Early Rehabilitation Management Research Articles

Early rehabilitation management strategy for septic arthritis of the knee

ObjectivesEarly rehabilitation management of septic arthritis in the native knee is not standardized. In this context, it is necessary to develop and validate an early rehabilitation strategy. Materiel and methodsBased on the formalized HAS consensus method, a 4-phase rehabilitation strategy has been developed: recovery of joint amplitudes, muscle recovery without resistance, recovery with technical aid (crutches, canes), continuation of the rehabilitation (pursuit of muscle, articular, proprioceptive and endurance recovery). ResultsIt was submitted to the opinion of multidisciplinary experts (PMR, general practitioner, rheumatologist, infectiologist, orthopedic surgeon, physiotherapist). Nearly 80% of the items were directly validated, with only five items scoring less than 5/10. Modifications were made in order to obtain a final version of the protocol. ConclusionUse of a rigorous methodology enabled a consensual strategy for early rehabilitation management to be developed. Prospective validation of this strategy is needed to confirm its feasibility and effectiveness.

Effects of early rehabilitation in improvement of paediatric burnt hands function.

BACKGROUNDHands are one of the most common burn sites in children. Hypertrophic scar contractures in hands after wound healing result in further reductions in their range of motion (ROM), motility, and fine motor activities. Rehabilitation can improve the function of hands. But the optimal time of rehabilitation intervention is still unclear. Therefore, this study was designed to investigate the effects of early rehabilitation management of paediatric burnt hands and to compare the efficacy between early and later rehabilitation intervention.AIMTo investigate the effects of early rehabilitation management of paediatric burnt hands. METHODSA total of 52 children with burnt hands were allocated into the early intervention group (≤ 1 mo from onset) and a late intervention group (> 1 mo from onset) between January 2016 and December 2017. The children received the same rehabilitation programme including skin care, scar massage, passive ROM exercises, active ROM exercises, compression therapy, orthotic devices wearing and game or music therapy. Rehabilitation assessments were performed before and after the rehabilitation treatment.RESULTSIn the early intervention group, the ROM of the hands was significantly improved after rehabilitation (P = 0.001). But in the late group the effect was not significant statistically (P = 0.142). In the early group, 38.5% of the patients showed significant improvement, while in the late group, 69.2% of the patients showed no significant improvement. The time from onset to posttraumatic rehabilitation (P = 0.0007) and length of hospital stay (P = 0.003) were negatively correlated with the hand function improvement. The length of rehabilitation stay was positively correlated with the hand function improvement (P = 0.005). CONCLUSIONThese findings suggest that early rehabilitation might show better results in terms of ROM.

An overview of applying virtual reality intervention to improve functional outcomes for post-stroke patients in rehabilitation

Post-stroke patients may have to experience a wide range of impairments or deficits such as movement dysfunction or cognitive impairments that require early rehabilitation management to get better recovery. The rapid development in technology facilitates for many aspects in medicine and rehabilitation. In recent years, virtual reality intervention has been a novel therapy improving functional outcomes among post-stroke patients (Lee, Park, & Park, 2019). Specifically, virtual reality technology has created a life-like environment to stimulate physical activities that may encourage stroke survivors to take part in activities willingly through interaction in virtual environment which is quite similar with the real world (Kizony, Levin, Hughey, Perez, & Fung, 2010). This overview is going to analyse the effectiveness of virtual reality intervention in improving functional outcomes for post-stroke patients and give some recommendations in clinical practice.

Therapeutic algorithm for native septic arthritis rehabilitation of the knee

To our knowledge, despite animal studies evidence; there is no rehabilitation consensus for rehabilitation after native septic arthritis ok the knee. The objective was to develop and validate an early rehabilitation protocol for knee Staphylococcus aureus arthritis. We followed, HAS guidelines to obtain formal consensus using several steps: systematic review of the literature, elaboration of a first version of the algorithm, critical review by a multidisciplinary expert panel involved in the management of septic arthritis (PMR physician, physiotherapist, rheumatologist, infectious disease physician, orthopaedic surgeon). Modification of the draft version, to obtain the final version of the algorithm. Only six of the 17 professionals asked to evaluate the established rehabilitation protocol responded. Among the 24 items proposed in this rehabilitation strategy, 79.2% obtained a direct validation. Five items scored below 5/10 with associated comments were discussed. The modifications in relation to the different opinions were carried out in order to obtain a final version of the algorithm. The rehabilitation strategy is based on 3 main successive phases: early mobilization to recover range of motion, muscular strengthening first unloaded without any resistance, then gradual re-loading with walking stick to finish with functional work. The use of a rigorous methodology resulted in a consensus strategy for early rehabilitation management. A clinical prospective validation is needed to definitely approve the effectiveness and tolerance of the algorithm. Daily practice implementation is also needed.

Comprehensive Rehabilitation Management for Children With Burn Injury on Hand

Background: Children are of the most susceptible groups for burn injuries, and hand injuries are prevailing among all sites of injuries. Due to the unique role of hands in children’s normal development, pediatric hand burn injuries may result in permanent disabilities that severely affect the functioning and quality of life of the child and the family. Therefore, other than proper wound care and timely surgery, rehabilitation management for children with burn injury on hand is essential. Objective: This presentation aims to propose a comprehensive rehabilitation management strategy for children with burn injuries on hands. Materials and Methods: Pediatric cases admitted to our university rehabilitation clinic with bilateral hand injuries due to second-degree burn are presented as case series. Tailor-made intervention regime was provided for each case. New methods of pressure therapy intervention was introduced, including innovative products of the Smart Pressure Monitored Suit and the Smart Pressure Monitored Padding, which were developed and patented by our research team. Splints were provided and monitored. Functional activities, parent education, and counseling, as well as home programs were also delivered. The state of preservation of the pressure intervention products, the splint condition and the rehabilitation progress of the children were monitored on a regular basis. The treatment outcomes are presented by comparing the pre- and post-intervention photos and functioning of the patients. Results: Cases with pediatric bilateral hand injuries demonstrated satisfactory recovery on both hand functions and scar appearances. Several features have been identified from the cases as key elements in successful management of pediatric burnt hand. The proper adoption of the concept of pressure therapy played an important role, and the therapists should not limited pressure intervention to pressure garment only. Proper splinting of hands prevented and corrected contracture and deformation effectively. Engaging children into age-appropriate activities should be also considered. Suitable environment that promotes participation and reduces psychological stress should be established. Moreover, the psychosocial well-being of the children and the caregiver should be addressed in order to achieve maximum compliance to the intervention regime. Finally, regular long-term follow-ups guarantee the effectiveness of the rehabilitation intervention. Conclusions: To achieve the optimal functional recovery that enables participation and engagement, individualized, comprehensive and early rehabilitation management is advocated. Rehabilitation on pediatric burns is a long-term process that requires not only collaboration and understanding among different parties but also persistent effort.

A Portable Soft Hand Exerciser With Variable Elastic Resistance for Rehabilitation and Strengthening of Finger, Wrist, and Hand1

Stroke is the leading cause of long term disability and has a major impact on societal and healthcare burden [1,2]. The recovery and rehabilitation process, if not well-managed, can lead to aftereffects which will impact on the quality of lives of the patients and their families. It was reported that early rehabilitation management after acute stroke leads to better outcomes and shorter hospitalization stays [3]. However, stroke rehabilitation is both manpower and resourceintensive. Hence, the shortage of skilled expertise and equipment is the primary limiting factor to the amount of rehabilitation each patient can receive. It is also observed that stroke patients spend a large part of their time resting in bed without any activity and this time could be better utilized for bedside therapy at their own convenience [4]. Existing hand exercisers, such as putty, elastic bands, grip strengtheners, soft balls and finger webs, are associated with disadvantages such as portability, durability, limited range of motion, and operational use on one hand only. Most devices also consist of only one elastic resistance in one unit, requiring the user to purchase multiple color-coded units as they progress in their rehabilitation or strength training. In this study, we aim to develop a portable, lightweight, and intuitively designed multifunctional soft hand exerciser with variable elastic resistances within one unit. The gradient feature of different resistance levels is expected to motivate and hasten user progress up the level of difficulty. This device should support a variety of finger, hand, wrist, and arm exercises in multiple planes of motion. Currently, this device is intended for use by outpatients suffering from hand injuries or disabilities, but with some residual strength in their fingers, hand, and wrist, and are in the stage of recovery toward regaining their strength. This portable and lightweight device is designed primarily for use at home to facilitate patient’s recovery outside of in-clinics therapy. Other user groups such as the elderly could also utilize this device for strength and flexibility training. Eventually, our goal is to make iterations to this device for use as a supplementary therapeutic intervention for stroke in-patients to self-manage a range of hand, finger, and wrist exercises by their bedside.

Diagnostic Accuracy of the Barthel Index for Measuring Activities of Daily Living Outcome After Ischemic Hemispheric Stroke

This study investigated the diagnostic accuracy of the Barthel Index (BI) in 206 stroke patients, measured within 72 hours, for activities of daily living at 6 months and determined whether the timing of BI assessment during the first days affects the accuracy of predicting activities of daily living outcome at 6 months. Receiver operating characteristic curves were constructed to determine the area under the curve and optimal cutoff points for BI at Days 2, 5, and 9. OR, sensitivity, specificity, positive predictive value, and negative predictive value were calculated to predict BI ≥19. The area under the curve ranged from 0.785 on Day 2 to 0.837 and 0.848 on Days 5 and 9. Comparison of the receiver operating characteristic curves showed that the area under the curve was significantly different between Days 2 and 5 (P<0.001) and between Days 2 and 9 (P<0.001). No significant difference was found between Days 5 and 9 (P=0.08). Using a BI cutoff score of 7, the positive predictive value gradually increased from 0.696 on Day 2 to 0.817 on Day 2 to 0.864 on Day 9, whereas negative predictive value declined from 0.778 on Day 2 to 0.613 on Day 9. Assessment of the BI early poststroke showed good discriminative properties for final outcome of BI at 6 months. However, Day 5 proved to be the earliest time for making an optimal prediction of final outcome of activities of daily living. The BI should be measured at the end of the first week in hospital-based stroke units for early rehabilitation management.

Early rehabilitation management after stroke: What do stroke patients prefer?

Stroke rehabilitation is moving towards more intense therapy models that incorporate technologies such as robotics and computer games. It is unclear how acceptable these changes will be to stroke survivors, as little is known about which aspects of rehabilitation programmes are currently valued. Discrete choice experiments are a potential approach to assessing patient preferences, as they reveal the characteristics of programmes that are most important to consumers. A discrete choice experiment was presented as a face-to-face interview to assess the priorities and preferences of stroke survivors (n=50, mean age 72 years) for alternative rehabilitation service configurations. The discrete choice experiment was presented to the participants while they were on the stroke rehabilitation ward (approximately 3-4 weeks following stroke). Participants were highly focused on recovery and expressed strong preferences for therapy delivered one-to-one, but they did not favour very high intensity programmes (6 hours per day). While the attitudinal statements indicated high levels of agreement for programmes to incorporate the latest technology, the results from the discrete choice experiment indicated that participants were averse to computer-delivered therapy. Whilst rehabilitation therapy is highly valued, stroke survivors exhibited stronger preferences for low-intensity programmes and rest periods. High-intensity therapy protocols or approaches dependent on new technologies will require careful introduction to achieve uptake and acceptability.

Predictive value of the NIHSS for ADL outcome after ischemic hemispheric stroke: Does timing of early assessment matter?

Background and purpose Early prediction of future functional abilities is important for stroke management. The objective of the present study was to investigate the predictive value of the 13-item National Institutes of Health Stroke Scale (NIHSS), measured within 72 h after stroke, for the outcome in terms of activities of daily living (ADL) 6 months post stroke. The second aim was to examine if the timing of NIHSS assessment during the first days post stroke affects the accuracy of predicting ADL outcome 6 months post stroke. Methods Baseline characteristics including neurological deficits were measured in 188 stroke patients, using the 13-item NIHSS, within 72 h and at 5 and 9 days after a first-ever ischemic hemispheric stroke. Outcome in terms of ADL dependency was measured with the Barthel Index (BI) at 6 months post stroke. The area under the curve (AUC) from the receiver operating characteristic (ROC) was used to determine the discriminative properties of the NIHSS at days 2, 5 and 9 for outcome of the BI. In addition, at optimal cut-off odds ratio (OR), sensitivity, specificity, positive (PPV) and negative predicted values (NPV) for the different moments of NIHSS assessment post stroke were calculated. Results One hundred and fifty-nine of the 188 patients were assessed at a mean of 2.2 (1.3), 5.4 (1.4) and 9.0 (1.8) days after stroke. Significant Spearman rank correlation coefficients were found between BI at 6 months and NIHSS scores on days 2 ( r s = 0.549, p < 0.001), 5 ( r s = 0.592, p < 0.001) and 9 ( r s = 0.567, p < 0.001). The AUC ranged from 0.789 (95%CI, 0.715–0.864) for measurements on day 2 to 0.804 (95%CI, 0.733–0.874) and 0.808 (95%CI, 0.739–0.877) for days 5 and 9, respectively. Odds ratio's ranged from 0.143 (95%CI, 0.069–0.295) for assessment on day 2 to a maximum of 0.148 (95%CI, 0.073–0.301) for day 5. The NPV gradually increased from 0.610 (95%CI, 0.536–0.672) for assessment on day 2 to 0.679 (95%CI, 0.578–0.765) for day 9, whereas PPV declined from 0.810 (95%CI, 0.747–0.875) for assessment on day 2 to 0.767 (95%CI, 0.712–0.814) for day 9. The overall accuracy of predictions increased from 71.7% for assessment on day 2 to 73.6% for day 9. Conclusions When measured within 9 days, the 13-item NIHSS is highly associated with final outcome in terms of BI at 6 months post stroke. The moment of assessment beyond 2 days post stroke does not significantly affect the accuracy of prediction of ADL dependency at 6 months. The NIHSS can therefore be used at acute hospital stroke units for early rehabilitation management during the first 9 days post stroke, as the accuracy of prediction remained about 72%, irrespective of the moment of assessment.