Rehabilitation Medicine Department Research Articles

Intervention Effect of Rehabilitation Robotic Bed Under Machine Learning Combined With Intensive Motor Training on Stroke Patients With Hemiplegia.

It was aimed to discuss the effect of bed-type rehabilitation robots under machine learning combined with intensive motor training on the motor function of lower limbs of stroke patients with hemiplegia. A total of 80 patients with stroke hemiplegia were taken as the subjects, who all had a course of treatment for less than 6 months in the Rehabilitation Medicine Department of Ganzhou Hospital. These patients were divided into the experimental group (40 cases) and the control group (40 cases) by random number method. For patients in the control group, conventional intensive motor training was adopted, whereas the conventional intensive motor training combined with the bed-type rehabilitation robot under machine learning was applied for patients in the experimental group. Fugl-Meyer Assessment of Lower Extremity (FMA-LE), Rivermead Mobility Index (RMI), and Modified Barthel Index (MBI) were used to evaluate the motor function and mobility of patients. The human–machine collaboration experiment system was constructed, and the software and hardware of the control system were designed. Then, the experimental platform for lower limb rehabilitation training robots was built, and the rehabilitation training methods for stroke patients with hemiplegia were determined by completing the contact force experiment. The results showed that the prediction effect of back-propagation neural network (BPNN) was better than that of the radial basis neural network (RBNN). The bed-type rehabilitation robot under machine learning combined with intensive motor training could significantly improve the motor function and mobility of the lower limbs of stroke patients with hemiplegia.

The Safety of Food and Drink Consistencies Based on a Fiberoptic Endoscopic Evaluation of Swallowing Study Results in Stroke Patients with Dysphagia

Objective: Knowing such dysphagic stroke patients’ ability to swallow various food consistencies from instrumental investigations will help the medical staff choose the appropriate and safe food consistencies, and lead to a better swallowing outcome. This study aimed to determine the safety of food textures and drink consistencies in stroke patients with dysphagia.Materials and Methods: Stroke patients who failed the small-volume water swallow test (WST) and underwent fiberoptic endoscopic evaluation of swallowing (FEES) at the Department of Rehabilitation Medicine from 2017 to 2020 were reviewed. The patients’ characteristics and safe food textures and drink consistencies from their FEES results were collected. They were given a bolus test, which included four modified food textures and three varying drink consistencies, as adapted from the International Dysphagia Diet Standardization Initiative. The sequence of bolus test was adjusted by participants’ swallowing abilities individually. Moreover, their compensatory techniques were reviewed.Results: Forty-three participants were recruited. Most of them (81.3%) could safely swallow one consistency of drink. Twenty-five (58.1%) could safely swallow a mildly thick liquid. About 20% of them could not safely swallow any food textures. Most participants (76%) who safely swallowed a mildly thick liquid could also safely swallow at least one kind of food texture. About half of them (53%) used the chin-tuck technique during the FEES testing.Conclusion: Half of stroke patients with dysphagia who failed small-volume WST could safely swallow with a mildly thick liquid with compensatory techniques. Therefore, they should be referred to dysphagia specialists for comprehensive evaluation and management.

Informatics Research on Mental Health Functioning: Decision Support for the Social Security Administration Disability Program.

The disability determination process of the Social Security Administration's (SSA's) disability program requires assessing work-related functioning for individual claimants alleging disability due to mental impairment. This task is particularly challenging because the determination process involves the review of a large file of information, including objective medical evidence and self-reports from claimants, families, and former employers. To improve this decision-making process, SSA entered an interagency agreement with the Rehabilitation Medicine Department, Epidemiology and Biostatistics Section, in the Clinical Center of the National Institutes of Health, intending to use data science and informatics to develop decision support tools. This collaborative effort over the past decade has led to the development of the Work Disability-Functional Assessment Battery and has initiated an approach to applying natural language processing to the review of claimants' files for information on mental health functioning. This informatics research collaboration holds promise for improving the process of disability determination for individuals with mental impairments who make claims at the SSA.

Clinical Efficacy of Cervical Core Strengthening Exercise in the Treatment of Cervicogenic Headache

<bold>Objective</bold> To explore the clinical efficacy of cervical core strengthening exercise in the treatment of cervicogenic headache. <bold>Methods</bold> A total of 168 patients with cervicogenic headache who visited Rehabilitation Medicine Department of Beijing Jishuitan Hospital from January 2016 to December 2017 were randomly divided into control group and treatment group using a random number table sampling method, with 84 cases in each group. The patients in the control group were treated with conventional treatment, including taking rest, treating with therapeutic modalities, oral drugs. Therapeutic modalities included ultrashort wave, interferential current therapy, laser, magnetic therapy (15 minutes per time, once per day). On the other hand, drug therapy included nonsteroidal anti-inflammatory drugs, eperisone hydrochloride and gabapentin, etc. In addition of the conventional treatment, the treatment group also participated in strengthening exercise of anterior, posterior and lateral core muscles of cervical vertebra (each movement held for 10 seconds, 20 movements at a time, and 5 sets of exercise per day) for 4 weeks. Furthermore, it was changed to 2 sets of exercise per day for 12 months. In addition, visual analog scale (VAS) score, Hamilton's Depression Scale-17 (HAMD-17), Pittsburgh Sleep Quality Index (PSQI) and Patients' Global Impression of Change (PGIC) scale were evaluated before treatment and at 1 month, 3 months and 12 months of treatment. <bold>Results</bold> In terms of the intragroup comparison, the VAS score in control group improved at 1 month of treatment compared with that before treatment (<italic>P</italic>&lt;0.05). There were no significant changes in each index at each time point (<italic>P</italic>&gt;0.05). By contrast, the VAS, HAMD-17, PSQI and PGIC scores in the treatment group improved at 1 month, 3 months and 12 months of treatment compared with those before treatment (<italic>P</italic>&lt;0.05). The comparison between groups showed that no significant differences were found in VAS, HAMD-17, PSQI and PGIC scores between the two groups at 1 month of treatment (<italic>P</italic>&gt;0.05). Apart from that, the VAS, HAMD-17, PSQI and PGIC scores in the treatment group improved more than those in the control group at 3 months and 12 months of treatment (<italic>P</italic>&lt;0.05). Specifically, at 3 months of treatment, the scores of the treatment group were VAS (2.96±1.11), HAMD-17 (25.95±5.91), PSQI (4.55±0.81), and PGIC (4.87±1.47), while the scores of the control group were VAS (5.86±1.31), HAMD-17 (36.97±7.62), PSQI (6.97±1.21), and PGIC (2.36±0.74), and the difference was statistically significant respectively (<italic>P</italic>&lt;0.05). Last, at 12 months of treatment, the treatment group's VAS (1.92±0.91), HAMD-17 (21.94±7.52), PSQI (2.32±0.61), and PGIC (5.50±1.41) were better than the control group's VAS (6.97±1.01), HAMD-17 (41.38±9.02), PSQI (5.15±1.11), and PGIC (2.50±0.91), and the difference was statistically significant respectively (<italic>P</italic>&lt;0.05). <bold>Conclusion</bold> The cervical core strengthening exercise will relieve pain, improve scores of mood and sleep in patients with cervicogenic headache.

Clinical Study of Repetitive Transcranial Direct Current Stimulation Combined with Rehabilitation Therapy for Patients with Consciousness Disorder

<bold>Objective</bold> To explore the effect of repetitive transcranial direct current combined with rehabilitation therapy on promoting consciousness and improving spasticity in patients with consciousness disorder. <bold>Methods</bold> A retrospective analysis was performed on 42 patients with disturbance of consciousness，whom hospitalized in rehabilitation medicine department of Lanzhou University Second Hospital from April 2017 to April 2021. They were divided into observation group and control group according to whether they received transcranial direct current stimulation （tDCS），21 cases in each group. The control group were treated with conventional rehabilitation treatment and the observation group were treated with conventional rehabilitation therapy and tDCS，the anode was placed in the left primary motor cortex （M1） and the cathode was placed in the right shoulder region，current intensity of 2 mA，once daily，20 min once a day，5 times per week，for 6 weeks. Before and after treatment，the level of consciousness was assessed by the Coma Recovery Scale-Revised （CRS-R） and Glasgow Coma Scale （GCS），the Modified Ashworth Scale （MAS） was used to assess changes muscle tone of the right flexor elbow muscle. <bold>Results</bold> Before treatment，there were no significant difference in CRS-R and GCS scores between the two groups （<italic>P</italic>＞0.05）；After treatment，the scores of the two groups were improved，and the CRS-R and GCS scores of the observation group were better than the control group，the differences were statistically significant （<italic>P</italic>&lt;0.05）. In terms of clinical efficacy，there were 13 （38.10%） responders and 8 （61.90%） non responders in the observation group. In the control group，there were 2 （9.50%） patients with responded and 19 （90.50%） patients who did not respond，the difference between the two groups was significant difference （<italic>P</italic>&lt;0.05）. As for MAS score，there was no significant difference in MAS score of right flexor elbow muscle between the two groups before treatment （<italic>P</italic>＞0.05）; There was no significant difference in MAS score of bilateral flexor elbow muscle in the control group before and after treatment （<italic>P</italic>＞0.05），but there was significant difference in the observation group before and after treatment （<italic>P</italic>&lt;0.05）. Comparison among groups，MAS score of flexor elbow muscle in the observation group was better than the control group，the difference was significant difference （<italic>P</italic>&lt;0.05）. <bold>Conclusion</bold> Repetitive transcranial direct current stimulation combined with rehabilitation therapy can effectively improve the level of consciousness and spasticity of patients with consciousness disorder.

Telerehabilitation as a Method for Achieving Competencies in Physical and Rehabilitation Medicine Residency Training in a Developing Country: A Protocol for a Pilot Mixed-Methods Study.

BackgroundIn the second year of the COVID-19 pandemic, Physical and Rehabilitation Medicine (PRM) residents in a developing country continue to face a lack of in-person clinical exposure and learning opportunities. With the unprecedented shift to virtual care, it remains uncertain whether residents can achieve PRM competencies using telerehabilitation as a method of instruction.ObjectiveTo determine the PRM residents' ability to achieve competencies through telerehabilitation, as perceived by different stakeholders (residents, chief residents, training officers, and department heads).MethodsThis will be a pilot mixed-methods study, employing concurrent triangulation, in the Department of Rehabilitation Medicine in one large private medical center and one large government hospital in Manila, Philippines. There will be two phases of online data collection upon approval by their respective research ethics board. The first phase will involve an online Likert-scale questionnaire to obtain the residents' self-perceived attainment of competencies and learning of PRM topics and skills specified by the International Society of Physical and Rehabilitation Medicine and the Philippine Board of Rehabilitation Medicine. The results of the survey will then be summarized and presented in a focus group discussion (FGD) with the department heads, training officers, and chief residents of the two institutions in an attempt to explain the residents' perceptions on their competencies achieved through virtual care. Afterwards, the qualitative data obtained from the FGD will then be thematically analyzed, and mixed methods integration will be employed to generate knowledge and recommendations.DiscussionIt is hypothesized that the majority of the residents had little to no experience with telerehabilitation pre-pandemic. Suddenly telerehabilitation was used to augment clinical training during the pandemic. It is uncertain whether telerehabilitation can help residents achieve competencies in the different domains of training, namely: patient safety and quality patient care; medical knowledge and procedural skills; interpersonal and communication skills; practice- and systems-based learning and improvement; reintegration of people with disabilities into the society; medical ethics and public health; quality assurance; policies of care and prevention for disabled people; and professionalism. The study results can provide insights on the aspects of a PRM curriculum that may have to be modified to ensure the training program is sensitive and appropriate to the changing training needs of the residents amid the pandemic and similar crises that may disrupt in-person clinical encounters in the future.

Is Conservative Treatment Better than Surgical Treatment for Basal Ganglia Hemorrhage in a Conventionally Non-Surgical Indication Group with Poor Motor Function?

Background: The treatment options for basal ganglia intracerebral hemorrhage (ICH), either surgical or conservative, remain controversial. A previous study developed “A new modified ICH (MICH) score” that suggests which treatment option will be better for basal ganglia ICH. According to this scoring system, a MICH score of 0 or 1 indicates that conservative treatment is better than surgical treatment. The purpose of this study was to determine whether conservative treatment is still a better option for a basal ganglia hemorrhage in patients with MICH scores of 0 and 1, with initial poor motor grades. Methods: This retrospective study was comprised of 41 patients with a spontaneous basal ganglia hemorrhage. These patient groups had no previous brain lesions, their initial MICH score was 0 or 1, and the manual muscle test (MMT) of their hand was grade 2+ or lower in the initial evaluation. All patients were transferred to the Department of Rehabilitation Medicine and received rehabilitation treatment. Ten patients had an operative intervention, which was burr-hole aspiration or craniotomy with hematoma removal. The control group included 31 patients who underwent conservative treatment. Outcome evaluations used the Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Brunnstrom recovery stage (BRS) which were evaluated at initial and regular follow-ups after 1, 3, and 6 months. We defined an improvement state if the BRS of their hand became 4 or more in 6 months, which means an escape from the synergic pattern. Results: Demographic characteristics showed no significant differences in age, sex, hemiplegic side, initial GCS score, presence of IVH and hydrocephalus, or distribution of MICH scores 0 and 1. There was only a significant difference in the distribution of hematoma volume between groups of less than 20 mL and groups from 21 to 50 mL (p = 0.049). There were no significant differences in MBI values in 1 month or improvement of BRS of their hand in 6 months between the two groups. Conclusions: Even in the group classified as predominantly conservative in basal ganglia hemorrhage patients, if the initial muscle strength is low, it is necessary to reconsider whether conservative treatment is superior to surgical treatment in terms of functional improvement.

Effects of Long-term Hybrid Assistive Limb Use on Gait in Patients with Amyotrophic Lateral Sclerosis.

Objective To assess the long-term effects of hybrid assistive limb (HAL) treatment on gait in patients with amyotrophic lateral sclerosis (ALS). Methods Three courses of treatment with HAL were administered to three women with ALS. Each course had a four- to five-week duration, during which the treatment was performed nine times, with a rest period of at least two months between each course. Gait ability (2-minutes-walk and 10-m-walk tests), ALS Functional Rating Scale-Revised, and respiratory function tests were performed before and after each treatment course. Patients Patients diagnosed with ALS, according to the updated Awaji criteria, by board-certified neurologists in the Department of Neurology and Department of Rehabilitation Medicine, Toho University Omori Faculty of Medicine between January and December 2019 were recruited. Results The average time from the start to the end of the 3 courses was 319.7±33.7 days. A multiple regression analysis was performed for the 2-minutes-walk and 10-m-walk tests, using the baseline value, each participant's ID, and time point as covariates. Changes after each course were considered outcomes. Following the 3 treatment courses, the 2-minutes walk distance improved by 16.61 m (95% confidence interval, -9.33-42.54) compared with the baseline value, but this improvement was not statistically significant (p=0.21). However, cadence significantly improved by 1.30 steps (95% confidence interval, 0.17-2.42; p=0.02). Conclusion Long-term, repetitive HAL treatments may help patients with ALS maintain their gait.

Self-Rehabilitation Through Dance: An Ethnographic Study on Candy Girls Breast Cancer Survivor Group in Kuala Lumpur, Malaysia

This study intends to examine a breast cancer survivor group called the Candy Girls. Candy Girls comprises 26 to 30 women (aged between 40 and 73 years), who are breast cancer survivors in the post-clinical phase. They all have successfully undergone various combinations of treatment such as lumpectomy, mastectomy, radiotherapy and chemotherapy for breast cancer and are on the path to recovery and post-recovery. In 2010, this group came together for a year-long research conducted by the Universiti Malaya’s Faculty of Medicine through the Department of Rehabilitation Medicine. Realising the benefits of exercise for the well-being of cancer survivors, Candy Girls decided to continue dancing on their own even after the completion of the research study. With the support of breast surgeons at the University of Malaya Medical Centre (UMMC), this group began a weekly three-hour self-administered exercise session, that is still, to this day, taking place every Saturday. Their activities focus primarily on dance. The group gradually expanded dance genres by incorporating line dance, Latin dances-based Zumba sessions, Malay folk dance forms such as joget and zapin, and Bollywood dance. While the multi-ethnic women are determined to stay healthy and happy through their weekly dance routines, they have made significant impact on women at large by performing dances at Breast Cancer Relays, Awareness Campaigns and Health Conferences. By engaging with this community of survivors, the researchers have not only been able to observe their activities but also to support them through additional yoga and dance trainings. The act of giving back to the community has further strengthened the researchers' relationship with the study subjects and has allowed deeper engagement with the community. This ethnographic research shows that dance as self-rehabilitation, not only enhances physical mobility and emotional well-being, but forges a strong group solidarity among the women as a much-needed support system for survivors.

MIRROR THERAPY IN PHYSIOTHERAPEUTIC PRACTICE FOR RECOVERY OF THE MOTOR FUNCTION OF THE UPPER LIMB IN PATIENTS WITH ISCHEMIC STROKE

Cerebrovascular diseases occupy a major place among socially significant diseases due to high morbidity, mortality and severe disability. Bulgaria is one of the first places in the world in these indicators. Timely and properly applied, physiotherapy has a positive effect on their independence and self-care. Modern physiotherapy is based on the theory of neuroplasticity - the ability of the brain to change adaptively with significant changes in the body and the environment. Mirror therapy is a contemporary approach to restoring the function of the upper limb after a stroke. It is based on the principle of stimulating movement in the affected limb through visual signals coming from the other side of the body. This aroused the interest to develop and implement a program and methodology of its application, including mirror therapy. The aim of the study was: To develop and implement a physiotherapy program and methodology of its application, including mirror therapy, to improve motor function of the upper limb in the recovery of patients with ischemic brain disease and to study the effect of its application. The present study was conducted in the Department of Physical and Rehabilitation Medicine of the University Hospital "Medica-Russe" in the period from January 2019 to June 2020. Of the patients diagnosed with ischemic stroke, were formed two groups - control and experimental. Ten patients were included in each group. The presented own results make it possible to analyze the effect of the applied complex physiotherapy program and mirror therapy in the late recovery period.

Prevalence and influencing factors of spinal cord injury-related osteoporosis and fragility fractures in Thai people with chronic spinal cord injury: A cross-sectional, observational study

Objective To investigate the prevalence and influencing factors of spinal cord injury (SCI)-related osteoporosis and fragility fractures in Thai people with chronic spinal cord injury. Design A cross-sectional, observational study. Setting Outpatient clinic, Department of Rehabilitation Medicine, Maharaj Nakorn Chiang Mai Hospital. Participants Thais with chronic spinal cord injury (SCI) (duration of injury at least one year). Intervention Not applicable. Outcome measures Dual-energy X-ray absorptiometry (DXA) was performed to measure bone mineral density (BMD) at the hip. Analyses were performed to identify risk factors for SCI-related osteoporosis or fragility fracture development. Thai FRAX® score was calculated with and without BMD and compared for each participant. Results Among 64 Thais with chronic SCI, the prevalence of SCI-related osteoporosis was 43.8%. Female sex, non-ambulatory status, and at least 10 years duration of spinal cord injury increased the risk of having SCI-related osteoporosis. The prevalence of fragility fracture was 9.4%. Female sex, duration of SCI, and being diagnosed with SCI-related osteoporosis increased the risk of having a fragility fracture. Thai FRAX® score without BMD value underestimated the risk of prevalent fracture in 7.8% of participants. Conclusions SCI-related osteoporosis and fragility fractures are common in Thais with chronic SCI. Our findings emphasize the importance of SCI-related osteoporosis and fragility fracture surveillance in people with chronic SCI regardless of their ethnicity. FRAX® without BMD calculations could underestimate the risk of fragility fracture in people with chronic SCI. Therefore, further studies are needed to develop an SCI-specific fracture-risk assessment tool using risk factors proposed in previous studies and in this study.

Effect of High Frequency Repetitive Transcranial Magnetic Stimulation Combined with Voice Training on Voice Function of Patients with Parkinson's Disease

<bold>Objective</bold> To observe the effect of high frequency repetitive transcranial magnetic stimulation (rTMS) combined with voice training on voice function of patients with Parkinson's disease (PD). <bold>Methods</bold> A total of 30 patients of Parkinson's disease with voice disorder were treated in the department of rehabilitation medicine and the department of geriatrics of Shanghai Fifth Rehabilitation Hospital from October 2019 to July 2021, which were randomly divided into the control group and the observation group according to Excel RAND function, with 15 cases in each group. The control group were treated with routine anti PD drugs and routine voice training, including abdominal breathing training, respiratory and vocal coordination training, breathing support ability training, voice real-time stress therapy, tonal training,vocal cord relaxation training, tone quality training,resonance relaxation training, etc.The training time was 40 minutes a time, once a day, continuous training for 30 days.The observation group received high-frequency rTMS stimulation on the basis of the control group. High frequency (5 Hz) rTMS was used to stimulate bilateral primary motor cortex (M1 area). The stimulation time was 10 minutes, 20 minutes a time,once a day, continuous training for 30 days. Before treatment, after treatment (after treatment for 30 days) and follow-up (30 days after the end of treatment), voice function detection and correction instrument, voice function detection and correction instrument were used to detect voice function under the framework of ICF, mainly including voice production index [(maximum phonation time, MPT), (maximum counting ability, cMCA), (fundamental frequency, F₀), (contact quotient, CQ), (contact quotient perturbation, CQP), (fundamental frequency tremor, F₀t),(frequency band energy concentration rate，Ec)] and voice quality index[Jitter, Shimmer, (normalized noise energy, NNE), F₂/u/,F₂/i/]. Voice handicap index (VHI) questionnaire were used to evaluate the subjective feelings of patients with voice disorders. <bold>Results</bold> Before treatment, there were no significant difference in MPT, cMCA, F₀t, Ec, F₀, CQ, CQP, Jitter, Shimmer, NNE, F₂/i/, F₂/u/, VHI between the two groups (<italic>P</italic>&gt;0.05). Compared with before treatment, MPT,cMCA, F₀t, Ec and F₂/i/ of the two groups after treatment were significantly increased, F₀, NNE and VHI score of the two groups after treatment were significantly decreased (<italic>P</italic>&lt;0.05); MPT, cMCA, F₀t, Ec, F₂/i/ score of the observation group follow-up were significantly increased (<italic>P</italic>&lt;0.05),and the scores of F₀, NNE and VHI score of the observation group follow-up were significantly decreased (<italic>P</italic>&lt;0.05). Compared with after treatment, MPT and cMCA of the observation group follow-up were significantly decreased (<italic>P</italic>&lt;0.05). Compared with the control group at the same time, MPT, cMCA, F₀t, Ec, F₂/i/ of the observation group after treatment and follow-up were significantly increased, and the scores of CQP, NNE and VHI score were significantly decreased (<italic>P</italic>&lt;0.05). <bold>Conclusion</bold> High frequency rTMS combined voice training can improve the respiratory support ability, the coordination ability of breathing and vocalization, the regularity of vocal cord closure, the forward movement ability of tongue in PD patients; reduce vocal cord tremor, attenuation of harmonic energy during vocal cord vibration,breath sound and self subjective feeling of voice disorder, and its long-term effect is also good, which is worthy of clinical promotion.

Spinal Cord Injury Rehabilitation: Basics and Beyond

This special issue is dedicated to the Borneo International Spinal Cord Injury (SCI) Rehabilitation Conference (BISCIR) which was held on 30th July – 1st August 2021 through a virtual platform. It was co-organized by the Department of Rehabilitation Medicine, Queen Elizabeth Hospital, and Rehabilitation Medicine Unit, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah in partnership with Docquity and Kelab Perubatan Rehabilitasi Sabah. Attended by almost 500 delegates from Southeast Asian countries including the hosting country of Malaysia, the conference served its purpose as a global sharing platform by having invited local and international experts from Thailand, the Philippines, India, South Korea, and Australia. With the theme “SCI Rehabilitation: Basics and Beyond”, there was a great opportunity for participating delegates to submit their abstracts for oral and poster competition on spinal cord-related disorders and their rehabilitation. The covered areas include but are not exhaustive to the spinal cord pathophysiology, disease presentations, complications, and management, as well as rehabilitation interventions. Each submitted abstract was double-blinded peer-reviewed by two external reviewers. A total of 15 abstracts were accepted after rigorous review based on objective judging criteria, with seven and eight abstracts as oral and poster submissions respectively. Most of them were case reports with four cross-sectional studies and one review article. “Managing Tetraplegia with Blindness: Rehabilitation Approach” presented the improvement in mobility and daily living skills through orientation and mobility training with sensory education and repeated verbal instructions for compensating the loss of visual and sensory feedback. The “International Lower Urinary Tract Function Data Set: A Study in SCI Population in HRC” reviews the epidemiology of spinal cord injury patients with the neurogenic bladder in the largest rehabilitation hospital in Malaysia. “Navigating Neurological Recovery with NeuroAiD in Severe Spinal Cord Injury: A Noteworthy Novelty?” reported a case of complete tetraplegia who regained some neurological recovery following NeuroAiD supplementation. “A Case of Incomplete Spinal Cord Injury Associated with Brown Sequard Syndrome After Cervical Blunt Trauma with Atlanto-Axial Rotatory Subluxation in a Paediatric Patient” exhibited a case of a paediatric patient with high cervical spinal cord injury secondary to blunt trauma that has resulted in atlantoaxial rotatory subluxation. The “Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report” showed that the use of long CTLSO rigid external stabilization justifies the reason to boost protection while recovering from spinal tuberculosis despite receiving stable internal stabilization. “Orthotic Intervention for Ageing Individuals with Spinal Cord Injury: A Brief Review” explored the use of orthotic intervention among the elderly with SCI in 25 published articles. The “Demographic Characteristic of Spinal Cord Injury Patients Referred for Rehabilitation in Miri Hospital” aimed to explore the demographic characteristics among the referrals for rehabilitation among spinal cord injury populations in that tertiary hospital. The “Autonomic Dysreflexia with Concurrent Orthostatic Hypotension: A Clinical Approach Dilemma” highlighted the complicated conditions of managing concurrent Autonomic dysreflexia and orthostatic hypotension in a patient with high cervical spinal cord injury. “A Pinch of Salt Won’t Kill: The Role of Salt Tablets in Reversing Intractable Orthostatic Hypotension in an Incomplete Tetraplegic Patient” presented a case of intractable orthostatic hypotension in incomplete tetraplegia, which resolved after the initiation of salt tablets. The “Marching Forward with Mirabegron: A Novel Treatment Option for Neurogenic Detrusor Overactivity in Traumatic Spinal Cord Injury” showcased a case of young traumatic paraplegia who has been successfully treated with Mirabegron as an alternative to anticholinergics in treating overactive bladder for its better tolerability and comparable efficacy. “A Retrospective Pilot Study on the Prevalence of Acceptability for Teleconsultation among Spinal Cord Injury Patients” observed the acceptability of teleconsultation among SCI patients in a major tertiary rehabilitation hospital with a description of their clinical and demographic features. “Performing Solat in Spinal Cord Injury Patients: Challenges and Solutions” emphasized the importance to educate healthcare workers for identifying the limitations and leniency in Islam related to performing prayer (solah) and understand the conditions of the validity of the performed prayer as means to equip patients with the right knowledge and method. The ”Sharing of Experience of Teleconsultation with Spinal Cord Injury Patients” proven that the use of teleconsultation is a beneficial service among SCI patients during the COVID-19 pandemic. “Fleet Enema-Induced Autonomic Dysreflexia in Spinal Cord Injured Patient” reported the use of fleet enema in spinal cord injured patients that can cause autonomic response leading to severe complication of a generalized tonic-clonic seizure. The “An Uncommon Case Post-traumatic Syringobulbia: A Case Report” showed that the formation of syringobulbia, although rare, is one of the causes of the delayed-onset neurological deterioration in spinal cord injured patients. The accepted abstracts are presented in the following sections of this issue. Readers are welcome to contact us for any comments or queries.

Spinal Cord Injury Rehabilitation: Basics and Beyond

This special issue is dedicated to the Borneo International Spinal Cord Injury (SCI) Rehabilitation Conference (BISCIR) which was held on 30th July – 1st August 2021 through a virtual platform. It was co-organized by the Department of Rehabilitation Medicine, Queen Elizabeth Hospital, and Rehabilitation Medicine Unit, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah in partnership with Docquity and Kelab Perubatan Rehabilitasi Sabah. Attended by almost 500 delegates from Southeast Asian countries including the hosting country of Malaysia, the conference served its purpose as a global sharing platform by having invited local and international experts from Thailand, the Philippines, India, South Korea, and Australia. With the theme “SCI Rehabilitation: Basics and Beyond”, there was a great opportunity for participating delegates to submit their abstracts for oral and poster competition on spinal cord-related disorders and their rehabilitation. The covered areas include but are not exhaustive to the spinal cord pathophysiology, disease presentations, complications, and management, as well as rehabilitation interventions. Each submitted abstract was double-blinded peer-reviewed by two external reviewers. A total of 15 abstracts were accepted after rigorous review based on objective judging criteria, with seven and eight abstracts as oral and poster submissions respectively. Most of them were case reports with four cross-sectional studies and one review article. “Managing Tetraplegia with Blindness: Rehabilitation Approach” presented the improvement in mobility and daily living skills through orientation and mobility training with sensory education and repeated verbal instructions for compensating the loss of visual and sensory feedback. The “International Lower Urinary Tract Function Data Set: A Study in SCI Population in HRC” reviews the epidemiology of spinal cord injury patients with the neurogenic bladder in the largest rehabilitation hospital in Malaysia. “Navigating Neurological Recovery with NeuroAiD in Severe Spinal Cord Injury: A Noteworthy Novelty?” reported a case of complete tetraplegia who regained some neurological recovery following NeuroAiD supplementation. “A Case of Incomplete Spinal Cord Injury Associated with Brown Sequard Syndrome After Cervical Blunt Trauma with Atlanto-Axial Rotatory Subluxation in a Paediatric Patient” exhibited a case of a paediatric patient with high cervical spinal cord injury secondary to blunt trauma that has resulted in atlantoaxial rotatory subluxation. The “Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report” showed that the use of long CTLSO rigid external stabilization justifies the reason to boost protection while recovering from spinal tuberculosis despite receiving stable internal stabilization. “Orthotic Intervention for Ageing Individuals with Spinal Cord Injury: A Brief Review” explored the use of orthotic intervention among the elderly with SCI in 25 published articles. The “Demographic Characteristic of Spinal Cord Injury Patients Referred for Rehabilitation in Miri Hospital” aimed to explore the demographic characteristics among the referrals for rehabilitation among spinal cord injury populations in that tertiary hospital. The “Autonomic Dysreflexia with Concurrent Orthostatic Hypotension: A Clinical Approach Dilemma” highlighted the complicated conditions of managing concurrent Autonomic dysreflexia and orthostatic hypotension in a patient with high cervical spinal cord injury. “A Pinch of Salt Won’t Kill: The Role of Salt Tablets in Reversing Intractable Orthostatic Hypotension in an Incomplete Tetraplegic Patient” presented a case of intractable orthostatic hypotension in incomplete tetraplegia, which resolved after the initiation of salt tablets. The “Marching Forward with Mirabegron: A Novel Treatment Option for Neurogenic Detrusor Overactivity in Traumatic Spinal Cord Injury” showcased a case of young traumatic paraplegia who has been successfully treated with Mirabegron as an alternative to anticholinergics in treating overactive bladder for its better tolerability and comparable efficacy. “A Retrospective Pilot Study on the Prevalence of Acceptability for Teleconsultation among Spinal Cord Injury Patients” observed the acceptability of teleconsultation among SCI patients in a major tertiary rehabilitation hospital with a description of their clinical and demographic features. “Performing Solat in Spinal Cord Injury Patients: Challenges and Solutions” emphasized the importance to educate healthcare workers for identifying the limitations and leniency in Islam related to performing prayer (solah) and understand the conditions of the validity of the performed prayer as means to equip patients with the right knowledge and method. The ”Sharing of Experience of Teleconsultation with Spinal Cord Injury Patients” proven that the use of teleconsultation is a beneficial service among SCI patients during the COVID-19 pandemic. “Fleet Enema-Induced Autonomic Dysreflexia in Spinal Cord Injured Patient” reported the use of fleet enema in spinal cord injured patients that can cause autonomic response leading to severe complication of a generalized tonic-clonic seizure. The “An Uncommon Case Post-traumatic Syringobulbia: A Case Report” showed that the formation of syringobulbia, although rare, is one of the causes of the delayed-onset neurological deterioration in spinal cord injured patients. The accepted abstracts are presented in the following sections of this issue. Readers are welcome to contact us for any comments or queries.

50th Anniversary Department of Rehabilitation Medicine, UP-PGH

50th Anniversary Department of Rehabilitation Medicine, UP-PGH

Continuing Care through Telerehabilitation for Patients in a COVID-19 Referral Center in the Philippines: A Case Series

In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings.

Fear, Anxiety, and Depression among Employees of the Department of Rehabilitation Medicine - Philippine General Hospital amidst Changes from the COVID-19 Pandemic: A Cross-sectional Study

Objective. This study described levels of fear, anxiety, depression, and contributing factors among health providers and administrative staff of the Department of Rehabilitation Medicine, Philippine General Hospital (PGH-DRM) during the COVID-19 pandemic.&#x0D; Methods. The cross-sectional study was conducted from August to November 2020. We recruited 71 participants who were working in the premises of the hospital and those who were working from home by purposive sampling. The fear numerical rating scale and Hospital Anxiety and Depression Scale were used to determine the presence of fear, anxiety, and depression. The 36-Item Short Form Survey (SF-36) was used to determine the baseline level of physical and mental wellness among participants.&#x0D; Results. Seventy-three percent of the full-time, permanent employees of the PGH-DRM unit joined the study. Majority of the respondents were health providers (86%) but only one hospital staff had high-risk contact with patients with COVID-19. Most participants (63%) did a combination of on-site work and home-based work and three (4%) worked entirely from home. Moderate to severe levels of fear was reported by 54% of the participants. Fear levels were highest among those who worked on-site. Anxiety was borderline in 32%, and abnormal in 30%, while depression was borderline in 21%, and abnormally high in 34% of the participating employees. Feelings of anxiety were higher among those who worked on-site and who worked both on-site and from home, while depression was highest among those who worked from home. The SF-36 Physical Health Summary score (x̄ = 72.49) was higher than the Mental Health Summary score (x̄ = 55.45). Employees who worked from home had the highest SF-36 summary scores for both mental and physical health.&#x0D; Conclusion. The employees of the DRM had low-risk contact work assignments when the PGH transitioned to a tertiary level COVID-19 referral hospital. Half of the employees experienced fear, anxiety, and depression and had low SF-36 summary scores in mental health. Further studies are needed to determine the key factors that affect their mental health and well-being during the pandemic. A relevant mental health and wellness program is strongly recommended.

Message

Greetings!&#x0D; The past years have been marked by milestones, the likes of which the medical community, and humanity as a whole, have never experienced before. The Department of Rehabilitation Medicine too is experiencing a landmark event as it moves beyond the fifty years of its existence. Challenge after challenge, the Department has survived and grown, emerging stronger and wiser. The latest of its accomplishments is producing this Acta Medica Philippina Rehabilitation Medicine Issue in the midst of the pandemic.&#x0D; This is a testimony of the Department’s commitment to promoting a culture of research, which has been identified as one of the strategies to attain the goals of the “Rehabilitation Decade in the Philippines (2020-2030): Optimizing Function Overcoming Disability”, formally launched in February 2020.&#x0D; We realized that so much can be done for all our stakeholders and that information gathered from well-designed researches will enable the Rehabilitation community to move forward with more confidence as it cares for its patients.&#x0D; Rehabilitation Medicine has a wide scope as clearly manifested in the diversity of topics in the articles of this institutional issue. We hope this can guide all of us in preventing disability and in empowering our patients to reach their optimum potential.&#x0D; &#x0D; Sharon D. Ignacio, MD, DPBRM, FPARM Chair, Department of Rehabilitation Medicine College of Medicine and Philippine General Hospital University of the Philippines Manila

Evaluating the Usability of the Expanded Telerehabilitation Program Implemented by Philippine General Hospital during the COVID-19 Pandemic: A Cross-sectional Study

Background. The Department of Rehabilitation Medicine of the University of the Philippines-Philippine General Hospital (UP-PGH) established its telerehabilitation service program in 2017. The program previously catered to patients in a partner rural community by providing teleconsultation and teletherapy over a distance. With the unprecedented coronavirus disease 2019 (COVID-19) pandemic, the program has expanded its service to outpatients previously managed face-to-face by the department, regardless of location.&#x0D; Objectives. This study aimed to evaluate the usability of the telerehabilitation service program at UP-PGH when it was expanded during the pandemic and to associate telerehabilitation usability ratings with the participant groups, demographic characteristics, and prior telemedicine knowledge and experience.&#x0D; Methods. This cross-sectional study involved the doctors, physical therapists, occupational therapists, psychologists, patients, and patients’ carers, who participated in at least one telerehabilitation session and consented to respond to a digital survey thereafter. Total enumeration sampling of all telerehabilitation participants was employed. The study outcome was the usability of the expanded telerehabilitation program based on the System Usability Scale (SUS) benchmarked at 68. Descriptive and inferential statistics were done at a 95% confidence interval. The participants’ responses to open-ended questions regarding telerehabilitation experience and recommendations were also presented.&#x0D; Results. The participants consisted of 19 doctors, 11 therapists, 37 patients, and 74 caregivers. The majority of the participants were female and lived in urban areas. The primary online telerehabilitation platforms used were Viber™ and Zoom™. The mean of overall SUS scores was below average for health providers [doctors (mean = 61.71), therapists (mean = 67.73)]; and above average for end-users [patients (mean 74.56), and carers (mean = 71.89)]. There was a significant difference in the overall SUS scores between doctors (mean: 61.7) and patients (mean: 74.6), p&lt;0.05. In terms of videoconferencing platform, participants reported significantly higher system usability for those who used either Zoom™ (mean: 75.0) or Viber™ (mean: 69.3), as compared to Google Meet™ (mean: 53.1), p&lt;0.05. There was no significant difference in the overall SUS scores across sexes, places of residence, primary telerehabilitation techniques used, prior telemedicine knowledge, and experience. The majority viewed telerehabilitation as a valuable method to provide service during the pandemic, but they were mostly concerned with technical problems, particularly an unstable Internet connection.&#x0D; Conclusion. The expanded telerehabilitation service program of the PGH was perceived as useful by patients and caregivers but not by the health providers. While the program succeeded in providing continued outpatient rehabilitation services during the pandemic, the challenges experienced by its telehealth providers must be investigated and addressed.

Coping Strategies and Job Satisfaction among Rehabilitation Medical and Paramedical Staff in a COVID-19 Referral Center: A Cross-sectional Study

Objectives. The objective of this study was to determine the coping strategies and job satisfaction among rehabilitation medical and paramedical staff deployed to different areas at the University of the Philippines Manila Philippine General Hospital, a designated COVID-19 referral center.&#x0D; Method. This was a cross-sectional study that utilized total population sampling of the medical and paramedical staff of the Department of Rehabilitation Medicine deployed to other areas in PGH and who carried out non-rehabilitation-related clinical work responsibilities during the COVID-19 pandemic. Electronic informed consent was obtained from each participant. Two sets of validated and reliable self-administered online questionnaires, namely, the Brief Coping Orientation to Problems Experienced (COPE) Inventory Tool and Satisfaction of Employee in Health Care (SEHC) Survey, were used to determine coping strategies and work satisfaction, respectively. Descriptive statistics (such as frequencies, percentages, ranges, means) were used to present the data.&#x0D; Results. A total of 50 medical and paramedical staff participated in the study. The participants’ age ranged from 22 to 60 years (mean: 30.2 ± 8.7). The majority were single (84%), women (64%), and with a Bachelor of Science degree. Most of the participants were assigned in the orange zone, which included the COVID ward nurses’ station and donning/doffing areas; with 30% who rotated in the COVID wards. There were three types of coping strategies utilized by the department staff: (1) emotion-focused coping, (2) problem-focused coping, and (3) dysfunctional coping. Problem-focused coping was the most common general strategy (mean COPE score for all problem-focused strategies, 3.1 ± 0.9). Acceptance was the most common specific coping strategy, followed by active coping and a tie among positive reframing, planning, and self-distraction. The work satisfaction rate was at 76.9% ± 13.2. Three out of 4 participants would recommend their workplace to other healthcare workers.&#x0D; Conclusion. The medical and paramedical staff of the Department of Rehabilitation Medicine in a COVID referral center had relatively high job satisfaction despite their health risks and changes in responsibilities among others. The majority utilized functional coping strategies to help them adapt to the work demands. The sources of motivation and values of the staff are areas for future research to help explain their positive outlook about their jobs and generally high recommendation about their workplace in the middle of the COVID-19 crisis.