Early Rehabilitation Research Articles

Psychiatric rehabilitation in routine Indian mental health practice: A review of social protections for persons with mental health conditions.

An estimated 200 million Indians have mental health conditions - a sizeable proportion of them requiring psychiatric rehabilitation services. The numbers of mental health professionals are abysmally low. Early psycho-social rehabilitation interventions can improve functional outcomes, reducing disability. Psycho-social interventions have been made possible with the shift away from medical and charity models of disability to the establishment of social protections for vulnerable groups. The authors have undertaken a narrative review of all the social protection measures that can be explained to persons affected by mental health conditions and their family members. A larger tabulation is provided as an appendix to this article that has details of all the social protection measures across the states and union territories of India. This tabulation can be useful as a one-stop reference for every mental health practitioner in India toward informing persons affected by mental health conditions and their family members about how recovery journeys can be advanced. The data have been compiled after extensive searches of official government websites, information brochures, and even relevant legal provisions. For almost all the social protection measures provided by the central or state government, a disability certificate is a prerequisite. Rehabilitation today is a collaborative process aimed at community re-integration. In the absence of specialized services like those of clinical psychologists, vocational trainers, and psychiatric social workers, the psychiatrist becomes the sole point of contact. Motivated community members, recovered services users, and family members can aid mental health professionals by disseminating this knowledge further.

Early Cardiac Rehabilitation Improves Carotid Arterial Stiffness in Patients with Myocardial Infarction.

Little is known about the effect of cardiac rehabilitation (CR) on carotid arterial stiffness (CAS) in patients with myocardial infarction (MI). Rehabilitation group (B) included 90 patients with MI subjected to CR, control group (K) consisted of 30 patients with MI not participatingin CR,and healthy group comprised 38 persons without cardiovascular risk factors. CAS was determined using echo-tracking before and after CR. Atbaseline, patients with MI (B+K) presented with significantly higher mean values of CAS parameters: beta-stiffness index (7.1 vs 6.4, p = 0.004), Peterson's elastic modulus (96 kPa vs 77 kPa, p < 0.001) and PWV-beta (6.1 m/s vs 5.2 m/s, p < 0.001) than healthy persons. Age (beta: r = 0.242, p = 0.008; EP: r = 0.250, p = 0.006; PWV-beta: r = 0.224, p = 0.014) and blood pressure: SBP (EP: r = 0.388, PWV-beta: r = 0.360), DBP (AC: r = 0.225) and PP (PWV-beta: r = 0.221) correlated positively with the initial parameters of CAS. Beta-stiffness index (Rho=-0.26, p = 0.04) and PWV-beta (Rho = 0.29, p = 0.03) correlated inversely with peak exercise capacity expressed in METs. After CR, mean values of beta-stiffness index (6.2 vs 7.1, p = 0.016), EP (78 kPa vs 101 kPa, p = 0.001) and PWV-beta (5.4 m/s vs 6.2 m/s, p = 0.001) in group B were significantly lower than in group K. In group B, CAS parameters decreased significantly after CR. Univariate analysis demonstrated that the likelihood of an improvement in CAS after CR was significantly higher in patients with baseline systolic blood pressure <120 mm Hg (OR = 2.74, p = 0.009) and left ventricular ejection fraction <43% (OR = 5.05, p = 0.005). In patients with MI,CR exerted a beneficial effect on CAS parameters.The improvement in CAS was predicted by lower SBPand LVEF at baseline.

Impact of Early Mobilization on Patients With Acute Ischemic Stroke Treated With Thrombolysis or Thrombectomy: A Randomized Controlled Trial

Background Early mobilization (EM) within 24 to 72 hours post-stroke may improve patients’ performance and ability. However, after intravenous thrombolysis (IVT) or mechanical thrombectomy (MT), the increased risk of hemorrhagic complications impacts the implementation of early out-of-bed mobilization. Few studies have investigated EM after IVT or MT for acute ischemic stroke (AIS), and its impact in these patients is unknown. Objective To investigate the effect of EM on AIS treated with IVT or MT.| Methods We recruited 122 patients with first AIS; 60 patients were treated with IVT, and 62 patients were treated with MT. For each IVT and MT cohort, the control groups received standard early rehabilitation, and the intervention groups received an EM protocol. The training lasted 30 minutes/day, 5 days/week until discharge. Main Outcomes Measures The effectiveness of the interventions was evaluated using the motor domain of the Functional Independence Measure (FIM-motor) and the Postural Assessment Scale for Stroke Patients (PASS) at baseline, 2-week, 4-week, and 3-month post-stroke, the Functional Ambulation Category 2-week post-stroke, and the total length of stay at the stroke center. Results Both IVT and MT treatment groups showed improved FIM-motor and PASS scores over time; however, only the IVT EM group had significantly improved FIM-motor performance within 1 month after stroke than the control group. Conclusion. An EM protocol with the same intervention time and session frequency per day as in the standard care protocol was effective in improving the functional ability of stroke patients after IVT.

Postoperative pain and pain management following selective dorsal rhizotomy

BackgroundSelective dorsal rhizotomy (SDR) is a neurosurgical procedure that reduces lower limb spasticity, performed in some children with spastic diplegic cerebral palsy. Effective pain management after SDR is essential for...

Early Postoperative Cardiac Rehabilitation in LVAD Patients: A Case Report

This study emphasizes the crucial role of early mobilization and proactive physical therapy for individuals undergoing left ventricular assist device (LVAD) therapy in the context of chronic or end-stage heart failure. Given the intricate medical complexities and prolonged hospitalizations inherent in this patient cohort, specialized cardiac rehabilitation (CR) strategies emerge as indispensable components in cardiovascular medicine. Detailed herein is a case study featuring a 62-year-old male patient who underwent LVAD implantation and participated in a 7-week cardiac rehabilitation program. The observed outcomes revealed substantial improvements in exercise capacity and muscle strength, assessed through standardized physical assessments. Importantly, echocardiographic evaluation demonstrated no adverse effects on left ventricular function. This case underscores the pivotal significance of early rehabilitation intervention during the postoperative phase, particularly in patients exhibiting stable vital signs and hemodynamics. The findings contribute to the refinement of tailored rehabilitation approaches for LVAD recipients, thereby fostering enhanced clinical outcomes and an elevated quality of life in this specialized patient population. The study underscores the critical importance of implementing early rehabilitation strategies in the holistic care paradigm for LVAD recipients, with potential implications for optimizing therapeutic protocols and improving long-term patient outcomes in the field of cardiovascular rehabilitation.

The Effectiveness of Early Rehabilitation in Limiting the Progression of Idiopathic Scoliosis.

Background: The purpose of this study was to assess specific rehabilitation methods' effectiveness in early idiopathic scoliosis (IS) development, focusing on lower limb functional inequality's role in scoliosis progression. Materials and Methods: This study comprised 812 patients aged 6-16 years at risk of developing idiopathic scoliosis (IS). The mean (SD) age was 10.66 (3.16) years. Patients were categorized into high- and medium-risk groups based on the angle of trunk rotation (ATR) size. Specific scoliosis physiotherapy was used, and the average follow-up period was 28.1 ± 14.5 months. Changes in ATR, Cobb angle, and functional length of the lower limbs pre- and post-treatment were statistically analyzed across three age groups (6-9, 10-12, and 13-16 years) and three scoliosis locations. Results: Significant effectiveness of early rehabilitation was observed in the high-risk group of children aged 6-9 years. In the medium-risk group, significant reductions in ATR were observed in both the 6-9 and 10-12 age groups across all three scoliosis locations. Additionally, there was a significant decrease in the Cobb angle in the thoracolumbar region and a significant reduction in lower limb inequality across all age groups and scoliosis locations. Conclusions: The early implementation of specific physiotherapy may enhance the efficacy of idiopathic scoliosis treatment by attenuating factors contributing to its progression.

USING OF CUPPING TECHNIQUE AS A THERAPEUTIC MODEL IN TREATMENT OF NON-DISCOGENIC LOW BACK PAIN

Background: Cupping therapy is one of the traditional medical technologies practiced for thousands of years. it might have some additional benefits on early rehabilitation for post-stroke complications. Aim of the work: to examine if the use of cupping technique as a therapeutic model in treatment of discogenic low back pain has a significant impact or not. Methodology: 60 Patients divided into two equal groups were participated in this study: Group 1 treated by conventional post-stroke therapy and Group 2 treated by wet cupping in addition to conventional post-stroke therapy. The national institute of health stroke scale (NIHSS) index was sed as patients assessment tool for neurologic deficit evaluation motor functions is assessed by the Fugl-Meyer assessment (FMA) scale, the healing process depended on the bedside swallowing assessment (BSA). For cognitive function, the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) have been used, and any undesirable effect of wet cupping were noted for safety evaluation. Results: Better results have been documented with wet cupping therapy. Statistically significant improvement in pain reduction for both techniques of cupping (dry &amp; wet) when compared to conventional medical therapy without augmentation with cupping therapy. Conclusion:Significant Effect of Hijama (Wet cupping) in post-stroke rehabilitation.

Inferior acromio-clavicular disjunction stage VI with clavicular shaft fracture: Very rare case report and review of the literature

Introduction and importance: Acromioclavicular dislocations are relatively common in the young, athletic population. We report a rare case of a rockwood stage VI acromioclavicular dislocation associated with one of the clavicle. This is the case of a patient who presented with an inferior right acromioclavicular dislocation associated with a well-engaged mediodiaphyseal fracture of the right clavicle, treated surgically with a good functional result. Our work will be based on the study of this case, with a review of the clinical and therapeutic literature. Case report: This is a 41-year-old female patient who presented to the emergency department with closed trauma of the right shoulder following a fall from a horse, with direct landing on the right shoulder. She complained of pain with total functional impotence of her right upper limb, with no downstream vascular-nervous disorders or other associated lesions. X-rays of the right shoulder face and profile with lamy and a right accromioclavicular defilement were consistent with Rockwood stage VI inferior right acromioclavicular dislocation associated with a well-engaged medio-diaphyseal fracture of the right clavicle. Treatment was surgical, with osteosynthesis of the right clavicle and reduction of the acromioclavicular joint, with satisfactory stability control, supplemented by immobilization in an elbow-to-body brace for 3 weeks and free mobilization beyond 3 weeks, as well as muscle strengthening from the 6th postoperative week. Discussion: Very few cases of type VI acromioclavicular dislocation have been found in the literature. These dislocations are observed very rarely and are difficult to diagnose in the early clinical findings, or may simply be overlooked due to the association of multiple traumas, as well as being associated with fractures of the acromion, clavicle, scapula and/or ribs. The therapeutic attitude is controversial, although surgical techniques differ, and conservative treatment with therapeutic abstention takes its place. Acromioclavicular dislocations must be classified into subtype VI-A for the subacromial and subtype VI-B for the subcoracoid, in order to codify the therapeutic attitude. Surgical treatment of this type of dislocation guarantees a satisfactory functional outcome, and our work supports this observation and is in line with the literature. Conclusion: Rockwood stage VI acromioclavicular dislocations, with its 2 subtypes, remain rare lesions requiring adequate surgical treatment with early and appropriate rehabilitation to ensure satisfactory functional results.

SOMNOLOGIC SCREENING AND MONITORING IN PATIENTS IN THE ACUTE PERIOD OF ISCHEMIC STROKE

Summary. Cerebral stroke – is one of the leading causes of morbidity and mortality, the frequency of which is constantly increasing and is about 1 million people per year in Europe; and from 13 to 35% of these patients die within the first 30 days of treatment, and 20-40% of patients who survived, are dependent on the external physical assistance and only about 10% return to a full-quality life. A significant part of patients with ischemic stroke has obstructive sleep breathing disorders, which are often the cause of the stroke development and significantly complicate its course, primarily due to the impaired airway patency, numerous episodes of apnea/hypopnea and hypoxemia, hypercapnia, etc. A comprehensive study of the frequency of the obstructive sleep apnea syndrome development and its degree of severity, its inherent ventilation and oxygenation disorders against the background of standard treatment and in combination with noninvasive respiratory support in patients with ischemic stroke, can play an important positive role on the way to the improvement of the results of treatment and rehabilitation. Objective. To study changes in ventilation and oxygenation in patients in the acute period of ischemic stroke, depending on the method of intensive therapy. Methods. Ischemic patients were performed a questionnaire survey and screening monitoring to find sleep breathing disorders («SomnoChek micro», Weinman, Germany), based on the results of which there were formed two groups: traditional stroke treatment and in combination with auto-CPAP support, which was performed with the help of «ResMed Air Sence-i» (Australia). To control the effectiveness of respiratory support, «SomnoChek micro» (Weinman, Germany) and «Masimo SafetyNet» (Masimo, USA) were used, the obtained somnological indices were processed statistically. Results. The frequency of detection of obstructive sleep apnea syndrome in patients with ischemic stroke in the acute period is 44%. The initial values of the apnea/hypopnea index (AHI) did not statistically significantly differ from each other and were 51.38±20.31/hour in the patients of the experimental group, and 51.21±20.27/hour in patients of the control group. During the 7th day, the AHI values in patients of the experimental group, whose traditional treatment of ischemic stroke was supplemented with sessions of CPAP-therapy at night, statistically significantly decreased at 89.2% compared to the initial data and were 5.54±1.98/hour, which are normal values and indicate the rapid and high efficiency of CPAP-support and its good tolerability by patients. In patients of the control group receiving only traditional treatment, the AHI values remained high, within pathological values and were 46.73±20.21/hour. When comparing reliable AHI intervals in observation groups, their 8.4-fold difference was determined. Against the background of CPAP-therapy, during the 7th day of observation, a statistically significant decrease in hypercapnia was determined in the patients of the experimental group, namely a decrease in the average PnCO2 at 23% compared to the initial level up to the limit of 37.57±1.04 mm Hg. Against the background of the use of CPAPtherapy in patients of the experimental group during the 7th day of observation, there was found a decrease (p&lt;0.001) of snoring at 92.1% (12.6-fold), compared to the initial level up to the limit of 2.43±2.22%, which indicates a stable restoration and maintenance of free patency of the upper respiratory tract under the influence of CPAP-support. Conclusion. Manifestations of obstructive sleep apnea syndrome in patients with ischemic stroke in the acute period were found in 88 people (44%), of which 68% had a moderate and severe form of nocturnal breathing disorders that required respiratory correction. Standardized medicinal therapy and early rehabilitation of patients with ischemic stroke does not affect the course and severity of the accompanying syndrome of obstructive sleep apnea and needs to be supplemented with methods of non-invasive respiratory support. In patients with ischemic stroke against the background of auto CPAP-therapy, positive dynamics was recorded in terms of correction of obstructive sleep apnea syndrome: a steady tendency or normalization of somnologic indices, ventilation, oxygenation, cessation of snoring. A clinical problem remains the low patients’ adherence to the use of CPAP-support and its tolerability, despite the absolute indications for its use.

Implementation of early prophylaxis for deep-vein thrombosis in intracerebral hemorrhage patients: an observational study from the Chinese Stroke Center Alliance

BackgroundThere is substantial evidence to support the use of several methods for preventing deep-vein thrombosis (DVT) following intracerebral hemorrhage (ICH). However, the extent to which these measures are implemented in clinical practice and the factors influencing patients’ receipt of preventive measures remain unclear. Therefore, we aimed to evaluate the rate of the early implementation of DVT prophylaxis and the factors associated with its success in patients with ICH.MethodsThis study enrolled 49,950 patients with spontaneous ICH from the Chinese Stroke Center Alliance (CSCA) between August 2015 and July 2019. Early DVT prophylaxis implementation was defined as an intervention occurring within 48 h after admission. Univariate and multivariate logistic regression analyses were conducted to identify the rate and factors associated with the implementation of early prophylaxis for DVT in patients with ICH.ResultsAmong the 49,950 ICH patients, the rate of early DVT prophylaxis implementation was 49.9%, the rate of early mobilization implementation was 29.49%, and that of pharmacological prophylaxis was 2.02%. Factors associated with an increased likelihood of early DVT prophylaxis being administered in the multivariable model included receiving early rehabilitation therapy (odds ratio [OR], 2.531); admission to stroke unit (OR 2.231); admission to intensive care unit (OR 1.975); being located in central (OR 1.879) or eastern regions (OR 1.529); having a history of chronic obstructive pulmonary disease (OR 1.292), ischemic stroke (OR 1.245), coronary heart disease or myocardial infarction (OR 1.2); taking antihypertensive drugs (OR 1.136); and having a higher Glasgow Coma Scale (GCS) score (OR 1.045). Conversely, being male (OR 0.936), being hospitalized in tertiary hospitals (OR 0.778), and having a previous intracranial hemorrhage (OR 0.733) were associated with a lower likelihood of early DVT prophylaxis being administered in patients with ICH.ConclusionsThe implementation rate of early DVT prophylaxis among Chinese patients with ICH was subpar, with pharmacological prophylaxis showing the lowest prevalence. Various controllable factors exerted an impact on the implementation of early DVT prophylaxis in this population.

Outcome of dynamic locked plate in treatment of intracapsular femur neck fracture

Background: The ideal surgical treatment of femoral neck fractures is still debatable. When internal fixation is used, many implants are available. This study aimed to evaluate the outcome following fixation of intracapsular femur neck fractures using the Targon-FN system (B. Braun, AG. Melsungen, Germany) comparing the results with a similar study done by the manufacturer and to assess risk factors associated with complications. Methods: A prospective interventional case series involved 30 consecutive patients aged from 23 to 82 (Mean 49 years) treated at Al-Jalaa trauma hospital in Benghazi- Libya in period from January 2016 to July 2017, for an intracapsular femur neck fracture with Targon-FN system. According to Garden classification 9 fractures (30%) undisplaced and 21 (70%) were displaced fractures, with 2 patients (6.7%) had type I, 7 patients (23.3%) had type II, 7 patients (23.3%) had type III and 14 patients (46.7%) had type IV fracture. Epidemiological data were collected. Patients were followed-up for 2 years (average 16 months). Joint function was assessed clinically by using Harris hip score (HHS) and fracture healing by radiological assessment at sex weeks, 3 months, 6 months, 1 year and finally at 2 years. Complications were recorded. Statistical analysis done to predict risk factors associated with reoperation and complications. Results: Sixteen patients (53.3%) developed one or more complications. Complications were higher than those of manufacturer’s study and included avascular necrosis (53.3%, n=16), nonunion (30%, n=9), blown out implant (16.66%, n=5), loosening screw (3.3%, n=1), and deep infection (3.3%, n=1). In total, 5 patients required total hip replacements. At end of 2 years 19 patients (63%) had poor result, one patient (3.3%) had fair result, 1 patient (3.3%) had good result and 9 patients (30%) had excellent result according to HHS. Delayed surgery, fracture displacement, surgeon’s experience, age ≥40 years and time to postop weight bearing recognized as risk factors for complications. Conclusions: A minimally-invasive surgery of Targon FN justifies use of this system for the preservation of the patient’s hip joint, early rehabilitation and mobilization. Complications and re-operation could be minimized by performing surgery within 24-48 hours, provision of skillful surgeons, and proper timing of postoperative weight bearing. The main limitation is the small number of cases and short follow-up averaged at 16 months.

Exploring the influence of a financial incentive scheme on early mobilization and rehabilitation in ICU patients: an interrupted time-series analysis

BackgroundClinical guidelines recommend early mobilization and rehabilitation (EMR) for patients who are critically ill. However, various barriers impede its implementation in real-world clinical settings. In 2018, the Japanese universal healthcare coverage system announced a unique financial incentive scheme to facilitate EMR for patients in intensive care units (ICU). This study evaluated whether such an incentive improved patients’ activities of daily living (ADL) and reduced their hospital length of stay (LOS).MethodsUsing the national inpatient database in Japan, we identified patients admitted to the ICU, who stayed over 48 hours between April 2017 and March 2019. The financial incentive required medical institutions to form a multidisciplinary team approach for EMR, development and periodic review of the standardized rehabilitation protocol, starting rehabilitation within 2 days of ICU admission. The incentive amounted to 34.6 United States Dollars per patient per day with limit 14 days, structured as a per diem payment. Hospitals were not mandated to provide detailed information on individual rehabilitation for government, and the insurer made payments directly to the hospitals based on their claims. Exposure was the introduction of the financial incentive defined as the first day of claim by each hospital. We conducted an interrupted time-series analysis to assess the impact of the financial incentive scheme. Multivariable radon-effects regression and Tobit regression analysis were performed with random intercept for the hospital of admission.ResultsA total of 33,568 patients were deemed eligible. We confirmed that the basic assumption of ITS was fulfilled. The financial incentive was associated with an improvement in the Barthel index at discharge (0.44 points change in trend per month; 95% confidence interval = 0.20–0.68) and shorter hospital LOS (− 0.66 days change in trend per month; 95% confidence interval = − 0.88 – -0.44). The sensitivity and subgroup analyses showed consistent results.ConclusionsThe study suggests a potential association between the financial incentive for EMR in ICU patients and improved outcomes. This incentive scheme may provide a unique solution to EMR barrier in practice, however, caution is warranted in interpreting these findings due to recent changes in ICU care practices.

Symptoms and Disability after Mild Traumatic Brain Injury: A Five-Year Follow-up.

Every year, many people suffer from traumatic brain injuries (TBI) with dramatic consequences for both the victim and their close relatives in the form of remaining lifelong symptoms and functional disabilities as a result. This study evaluates the outcomes of 49 patients after mild TBI (mTBI) at follow-up after 5 years by using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) to assess post-TBI symptoms and the Glasgow Outcome Scale Extended (GOSE) to assess disability. The specific aim was to evaluate post-TBI characteristics concerning age, gender, pre-injury systemic disease, computed tomography (CT) result and additional TBIs. Almost eighty percent reported RPQ symptoms, the most common for both genders being fatigue (51%) and poor concentration (51%). Seventy-six percent had a good recovery, 18% moderate disability, while 6% reported severe disability. The number of symptoms was significantly correlated to the level of disability. All participants with severe disability had repeated mTBI. Only twenty-one percent reported that they received some form of rehabilitation intervention after their mTBI. Five years after suffering mTBI, patients reported high rates of symptoms and disabilities. Our findings suggest that tailored rehabilitation interventions should be designed to identify mTBI patients in need of early rehabilitation. This would result in minimized suffering for the individual and improved cost-effectiveness for society.

Pediatric osteochondral fractures: clinical insights associate early diagnosis to early rehabilitation via arthroscopy

PurposeThis retrospective observational cohort analysis aims to address diagnostic and therapeutic challenges in managing osteochondral fractures (OCFs) resulting from acute patella dislocation and ankle sprains in children.MethodsThe study includes 15 children treated for OCFs between January 2020 and July 2022. Data were obtained from medical records and analyzed using logistic regression.ResultsThe diagnostic and treatment algorithm involves detailed history, clinical examination, and imaging, with MRI guiding therapeutic decisions. Arthroscopic or mini open fixation led to successful rehabilitation, with 93% achieving full mobility at 9 months. Age was identified as a slight risk factor for free fragments in MRI, and arthroscopic management correlated with faster recovery at 3 months.ConclusionThis study underscores the importance of immediate diagnosis and minimally invasive intervention for OCFs in children. Timely treatment, guided by a diagnostic algorithm, facilitates joint restoration and prevents degenerative consequences, ensuring a return to regular activities within a year postoperatively.Level of Evidence IV

Regional healing trajectory of the patellar tendon after bone-patellar tendon-bone autograft harvest for anterior cruciate ligament reconstruction.

Graft site morbidities after bone-patellar tendon-bone (BPTB) autograft harvest for anterior cruciate ligament reconstruction (ACLR) negatively impacts rehabilitation. The purpose of this study was to establish tendon structural properties 1-month after BPTB autograft harvest compared to the uninvolved patellar tendon, and subsequently to quantify the healing trajectory of the patellar tendon over the course of rehabilitation. Patellar tendon morphology (ultrasound) and mechanical properties (continuous shear wave elastography) from 3 regions of the tendon (medial, lateral, central) were measured in 34 participants at 1 month, 3-4 months, and 6-9 months after ACLR. Mixed models were used to compare tendon structure between limbs at 1 month, and quantify healing over 3 timepoints. The involved patellar tendon had increased cross-sectional area and thickness in all regions 1-month after ACLR. Thickness reduced uniformly over time. Possible tendon elongation was observed and remained stable over time. Tendon viscosity was uniform across the three regions in the involved limb while the medial region had higher viscosity in the uninvolved limb, and shear modulus was elevated in all three regions at 1 month. Viscosity and shear modulus in only the central region reduced over time. Statement of Clinical Significance: The entire patellar tendon, and not just the central third, is altered after graft harvest. Tendon structure starts to normalize over time, but alterations remain especially in the central third at the time athletes are returning to sport. Early rehabilitation consisting of tendon loading protocols may be necessary to optimize biologic healing at the graft site tendon.

The effect of vestibular and somatosensory rehabilitation in addition to early rehabilitation on balance after stroke: a randomized controlled trial

ABSTRACT Background The goal of post-stroke early rehabilitation is to regain ambulation, standing and balance. Objective The purpose of this study was to investigate the effects of vestibular and somatosensory rehabilitation in addition to early rehabilitation on balance in patients with early subacute stroke. Design and setting A randomized controlled trial was conducted at a university hospital. Methods The study was included 52 hemiplegic hospitalized early suacute stroke patients. The experimental group (n: 30), was applied with vestibular and somatosensorial rehabilitation together with early rehabilitation. Vestibular exercises, included Cawthorne-Cooksey exercises, stimulate the vestibulo-ocular and vestibulo-spinal reflex. Somatosensory exercises, which included Frenkel exercises, stimulate the sensory proprioception and somatosensory systems. The control group (n: 22) patients with early subacute stroke were treated with the early rehabilitation program only. The balance parameters of the patients were evaluated with the Korebalance System, Functional Reach Test, Postural Assessment Scale for Stroke, and Functional Ambulation Scale. Results The mean age of the patients was 67.32 ± 9.46 years, and the mean number of days that had passed since the stroke occurred was 17.90 ± 7.26. In calculating the balance scores, statistically significant differences were observed in the experimental and control groups, with a statistically greater improvement in the rehabilitation group. Statistically significant differences were determined between the groups in respect of the balance scores. Conclusions Based on these findings, the use of vestibular and somatosensory rehabilitation can be recommended for better functioning of the compensatory mechanism of early subacute-stroke hemiplegic patients in early ambulation, and this can lead to considerably improved standing and dynamic upper and lower body balance.

Frankfurt concept of early inpatient rehabilitation after cochlear implant treatment : Feasibility for aftercare. German version

The Association of the Scientific Medical Societies in Germany (AWMF) clinical practice guideline on cochlear implant (CI) treatment, which was updated in 2020, defined the entire process of CI care for the first time. In the present study, the feasibility and results of very early rehabilitation were examined. The intervention group (IG) comprised 54patients in whom rehabilitation was initiated within 14(maximally28) days after implantation. Patients with asignificantly longer waiting time were included in the control group (CG, n = 21). In addition to the start and duration of rehabilitation, the speech intelligibility achieved with CI was recorded at different timepoints within a12-month period. In addition, questionnaires were used to assess the effort of fitting the CI processor and the patients' satisfaction with the outcome as well as the timing of the start of rehabilitation. Median waiting time between implantation and start of rehabilitation was 14days in the IG and 106days in the CG; 92.6% of IG patients were able to start rehabilitation within 14days. The effect of rehabilitation in the IG was 35and in the CG 25percentage points (Freiburg monosyllabic test). After 6and 12months of CI use, both groups showed comparable results in the test condition in quiet (IG/CG6months: 70%/70%; 12months: 70%/60%, Freiburg monosyllabic test) and in noise (IG/CG6months: -1.1-0.85 dB SNR; 12months: -0.65 dB SNR/0.3 dB SNR, Oldenburg sentence test). Hearing quality assessment scores collected by SSQ (Speech, Spatial and Qualities of Hearing Scale) questionnaire showed better scores in the IG at 6months, which converged to CG scores at 12months. The IG was significantly more satisfied with the timing of the start of rehab than the CG. All other data obtained from questionnaires showed no differences between the two groups. Avery early start of inpatient rehabilitation after cochlear implantation was successfully implemented. The rehabilitation was completed within 7weeks of CI surgery. Comparison of speech recognition test results before and after rehabilitation showed asignificant improvement. Aclear rehabilitation effect can therefore be demonstrated. Inclusion of CI rehabilitation in the German catalog of follow-up treatments is thus scientifically justified and therefore strongly recommended.

Fractures of the Humeral Paddle in Children: About 15 Cases Followed At The Celpa-Bukavu Hospital Center From 01.01.2020-31.12.2023

Introduction: Fractures of the humeral paddle in children are one of the most frequent causes of emergency trauma. The aim of this study is to describe the epidemiological, clinical and therapeutic aspects of humeral paddle fractures in children followed in our department for 3 years. Patients and Methods: Prospective study involving 15 consecutive patients followed for fracture of the humeral paddle in our department from January 1, 2020 to December 31, 2022. The sampling was exhaustive, the data were collected on a preestablished form. Sociodemographic, clinical and therapeutic parameters were studied. Lesions were classified according to the Rigault and Lagrange classification. All these patients were operated on and followed by the same surgeon with a one-year follow-up. Results: The 5-8 year old age group predominated (66.7%); the sex ratio was 2.5 in favor of boys. Gaming accidents were the most dominant in 60%, the indirect mechanism was the most represented. All patients presented with a painful and impotent elbow. Supra-condylar fractures were the most common (60% of cases) and type II fractures were the most frequent in 53.3% of cases. The immediate complications were predominated by the absence of the radial pulse. The treatment was orthopedic in 73.3% of cases, and according to the Blount method in 72.7%. The results were satisfactory in 93.3% of cases. Elbow stiffness was the main complication (6.7%). Conclusion: Fractures of the humeral paddle are common in children, and often occur during play. The prognosis depends on the precocity and effectiveness of treatment. Early rehabilitation helps prevent elbow stiffness. Supervision of children's games by adults remains essential to prevent these fractures.

Pull-out vs. suture in zone Ia-Ib flexor tendon injuries: clinical results from a multicentre cohort study.

Several surgical techniques have been reported for flexor tendon zone 1a-b lacerations without a clear consensus on the gold standard treatment. The purpose of this multicentre study was to measure the outcomes of zone 1a-b flexor tendon injuries treated with a pull-out suture (POS) versus direct suture (DS) technique. Fifteen patients were treated with the pull-out technique and 22 patients with a direct suture technique between 2014 and 2020. The controlled active motion (CAM) regimen protocol and a standardised follow-up schedule were used in both groups. Data on the demographics, surgery, and treatment characteristics were collected at baseline as well as at week 6 and 13 post-operatively. The primary outcome measurement was the complication rate. Secondary outcome measurements were reoperation rate, finger range of motion (ROM), strength as well as patient satisfaction. The patient age ranged from 18 to 75 years in both groups with all patients having a complete FDP lesion after a clean-cut injury. The complication rate was 41% in the POS group and 16% in the DS group. The reoperation rate was 29% in the POS group and 8% in the DS group. Significant between-group differences in favour of the DS group were found in the passive DIP and passive PIP+DIP ROM at week 6 and week 13. Mean hand strength was 28.7 (11.6) kg in the POS group at week 13 and 21.3 (7.9) kg in the DS group. This difference was statistically significant (p=0.012) with a medium effect size (r=-0.41). Average patient satisfaction at week 13 was 7.5 (2.2) points in the POS and 7.7 (1.3) points in the DS group. The difference between groups was not significant (p=0.839). This register-based study demonstrates lower complication and reoperation rates with the direct suture approach compared with a pull-out button technique. Although clinical results were similar between the two surgery techniques at week 13 post-surgery, a direct suture approach should always be attempted whenever possible. If necessary, other local structures should be included to increase suture strength and allow for early active motion rehabilitation regimens.

Weak Points of Double-Plate Stabilization Used in the Treatment of Distal Humerus Fracture through Finite Element Analysis.

Multi-comminuted, intra-articular fractures of the distal humerus still pose a challenge to modern orthopedics due to unsatisfactory treatment results and a high percentage (over 50%) of postoperative complications. When surgical treatment is chosen, such fractures are fixed using two plates with locking screws, which can be used in three spatial configurations: either parallel or one of two perpendicular variants (posterolateral and posteromedial). The evaluation of the fracture healing conditions for these plate configurations is unambiguous. The contradictions between the conclusions of biomechanical studies and clinical observations were the motivation to undertake a more in-depth biomechanical analysis aiming to indicate the weak points of two-plate fracture stabilization. Research was conducted using the finite element method based on an experimentally validated model. Three variants of distal humerus fracture (Y, λ, and H) were fixed using three different plate configurations (parallel, posterolateral, and posteromedial), and they were analyzed under six loading conditions, covering the whole range of flexion in the elbow joint (0-145°). A joint reaction force equal to 150 N was assumed, which corresponds with holding a weight of 1 kg in the hand. The biomechanical conditions of bone union were assessed based on the interfragmentary movement (IFM) and using criteria formulated by Steiner et al. Results: The IFMs were established for particular regions of all of the analyzed types of fracture, with distinction to the normal and tangential components. In general, the tangential component of IFM was greater than normal. A strong influence of the elbow joint's angular position on the IFM was observed, with excessive values occurring for flexion angles greater than 90°. In most cases, the smallest IFM values were obtained for the parallel plaiting, while the greatest values were obtained for the posteromedial plating. Based on IFM values, fracture healing conditions in particular cases (fracture type, plate configuration, loading condition, and fracture gap localization) were classified into one of four groups: optimal bone union (OPT), probable union (PU), probable non-union (PNU), and non-union (NU). No plating configuration is able to ensure distal humerus fracture union when the full elbow flexion is allowed while holding a weight of 1 kg in the hand. However, flexion in the range of 0-90° with such loadings is acceptable when using parallel plating, which is a positive finding in the context of the early rehabilitation process. In general, parallel plating ensures better conditions for fracture healing than perpendicular plate configurations, especially the posteromedial version.