Effective Rehabilitation Research Articles

Guidelines for safe extubation and respiratory rehabilitation in the intensive care unit

Safe extubation and effective respiratory rehabilitation are pivotal in the recovery of critically ill patients in the intensive care unit (ICU). Extubation readiness is determined by assessing respiratory function, airway patency, neurological status, and hemodynamic stability. Tools such as spontaneous breathing trials (SBTs) and the cuff leak test provide valuable insights, while neurological and hemodynamic evaluations further guide decision-making. Ensuring the resolution of the primary illness is critical to minimize the risk of extubation failure and its associated complications. The process of extubation involves meticulous preparation and technique to ensure a smooth transition from mechanical ventilation. Pre-extubation interventions, including secretion management and corticosteroid administration for high-risk patients, are vital. Techniques like gradual cuff deflation and tube removal during peak inspiration, coupled with positioning strategies, reduce complications such as aspiration and airway obstruction. Post-extubation respiratory support, including high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV), plays a crucial role in stabilizing high-risk patients and preventing reintubation. Rehabilitation strategies focus on early mobilization, inspiratory muscle training, and pulmonary physiotherapy to enhance recovery and prevent long-term sequelae. Nutritional optimization is emphasized to counteract muscle weakness and promote tissue repair. Continuous monitoring for respiratory distress and addressing psychological impacts, such as post-intensive care syndrome (PICS), are integral to comprehensive care. Evidence-based protocols, individualized care plans, and multidisciplinary collaboration are essential to improving patient outcomes and reducing ICU-related morbidity and mortality.

Effects of Arm Swing in Lower Limb Muscle Activation and Coordination During Treadmill Walking

Arm swing is an inherent aspect of human locomotion that enhances lower limb (LL) muscle activation, which may explain its benefits for stroke rehabilitation over fixed-arm approaches. This study analyzed how restricting arm movement affects LL muscle coordination by comparing treadmill walking with arms (WWA) and walking with no arms (WNA) through muscle synergy analysis. Surface electromyography was recorded from eight LL muscles in ten healthy participants. Significant differences were found in muscle activity envelopes at 50% of the gait cycle (GC) for the Gluteus Medius, 0% and 100% GC for the Vastus Lateralis and Semitendinosus, and 25% GC for the Semitendinosus, Gastrocnemius Medialis, and Soleus. The Rectus Femoris and Vastus Lateralis showed higher variability and activation in WNA compared to WWA. Synergy analysis revealed four muscle synergies, with a median global variance of 95%. While spatial components were similar, temporal differences emerged at 0% GC for Synergy 1, 5% and 90% GC for Synergy 2, and 95% GC for Synergy 3 (p < 0.05). Our results suggest that arm swing influences LL muscle activity and coordination during walking. Future studies will aim at understanding the effects of arm swing in stroke rehabilitation, which could help design more effective gait rehabilitation protocols including arm swing.

Sanksi Rehabilitasi Bagi Anak Pecandu Narkotika

The use and abuse of drugs, especially by children, causes harm to individuals and society. Child drug abusers are considered self-victimizing victims, as they become victims of their own actions. The problem that often occurs in Indonesia is that drug cases in children are not given legal protection and many of these cases children are actually given sentences in prison. Therefore, the concept of punishment for drug addicted children through restorative justice is needed. Punishment can be carried out through a double track system if the conditions of restorative justice are not met. Article 127 of the Narcotics Law provides guidance to consider medical and social rehabilitation for child drug abusers. The application of criminal sanctions against child drug abusers needs to consider the rehabilitation aspect as the main alternative, considering the child as a victim who is not fully responsible for his actions. This research uses normative and doctrinal juridical research methods that focus on analyzing legal regulations, legal documents, and legal theories. The results of the research show that although there are regulations governing rehabilitation, its implementation still faces obstacles, such as the dominance of prison sentences for children who abuse drugs. The criminal justice process for children who abuse drugs has not fulfilled children's rights, which include protection, assistance, and guidance that takes into account the best interests of the child. The best interests of child victims of narcotics crime should be carried out through the provision of rehabilitation criminal sanctions. Therefore, legal protection of child drug abusers needs to be improved through a more effective and in-depth rehabilitation approach, as well as collective awareness to involve all parties in protecting children as the nation's assets.

Comparing virtual reality and balance training effects on postural strategies during ball kicking in soccer players with chronic ankle instability

The study aimed to determine if virtual reality (VR) games could enhance neuromuscular control and improve anticipatory and compensatory strategies in ball-kicking for soccer players. It was a single-blind randomized clinical trial involving 32 male soccer players with chronic ankle instability. Participants were divided into two groups: VR games and balance training. The primary outcomes measured were the amplitude and onset time of muscle activities in the peroneus longus (PL), tibialis anterior (TA), soleus (SOL), rectus femoris (RF), biceps femoris (BF), and gluteus medius (GM) in three phases: anticipatory (APA), compensatory 1 (CPA1), and compensatory 2 (CPA2). Secondary outcomes included the Y-balance test and perceived ankle instability. Evaluations were done before and after treatment. Both groups underwent 12 sessions, three times a week, each lasting 60 min. In the VR games group, there was a significant decrease in SOL muscle activity amplitude during CPA2 after treatment (P = 0.033), and the BF muscle activated earlier (P = 0.043). The balance training group showed a significant increase in GM muscle activity amplitude during APA (P = 0.037) and earlier activation of the GM muscle post-treatment (P = 0.050). Additionally, this group demonstrated significant decreases in RF activity during CPA1 and PL activity in CPA1 and CPA2 (P = 0.048, P = 0.030, and P = 0.050, respectively). Between-group comparisons indicated a significant increase in GM muscle activity amplitude during APA and a reduction during CPA1 for the balance training group compared to the VR games group (P = 0.050 and P = 0.012, respectively). Both groups showed significant reductions in perceived ankle instability (VR group: P = 0.002, balance training group: P < 0.001) and improvements on the Y-balance test (VR group: P < 0.021, balance training group: P < 0.033), although neither group showed significant improvement in the anterior direction. Overall, both VR games and balance training effectively enhanced perceived ankle stability and dynamic postural control, with neither approach showing clear superiority. Both groups exhibited improvements in muscle activation timing, though neither outperformed the other. While both interventions led to increased muscle activity amplitude during the anticipatory and compensatory phases, the balance training group achieved somewhat greater improvements. These results suggest that both VR games and balance training are effective rehabilitation approaches for chronic ankle instability, providing comparable benefits for enhancing ankle stability and neuromuscular control, without a distinct advantage of one over the other.RCT Registration: On the Iranian Registry of Clinical Trials (IRCT20230124057197N1). Registration date: 30/06/2023

Investigating the effects of home-based rehabilitation after intensive inpatient rehabilitation on motor function, activities of daily living, and caregiver burden.

Home-based rehabilitation involves professional rehabilitation care and guidance offered by physical, occupational, and speech therapists to patients in their homes to help them recuperate in a familiar living environment. The effects on the patient's motor function and activities of daily living (ADLs), and caregiver burden for community-dwelling patients are well-documented; however, little is known about the immediate benefits in patients discharged from the hospital. Therefore, we examined the effects of continuous home-based rehabilitation immediately after discharge to patients who received intensive rehabilitation during hospitalization. We retrospectively reviewed 150 patients [mean (standard deviation, SD) = 81 (9) years] discharged from the convalescent rehabilitation and community-based integrated care wards undergoing tailored home-based rehabilitation for 6 months (provided by physical or occupational therapists: 1-2 sessions of 40-60 min each per week). The outcome measures at baseline and after 3 and 6 months were compared. The participants included in this study had orthopedic (n = 76), cerebrovascular (n = 50), neuromuscular (n = 11), cardiovascular (n = 5), respiratory (n = 3), cancer (n = 3) and other diseases (n = 2). The mean (SD) time from discharge to the start of rehabilitation was 4 (4) days. One-way analysis of variance and post-hoc comparisons showed significant improvements at 3 months from baseline in grip strength (p = 0.002), 5-repetition sit-to-stand test (p < 0.001), Standing test for Imbalance and Disequilibrium test (p = 0.025), Functional Independence Measure (p < 0.001), modified Frenchay Activities Index (p < 0.001). Additionally, a statistically significant improvement was observed in the Japanese Zarit Caregiver Burden Interview score at 6 months from baseline (p < 0.001). Home-based rehabilitation improves motor function, ADLs, and instrumental ADLs even after intensive inpatient rehabilitation and decreases the burden of the caregiver in the long term. Hence, tailored home-based rehabilitation should be continuously implemented after the completion of intensive inpatient rehabilitation.

The Role of Laboratory Findings in Guiding Physiotherapy Treatment Plans: A Review

The integration of laboratory findings into physiotherapy treatment planning is a critical step toward personalized and evidence-based patient care. This review explores the role of laboratory diagnostics in guiding physiotherapy interventions, with a focus on key biomarkers such as inflammatory markers, metabolic indicators, and oxygenation levels. By synthesizing findings from recent studies, the review highlights how laboratory data can inform the intensity, type, and progression of physiotherapy, particularly in managing conditions like rheumatoid arthritis, diabetes, and pulmonary diseases. The evidence suggests that laboratory-guided physiotherapy not only enhances patient outcomes but also ensures safer and more effective rehabilitation. Challenges, including the accessibility of diagnostic tools and interdisciplinary collaboration, are discussed alongside recommendations for integrating laboratory findings into physiotherapy practice and education.

The Intersection of Laboratory Testing and Physical Therapy: Implications for Patient Rehabilitation – A Systematic Review

This systematic review explores the intersection of laboratory testing and physical therapy in the context of patient rehabilitation, emphasizing the role of diagnostic markers in optimizing therapeutic outcomes. The integration of laboratory diagnostics into physical therapy practices has gained significant attention, as it enables more personalized and effective rehabilitation strategies. This review synthesizes findings from recent studies, highlighting the influence of laboratory tests, such as blood biomarkers, imaging, and metabolic evaluations, on tailoring therapy plans and enhancing recovery. Results demonstrate the potential of diagnostic data to refine physical therapy interventions, improve patient outcomes, and reduce recovery times. However, challenges such as cost, accessibility, and the need for interdisciplinary collaboration remain critical considerations. The findings underline the importance of leveraging laboratory diagnostics to advance evidence-based physical therapy and promote comprehensive, patient-centered care.

Evolution of Physical Self-Esteem During Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: An Observational Study.

Background/Objectives: Patients with COPD have altered self-esteem, and good self-esteem promotes personal, health, and social success. Improving self-esteem could be a method for encouraging the maintenance of physical activity. Only one study has evaluated the effects of pulmonary rehabilitation (PR) on self-esteem in moderate COPD patients. The objective was to assess the evolution of self-esteem in COPD patients of all stages of severity during PR. Methods: COPD patients undergoing PR were included in this prospective observational study. Patients were evaluated before and after the 4-week PR program. The objectives were to (1) assess the evolution of self-esteem using the Physical Self Inventory-6 questionnaire (PSI-6), (2) assess the evolution in each sub-score of PSI-6, (3) examine the correlations between the evolution of self-esteem and the evolution of parameters usually used during PR, and (4) determine an MID for self-esteem. Results: In total, 76 patients were included. We found that there was a significant increase in the total score in PSI-6 (9.29, p < 0.001), CI 95% [6.74; 11.83], and in the sub-scores of PSI-6. The evolution of the PSI-6 score was moderately correlated with changes in exercise capacity using STST1 (r = 0.352, p = 0.002) and quality of life (r = -0.361, p = 0.001) and weakly correlated to changes in dyspnea (r = -0.245, p = 0.03), anxiety (r = -0.248, p = 0.03), and depression (r = -0.290, p = 0.01). Using a distribution-based analysis, we found an MID between 5.2 and 5.6. Conclusions: We showed a significant increase in global score and in each sub-score of self-esteem using PSI-6 in COPD patients undergoing a PR program. We propose an MID of 5.6.

Systematic Evaluation of IMU Sensors for Application in Smart Glove System for Remote Monitoring of Hand Differences.

Human hands have over 20 degrees of freedom, enabled by a complex system of bones, muscles, and joints. Hand differences can significantly impair dexterity and independence in daily activities. Accurate assessment of hand function, particularly digit movement, is vital for effective intervention and rehabilitation. However, current clinical methods rely on subjective observations and limited tests. Smart gloves with inertial measurement unit (IMU) sensors have emerged as tools for capturing digit movements, yet their sensor accuracy remains underexplored. This study developed and validated an IMU-based smart glove system for measuring finger joint movements in individuals with hand differences. The glove measured 3D digit rotations and was evaluated against an industrial robotic arm. Tests included rotations around three axes at 1°, 10°, and 90°, simulating extension/flexion, supination/pronation, and abduction/adduction. The IMU sensors demonstrated high accuracy and reliability, with minimal systematic bias and strong positive correlations (p > 0.95 across all tests). Agreement matrices revealed high agreement (<1°) in 24 trials, moderate (1-10°) in 12 trials, and low (>10°) in only 4 trials. The Root Mean Square Error (RMSE) ranged from 1.357 to 5.262 for the 90° tests, 0.094 to 0.538 for the 10° tests, and 0.129 to 0.36 for the 1° tests. Likewise, mean absolute error (MAE) ranged from 0.967 to 4.679 for the 90° tests, 0.073 to 0.386 for the 10° tests, and 0.102 to 0.309 for the 1° tests. The sensor provided precise measurements of digit angles across 0-90° in multiple directions, enabling reliable clinical assessment, remote monitoring, and improved diagnosis, treatment, and rehabilitation for individuals with hand differences.

Cognitive Functioning in Children and Young People with Congenital Heart Disease: A Systematic Review of Meta-Analyses.

Objectives: Congenital heart disease (CHD) is a prevalent condition affecting young people that often necessitates complex medical interventions. This study aims to provide a synthesis of existing meta-analyses examining the impact of CHD on the cognitive functioning in children and young people; Methods: A comprehensive literature review was conducted, identifying peer-reviewed meta-analyses from 1 January 1976 to 17 December 2024, focusing on the cognitive outcomes of CHD patients aged 0-24 years. Data extraction covered study details, participant demographics, outcomes, and quality assessments. Quality assessment followed the Scottish Intercollegiate Guidelines Network (SIGN) checklist, and a narrative synthesis was conducted; Results: The narrative synthesis highlighted significant cognitive impairments in children with CHD across domains such as Intelligence Quotient (IQ), executive functions (EF), memory, and alertness. Cognitive impairments were also observed to become worse with increasing age. Furthermore, surgical interventions were found to impact cognitive outcomes, with surgeries at an early age improving survival rates but not entirely mitigating cognitive deficits. Cognitive impairments were more marked in young people assessed at an older age and with a more complex CHD presentation. Conclusions: Children with CHD face persistent cognitive challenges, underscoring the need for early identification and tailored interventions. Routine cognitive assessments and comprehensive care, including educational and psychological support, are crucial for improving neurodevelopmental outcomes. Future research should focus on longitudinal studies to track cognitive development and explore effective rehabilitation programs.

Could video game-based physical rehabilitation substitute for conventional physiotherapy in patients with glioma? A proof-of-concept study.

The present study investigated the clinical feasibility of replacing a part of conventional physiotherapy (PT) with Nintendo Wii® for the recovery of motor function and activities of daily living (ADL) in patients with glioma. This study included 10 patients with first-episode gliomas who were admitted to the neurosurgery department of a tertiary hospital. According to the patients' preferences, they were allocated to conventional PT or Wii® rehabilitation groups in which a part of the conventional PT sessions were replaced with Wii® training. The Fugl-Meyer Assessment (FMA), Short Physical Performance Battery (SPPB), Functional Independence Measure (FIM), and Hospital Anxiety and Depression Scale (HAD) measures were compared between the treatment groups using the Mann-Whitney U test. The Wii® rehabilitation and conventional PT groups included four (age 39 [26-53] years, n = 2 each WHO grade III and IV) and six patients (age 72 [59-80] years; all WHO grade IV), respectively. No patient dropouts were observed. The beneficial changes did not differ significantly between the conventional PT and Wii® groups (FMA: 1.0 vs. 1.5, SPPB: - 1.0 vs. - 0.5, FIM: - 2.5 vs. 2.5, HAD: 6 vs. 0). No adverse events such as falls were observed in either treatment group. Wii® rehabilitation had comparable effects with conventional PT for the inpatient rehabilitation of patients with glioma, with no adverse effects. Wii® rehabilitation showed potential as a home-based training modality because no physical assistance was required. Further investigation will be required because of the selection bias as a non-randomized trial. Exergame Wii® could be an effective rehabilitation tool for brain tumor patients.

Combined Effects of Dietary Guidance and Prosthodontic Rehabilitation on Nutritional Biomarkers in Edentulous Patients: A Randomized Controlled Trial.

Background Previous studies have suggested that providing dietary guidance along with denture treatment may improve dietary diversity in edentulous patients; however, none have examined the effects on nutritional blood biomarkers. This study investigated the effects of individualized dietary guidance combined with complete denture treatment on nutritional blood biomarker levels, dietary intake, and masticatory function. Materials and methods This was a prospective, randomized, open-label, controlled trial. Patients seeking new dentures with at least one edentulous arch were randomly allocated to Group A (denture treatment only) or Group B (dietary guidance followed by denture treatment). Individualized dietary guidance was provided exclusively to Group B by dentists based on baseline assessments. Baseline and post-treatment assessments included blood tests, a dietary survey using the Brief-type Self-Administered Diet History Questionnaire (BDHQ), occlusal force measurements using pressure-sensitive film, and masticatory performance tests using gummy jelly. The results from the baseline and post-treatment assessments were compared within each group, and exploratory comparisons of changes were conducted between groups. Results A total of 39 individuals completed the protocol (20 in Group A and 19 in Group B; mean age 73.4 ± 10.6 years; 17 males, 22 females). Both groups showed a significant increase in occlusal force after treatment (P = 0.007 for Group A; P = 0.011 for Group B), while no improvement in blood biomarkers was observed. In Group B, the intake of fish with bones (P = 0.035) and non-oily fish (P = 0.030), as evaluated using the BDHQ, significantly increased after treatment. Group B also showed significantly greater increases than Group A in methionine (P = 0.012), lysine (P = 0.048), and total essential amino acids (P = 0.029), as evaluated by blood tests, as well as the intake of fish with bones (P = 0.043). Conclusion Although denture treatment may increase occlusal force, combining dietary guidance with prosthetic treatment appears to further enhance dietary habits and support the nutritional status of edentulous patients.

Early pulmonary rehabilitation in ARDS patients: Effects on respiratory function and long-term outcomes: A retrospective study.

This retrospective cohort study, conducted at People's Hospital of Wenjiang Chengdu (January 2018 to January 2022), aimed to evaluate the effects of early pulmonary rehabilitation (PR) on respiratory function in acute respiratory distress syndrome patients after discontinuing invasive mechanical ventilation in the intensive care unit. Patients were divided into PR and control groups based on an offline training protocol. Outcome measures included short physical performance battery scores, respiratory muscle strength, and pulmonary function indicators at discharge and 3 months post-discharge, including peak expiratory flow, forced expiratory volume in 1 second/forced vital capacity, and vital capacity. Kaplan-Meier analysis assessed 6-month survival rates. Among the 240 patients, 120 received traditional training and 120 received early PR. Both groups had no significant differences in baseline characteristics. Short physical performance battery scores and respiratory muscle strength showed gradual improvements in both groups, with the PR group achieving significantly higher scores at 5 and 7 days (P < .05). At 3 months post-discharge, pulmonary function indicators such as peak expiratory flow, forced expiratory volume in 1 second/forced vital capacity, and vital capacity in the PR group were significantly improved compared to discharge and were higher than those in the control group (P < .05). The number of sputum aspirations in the PR group significantly decreased (P < .05), and intensive care unit stays after weaning were significantly shorter (P < .05). Kaplan-Meier survival analysis revealed that the cumulative survival rate at 6 months post-discharge was significantly higher in the PR group compared to the control group (hazard ratio = 0.660, 95% CI: 0.472-0.922, P = .014). These findings suggest that early PR significantly enhances respiratory function recovery, reduces complications, and improves survival outcomes in acute respiratory distress syndrome patients after invasive ventilation.

Single versus two dental implants retained mandibular over dentures: comparison of function, patient satisfaction, oral health–related quality of life and success of treatment

ObjectiveTo compare the effectiveness of prosthetic rehabilitation of edentulous patients using conventional complete dentures (CD), single median dental implant retained over dentures (SIMOD) with over dentures retained by two dental implants (TIMOD).MethodsThirty completely edentulous patients (fifteen each arm) presented to the Faculty of Dental Sciences, University of Peradeniya were randomly selected for the SIMOD or TIMOD groups. Patients were initially provided with CD. Surgical implant placement and prosthetic procedures were conducted at the Faculty of Dental Sciences. Osseointergration was confirmed, healing caps and then ball attachments were fixed on the implants. Clinical outcome was assessed by clinician, patient, and oral health related quality of life (OHRQOL) using OHIP-14 scale. Data were analyzed using Minitab P < 0.05 was considered as statistically significant level.ResultsPatient comfort, esthetics, chewing, speech, general satisfaction, denture retention, stability, and support with TIMOD & SIMOD had been significantly increased than CD (p < 0.05) at 3, 6 months, and 1 year review. OHIP-14 scale showed statistically significant improved oral health related quality of life with SIMOD and TIMOD compared to CD.ConclusionSIMOD & TIMOD have improved outcome assessed by the patient and clinician and OHRQOL of the individual than CD. SIMOD can also be considered for successful management of completely edentulous patients.

Biochemical Mechanisms and Rehabilitation Strategies in Osteoporosis-Related Pain: A Systematic Review.

Osteoporosis causes a bone mass reduction and often determines acute and chronic pain. Understanding the biochemical and neurophysiological mechanisms behind this pain is crucial for developing new, effective rehabilitative and therapeutic approaches. This systematic review synthesizes recent advances in muscle-bone interactions and molecular pathways related to osteoporosis-associated pain. We carried out a systematic review including studies published from 2018 to 2024 using PubMed, Scopus, clinicaltrials.gov and Cochrane Library. The Cochrane Collaboration tool was used to assess bias risk. The review adhered to PRISMA guidelines and is registered with PROSPERO (CRD42024574456); Results: Thirteen studies were included. It emerged that osteoporosis causes progressive bone loss due to disruptions in biochemical processes and muscle-bone interactions. This condition is also closely associated with the development of pain, both acute and chronic. Key findings include the role of the miR-92a-3p/PTEN/AKT pathway and the impact of muscle-bone disconnection on bone health. Mechanotransduction is critical for bone maintenance. Effective pain management and rehabilitation strategies include physical therapy and physical exercise, yoga, Pilates, and cognitive behavioral therapy (CBT); they all improve pain relief and functional outcomes by enhancing muscle strength, flexibility, and balance. Pharmacological options such as NSAIDs, opioids, and new agents like SHR-1222, along with surgical interventions like percutaneous vertebroplasty, offer additional pain reduction, especially when included in individualized rehabilitation projects; Conclusions: This review highlights advancements in understanding osteoporotic pain mechanisms and identifies promising treatments. Integrating targeted therapies and rehabilitation strategies can enhance patients' pain relief.

Predictive value of a self-administered frailty screening questionnaire for the effectiveness of functional rehabilitation evaluated with the locomotor functional independence measure in a geriatric rehabilitation unit: a multicentre cohort study

BackgroundPatient Reported Outcome Measures (PROMs) are questionnaires that collect health data directly from the patient, without any intervention from a third party. The aim of rehabilitation units is to restore function. Functional gain can be evaluated with classic scales, such as the locomotor subscale of the Functional Independence Measure. This study aimed to assess the accuracy of a new self-assessment questionnaire pertaining to physical, sensory and cognitive ability (abbreviated SEPCO) for the prediction of functional prognosis in older patients admitted to a rehabilitation unit.MethodsIn this multicentre observational study including patients admitted to 12 rehabilitation centres in France, all included patients completed the SEPCO on admission. Poor response to rehabilitation was defined as relative effectiveness < 40% on the evolution of the locomotor FIM subscale. Components of the questionnaire potentially associated with the outcome of rehabilitation were confirmed for inclusion upon expert review and summed to form an overall score. The final score had five components: the depression score of the HADS, the SOFRESC vision score, the SOFRESC balance score, the stress urinary incontinence subscale of the USP, and the EPICES socio-economic deprivation score. A logistic regression model adjusted for baseline characteristics assessed the performance of the SEPCO score to predict change in functional status, defined by the relative functional gain for the locomotion subscale of the Functional Independence Measure (FIM).ResultsA total of 153 patients (mean age 79.2 ± 8.1 years, 72.5% women) were included. By multivariate analysis, a 5-scale SEPCO score ≥ 1.1 predicted worse functional improvement with an odds ratio (OR) of 2.575, 95% Confidence Interval (CI) 1.081 to 6.133, p = 0.03. Sensitivity for this threshold was 67.4% (95% CI 52.0–80.5%), with a specificity of 58.8% (95% CI 46.2–70.6%). Having a SEPCO ≥ 1.1 almost doubled the probability of poor response to rehabilitation (from 27.3 to 52.5%).ConclusionThe SEPCO score can predict poor functional gain from rehabilitation. Future studies should validate this score on an external cohort. The SEPCO could serve as a complement to the initial clinical evaluation performed by physicians, and assist physicians in setting each patient’s rehabilitation goals.

My back: co-designing municipal rehabilitation with and for individuals with long-lasting back problems: study protocol

BackgroundIn Denmark, the organization and content of rehabilitation for people with back problems vary by municipality. Furthermore, there is no systematic evaluation of the overall effect and quality of municipal rehabilitation efforts. Since individuals with long-lasting back problems often receive multiple interventions delivered by various professionals, departments, and sectors, a coordinated effort is essential within complex systems, like municipal organizations. Therefore, the Municipality of Svendborg, the University of Southern Denmark, and UCL University College aim to co-design an improved municipal rehabilitation program with and for individuals with back problems, within the existing municipal context. The new practices developed in the program seek to better support individuals to manage everyday life with back problems, develop effective rehabilitation practices, and decrease the associated municipal costs.MethodsMy Back is a mixed-method research study, utilizing a Plan-Do-Study-Act (PDSA) approach to ensure iterative development and continuous improvement of municipal rehabilitation practices. This study is structured into several work packages (WPs) that focus on identifying experiences (WP 1), mapping current practices (WP 2), summarizing relevant literature (WP 3), conducting co-design workshops (WP 4), and the development and implementation of new rehabilitation practices via PDSA cycles (WP 5). These WPs will inform the development and implementation of new rehabilitation practices, which will be evaluated for quality and effectiveness (WP 6), and system-level changes (WP 7), followed by dissemination of results (WP 8).DiscussionThrough a local co-design process involving individuals with back problems, municipal professionals, and leaders, we expect strong relevance and engagement, ensuring successful implementation. The new practices aim to better support people with back problems to manage everyday life through improved rehabilitation and interdisciplinary collaboration among municipal social and health professionals. A platform model for monitoring local rehabilitation will be introduced to evaluate workability and economic implications within the target population. The knowledge and results from this study can be disseminated and adapted to public contexts throughout Denmark and potentially other countries with similar municipal healthcare structures. Sharing best practices and lessons learned from the implementation process can inform rehabilitation practices in different international settings.

A cable-driven elbow exoskeleton with variable stiffness actuator for upper limb rehabilitation

Abstract Elbow, with complex physiological structure, plays an important role in upper limb motion which can be assisted with exoskeleton in rehabilitation. However, the stiffness of elbow changes while training which decline the comfort and effect of rehabilitation. Moreover, the rotation axis of elbow is changing which will cause secondary injuries. In this paper, we design an elbow exoskeleton with a variable stiffness actuator and a deviation compensation unit to assist elbow rehabilitation. Firstly, we design a variable stiffness actuator by symmetric actuation principle to adapt the change of elbow stiffness. The parameters of the variable stiffness actuator are optimized by motion simulation. Next, we design a deviation compensation unit to follow the rotation axis deviation outside the horizontal plane. The compensation area is simulated to cover the deviation. Finally, simulation and experiments are carried out to show the performance of our elbow exoskeleton. The workspace can meet the need of daily elbow motion while the variable stiffness actuator can adjust the exoskeleton stiffness as expectation.

The Potential of Artificial Intelligence in Predicting Post-Stroke Rehabilitation Outcomes: Statistical Analysis Considering Rivermead Motor Assessment and Activities of Daily Living Indicators and Selected Demographic Variables

Strokes are currently the third most common cause of death worldwide and the leading cause of disability in people over 50 years of age. The functioning of post-stroke patients depends primarily on well-conducted rehabilitation, both in stationary conditions and at home. The aim of this study was to evaluate the functional outcomes of patients after ischemic stroke who underwent home rehabilitation. The RMA (Rivermead Motor Assessment) and ADL (activities of daily living) scales were used for evaluation. A total of 20 patients underwent a 4-week home rehabilitation program in Cracow. In the studied group, most patients showed functional improvement after the 4-week rehabilitation period. Predictive models were created (Net1, Net2, Net3) using artificial intelligence algorithms, including regression and classification methods. The analysis results indicate that the best outcomes in predicting the RMA and ADL indicators. For Net2, the prediction accuracy for the ADL indicator was 94.4%, which is significantly higher compared to the other indicators. The RMA1-3 indicators achieved relatively low accuracy rates of 38.9–44.4%. In contrast, for Net3, the RMA1-3 indicators showed high accuracy, achieving 89.1–91.3% correct results. The conclusions of the study suggest that using a combination of the Net2 and Net3 models can contribute to optimizing the rehabilitation process, allowing therapy to be tailored to the individual needs of patients. The research proves that it is possible to predict the effect of rehabilitation by using AI. The implementation of such solutions can increase the effectiveness of post-stroke rehabilitation, particularly through the personalization of therapy and dynamic monitoring of patient progress.

Impact of a Nosocomial COVID-19 Outbreak on Convalescent Rehabilitation Outcomes of Post-Stroke Patients.

This study aimed to elucidate the impact of a nosocomial COVID-19 outbreak on convalescent rehabilitation outcomes of post-stroke patients. This retrospective observational study included post-stroke patients who were hospitalized in convalescent rehabilitation wards of our hospital during a COVID-19 outbreak between July 22, 2022 and August 13, 2022 (outbreak group). The control group consisted of patients hospitalized in convalescent rehabilitation wards from October 1 to December 31, 2022 (non-outbreak group). The two groups were compared in terms of motor Functional Independence Measure (FIM) effectiveness at discharge, Brunnstrom Recovery Stage, length of stay, and duration of rehabilitation therapy. Furthermore, within the outbreak group, outcomes were compared according to whether patients were infected with SARS-CoV-2. The impact of the outbreak on motor FIM effectiveness at discharge was also evaluated. There were 30 patients in the outbreak group (COVID-19, n = 18; close contacts, n = 12) and 33 patients in the non-outbreak group. Motor FIM effectiveness at discharge was significantly lower in the outbreak group, but there was no significant difference in outcomes according to SARS-CoV-2 infection status. After adjusting for SARS-CoV-2 infection, the nosocomial outbreak was significantly associated with lower motor FIM effectiveness at discharge. A nosocomial COVID-19 outbreak affected motor FIM effectiveness in convalescent rehabilitation for post-stroke patients, regardless of SARS-CoV-2 infection status.