Daily Physiotherapy Research Articles

The effect of physiotherapy intervention on functional outcomes among COVID-19 patients: Clinical experimental study.

COVID-19 is a highly contagious virus that causes pneumonia, which quickly progresses to acute respiratory distress. In the case of COVID-19, physiotherapy is critical in non-invasive support management, postural changes, chest physiotherapy (CPT), and bed mobility. This study aims to look into the effects of physiotherapy intervention on functional outcome levels in COVID-19 patients in the acute stage. A total of 60 severe COVID-19 patients (54 males and 6 females) with a mean age of 50years were studied. The intervention group (n=30) had two daily physiotherapy sessions that included positioning, CPT, cardio exercises, breathing exercises, and early mobility, whereas the control group (n=30) received only standard medical care. Patients were tested twice at the baseline and discharge using peripheral oxygen saturation, respiratory rate (RR) test, dyspnea rate, two-min walk test, and spirometer scores, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). The two groups improved significantly between the baseline and discharge ratings. The intervention group, on the other hand, significantly improved all outcome indicators at discharge (p-value=0.00). This study found that physiotherapy management improved oxygen saturation, RR, dyspnea, and lung function tests in COVID-19 patients except in FVC (p-value=0.402) and FEV1(p-value=0.114). Physiotherapist interventions with COVID-19 patients increase respiratory function and treatment time.

Long-Term Outcome of Motor Functional Neurological Disorder After Rehabilitation.

Functional neurological disorder (FND) is defined as the presence of neurological symptoms that are inconsistent with a neurological disease. We performed a single-center retrospective study aimed at determining the long-term outcome of FND patients receiving inpatient rehabilitation and the predictors of a good outcome. A multidisciplinary graded exercise program was provided with one or two daily physiotherapy and occupational therapy sessions on 5 days each week, as well as weekly psychological support. Outcome was assessed using the motor part of the Functional Independence Measure scale (FIM; maximum score of 91) at admission, discharge, and follow-up, with the last assessment performed by phone interview. The 30 included patients were aged 43.6±14.7 years (mean±standard deviation), comprised 70% females, and received a mean of 4 weeks of rehabilitation. The admission FIM score (80.2±8.3) was significantly lower than the discharge FIM score (86.9±4.6; p<0.001, Wilcoxon signed-rank test). No notable difference was observed between discharge and follow-up FIM scores (85.5±8.5, p=0.54). The mean follow-up of the 36-month FIM scores at discharge and follow-up was dichotomized as a good outcome in cases where all items were scored ≥6 (functional independence). Binomial logistic regression showed that absence of a comorbid psychiatric disorder (p=0.039, odds ratio=10.7) was a predictive factor for a good outcome at follow-up. Other variables (e.g., sex and age) were not significant predictors of clinical outcome (all p≥0.058). These results suggest inpatient intensive rehabilitation for motor FND is effective and produces favorable long-term results. Further studies with larger groups are warranted so that the management protocols can be standardized.

Effect of Tear Size and Location on Supraspinatus Tendon Strain During Activities of Daily Living and Physiotherapy.

The supraspinatus tendon plays a crucial role in shoulder abduction, making it one of the common structures affected by injury. Clinically, crescent-shaped tears are the most commonly seen tear shape. By developing six specimen-specific, three-dimensional, supraspinatus-infraspinatus finite element model with heterogeneous material properties, this study aimed to examine the changes in tissue deformation (maximum principal strain) of the supraspinatus tendon due to specimen-specific material properties and rotator cuff tear size. FE models with small- and medium-sized full-thickness crescent-shaped tears were subjected to loads seen during activities of daily living and physiotherapy. Six fresh-frozen cadaveric shoulders were dissected to mechanically test the supraspinatus tendon and develop and validate FE models that can be used to assess changes in strain due to small (< 1cm, equivalent to 20-30% of the tendon width) and medium-sized (1-3cm, equivalent to 40-50% of the tendon width) tears that are located in the middle and posterior regions of the supraspinatus tendon. FE predictions of maximum principal strain at the tear tips were examined to determine whether failure strain was reached during activities of daily living (drinking and brushing teeth) and physiotherapy exercises (prone abduction and external rotation at 90° abduction). No significant differences were observed between the middle and posterior tear failure loads for small- and medium-sized tears. For prone abduction, there was a potential risk for tear progression (exceeded failure strain) for medium-sized tears in the supraspinatus tendon's middle and posterior regions. For external rotation at 90° abduction, one model with a middle tear and two with posterior tears experienced failure. For all daily activity loads, the strain never exceeded the failure strain. Our three-dimensional supraspinatus-infraspinatus FE model shows that small tears appear unlikely to progress based on the regional strain response; however, medium-sized tears are at higher risk during more strenuous physiotherapy exercises. Furthermore, differences in patient-specific tendon material properties are important in determining whether the tear will progress. Therefore, patient-specific management plans based on tear size may be beneficial to improve clinical outcomes.

Effectiveness of digital Cognitive-Behavioural Therapy for Insomnia in patients with musculoskeletal complaints and insomnia in primary care physiotherapy: study protocol for a randomised controlled trial

IntroductionInsomnia is prevalent among patients visiting physiotherapists due to musculoskeletal complaints and associated with poorer pain prognosis. Cognitive-Behavioural Therapy for Insomnia (CBT-I) may be effective for improving sleep quality and...

Health State Utilities Associated With Treatment Burden in Cystic Fibrosis: A Patient Valuation Study

BACKGROUNDWhile recent advancements in the treatment of cystic fibrosis (CF) have improved survival, reducing high levels of treatment burden remains a priority issue for many people with CF (pwCF). However, economic evaluations of novel interventions may fail to capture their impact on treatment burden due to a lack of suitable outcome measures. This study aimed to estimate health state utilities (HSUs), for changes in treatment burden associated with different CF treatments. RESEARCH QUESTIONWhat value do pwCF place on changes in treatment burden associated with intravenous antibiotic treatment of pulmonary exacerbations, inhaled medicines, and physiotherapy? STUDY DESIGNAND METHODS: Adults attending a specialist CF center were invited to participate in a web-based time trade-off interview. Participants valued their own health, and five health state vignettes describing varying levels of intensity of physiotherapy, inhaled, and IV antibiotic treatment. HSUs for additional instances of each treatment type were estimated using mixed effect linear regression models. RESULTSFifty one people with CF completed the interview (median age, 30 years; range, 19-66); 53% were female; mean FEV(1) % predicted, 65% [SD, 20%]).Mean utility scores for own health were very similar between the EQ-5D index value (0.81, SD 0.20) and the TTO value (0.82, SD 0.20), however limited concordance was observed at the individual level. Adjusted utility decrements associated with treatment burden were -0.037 (SE 0.008) for an additional annual IV antibiotic treatment, -0.029 (SE 0.014) for an additional daily physiotherapy session, and -0.019 (SE 0.013) for an additional daily inhaled medicine. INTERPRETATIONIncreasing treatment burden was associated with decreasing HSU values. The utility decrements associated with treatment burden changes suggest meaningful differences in health-related quality of life (HRQoL) for pwCF. These findings align with existing literature on the impact of treatment burden on HRQoL, and highlight the importance of considering treatment burden in economic evaluations of interventions in CF.

Introduction of enhanced weekend physiotherapy for patients with hip fracture is associated with improved early mobility outcomes.

To assess whether enhanced daily weekend physiotherapy (EWP) for patients with hip fracture was associated with improved clinical outcomes. We retrospectively analysed all previously ambulatory adults admitted with hip fracture to our tertiary hospital, comparing 'usual' ('control') care (09/19-03/20) to EWP (09/20-03/21). Outcomes included Day-7 mobility ≥20 m (primary), additional mobility measures, specified postoperative complications, new residential facility placement, acute length-of-stay (LOS) and 30-day death. Amongst 235 eligible patients (128 control, 107 EWP), 66% were female, mean age was 80.4 years (SD 10.5), 20% from residential care and 49% (114/235) were mobilising without aid at baseline (no between-group differences; all p ≥ .20). Median acute LOS was 10 days (IQR 6-15), total hospital LOS was 21 days (IQR 12-37) and 3% (n = 6) died by Day 30. Median Day-7 distance mobilised was 25 m (IQR 7-50) with EWP versus 10 m (3-40) (p = .06). No EWP patients developed pressure injury (0 vs. 6, p = .02); other outcomes were similar between groups. Adjusting for age, residence, baseline cognitive impairment, American Society of Anesthesiologist score and preadmission mobilisation without aids, EWP was independently associated with increased likelihood of mobilising ≥20 m at Day 7 (aOR 1.83, 95% CI 1.04-3.23, p = .03). Enhanced daily weekend physiotherapy was associated with improvement in early mobility, but not other outcomes assessed. These data would be strengthened by randomised controlled trial data exploring more intense physiotherapy, cost-benefit analysis and patient experience measures.

Boosting inpatient exercise after hip fracture using an alternative workforce: a mixed methods implementation evaluation

BackgroundHip fracture has a devastating impact on individuals and is an increasing burden for health systems and society. Compared to usual care, increased physiotherapy provision has demonstrated efficacy in improving patient and health service outcomes in this population. However, physiotherapy workforce challenges prevent sustained implementation.MethodsOur aim was to evaluate the safety, feasibility, acceptability, effectiveness and implementation cost of thrice daily physiotherapy for patients in the acute care setting after hip fracture at two public hospitals. We added twice-daily exercise implemented by an alternative workforce, to usual care consisting of daily mobility practice by a physiotherapist. Sites identified their preferred alternative workforce, with pre-registration physiotherapy students and allied health assistants chosen. We used a mixed methods approach, using the Consolidated Framework for Implementation Research (CFIR) as a determinant framework to guide implementation planning and data collection. We compared hospital length of stay data to a reference cohort.ResultsWe recruited 25 patients during the study period. Acute care hospital length of stay decreased from 11 days in the reference cohort to 8 days in the BOOST cohort (mean difference − 3.3 days, 95%CI -5.4 to -1.2 days, p = 0.003). Intervention fidelity was 72% indicating feasibility, no safety concerns were attributed to the intervention, and uptake was 96% of all eligible patients. The intervention was acceptable to patients, carers and healthcare providers. This intervention was cost-effective from the acute orthopaedic service perspective.ConclusionHigher daily frequency of physiotherapy can be safely, feasibly and effectively implemented by an alternative workforce for patients in the acute care setting following hip fracture surgery.

Virtual Reality-Assisted Exercise Therapy during Inpatient Treatment after Intensive Chemotherapy for Acute Myeloid Leukemia (AML) and after Autologous or Allogeneic Stem Cell Transplantation

Background and Objectives Medical advances in treatment of hematologic malignancies have led to improved survival. However, aggressive treatments come with the potential of significant side effects that can affect quality-adjusted life years. During treatment, physical activities are markedly reduced and immobility and psychologic burden, especially during long isolation processes, result in fatigue and decline of quality of life as well as loss of cognitive function. Physiotherapy and exercise therapy positively impact muscle strength, quality of life, cognitive functioning and fatigue, but sufficient implementation of training in the inpatient setting is often limited by shortage in human resources. The aim of this study was to assess the feasibility of a virtual reality (VR) based exercise program during inpatient stay of patients undergoing intensive treatment for hematologic malignancies, including autologous and allogeneic hematologic stem cell transplantation (HSCT). Method Patients aged 18 or above, admitted to the hematology ward for HSCT or intensive chemotherapy for acute leukemia were included. As this was a feasibility trial, there was no randomization. After consent, patients were asked to use the VR training device on a daily basis for the length of their stay, accompanied by medical personal. The training program consisted of customized VR-applications addressing movement, concentration and alertness as well as relaxation. An individual program was developed for every patient at the beginning of treatment and continuously readjusted according to individual needs and preferences. Patients who did not want to or were not able to use the VR device were asked to participate in the control group and received the standard-of-care treatment consisting of once daily physiotherapy. As objectives, quality of life, fatigue, strength and cognitive function were assessed once weekly until discharge as well as two weeks post discharge in both groups. The time of usage was recorded by the VR device. A structured interview was conducted after discharge to evaluate the patients' perspective on the intervention. Results Over a three-months period, a total of 10 patients were enrolled in the study, seven patients with intervention, three patients in the control group. The usage was feasible and well tolerated. No unpleasant side effects such as dizziness, nausea or fatigue were reported. Mean time of usage varied between patients (132.6±68.6 minutes, min 12.4, max 463.5 minutes) on 31±28.2% of hospitalization days. Patients in the intervention group achieved a higher overall score in EORTC QLQ-C30 after discharge (s). Moreover, the use of VR was associated with a trend towards improved mean symptom burden (60 vs 43.3 pts), cognitive function (83.3 vs. 16.7pts) and physical strength (63.3 vs 26.7pts) post discharge (significance was not calculated due to the small number of cases). VR occupation time was markedly affected by age and general condition during treatment. The patients perception of the intervention was positive. Conclusions The results show that the use of a VR based exercise program during inpatient stay of patients receiving intensive treatment for hematologic malignancies is feasible and safe, and can improve QoL. Because of the small number of subjects and distinctive differences in time of usage we can only recognize a trend towards positive effects so far. In view of these promising results a larger prospective, randomized trial has been designed.

Early Respiratory Physiotherapy versus an Individualized Postural Care Program for Reducing Mechanical Ventilation in Preterm Infants: A Randomised Controlled Trial.

Tactile stimulation manoeuvres stimulate spontaneous breathing in preterm newborns. The aim of this study is to evaluate the effect of early respiratory physiotherapy on the need for mechanical ventilation during the first week of life in preterm infants with respiratory failure. This is a monocentric, randomised controlled trial. Preterm infants (gestational age ≤ 30 weeks) not intubated in the delivery room and requiring non-invasive respiratory support at birth were eligible for the study. The intervention group received early respiratory physiotherapy, while the control group received only a daily physiotherapy program (i.e., modifying the infant's posture in accordance with the patient's needs). between October 2019 and March 2021, 133 preterm infants were studied, 68 infants in the study group and 65 in routine care. The study group showed a reduction in the need for mechanical ventilation (not statistically significant) and a statistically significant reduction in hemodynamically significant patent ductus arteriosus with respect to the control group (19/68 (28%) vs. 35/65 (54%), respectively, p = 0.03). early respiratory physiotherapy in preterm infants requiring non-invasive respiratory support at birth is safe and has proven to be protective against haemodynamically significant PDA.

BALANCE, GAIT AND LATEROPULSION DISORDERS IN THE ACUTE ISCHEMIC STROKE

Introduction: Stroke mortality rates has decreased to a considerable value over the past few decades owing to the improved medical facilities and technology. This has lead to more number of stroke survivors in the aging population. A strong predictor of independent living after stroke is maintaining body balance and it was showing strong correlation with the disability perceived at the time of patient's discharge from the stroke rehabilitation unit Methodology: All patients with acute ischemic stroke were taken for study. These initial assessments collected information about handedness, all motor decits, postural instability and gait disorders, and disability affecting motor function. The second assessment was performed after one week of stroke at the discharge after daily physiotherapy and only focused on postural and gait disorders. Motor weakness was assessed by a standardized examination of muscle strength adapted for participants with central neurological disorders. Lateropulsion, gait and balance disorders were identied by specic protocols. Results: It was observed that the lesions of frontal lobe, thalamus, basal ganglia and internal capsule had signicant assosciation with balance and gait abnormality post stroke while lesions of parietal lobe, temporal lobe and occipital lobe did not lead to any signicant gait or balance decits. Individuals with lateropulsion improves well on daily physiotherapy in both Lw/oP (r = -0.65) and for pushers (r = -0.61) to a signicantly improved state( r= -0.5 for upright and r= -0.24 for pushers).Conclusion: Lateropulsion is a main factor in determining recovery of balance and gait in the subacute stage of stroke recovery. Special emphasis should be given to the impaired body orientation with respect to gravity in stroke rehabilitation stage and techniques to improve lateropulsion has to be stressed during physiotherapy for better recovery of balance and gait post stroke

CFTR pharmacological modulators: A great advance in cystic fibrosis management

Cystic fibrosis is a severe monogenic disease that affects around 7400 patients in France. More than 2100 mutations in the cystic fibrosis conductance transmembrane regulator (CFTR), the gene encoding for an epithelial ion channel that normally transports chloride and bicarbonate, lead to mucus dehydration and impaired bronchial clearance. Systematic neonatal screening in France since 2002 has enabled early diagnosis of cystic fibrosis. Although highly demanding, supportive treatments including daily chest physiotherapy, inhaled aerosol therapy, frequent antibiotic courses, nutritional and pancreatic extracts have improved the prognosis. Median age at death is now beyond 30 years. Ivacaftor was the first CFTR modulator found to both reduce sweat chloride concentration and improve pulmonary function in the rare CFTR gating mutations. Combinations of modulators such as lumacaftor + ivacaftor or tezacaftor + ivacaftor were found to improve pulmonary function both in patients homozygous for the F508del mutation characterized by the lack of CFTR protein and those heterozygous for F508del with minimal CFTR activity. The triple combination of ivacaftor + tezacaftor + elexacaftor was recently shown to significantly improve pulmonary function and quality of life, to normalize sweat chloride concentration, and to reduce the need for antibiotic therapy in patients with at least one F508del mutation (83% in France). These impressive data, however, need to be confirmed in the long term. Nevertheless, it is encouraging to hear treated patients testify about their markedly improved quality of life and to observe that the number of lung transplants for cystic fibrosis decreased dramatically in France after 2020, despite the COVID pandemic, with no increase in deaths without lung transplant.

Whole-Body Cryostimulation in Fibromyalgia

<h3>Research Objectives</h3> to determine whether the addition of Whole-Body Cryostimulation (WBC) to a rehabilitation program is able to induce a greater reduction of pain, depressive symptoms, disease impact and improvement in function and sleep quality in female patients with fibromyalgia (FM) as compared to matched controls undergoing only a rehabilitation program. <h3>Design</h3> Randomized controlled trial. <h3>Setting</h3> Participants were recruited consecutively from the in-patients of the Rehabilitation Unit in our hospital. <h3>Participants</h3> We selected 45 patients with: i) age between 18 and 65 years; ii) FM diagnosed by a rheumatologist according to American College of Rheumatology criteria; iii) FM diagnosed for more than one year. 25 patients were randomly allocated to the WBC group and 20 patients to the control group. <h3>Interventions</h3> Daily 45-min physiotherapy and 45-min standard supervised adapted physical activity sessions for an average length of hospital stay of 26 days. Patients allocated to the WBC group received additional ten 2-minute WBC sessions at a temperature of -110°. <h3>Main Outcome Measures</h3> Pain severity (VAS 0-10); Disease impact (Fibromyalgia Impact Questionnaire); Depressive symptomatology(BDI-II25); Sleep quality (VAS 0-10); 6-min walking test (meters) were measured before (T0) and after the completion of the rehabilitation program (T1). <h3>Results</h3> No significant differences between groups at T0 in terms of age, BMI, pain duration, number of pain medications, and scores on questionnaires were observed. Both groups reported positive changes in all outcomes at T1. The between-group comparison showed a statistically larger magnitude of changes in the WBC group at T1, specifically, in pain severity, disease impact, sleep quality, and depressive symptoms. Statistically significant improvements in 6MWT were observed at T1 in both groups. The between-group comparison at T1 did not show significant differences, but longer distances walked were evident in the WBC group. <h3>Conclusions</h3> Our preliminary results suggest that WBC could represent an effective add-on treatment for improving pain, disease impact, sleep quality, and depressive symptoms in FM patients. Larger studies are needed to confirm our results. <h3>Author(s) Disclosures</h3> Nothing to disclose.

COVID-19 Lockdown Impacts Among Patients with Cystic Fibrosis: An Italian Regional Reference Centre Experience

Coronavirus pandemic has influenced our society with social distancing and management of chronic disease such as cystic fibrosis (CF). During the Italian lockdown from March to May 2020, CF patients reduced the number of outpatient visits, limited social interactions and spent more time at home. The aim of this study is to evaluate the impact of the lockdown on body mass index (BMI) and lung function tests on CF patients. We retrospectively reviewed clinical data about 111 CF patients followed in our Regional Cystic Fibrosis Reference Centre (Policlinico Umberto I, Rome) according to two periods: pre-lockdown (from October 2019-March 2020) and post-lockdown (from May 2020-October 2020). We collected data on nutritional (BMI and body weight) and lung function status; we chose the best values of the 'pre-lockdown' and 'post-lockdown' period for each patient. Patients were divided into 3 groups according to FEV1 value (Forced Expiratory Volume in the 1st second): group 1 (FEV1 <40%), group 2 (FEV1 40-70%), group 3 (FEV1 >70%). All patients received a telephone interview asking for the number of hours per week devoted to physical activity, number of pulmonary acute exacerbations and subjective evaluation of adherence to medical therapy, respiratory physiotherapy and diet, during the two periods. Comparing weight, BMI and respiratory function between pre and post lockdown periods, we noticed an increase in weight during among overall patients. Male patients improved weight, BMI, FEF 25-75% (Forced Expiratory flow between 25% and 75% of vital capacity) and Tiffenau index more than female patients. The most severely compromised patients (group 1), showed a significant loss of both weight and BMI. Instead, patients with moderate respiratory function (group 2) showed a significant increase of both weight and BMI and a slightly reduced CVF (Forced Vital capacity). We found no differences among patients with good respiratory function (group 3). Comparing each clinical sub-groups, we noticed a significative improvement of weight (p = 0.018) and BMI (p = 0.030) among patients with moderate respiratory function compared to patients with compromised respiratory function. During lockdown, patients reported less physical activity, no variation in food amount and composition, more adherence to therapy (43%) and more consistent daily respiratory physiotherapy (47.6%). Lockdown period had benefit among CF patients in terms of weight in particular in male patient. The greatest benefit on nutritional state was observed in patients with moderate reduction of respiratory function. In addition, we noted a stabilization and sometimes a slight improvement of lung function, instead of a continuous and steady decline that is normally observed in CF patients. These beneficial effects are slight but significative, bearing in mind the general worsening that CF patients experience annually.

The 3-Month Effectiveness of a Stratified Blended Physiotherapy Intervention in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial.

BackgroundPatient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning.ObjectiveThis study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP.MethodsThe study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ≥18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up.ResultsBoth the stratified blended physiotherapy group (104/208, 50%) and the face-to-face physiotherapy group (104/208, 50%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference −16.39, 95% CI −27.98 to −4.79) and several secondary outcomes.ConclusionsThe stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy.Trial RegistrationISRCTN Registry 94074203; https://doi.org/10.1186/ISRCTN94074203International Registered Report Identifier (IRRID)RR2-https://doi.org/10.1186/s12891-020-3174-z

Babinski-Nageotte Syndrome: Case Report of a rare variant of Lateral Medullary Infarction

Babinski-Nageotte Syndrome (BNS) is a rare variant of lateral medullary infarction, and only a few cases have been reported. In this case, a 52-year-old African-American gentleman presented with acute onset weakness on the left side of the body. On examination, there was a palpable right supraclavicular lymph node. Neurological examination showed right-sided gaze-evoked nystagmus and left hemiparesis with grade 3/5 power. Reflexes were normal except for extensor plantar responses on the left. MRI showed a subacute right-sided lateral brainstem infarct just below the pontomedullary junction with minimal progression in a repeat MRI after 24 hours. Workup for supraclavicular adenopathy with CT chest and CT abdomen and pelvis revealed neither neoplastic nor metastatic disease. Biopsy of supraclavicular lymph node was planned as an outpatient but was deferred as it was presumed to be reactive. He was conservatively managed with daily physiotherapy, aspirin, atorvastatin, and optimal blood pressure control. Babinski-Nageotte syndrome includes all symptoms of the Wallenberg syndrome with contralateral hemiparesis due to a spread of the lateral lesion to the pyramidal tract. Atherosclerotic occlusion and lipohyalinosis of the vertebral artery and posterior inferior cerebellar artery have been identified as the most common causes.

RARE CAUSE OF PROXIMAL BRONCHIECTASIS: MOUNIER-KUHN SYNDROME

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: Mounier-Kuhn syndrome (MKS), also known as tracheobronchomegaly is a rare cause of proximal bronchiectasis which is characterized by deficient smooth muscle and elastic fibers and absence of myenteric plexus in the proximal airway wall. Less than 400 cases of MKS have been reported (1) (2). We present a patient with numerous hospitalizations due to recurrent dyspnea and pneumonia spanning twenty years who met chest CT criteria for MKS. CASE PRESENTATION: 44-year-old African American male, a former smoker, presented with worsening dyspnea and productive cough for 2 days. He has had similar symptoms for 20 years. Examination revealed clubbing of extremities and coarse auscultation crackles bilaterally. Chest x-ray revealed right upper lobe emphysematous changes and bilateral diffuse central opacities with cystic changes. CT chest revealed para-septal emphysema and extensive proximal cystic bronchiectasis bilaterally. Blood tests were negative for HIV, connective tissue disorders, autoimmune disorders and immunodeficiency. The absence of asthma, patient's ethnicity, having biological children and absence of other organ damage, made cystic fibrosis (CF) and allergic bronchopulmonary aspergillosis (ABPA) unlikely. The trachea, left and right mainstem bronchus measured at 30mm, 25mm, 27mm on chest CT with outpouching noted on proximal trachea, which led to the diagnosis of MKS. DISCUSSION: Proximal bronchiectasis is rare. Acquired causes are ABPA, CF, and congenital causes are MKS and William Campbell Syndrome. MKS is a rare congenital abnormality characterized by tracheobronchial dilation due to atrophy of elastic fibers and thinning of smooth muscle layer in the trachea and main bronchi (2) up to 1st to 4th bronchial generations. Clinical manifestations include that of chronic bronchitis and bronchiectasis with recurrent lower respiratory infection. Subtypes include 1) tracheobronchomegaly alone, 2) tracheobronchomegaly with diverticula in the proximal trachea as seen in our patient, 3) tracheobronchomegtly with diverticula extending to lower bronchi. The gold standard diagnostic test for MKS is CT chest. Diagnostic criteria are trachea > 30mm, right main bronchus > 20-24mm, and left main bronchus >18-23mm (3). Airway wall weakness can lead to extensive dynamic airway occlusion further accentuating symptoms. Treatments rely on daily frequent chest physiotherapy with postural drainage, antibiotics during infections, and immunization to help prevent infections and further airway damage. CONCLUSIONS: In patients with bronchiectasis, early diagnosis of tracheobronchomegaly using chest CT criteria will allow for implementation of treatment strategies that will hopefully prevent recurrent infection and further airway damage. REFERENCE #1: Mounier-Kuhn syndrome in a Namibian female patient. Mkandawire MJ, Muramira NM, Mraba N. s.l. : Pan Afr Med J, 2020. REFERENCE #2: Tracheobronchomegaly. The Mounier-Kuhn Syndrome. Katz I, Levine M, Herman P. s.l. : Am Journal Roentgenol Radium Ther Nucl Med. 88:1084-1094. REFERENCE #3: Mounier-Kuhn syndrome: report of 8 cases of tracheobronchomegaly with associated complications. Balakrishnan, Menon, et al. 1, s.l. : Southern Medical Journal, 2008, Vol. 101. pp.83-87. DISCLOSURES: No relevant relationships by Thomas George, source=Web Response No relevant relationships by Padmanabhan Krishnan, source=Web Response No relevant relationships by Nikisha Pandya, source=Web Response No relevant relationships by Gurjit Inder Sidhu, source=Web Response No relevant relationships by Sarita Singh, source=Admin input No relevant relationships by Fardad Zaghi, source=Web Response

Validation of Skully Care as a Fast Method for Quantifying Positional Cranial Deformities.

ObjectiveCraniofacial measuring is valuable for diagnosis and evaluation of growth and treatment of positional skull deformities. Plagiocephalometry (PCM) quantifies skull deformities and is proven to be reliable and valid. However, PCM needs direct skin contact with thermoplastic material, is laborious and time-consuming. Therefore, Skully Care (SC) was developed to measure positional skull deformities with a smartphone application.DesignSC is retrospectively compared to PCM.SettingPediatric physiotherapy centers.PatientsAge ≤1 year, analyzed or treated for positional skull deformities.InterventionsA total of 60 skull shape analyses were performed.Main Outcome MeasuresThe main outcome measures employed are Pearson correlation coefficient between cranial vault asymmetry index (CVAI; in SC) and oblique diameter difference index (ODDI; in PCM) and between cranial index (CI; in SC) and cranial proportional index (CPI; in PCM). Mann–Whitney U test determined difference of time consumption between PCM and SC.ResultsHigh correlation was found between CVAI and ODDI (r = 0.849; P < .01) in positional plagiocephaly and very high correlation between CI and CPI (r = 0.938; P < .01) in positional brachycephaly. SC is significantly faster than PCM (P < .001).ConclusionsSC is valid in analyzing positional skull deformities and strongly correlates to PCM, the gold standard in daily physiotherapy practice. The combination of simplicity, validity, speed, and user and child convenience makes SC a promising craniofacial measuring method in daily practice. SC has potential to be the modern successor for analyzing positional skull deformities.

The functional method: experience from the Robert Debré Hospital.

BackgroundIn the 1970s a conservative treatment for clubfoot (CF) deformity based on daily physiotherapy combining specific sequences was developed: the French functional method (FFM). Over time, the FFM technique has improved and additional measures have been introduced. The aim of this study was to report mid-term and long-term results of clubfeet treated conservatively by the FFM at birth.MethodsAll patients consecutively treated for clubfoot by the FFM between 1993 and 2010 were prospectively included. Initial severity was assessed by the Dimeglio classification. All patients were followed up by the same treating surgeon until skeletal maturity. Final assessment was performed using the International Clubfoot Study Group evaluation system (ICFSG).ResultsA total of 779 feet were included. Surgery was required in 41% of cases (mean age 2.0±0.1 years). The incidence of surgery significantly decreased after the introduction of percutaneous Achilles tenotomy (PAT) in 2000 (63.4% vs. 29.6%). At latest evaluation (mean follow-up 12±0.2 years), 86% of patients had excellent or good outcomes (mean ICFSG was 1.83±0.1). Mean ankle dorsiflexion was 10° in non-idiopathic CF and 12.1° in idiopathic CF. Eleven percent of the idiopathic clubfeet exhibited decreased ankle function (0–10°). There were no cases of overcorrection into excess ankle dorsiflexion or rocker bottom foot deformities.ConclusionsCurrent team was the funding institution of the FFM and several modifications were proposed over times to improve outcomes. Eighty-six percent of feet had excellent to good outcomes according to the ICFSG score, with minimal residual deformities (ankle dorsiflexion between 0° and 10°, calcaneal-thigh angle between 10° and 20°) or insufficient radiological correction (defined by talo-calcaneal angle between 10° and 20°) at latest follow-up.

The effect of in-hospital physiotherapy on handgrip strength and physical activity levels after cardiac valve surgery: a randomized controlled trial.

Patients who undergo cardiac valve surgery undertake routine physical therapy program. Despite its routine use, its influence on physical activity level post- surgery has not been illustrated. This study was to investigate whether 5 days of in-hospital physiotherapy could improve physical activity levels after cardiac valve surgery. The study is a single-blind randomized controlled trial which performed in Cardiothoracic Surgery Department. Patients who underwent cardiac valve surgery (n=34) for confirmed cardiac valve disorders were assessed during hospitalization. The intervention group received a daily post-operative physiotherapy intervention, consisting of individualized mobilization, breathing exercises, ambulation with or without a walking aid. There was no physiotherapy treatment in the control group. Measurements: physical activity was assessed with the handgrip strength test and the timed up and go test. The treatment group showed significantly greater handgrip strength [20.58 (7.17) vs. 12.96 (4.65) kg] and less time on the timed up and go test [5.92 (2.91) vs. 6.53 (1.60) s] compared to the control group on the 5th post-operative day. Whilst there was no significant difference on the timed up and go test between the 2 groups, handgrip strength on the 5th post-operative day was significantly different between the 2 groups. Patients who received physiotherapy during hospitalization showed increased levels of handgrip strength and physical activity on the 5th day after cardiac valve surgery compared to the control group. The clinical value of increased levels of physical activity after in-hospital physiotherapy following cardiac valve surgery requires further investigation.

EPS1.03 Recommended shielding against COVID-19 impacts physical activity levels and adherence to airway clearance therapy in patients with cystic fibrosis

Background: Physical activity and physiotherapy are recommended as components of the cystic fibrosis (CF) treatment regimen. Objectives: To assess the impact of the lockdown during the second wave of the COVID-19 pandemic on daily airway clearance and physical activity levels among patients with CF. Methods: A telephone-based survey on adherence to physiotherapy and physical exercise was conducted among CF patients attending our CF Unit during the “second wave of the pandemic” (November 2020–January 2021). Results: A total of 120 patients were included, mean (StDev) age 13.8 (8.1) years, mean baseline FEV1 pp 101.0 (24.7) %. Before the lockdown, 79.5% of the patients reported performing physiotherapy daily, 8.2% reported performing physiotherapy 2–4 times per week, and 12.3% of the patients reported performing no physiotherapy at all. Most of the CF patients (69%) did not change the frequency of their daily physiotherapy practice during the COVID-19 pandemic. Moreover, 49.2% of the CF patients performed assisted airway clearance by having a physiotherapist visiting their home once a week through a home care program. Only 6.3% of them increased, 33.7% stopped, and 60% did not change the frequency of assisted physiotherapy during the study period. Concerning physical exercise, before the COVID-19 pandemic, 81% of the CF patients reported performing regular exercise. During the quarantine period, 58.4% of the patients needed to change the type of exercise, while 29% reported increasing the frequency, and 48% performed less exercise than before. Conclusions: Strict lockdown measures affected patients’ physical activity levels and their daily airway clearance practice. It is of vital importance to monitor CF patients and give incentives to maintain/increase the adherence to exercise and physiotherapy during such difficult circumstances.