Daily Physiotherapy Research Articles

WS21.3 Acute changes in the lung clearance index after physiotherapy in children with cystic fibrosis

Objectives The lung clearance index (LCI) is becoming a prominent endpoint for assessing interventions in cystic fibrosis (CF) concurrent with daily physiotherapy. We examined the acute time-course of change in LCI following positive expiratory pressure (PEP) chest physiotherapy in children with an acute pulmonary exacerbation of CF. Methods To assess the repeatability of our LCI measurements, 71 children, aged 8–18, with stable CF performed multiple-breath nitrogen washout (MBNW) reporting LCI. For the main study, 39 children, aged 8–18, admitted for acute exacerbations of CF were recruited on day 5 of admission to perform MBNW, spirometry and body plethysmography prior to supervised PEP. MBNW was then performed immediately after PEP, and at 1, 2 and 3 hours post-intervention. All lung function tests were repeated 24 hours after baseline measurement. Results Repeatability, expressed as the coefficient of variation (CoV), of LCI was 6.1(3.2)% in subjects with stable CF and 8.7(3.4)% in those with a pulmonary exacerbation. PEP significantly increased LCI, peaking at 1 hour post-intervention (8.82 to 9.81, p Conclusion The CoV for LCI was low in stable CF but increased in those with pulmonary exacerbations. In subjects with a pulmonary exacerbation of CF, ventilation inhomogeneity (LCI) acutely increases after physiotherapy on a background of overall improvement over 24 hours. This indicates standardisation of time of LCI measurement with respect to physiotherapy is required.

Counseling Children With Cystic Fibrosis: Recommendations for Practice and Counselor Self-Care

Cystic fibrosis is a progressive, chronic disease that affects approximately 30,000 adults and children in the United States. Counseling children with the special needs specific to cystic fibrosis can be overwhelming for mental health professionals due to the progressive and deteriorating nature of the illness, long-term contact with clients, and discouraging prognosis. Being exposed to long-term therapeutic relationships with chronically ill children and witnessing treatment failure can contribute to burnout, compassion fatigue and vicarious trauma in counselors, highlighting the need for targeted literature addressing holistic self-care strategies. The purpose of this manuscript is to provide a review of the current literature illuminating the challenges facing children with cystic fibrosis and to provide targeted self-care suggestions for professional counselors working with this population.Keywords: children, chronic disease, compassion fatigue, cystic fibrosis, self-careCystic fibrosis (CF) is a chronic, terminal disease targeting most organ systems (Withers, 2012) and affects approximately 30,000 children and adults nationwide (Cystic Fibrosis Foundation [CFF], 2014a). CF primarily affects the gastrointestinal and respiratory systems (Withers, 2012), and although the life expectancy has greatly improved, CF is fatal and there is no known cure (CFF, 2014a). Counseling children with chronic illnesses, such as CF, presents special challenges for mental health professionals (Sidell, 1997), including professional counselors. As the nature and severity of clients' problems impact levels of counselor burnout or compassion fatigue (Figley, 2002), it is essential that professional counselors working with children with CF maintain healthy self-care practices.There is an abundance of information examining the physiological aspects of CF that clients experience throughout the disease progression (CFF, 2014a; Pearson, Pumariega, & Seilheimer, 1991; Sawicki, Sellers, & Robinson, 2009; Sawicki & Tiddens, 2012). However, there is limited literature on the special considerations that need to be taken when counseling children with CF. Furthermore, there is a paucity of counseling literature targeting how professional counselors can foster personal self-care while working with young clients with special needs and chronic conditions. The purpose of this manuscript is to provide a review of literature that illuminates the challenges facing children with CF and provides a primer for self-care suggestions for professional counselors who work with these children.Special Needs of Children with Cystic FibrosisPhysiological Challenges Facing Children with Cystic FibrosisProfessional counselors need to be knowledgeable of chronic diseases affecting their clients in order to be sensitive to the traumas experienced by children and families coping with illness (Thompson & Henderson, 2007). CF is most commonly diagnosed during newborn screening and severely affects the exocrine system (CFF, 2014b). Within the exocrine system, there is a lack of appropriate enzymes available during digestion, so children with CF are unable to properly digest their food and absorb essential nutrients for healthy growth and development. They experience recurrent gastrointestinal distress such as issues of diarrhea and constipation with foul-smelling stools due to poor absorption (CF Living, 2014). As such, children with CF often suffer from malnutrition and an inability to maintain a healthy weight. However, the most notable signs and symptoms affecting children with CF result from chronic lung and respiratory infections that lead to frequent coughing spells to clear the lungs of thick mucus. This inability to clear the lungs requires multiple episodes of daily chest physiotherapy (Berge & Patterson, 2004). Over time, the respiratory infections produce lung damage that appears cyst-like, giving name to the disease cystic fibrosis (CFF, 2014a). …

Targeted Ultrasound-Guided Double Catheters (Infraclavicular-Brachial Plexus, Median Nerve) Facilitate Hand Rehabilitation with Superb Analgesia and Motor Function Retention

A 44-year-old male who suffered a crush-degloving hand injury complicated by Complex Regional Pain Syndrome (CRPS) type I was scheduled for operative hand manipulation and inpatient physiotherapy. Preoperative placement of an ultrasound-guided infraclavicular catheter provided incomplete analgesia requiring supplemental morphine during physiotherapy sessions despite continuous infusion of 0.1% bupivacaine at 20 mL/hour. Due to the patient’s adamant refusal of replacement of the infraclavicular catheter, a second ultrasound-guided median nerve catheter was placed distally at the mid-forearm level and elicited complete sensory blockade of the hand. Dual infusions were maintained with 0.25% bupivacaine at 5 mL/hour through the median nerve catheter and 0.1% bupivacaine at 20 mL/hour through the infraclavicular catheter, and subsequent daily physiotherapy progressed productively. Continuous perineural catheter use to facilitate rehabilitation is an emerging practice that may improve overall recovery. Combination catheters, infusing local anesthetics at separate locations, can be used synergistically to preserve motor function and reach a superior analgesic endpoint.

Myofascial Pain: An Update

Background: Myofascial pain, and its characteristic myofascial trigger points, is very common in physiotherapy practice. Objective/Method: This article, an update from 2006, reviews the latest research and points out some potential clinical implications for daily physiotherapy practice. Results/Conclusions: Myofascial pain is beginning to gain recognition as a neuromuscular disease and scientific studies of myofascial trigger points (MTrP) have found objective abnormalities that, together with observed changes in motor and sensory characteristics, implicate peripheral and central mechanisms in the development of myofascial pain. Beyond a primary muscle cause, predisposing and precipitating factors and remote lesions can be present, and need management as well.

An intensive physiotherapy program improves mobility for trauma patients

Physiotherapy is integral to modern trauma care. Early physiotherapy and mobility have been shown to improve outcomes in patients with isolated injuries; however, the optimal intensity of physiotherapy in the multitrauma patient population has not yet been examined. The primary aim of this study was to determine whether an intensive physiotherapy program resulted in improved inpatient mobility. We conducted a single-center prospective randomized controlled study of 90 consecutive patients admitted to the Alfred Hospital (a Level 1 trauma center) in Australia between October 2011 and June 2012 who could participate in ward-based physiotherapy. Participants were allocated to either usual care (daily physiotherapy treatment, approximately 30 minutes) or intensive physiotherapy (usual care plus two additional 30-minute treatments each day). The primary outcome measure was the modified Iowa Level of Assistance (mILOA) score, collected by a blinded assessor at Days 3 and 5 (or earlier if discharged). Secondary measures included physical readiness for discharge, hospital and rehabilitation length of stay, a patient confidence and satisfaction scale, and quality of life at 6 months. Groups were comparable at baseline. Participants in the intensive physiotherapy group achieved significantly improved mILOA scores on Day 3 (median, 7 points compared with 10 points; p = 0.02) and Day 5 (median, 7.5 points compared with 16 points; p = 0.04) and were more satisfied with their care (p = 0.01). There was no difference between groups in time to physical readiness, discharge destination, length of stay, or quality-of-life measures. Intensive physiotherapy resulted in improved mobility in trauma inpatients. Further studies are required to determine if specific groups benefit more from intensive physiotherapy and if this translates to long-term improvements in outcomes. Therapeutic study, level 1.

Voyage au pays de… PubMed

The Evidence-based medicine (EBM) should be part of daily physiotherapy. The PubMed search engine is the means to access the 21 million citations from 5 400 journals grouped into the medical world. This article is a practical guide to using PubMed service of the physiotherapist in their daily practice of EBM. Level of evidencenon applicable

Efectos de la antibioterapia y la técnica fisioterápica respiratoria en pacientes con fibrosis quística tratados por exacerbación pulmonar aguda: estudio experimental

Introduction: Intravenous antibiotics in combination with intensive respiratory physiotherapy were evaluated for acute lung exacerbations in chronic infections of Pseudomonas aeruginosa in cystic fibrosis patients. Forced expiratory technique (FET) was assessed during hospital stay and discharge. The aim of this study was 1) to evaluate the immediate effects of FET and of 2) Intravenous antibiotics in combination with daily respiratory physiotherapy (IA+RPT) on parameters of lung function, body anthropometry and clinical scores of cystic fibrosis patients with acute lung exacerbation with chronic infection by Pseudomonas aeruginosa, during hospital stay and at hospital discharge after clearing the infection. Patients and method: Eighteen patients between 7–28 years old were included in a prospective non-controlled clinical study. Body anthropometry values, Cystic Fibrosis Clinical Score (CFCS)

A prospective study of mechanical physiotherapy for lumbar disk prolapse: Five year follow-up and final report

To evaluate the long-term effect of a specific conservative treatment method for patients with lumbar disc prolapse. Low back pain and symptoms of disc herniation have a good prognosis. Yet the rates of disability and sick-leave because of recurrences are high and cost-intensive. Fifty consecutive patients with clinically and neuroradiologically confirmed lumbar disk prolapse, who responded to the first five daily physiotherapy sessions with pain centralization, were prospectively treated with mechanical physiotherapy with repeated end range spinal movements and leg movements. The results after one year of follow-up have been published previously (J Neurology 250 (2003), 746-749). From the initial cohort of 50 patients, 5 patients were operated within one year after discharge and one patient died. One patient had surgery for disc prolapse 13 months after discharge. Three patients were lost for follow-up. None of the 40 remaining patients has had surgery until the last follow-up. Pain centralization during the first 5 treatment sessions of mechanical physiotherapy is a useful diagnostic tool to predict a good longterm outcome. Mechanical physiotherapy with end range spinal movements and leg movements is an effective treatment strategy for many patients with lumbar disk disease.

Die operative Behandlung von Streckdefiziten am Kniegelenk

Restoration of full knee extension in patients with chronic extension deficits, especially in posttraumatic and postoperative cases. Chronic knee extension deficits of more than 10 degrees . Local intraarticular problems caused by cyclops syndrome, graft hypertrophy or graft impingement after anterior cruciate ligament reconstruction (notch impingement). These patients should be treated with arthroscopic procedures. Spastic flexion contracture. Noncompliant patients. Acute or chronic infections. Poor soft-tissue conditions on site of surgery. If necessary, arthroscopy before arthrolysis to assure that the extension deficit is not caused by a local problem (cyclops, osteophytes, graft hypertrophy or graft impingement after anterior cruciate ligament reconstruction). Anterior skin incision at the medial border of the patellar ligament. Resection of Hoffa's fat pad, which is extremely fibrotic in almost all cases. Second skin incision at the posteromedial side of the knee joint. Incision of the medial retinaculum between the posterior border of the medial collateral ligament and the posterior oblique ligament. Posteromedial arthrotomy between the distal part of the tendon of the adductor magnus muscle and the posterior horn of the medial meniscus. Release of all adhesions in the posterior recess of the knee joint. Complete release of the posterior joint capsule from the femoral shaft. Immobilization for 48 h after surgery in full extension (no knee motion allowed in the first 48 h). For 48 h after surgery only short walks to the bathroom are allowed. Special dynamic extension brace (Dynasplint((R)), CDS((R)) Forte, Albrecht company, Stephanskirchen, Germany) for 4-6 weeks after surgery 6-8 h per day. Painkillers following WHO (World Health Organization) protocol. Manual lymph drainage and electric muscle stimulation help to decrease pain and swelling. Physiotherapy twice daily starting at the 2nd postoperative day. No flexion exercises for the first 7 days after surgery. 15 kg partial weight bearing for 4-6 weeks. Daily physiotherapy is recommended after discharge. 121 patients underwent anterior and posterior arthrolysis between 1990 and 2000. 86 of these patients could be included in this study. The average follow-up was 4.6 years (1-10 years). The extension deficit before surgery averaged 20 degrees compared with the opposite side. At follow-up, the average extension had increased by 17 degrees , no patient had more than 5 degrees of flexion contracture. The Lysholm Score was 84 postoperatively. The Tegner Activity Scale increased from 1.9 to 4.0 after arthrolysis. In the AOSSM Subjective Outcome Score, 35 patients showed excellent and 60 good results. 14 patients were satisfied after surgery and nine were not. Three patients required revision surgery (two synovial fistulas, one hematoma).

Continuous passive motion provides good pain control in patients with adhesive capsulitis

Painful stiffening of the shoulder, 'frozen shoulder' is a common cause of shoulder pain and disability. Continuous passive motion (CPM) is an established method of preventing joint stiffness and of overcoming it. A randomized, comparative prospective clinical trial was planned to compare the early response with different rehabilitation methods [CPM vs. conventional physiotherapy treatment (CPT) protocol] for adhesive capsulitis taking into consideration the clinical efficacy. A total of 57 patients with frozen shoulder were included in this study. Patients were assigned randomly to receive daily CPM treatments or CPT protocol. Parameters were measured at baseline, and at weeks 4 and 12. All patients were evaluated with respect to pain (visual anologue scale) at rest, pain at movement, pain at night, measurement of range of motion (shoulder flexion, abduction, internal-external rotation were assessed), constant functional shoulder score and the shoulder pain and disability index. The first group (n=29) (CPM group) received CPM treatments for 1 h once a day for 20 days during a period of 4 weeks. The second group (n=28) (CPT group) had a daily physiotherapy treatment protocol including active stretching and pendulum exercises for 1 h once a day for 20 days during a period of 4 weeks. All patients in both groups were also instructed in a standardized home exercise programme consisting of passive range of motion and pendulum exercises to be performed every day. In both groups, statistically significant improvements were detected in all outcome measures compared with baseline. Pain reduction, however, evaluated with respect to pain at rest, at movement and at night was better in CPM group. In addition the CPM group showed better shoulder pain index scores than the CPT group. CPM treatment provides better response in pain reduction than the conventional physiotherapy treatment protocol in the early phase of treatment in adhesive capsulitis.

Comparison of two types of Constraint-Induced Movement Therapy in chronic stroke patients: A pilot study

Several studies showed that Constraint-Induced Movement Therapy (CIMT) leads to a lasting improvement of upper extremity function in chronic stroke patients. The original technique includes an intensive 2-week program with 6 hours of daily physiotherapy. Due to high expenses it is difficult to implement this concept in outpatient care. The objective of this study was to evaluate the effects of a 4-week homebased CIMT program among chronic stroke patients and to compare them with a 2-week CIMT program, based on the original technique. Seven adults with chronic stroke completed a newly developed variant of CIMT, performed at patients' homes (group1, CIMThome), supervised by an instructed family member, constraint of unaffected hand for a target of 60% of waking hours. The intervention was analysed with pre-, post-treatment and 6-month follow-up measurements. Effects on improvement in upper extremity function were compared with patients treated according to the original protocol (group2, CIMTclassic), supervised by a physiotherapist, constraint of unaffected hand for a target of 90% of waking hours. Patients from both groups showed almost identical improvement of their motor function according to scores on the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL) immediately after the treatment period as well as at follow-up after 6 months. Our study suggests that CIMThome is not only feasible but also as effective as CIMTclassic. This finding should be replicated in a larger prospective randomized trial to perform a non-inferiority analysis.

Postoperative pain after hip fracture is procedure specific

BackgroundHip fracture patients experience high pain levels during postoperative rehabilitation. The role of surgical technique on postoperative pain has not been evaluated previously. MethodsOne hundred and seventeen hip fracture patients were included in a descriptive prospective study. All patients received continuous epidural analgesia and were treated according to a standardized perioperative rehabilitation programme. Resting pain, pain on hip flexion, and walking were measured during daily physiotherapy sessions on a verbal five-point rating scale during the first four postoperative days. Patients were stratified into four groups according to surgical procedure: screws or pins, arthroplasty, dynamic hip screw (DHS), and intra-medullary hip screw (IMHS). ResultsCumulated pain levels were significantly different between surgical procedures both for hip flexion (P=0.002) and for walking (P=0.02) with highest dynamic pain levels for patients who had either DHSs or IMHSs compared with arthroplasty or parallel implants. There were significant negative correlations between ambulatory capacity assessed by the cumulated ambulation score and both the dynamic cumulated pain scores on hip flexion (r=−0.43, P<0.001) and walking (r=−0.36, P=0.004). ConclusionsPostoperative pain levels after surgery for hip fracture are dependent on the surgical procedure, which should be taken into account in future studies of analgesia and rehabilitation.

Effects of Intensive Physiotherapy in Infants Newly Diagnosed with Cerebral Palsy

This study was designed to examine effects of blocks of daily physiotherapy in 5 infants with cerebral palsy. A single-subject design was used. Intervention consisted of two 4-week periods of daily physiotherapy, interrupted by 8 weeks of physiotherapy as usual. The children were assessed every 4th week using the Gross Motor Function Measure. Results were visually analyzed, and statistical significance of Gross Motor Function Measure-66 scores was established with the 2 SD band method. Compliance was high. All infants showed gross motor progress compared with baseline, but separating effect of daily physiotherapy from physiotherapy as usual was inconclusive. Parents preferred the intensive treatment alternative. Blocks of intensive therapy can be an alternative to regular dosage of physiotherapy, but until further studies are conducted, the physiotherapy intervention, intensity, and frequency should be tailored to meet the needs of each individual infant and family.

Intensive group training protocol versus guideline physiotherapy for patients with chronic low back pain: a randomised controlled trial

Intensive group training using principles of graded activity has been proven to be effective in occupational care for workers with chronic low back pain. Objective of the study was to compare the effects of an intensive group training protocol aimed at returning to normal daily activities and guideline physiotherapy for primary care patients with non-specific chronic low back pain. The study was designed as pragmatic randomised controlled trial with a setup of 105 primary care physiotherapists in 49 practices and 114 patients with non-specific low back pain of more than 12 weeks duration participated in the study. In the intensive group training protocol exercise therapy, back school and operant-conditioning behavioural principles are combined. Patients were treated during 10 individual sessions along 20 group sessions. Usual care consisted of physiotherapy according to the Dutch guidelines for Low Back Pain. Main outcome measures were functional disability (Roland Morris disability questionnaire), pain intensity, perceived recovery and sick leave because of low back pain assessed at baseline and after 6, 13, 26 and 52 weeks. Both an intention-to-treat analysis and a per-protocol analysis were performed. Multilevel analysis did not show significant differences between both treatment groups on any outcome measures during the complete follow-up period, with one exception. After 26 weeks the protocol group showed more reduction in pain intensity than the guideline group, but this difference was absent after 52 weeks. We finally conclude that an intensive group training protocol was not more effective than usual physiotherapy for chronic low back pain.

Finding consensus on the physiotherapy management of asymptomatic infants with cystic fibrosis

Babies with cystic fibrosis diagnosed by neonatal screening often display no overt signs of respiratory disease. The role of traditional routine daily chest physiotherapy in this particular group of babies is unclear and has generated considerable international debate. There is currently no evidence addressing this issue and present circumstances preclude a rigorous trial in the UK. This study aimed to provide expert consensus regarding the physiotherapy management of asymptomatic infants with CF. A Delphi consensus method was used to gather and refine expert opinions of senior paediatric physiotherapists in the UK. Agreement was sought on 16 statements reflecting aspects of physiotherapy management in 'asymptomatic' babies with cystic fibrosis. Twenty-five senior paediatric physiotherapists from Specialist CF Centres throughout the UK participated in the study. Consensus was high amongst the respondents for 15 of the 16 statements. One statement failed to reach consensus. This related to the question of not routinely initiating a daily chest physiotherapy regimen in apparently healthy babies. Due to the lack of consensus an amendment to this statement was made, to allow a more flexible approach, where physiotherapists would not be obliged to initiate routine daily treatment in asymptomatic babies with CF, if they felt other another approach was justified. There was high consensus of opinion amongst senior physiotherapists in the UK on most aspects of the physiotherapy management of babies with CF. Consensus could not be achieved on whether routine daily chest physiotherapy is necessary in 'asymptomatic' babies. An agreed amendment to the original statement allows professionals to modify or change traditional practice with the sanction of their senior colleagues. The results of this process will be used by the Association of Chartered Physiotherapists in Cystic Fibrosis to form the basis of national clinical guidelines.

Let's play our part in the screening programme

Like many commuters in London, I like to pick up a copy of the newspaper Metro to glance through on my way to work. This morning my attention was immediately caught by the headline, ‘Brown's son has cystic fibrosis’. Gordon Brown has revealed that his son has been diagnosed with the disease, which put me in mind of this issue's theme of newborn screening. Apparently, the baby was diagnosed early which, although a tragedy, means with treatment he should avoid serious lung damage. Currently there is screening for cystic fibrosis in Scotland, Wales and Northern Ireland but in only certain areas of England (Cystic Fibrosis (CF) Trust, 2006). However, there are plans for phased implementation of screening for all babies by April 2007, a move which I welcome. My cousin has cystic fibrosis and, like other people in her position, she has undergone a strict regime of daily medication and physiotherapy her entire life. Luckily she has always been keen on swimming, which is considered particularly useful for draining the mucus from the lungs and other organs, and she is now a healthy nineteen-yearold enjoying university. The average life expectancy for a person with cystic fibrosis is thirty-one years (CF Trust, 2006).

Let's play our part in the screening programme

Like many commuters in London, I like to pick up a copy of the newspaper Metro to glance through on my way to work. This morning my attention was immediately caught by the headline, ‘Brown's son has cystic fibrosis’. Gordon Brown has revealed that his son has been diagnosed with the disease, which put me in mind of this issue's theme of newborn screening. Apparently, the baby was diagnosed early which, although a tragedy, means with treatment he should avoid serious lung damage. Currently there is screening for cystic fibrosis in Scotland, Wales and Northern Ireland but in only certain areas of England (Cystic Fibrosis (CF) Trust, 2006). However, there are plans for phased implementation of screening for all babies by April 2007, a move which I welcome. My cousin has cystic fibrosis and, like other people in her position, she has undergone a strict regime of daily medication and physiotherapy her entire life. Luckily she has always been keen on swimming, which is considered particularly useful for draining the mucus from the lungs and other organs, and she is now a healthy nineteen-yearold enjoying university. The average life expectancy for a person with cystic fibrosis is thirty-one years (CF Trust, 2006).

Predictive Factors of Response to Intensive Decongestive Physiotherapy in Upper Limb Lymphedema After Breast Cancer Treatment: a Cohort Study

Lymphedema is a frequent complication after breast cancer treatment. Reduction of lymphedema volume is obtained during an intensive phase with daily physiotherapy. Response to treatment remains unknown prior treatment. We purposed to analyze predictors of response of lymphedema treatment throughout the first course of physiotherapy. Patients with secondary arm lymphedema were recruited in a single lymphology unit between 2001 and 2004. For each patient, the following data were recorded: characteristics of breast cancer treatment, patient characteristics, body mass index and lymphedema volume prior and at the end of treatment. Three hundred and fifty-seven women (mean age: 53+/-11 years) were included. Initial excess volume of lymphedema was correlated to body mass index and duration of lymphedema. Mean duration of intensive decongestive therapy was 11.8+/-3.3 days. Mean excess volume of lymphedema was 1067+/-622 ml prior treatment and 663+/-366 ml after treatment (p<0.001), percentage of excess volume of lymphedema was 59+/-34% and 36+/-19%, respectively. Absolute volume reduction was 404+/-33 ml (p<0.001). Body mass index and duration of lymphedema before treatment were the two predictors of absolute reduction of lymphedema volume. Higher was the body mass index or the duration of lymphedema, more important was the absolute reduction of lymphedema volume. Mean relative percentage of volume reduction was 36+/-14% whatever mass index or the duration of lymphedema was. Duration of lymphedema from cancer treatment and body mass index were the only two predictors of absolute reduction of lymphedema volume after intensive decongestive physiotherapy. For all patients this latter treatment is highly effective in management of secondary upper limb lymphedema after breast cancer.

Rehabilitation of West Nile Fever (WNF) encephalitis in elderly

In the summer of 2000, an outbreak of WNF affected Israel. Thirty-two elderly patients were admitted to Meir Hospital. WNF encephalitis may result in residual functional damage. However, little information is available regarding the rehabilitation of these patients. Five elderly subjects with residual functional damage were referred to geriatric rehabilitation. Patients were treated with the routine program for neurological rehabilitation after stroke, including daily physiotherapy and occupational therapy. All five were over 77 years and independent before admission. The mean FIM score on admission was 71 (S.D. = ±8.5) and increased to 102 (S.D. = ±14) on discharge. MMSE on admission was 60% (S.D. = ±7.5%), and increased to over 90% on discharge in all of the patients. Clock Completion Test was normal in four on admission, and improved to normal in the fifth patient on discharge. WNF encephalitis may present with functional and intellectual impairment in the elderly. Routine geriatric neurological rehabilitation may benefit those with prolonged functional decline.

“Wandering resident” surgical exposure for 1- or 2-stage revision arthroplasty in stiff aseptic and septic knee arthroplasty

A retrospective study was performed on 18 patients who had undergone revision total knee arthroplasty (TKA) between 1992 and 2000 with stiff knee (average, 50° range of motion). The so-called “wandering resident” surgical exposure was used. This procedure was used twice in 5 cases with low-grade infection in a 2-stage revision of their septic prosthesis. Follow-up was from 1 to 8 years (average, 3.5 years). All patients had good clinical results, with an 86° average range of motion. The Knee Society Score preoperatively ranged from 35 to 52 (average, 40) and improved to 72 to 89 (average, 84). Postoperative rehabilitation was slower, requiring the use of a knee brace in extension for 6 weeks for support while the patient ambulated and without this support for daily physiotherapy and continuous passive motion at 0° to 70°. Full range of motion with no brace was started after 6 weeks.