Days Of Rehabilitation Research Articles

Text Messages to Promote Physical Activity in Patients With Cardiovascular Disease: A Micro-Randomized Trial of a Just-In-Time Adaptive Intervention.

Text messages may enhance physical activity levels in patients with cardiovascular disease, including those enrolled in cardiac rehabilitation. However, the independent and long-term effects of text messages remain uncertain. The VALENTINE study (Virtual Application-supported Environment to Increase Exercise) was a micro-randomized trial that delivered text messages through a smartwatch (Apple Watch or Fitbit Versa) to participants initiating cardiac rehabilitation. Participants were randomized 4× per day over 6-months to receive no text message or a message encouraging low-level physical activity. Text messages were tailored on contextual factors (eg, weather). Our primary outcome was step count 60 minutes following a text message, and we used a centered and weighted least squares mean method to estimate causal effects. Given potential measurement differences between devices determined a priori, data were assessed separately for Apple Watch and Fitbit Versa users over 3 time periods corresponding to the initiation (0-30 days), maintenance (31-120 days), and completion (121-182 days) of cardiac rehabilitation. One hundred eight participants were included with 70 552 randomizations over 6 months; mean age was 59.5 (SD, 10.7) years with 36 (32.4%) female and 68 (63.0%) Apple Watch participants. For Apple Watch participants, text messages led to a trend in increased step count by 10% in the 60-minutes following a message during days 1 to 30 (95% CI, -1% to +20%), with no effect from days 31 to 120 (+1% [95% CI, -4% to +5%]), and a significant 6% increase during days 121 to 182 (95% CI, +0% to +11%). For Fitbit users, text messages significantly increased step count by 17% (95% CI, +7% to +28%) in the 60-minutes following a message in the first 30 days of the study with no effect subsequently. In patients undergoing cardiac rehabilitation, contextually tailored text messages may increase physical activity, but this effect varies over time and by device. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04587882.

Effect of inpatient rehabilitation on the quality of life and life satisfaction in spinal cord injury.

Assess the impact of inpatient rehabilitation on the quality of life and life satisfaction of individuals with spinal cord injury by considering the level of injury. QuasiExperimental study. Rehabilitation Hospital. A total of 71 Patients with Spinal cord injury were admitted for rehabilitation. The quality of life and life satisfaction of patients were assessed both before and after 63 days of inpatient rehabilitation. Functional independence measure score (FIM), the Short Form-36 (SF-36), and the Life Satisfaction Scale (LSS). The average age of the study population was 34 ± 14 years. At the end of 63 days, significant improvements were observed in FIM, mood, health, physical performance, role physical, role emotional, pain, and total score of LSS (Π - Value <0.05). The variation in FIM changes significantly improved the total LSS score in the thoracic and thoracolumbar subgroups, but not in the cervical group. In addition, the total score of SF36 was improved significantly just in the cervical subgroup (Π = 0.006). No significant correlations were found between SF-36 and LSS scores (before and after the intervention) in relation to marriage, education, and time. In the context of spinal cord injury, inpatient rehabilitation can play a role in improving functional independence which, in turn, impacts certain aspects affecting life satisfaction and the quality of life. It is important to note that the extent of this correlation varies among patients with different injury levels. In some cases, even minor changes, such as those seen in quadriplegic patients, could have a significant impact on their quality of life.

Osteolytic Lesions in a Sub-Adult Loggerhead Sea Turtle (Caretta caretta): A Case Report.

Osteolytic lesions in loggerhead sea turtles (Caretta caretta) during rehabilitation are attributed to multiple causes, including gas embolism, hypothermia, and osteomyelitis due to bacterial or fungal infection. This study reports the appearance of osteolytic lesions in a sub-adult loggerhead sea turtle with involvement of the right fore and hind flippers, visible swelling of the elbow and knee joints, and accompanied by lameness after 45 days of rehabilitation. Radiographs and computed tomography revealed multiple lytic bone lesions. This was the fourth rehabilitation admission of the turtle after being accidentally captured by trawler ships (bycatch) in 2019, 2020, 2022, and 2023. Potential causes were dysbaric osteonecrosis due to a past decompression sickness event and hypothermia with osteomyelitis from bacterial infection. Blood cultures and antibiotic susceptibility testing led to the isolation of Ewingella americana responsive to enrofloxacin. This study investigates extensive fore and hind flipper involvement in a sub-adult loggerhead turtle, aiming to determine causes and risk factors. The pathogenesis and significance of these lesions is discussed.

Accidental transdermal fentanyl overdose in a child

Fentanyl is a synthetic opioid that provides analgesia for procedures with moderate to severe pain and also can be used to manage acute or chronic pain. Fentanyl is available in several dosing forms and is more widely used as a transdermal patch for the management of chronic pain at home. Accidental exposure to even one dose of fentanyl, especially by children can result in a fatal overdose leading to disturbances of consciousness and/or respiratory depression. A nine-year-old boy was referred to the pediatric emergency department because of disturbed consciousness and respiratory depression. A patch of fentanyl 100 mcg/h was found on the bruised knee during the examination. For treatment, he got naloxone 0.1 mg, infusion therapy and artificial lung ventilation due to respiratory depression. Signs characteristic of acute toxic leukoencephalopathy and hypoxic-ischemic encephalopathy were found on brain magnetic resonance imaging (MRI). After 29 days in the inpatient unit and 120 days of rehabilitation, the patient was discharged home with moderate neurological impairment. Opioid misuse can cause serious life-threatening consequences especially in children resulting in death or severe neurological impairment. When dealing with cases of fentanyl overdose, doctors should keep in mind not only respiratory depression and hypotension, but the presence of toxic leukoencephalopathy as well. These cases may be preventable through better education of prescribers and patients.

Micronutrients and nutritional status among children living with HIV with and without severe acute malnutrition: IMPAACT P1092

BackgroundMicronutrient deficiencies from malabsorption, gut infections, and altered gut barrier function are common in children living with the human immunodeficiency virus (CLHIV) and may worsen with severe acute malnutrition (SAM). Exploratory data of baseline zinc and selenium levels and changes over 48 weeks in children living with HIV by nutritional status are presented.MethodsZinc, selenium, serum protein and albumin levels measured at study entry and over 48 weeks were compared between children aged 6 to < 36 months who were living with HIV and had SAM or mild malnutrition-normal nutrition. Children with SAM were enrolled after 10–18 days of nutritional rehabilitation. Two-sided t-tests were used to compare levels and changes in levels of micronutrients and proteins by nutritional status.ResultsFifty-two participants, 25 with and 27 without SAM, of median (Q1,Q3) age 19 (13,25) and 18 (12,25) months respectively, were enrolled. Zinc deficiency was present at entry in 2/25 (8%) of those who had SAM. Mean (SD) baseline zinc levels were [52.2(15.3) and 54.7(12.0) µg/dL] for the SAM and non-SAM cohorts respectively while selenium levels were similar [92.9(25.0), 84.3(29.2) µg/L]. Mean changes of zinc and selenium from study entry to week 48 were similar between the children with and without SAM. There was no significant difference between baseline protein levels [75.2(13.2), 77.3(9.4) g/L] and the mean change from study entry to 48 weeks was also similar between the two groups; with a mean difference of 4.6 g/L [95% CI, (-2.4,11.6)].Children with SAM compared to those without had significantly lower serum albumin levels at study entry with similar levels at 48 weeks.ConclusionsChildren with severe malnutrition who were initiated/switched to zidovudine/lamivudine/boosted lopinavir following 10 to 18 days of nutritional rehabilitation showed normal baseline levels of selenium and zinc, and had comparable selenium levels after 48 weeks. There was a strong positive correlation in entry and week 48 selenium levels within each cohort and for zinc in the non-SAM cohort. These data support the current WHO recommended approach to management of severe malnutrition in CLHIV who are initiated on combination antiretroviral treatment.Trial registrationRegistered with ClinicalTrials.gov Identifier NCT01818258 26/03/2013.

Implementing early rehabilitation and mobilisation for children in UK paediatric intensive care units: the PERMIT feasibility study.

Early rehabilitation and mobilisation encompass patient-tailored interventions, delivered within intensive care, but there are few studies in children and young people within paediatric intensive care units. To explore how healthcare professionals currently practise early rehabilitation and mobilisation using qualitative and quantitative approaches; co-design the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual of early rehabilitation and mobilisation interventions, with primary and secondary patient-centred outcomes; explore feasibility and acceptability of implementing the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual within three paediatric intensive care units. Mixed-methods feasibility with five interlinked studies (scoping review, survey, observational study, codesign workshops, feasibility study) in three phases. United Kingdom paediatric intensive care units. Children and young people aged 0-16 years remaining within paediatric intensive care on day 3, their parents/guardians and healthcare professionals. In Phase 3, unit-wide implementation of manualised early rehabilitation and mobilisation. Phase 1 observational study: prevalence of any early rehabilitation and mobilisation on day 3. Phase 3 feasibility study: acceptability of early rehabilitation and mobilisation intervention; adverse events; acceptability of study design; acceptability of outcome measures. Searched Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PEDro, Open grey and Cochrane CENTRAL databases. Narrative synthesis. In the scoping review we identified 36 full-text reports evaluating rehabilitation initiated within 7 days of paediatric intensive care unit admission, outlining non-mobility and mobility early rehabilitation and mobilisation interventions from 24 to 72 hours and delivered twice daily. With the survey, 124/191 (65%) responded from 26/29 (90%) United Kingdom paediatric intensive care units; the majority considered early rehabilitation and mobilisation a priority. The observational study followed 169 patients from 15 units; prevalence of any early rehabilitation and mobilisation on day 3 was 95.3%. We then developed a manualised early rehabilitation and mobilisation intervention informed by current evidence, experience and theory. All three sites implemented the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual successfully, recruited to target (30 patients recruited) and followed up the patients until day 30 or discharge; 21/30 parents consented to complete additional outcome measures. The findings represent the views of National Health Service staff but may not be generalisable. We were unable to conduct workshops and interviews with children, young people and parents to support the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual development due to pandemic restrictions. A randomised controlled trial is recommended to assess the effectiveness of the manualised early rehabilitation and mobilisation intervention. A definitive cluster randomised trial of early rehabilitation and mobilisation in paediatric intensive care requires selection of outcome measure and health economic evaluation. The study is registered as PROSPERO CRD42019151050. The Phase 1 observational study is registered Clinicaltrials.gov NCT04110938 (Phase 1) (registered 1 October 2019) and the Phase 3 feasibility study is registered NCT04909762 (Phase 3) (registered 2 June 2021). This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/21/06) and is published in full in Health Technology Assessment; Vol. 27, No. 27. See the NIHR Funding and Awards website for further award information.

The 4DBODY system as a new tool for chest mobility assessment in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory, progressive disease, which leads to deterioration of chest and spine mobility and decrease of physical capacity with abnormal chest movement patterns. We aimed to assess the usefulness of the 4DBODY technology for evaluation of the effectiveness of AS treatment. The 4DBODY technology was assessed on single AS patient with axial involvement. The patient was examined twice, before and after 14 days of rehabilitation. Physiotherapeutic and plethysmographic examinations were used, as well as angular measurement of spine curvatures and measurement of chest mobility. Chest activity measured using the 4DBODY system and the quality of movement were visualized. There was observed an increase of chest mobility from 18 mm to 27.9 mm (up 55%) in the 4DBODY system measurement. The quality of the chest movement also improved, the required phases of inspiration were synchronized. The angular position of the spine has also changed. The chest expansion improved from 25 mm to 50 mm measured on the level of the fourth intercostal space and from 30 mm to 50 mm at the Th10 level. Inspiratory and expiratory muscle strength increased respectively from 80% to 93% and from 46% to 86% of the predicted values. Total airway resistance (Rtot) - increase from 59% to 67%, whereas functional residual capacity (FRC) and total lung capacity (TLC) did not change significantly. The new 4DBODY technology was found to be an effective method of examination and assessment of the effectiveness of rehabilitation of patients with AS.

Non-adaptation to new mandibular complete dentures: A survival analysis and interpretation of the time to adaptation.

To determine the average time it takes for patients to adapt to mandibular complete dentures and the factors associated with this critical period. A total of 108 completely edentulous patients were rehabilitated using complete dentures. Adaptation was evaluated based on the following criteria: mastication, comfort, speech, and swallowing with dentures. Kaplan-Meier analyses were used to estimate the average time to adaptation. Log-rank test was used to assess the adaptation period and associated factors. Of the 108 rehabilitated patients, 89 had adapted to mandibular complete dentures at the 6-month follow-up. The mean time to adaptation estimated from the Kaplan-Meier curve was 78.54 days (95% CI: 71.04 to 86.04). The factors associated with the adaptation period were previous experience with a mandibular denture (P = .032), the professional who made the previous complete dentures (P = .034), frequency of appearance of traumatic lesions after 15 days of rehabilitation (P = .023), posterior mandibular ridge height (P = .005), and regular use of the new dentures (P = .002). Most patients adapted to mandibular dentures after 2.6 months. No prior mandibular denture experience, use of old dentures made by a dental technician, occurrence of traumatic injuries 15 days after complete denture delivery, presence of a resorbed posterior mandibular ridge, and nonregular wear were associated with longer adaptation time to the new mandibular complete dentures.

일주일간의 입원 기간 동안 운동 기반 심장재활이 급성 심근경색 환자의 젖산 수치에 미치는 영향

Purpose: Few studies have been conducted to examine changes in lactate levels associated with the severity of myocardial infarction during cardiac rehabilitation. Thus, this study aimed to investigate the effects of exercise-based cardiac rehabilitation on lactate levels in patients with acute myocardial infarction. Methods: A total of eight patients (7 males and 1 female, aged 64.1 ± 12.8 years) who were diagnosed with acute myocardial infarction and participated in an inpatient cardiac rehabilitation program were included in this study. Lactate levels were measured using Lactate Plus (Nova Biomedical, Rodermark, Germany), which can measure lactate levels from 0.3 to 25.0 mmol/L. Exercise intensity during the inpatient cardiac rehabilitation period was set at 40%-60% of peak oxygen uptake (peak VO2), and cardiopulmonary exercise testing and lactate level measurements were conducted before and after exercise. Normally distributed data were analyzed using paired t-tests, and non-normally distributed data were analyzed using the Wilcoxon signed-rank test. Results: VO2peak and metabolic equivalents significantly increased, and minute ventilation per unit carbon dioxide production showed a decreasing trend but not a significant decrease (p=.014, p=.02). During the one-week inpatient rehabilitation period, lactate levels at rest before exercise on the first and last days of rehabilitation significantly decreased (p=.036). Lactate levels significantly increased immediately after exercise (p=.014), while lactate levels before exercise showed a decreasing trend in all eight patients. Conclusion: In patients with acute myocardial infarction, lactate levels increased immediately after exercise-based cardiac rehabilitation, while lactate levels at rest decreased during the one-week rehabilitation period as aerobic capacity improved.

Etiological factors of chronic pain syndrome in young adults with post-coronavirus disease 2019 condition.

The coronavirus disease 2019 (COVID-19) generates long-term sequelae, but studies investigating patients with chronic pain syndrome (CPS) are limited. This study aimed to establish the etiological factors of CPS in patients with post-COVID-19 conditions. This was a case-control retrospective study. The predictor variables were sex, diabetes mellitus, obesity (predisposing factors), unfavorable socioeconomic conditions, impaired rehabilitation (disabling factors), repeated exposure to COVID-19 (precipitating factor), home isolation, stress overload, fear of dying, admission to intensive care unit, prone positioning, and use of medications (reinforcing factors). The outcome variable was the presence of CPS. This study included 120 individuals. Prolonged days of isolation (p=0.005), fear (p<0.001), stress overload (p<0.001), and impaired rehabilitation (p=0.003) were significantly associated with CPS. A significant relationship was found between prolonged days of isolation, fear, stress overload, impaired rehabilitation, and CPS. The study findings can assist nurses by promoting their knowledge of the causes of CPS and supporting the care planning needs of patients with post-COVID-19 conditions, in addition to promoting the use of the NANDA-International taxonomy.

Cardiac rehabilitation in the Comprehensive Cardiac Care program in the time of a COVID – 19 pandemic

Introduction and purpose: Cardiac rehabilitation in patients after myocardial infarction is an established form of therapy. Its main tasks in the context of the implementation of the KOS program are to improve quality of life, consolidate the effects of hospital treatment and ensure better functioning after a cardiovascular incident. The purpose of this paper is to analyze the current level of knowledge regarding cardiac rehabilitation of patients during the COVID-19 pandemic.&#x0D; Description of the state of knowledge: COVID-19 poses a significant threat to patients with cardiovascular disease. Physiotherapy in the Cardiac Rehabilitation Unit involves a step-by-step, individualized rehabilitation plan in accordance with the patient's condition. An important tool for clinical evaluation is capacity tests, the results of which provide key information for the rehabilitation team in selecting exercise intensity. These tests are performed on the first and last days of rehabilitation. In Polish conditions, the most common tests examining capacity are an exercise test on a treadmill or bicycle cycler or a 6-minute walk test. Due to the diversion of a significant number of specialists and health care teams to treat COVID - 19 patients, access to the possibility of implementing the various stages of the Coordinated Specialized Care program after myocardial infarction has been limited.&#x0D; Summary: Post-infection patients are often forced to live a sparing lifestyle. They show reduced exercise tolerance and easier fatigability. With these aspects in mind, improving the quality of life of patients after cardiovascular incidents in the era of the pandemic requires even greater involvement of the entire rehabilitation team.

The Role of Acute Rehabilitation during the COVID-19 Pandemic: A Retrospective Study in the Czech Republic.

In this retrospective study, we used data from the hospital information system (HIS) to evaluate the influence of the COVID-19 pandemic on rehabilitation care at the University Hospital of Ostrava (UHO). From March 2020 to December 2021, 5173 COVID-19 cases were hospitalized at UHO. Cases within individual groups and categories are shown in a flowchart. The average patient age was 64.9 ± 16.9 years. The mean BMI value was 30.6 ± 6.8 in the rehabilitated group, which was significantly higher compared to that among the non-rehabilitated cases 29.1 ± 6.9 (p < 0.001). Among the admitted patients, 16.6% required artificial pulmonary ventilation (APV), 1.8% extracorporeal membrane oxygenation (ECMO), and 11.9% high-flow oxygenation (HF). The days of rehabilitation ranged from 1-102 days. Among all rehabilitated patients, 92.0% (n = 1302) had a hospitalization duration ranging from 1-15 days and 8.0% (n = 114) longer than 15 days. Overall, rehabilitation care plays an important role in providing exercise, mobilization, and rehabilitation interventions to survivors of critical illness associated with COVID-19, enabling the early and functional return to home, and it must, therefore, be integrated into the clinical care of patients with COVID-19.

Randomized controlled trial to compare conventional physiotherapy with task-oriented exercises after total hip replacement.

Different interventions are used during rehabilitation after hip replacement surgery, but it is unclear if task-oriented exercise is more effective than conventional physiotherapy. This study compared the effectiveness of conventional physiotherapy (CPT) programme with task-oriented exercise (TOE) on hip pain, function, static and dynamic balance during the early rehabilitation stage after total hip replacement. This randomized controlled parallel-group trial was executed in an inpatient physical medicine and rehabilitation centre. The study included 40 patients who were randomly classified into CPT and TOE groups (n= 20 in each). Hip pain (assessed by visual analogue scale), function in the operated leg (assessed by modified Harris Hip Score, mHHS), static balance (assessed by Abili Balance analyser system) and dynamic balance (assessed by Berg Balance Scale) were evaluated at baseline and after 18 days of rehabilitation. Cohen's effect size (d) was calculated. Greater pain reduction (p< 0.05; d= 0.08) was observed after TOE (1.6 ± 0.68 scores) compared with the CPT programme (2.2 ± 0.83 scores). Hip function assessed by the modified mHHS improved more (p< 0.05; d= 0.30) in the TOE group (73.45 ± 6.23 scores) than in the CPT group (54.90 ± 6.28 scores). Static balance improved significantly in both groups after the interventions but did not differ significantly between the groups. The improvement in dynamic balance was significantly greater (p< 0.05; d= 0.45) after TOE (50.55 ± 1.57 scores) than after CPT (38.55 ± 3.43 scores). Both interventions reduced pain and improved function of the operated leg and static and dynamic balance. The effect on hip function was superior for TOE compared with CPT.

Benefits of Acute Rehabilitation in COVID Recovered Patients and Changes in the Current Treatment Guidelines Related to COVID-19

Objective: Over the past year, clinical focus worldwide has centered on the treatment and prevention of COVID-19. The prevalence of this disease continues unabated; consequently, COVID-19 treatment modalities continue to improve. As a result, there are now more survivors of COVID-19. The expansion of this COVID-19 survivor demographic necessitates attention, specifically regarding patient rehabilitation. The benefits that rehabilitation offers to COVID-19 survivors must be examined, especially as this disease has begun to affect individuals with complex comorbidities. Design: Observational Prospective Study that followed 60 patients from admission into the Acute Medical Rehabilitation Hospital from the beginning of the pandemic up until March 2021. Data collected were analyzed to determine the benefit of acute rehabilitation in COVID-19 recovered patients in addition to the changes of the current treatment related to COVID-19. Results: Overall, acute rehabilitation significantly improved patients’ Self-Care and Mobility Section GG (GG) outcomes in their overall functional assessment. The average increase in GG overall was 29.45. Patients that only required 10 days or fewer of rehabilitation had an average GG increase of 34.1. Those that required 11-20 days of rehabilitation had an increase in GG of 26.5. Conclusions: Acute rehabilitation plays a primarily positive role in the outcome of patients with COVID-19. This increase in the GG scores can be attributed to the different therapies provided during their acute inpatient rehabilitation.

An Indo-Pacific humpback dolphin (Sousa chinensis) severely injured by vessel collision: live rescue at sea, clinical care, and postmortem examination using a virtopsy-integrated approach

BackgroundVessel collision induces blunt and sharp force traumas to aquatic animals and is a leading anthropogenic impact affecting cetaceans worldwide. Vessel collision is an important threat affecting vulnerable coastal cetaceans such as the Indo-Pacific humpback dolphins (Sousa chinensis) which reside in coastal waters of Hong Kong amongst heavy marine traffic.Case presentationA severely injured subadult S. chinensis was sighted in the waters off southwestern Hong Kong with four gaping incision wounds on its dorsum. It was in poor body condition and seemed unable to use the fluke effectively. The deepest wound located at the caudal peduncle near the base of the fluke and exposed the underlying fractured caudal vertebrae. The dolphin was monitored in the field over three weeks and eventually captured for medical intervention as veterinary assessment indicated progressive and life-threatening deterioration. During rehabilitation, the dolphin demonstrated initial signs of improvement over the first 36 hours as supported by diagnostic tests but then deteriorated rapidly. It was humanely euthanised after three days of rehabilitation. Postmortem investigation was carried out using virtopsy (postmortem computed tomography and magnetic resonance imaging) and conventional necropsy, with special attention to the traumatic musculoskeletal injuries caused by vessel collision and also revealed acute gastrointestinal compromise and respiratory disease that further hampered the rehabilitation.ConclusionIn cetaceans, the prognosis for recovery from injuries caused by vessel collision depends on the extent, location, and gravity of the injuries (i.e., superficial, deep, penetrating, blunt vs. sharp, fresh vs. septic), as well as the health status of the individual and its ability to respond to the insult. Injuries extending deep into the vertebral column may lead to delayed death and associated welfare issues. The prognosis of this case was likely poor given the severity and location of the injuries, but the attempted rehabilitation and postmortem investigation provided valuable insights for clinical management if similar cases are encountered in the future. Being able to non-invasively assess and document traumatic injuries and other pathologies, diagnostic imaging is particularly useful in the clinical assessment and postmortem investigation (virtopsy) of cases with vessel-induced injuries.

Effectiveness of Rehabilitation on Functional Changes of the Respiratory System in Persons with Severe and Critical Form of Covid-19 Disease

Background. It has been established that the disease of Covid-19 negatively affects the functions of the respiratory system of individuals. Since the disease appeared relatively recently, there are not many studies examining the functional state of the respiratory system of individuals after Covid-19 infection, but it is known that individuals who have suffered from a severe or critical form of the Covid-19 disease are diagnosed with many different complications. The aim. To assess the effectiveness of rehabilitation for functional changes in the respiratory system of persons suffering from a severe and critical form of the Covid-19 disease. Methods. 20 persons (11 men and nine women) aged 54.95±5.02 years who suffered from a severe or critical form of the Covid-19 disease participated in the study. Testing was done twice, before and after rehabilitation. During the study, the subjects’ respiratory system function was evaluated (Stange-Hench sample, respiratory rate, chest excursion, spirometry (VC, FEV, FEV1). Results. After rehabilitation, the parameters of the Stange and Hench functional tests, respiratory rate, chest excursion and Vital Capacity improved. Conclusion. It was established that after 20 days of rehabilitation, the respiratory system function of persons suffering from a severe or critical form of the Covid-19 disease improved. Keywords: Covid-19, Stange and Hench sample, respiratory rate, chest excursion, spirometry.

The role of daily adjustment disorder, depression and anxiety symptoms for the physical activity of cardiac patients.

Physical activity (PA) is crucial in the treatment of cardiac disease. There is a high prevalence of stress-response and affective disorders among cardiac patients, which might be negatively associated with their PA. This study aimed at investigating daily differential associations of International Classification of Diseases (ICD)-11 adjustment disorder, depression and anxiety symptoms with PA and sedentary behaviour (SB) during and right after inpatient cardiac rehabilitation. The sample included N = 129 inpatients in cardiac rehabilitation, Mage = 62.2, s.d.age = 11.3, 84.5% male, n = 2845 days. Adjustment disorder, depression and anxiety symptoms were measured daily during the last 7 days of rehabilitation and for 3 weeks after discharge. Moderate-to-vigorous PA (MVPA), light PA (LPA) and SB were measured with an accelerometer. Bayesian lagged multilevel regressions including all three symptoms to obtain their unique effects were conducted. On days with higher adjustment disorder symptoms than usual, patients engaged in less MVPA, and more SB. Patients with overall higher depression symptoms engaged in less MVPA, less LPA and more SB. On days with higher depression symptoms than usual, there was less MVPA and LPA, and more SB. Patients with higher anxiety symptoms engaged in more LPA and less SB. Results highlight the necessity to screen for and treat adjustment disorder and depression symptoms during cardiac rehabilitation.

A Random Tree Forest decision support system to personalize upper extremity robot-assisted rehabilitation in stroke: a pilot study.

Robotic-based rehabilitation administered by means of serious games certainly represents the frontier of rehabilitation treatments, offering a high degree of customization of therapy, to meet individual patients' needs and to tailor a proper rehabilitation therapy. Despite the rush on developing complex rehabilitation systems, they often do not provide clinicians with long-term information about the outcome of rehabilitation, thus, not supporting them in the initial set-up phase of the therapy. In this paper, a Random-Forest based system was trained and tested to provide a prediction at discharge of several clinical scales outcomes (i.e. FMA, ARAT, and MI), having clinical scale scores and measures from the robotic system at the enrollment as inputs. The dataset includes 25 post-stroke patients from different clinics, that underwent a variable number of days of rehabilitation with a robotic treatment. Results have shown that the system is able to predict the final outcome with an accuracy ranging from 60% to 73% on the selected scales. Also results provide information on which variables are more relevant for the prediction of outcome of therapy, in particular clinical scales scores such as FMA, ARAT, MI, NRS, PCS, and MCS and robotic automatically extracted measurements related to patient's work expenditure and time. This supports the idea of using such a system in a clinical environment in a decision support tool for clinicians.

Early Intensive Physical Rehabilitation Combined with a Protocolized Decannulation Process in Tracheostomized Survivors from Severe COVID-19 Pneumonia with Chronic Critical Illness.

(1) Background: Intensive care unit (ICU) survivors from severe COVID-19 acute respiratory distress syndrome (CARDS) with chronic critical illness (CCI) may be considered vast resource consumers with a poor prognosis. We hypothesized that a holistic approach combining an early intensive rehabilitation with a protocol of difficult weaning would improve patient outcomes (2) Methods: A single-center retrospective study in a five-bed post-ICU weaning and intensive rehabilitation center with a dedicated fitness room specifically equipped to safely deliver physical activity sessions in frail patients with CCI. (3) Results: Among 502 CARDS patients admitted to the ICU from March 2020 to March 2022, 50 consecutive tracheostomized patients were included in the program. After a median of 39 ICU days, 25 days of rehabilitation were needed to restore patients’ autonomy (ADL, from 0 to 6; p < 0.001), to significantly improve their aerobic capacity (6-min walking test distance, from 0 to 253 m; p < 0.001) and to reduce patients’ vulnerability (frailty score, from 7 to 3; p < 0.001) and hospital anxiety and depression scale (HADS, from 18 to 10; p < 0.001). Forty-eight decannulated patients (96%) were discharged home. (4) Conclusions: A protocolized weaning strategy combined with early intensive rehabilitation in a dedicated specialized center boosted the physical and mental recovery.

Changes in Muscle Quality after Physical Rehabilitation Reduce Blood Pressure in Weightlifters with Arterial Hypertension: Randomized Controlled Trial

Hypertension is a frequent diagnosis in power athletes. Aim. To assess the effect of increased muscle oxidative capacity on blood pressure in athletes with arterial hypertension from power sports, heavy weight categories. Material and methods. The study was conducted at the Department of Sports Medicine of the Russian State University of Physical Culture, Sports, Youth and Tourism and lasted 180 days. The study involved 65 representatives of strength sports (weightlifting), heavy weight categories with arterial hypertension. Athletes were randomized into two main groups: the HIIT (High Intensity Interval Training, n=23) group, the MICE (Moderate Intensity Continuous Exercise, n=22) group and the RT (Resistance Training, n=20) control group. The following methods were used to achieve the aim of the study: ergospirometry, muscle tissue oxygenation level measurement, blood pressure measurement and methods of mathematical statistics. Athletes in the main groups trained for 180 days (3 times per week) on a cycle ergometer using a high-intensity interval and uniform protocol, and participants in the control group trained for 180 days (3 times per week) according to their traditional strength protocol. Results. After 180 days of physical rehabilitation, participants of the main groups had increased oxygen consumption at the anaerobic threshold, decreased thigh muscle oxygenation and increased maximum oxygen consumption, resulting in an average decrease in systolic blood pressure of 11.1 mm Hg and diastolic blood pressure of 11.2 mm Hg in the intervention groups. Conclusion. The physical rehabilitation systems we have developed for power athletes allow us to effectively and safely influence the oxidative capacity of working muscles and blood pressure, but the time spent by athletes on non-specific training activities in the HIIT system is 38% less.