitation (CPReh) offered according to different therapeutic protocols in reducing chronic frontal syndrome in patients 10 years following neurosurgery for post-traumatic intracerebral hematoma.Out of 568 adult car accident patients who underwent neurosurgery for post-traumatic intracerebral hematoma between 2004 and 2010 at the Department of Neurosurgery and Neurotraumatology of the Jagiellonian University's Collegium Medicum in Krakow, 90 patients with OFC injury and Chronic Frontal Syndrome were selected for the study. Patients were divided into three groups A, B and C of 30 each, matched for age, gender and injury severity. The Comprehensive Rehabilitation Program (CPReh) (cf. Pąchalska 2008) was applied in all groups ten years after hospitalization and surgery for intracerebral hematoma and was conducted according to three therapeutic Protocols:- Protocol 1 administered in group A, combained cognitive training (CT) and the "Life Academy" program administered twice a week. The activities were continued as long as the patient was able and willing to continue (average 24 months 1.18).- Protocol 2 administered in group B, included CT and the "Academy of Life" program also administered twice a week but lasting for the standard period of about a year (average 12 months 1.03).- Protocol 3 administered in group C, included CT and the "Community Base Treatment" program similarly administered twice a week and also lasting about a year as standard (average 12 months 1.27).Evaluation of the effects of rehabilitation using the Frontal Behavioral Inventory (FBInv) was conducted 2 times: Study I (baseline, 10 years follow up after operation)-before the start of rehabilitation, Study II (follow up) after the end of rehabilitation according to all protocols.all or most of the positive or negative symptoms tested by FBInv, including neurological, cognitive, emotional and behavioral ones. A modified CPReh program administered with Protocol 1. in which combined cognitive training (CT) and the "Academy of Life" program is provided twice a week, but which continues as long as the patient was able and willing to continue, is more effective in reducing these symptoms, like the standard CPReh program administered with Protocol 2 or 3 administered only up to a year as a standard. It was also found that the "Academy of Life " program has also been shown to be a more effective component of CPReh than the Community Base Treatment.The improvement achieved by group A, in which a modified CPReh administered with Protocol 1. that provided the patient the opportunity to continue rehabilitation as long as the patient was able and willing to continue was more effective in the reduction of Chronic Frontal Syndrome than the standard CPReh administered with Protocols 2. and 3. for the patients in groups B and C.