Functional Rehabilitation Exercise Research Articles

Treatment of Femoral Traumatic Fractures with a Custom Bridge Combined Fixation System

Background: With the development of transportation in modern China, the incidence of traumatic fracture and the global degree of fracture complexity are increasing. This study explored the use and curative effect of a novel custom-manufactured bridge combined fixation system for traumatic fractures of the femur. The bridge combined fixation system can be tailored to the specific patient's requirements by bending the rods and sliding the attachment modules. Methods: From May 2013 to August 2017, 14 patients with traumatic femur fractures were managed with the bridge combined fixation system. The operation was conducted according to the routine incision approach of femur fracture. The patients were given early postoperative functional rehabilitation exercise. The curative effect was evaluated according to clinical manifestations, postoperative imaging, and a self-developed standard for bone healing. Results: All patients were followed for 12–24 (median: 12.5) months. Fracture healing was assessed based on clinical symptoms and postoperative X-ray. After 3 months, complete weight-bearing on the affected leg was painless. X-ray showed that the fracture line had disappeared by 6–9 months postoperatively and showed bone healing. According to the self-developed standard for bone healing, 13/14 (92.8%) patients achieved excellent/good clinical outcomes. Bone union was achieved in all patients within 2 years. Conclusion: The custommanufactured bridge combined fixation system is simple and can effectively achieve tailored reduction of the fracture. The fixation was stable, with few complications after surgery and with good treatment effect for traumatic fractures.

Effect of virtual reality video games on gross motor function of children with cerebral palsy

Objective To explore the effect of virtual reality video games on gross motor skills of children with cerebral palsy. Methods The 56 patients with cerebral palsy treated in the Fifth Affiliated Hospital of Zhengzhou University from April 2015 to April 2017 were selected as the subjects.The age of the patients was (5.4±1.2) years old (5-7 years old). According to the results of Gross Motor Function Classification System (GMFCS) assessment, all patients belonged to level Ⅰ-Ⅱ.All patients were randomly divided-into 2 groups: video-game group and conventional exercise group for 6 weeks of functional exercise.The evaluation criteria included the average exercise time, the 6-minute walk test (6MWT) and general motion function challenge module (GMFMS-CM) measurement and evaluation. Results The average exercise time of video games in video game group was (44.2 ± 6.1) minutes.The encouragement from the therapists in the intervention process was very important.The technical problems also had a relatively high proportion, and the technical guidance and training should be emphasized at the beginning of the study.The ave-rage score of the Likert scale showed that the practice program was suitable for the patients; GMFMS-CM in video-game group was significantly higher [mean difference was 4.8, the quartile (IQP) was 4.68, Z=-2.025, P=0.035], while conventional exercise group showed an increasing trend which was not significantly different; 6MWT showed a significant increase in the mean level of video-game group (mean difference was 69.1 m, IQR was 40.2 m, Z=-2.108, P=0.045), conventional exercise group was significantly lower than the average level of subjects in video-game group and there was no significant change in the study period. Conclusion For children with cerebral palsy, routine functional rehabilitation exercise plus family-style virtual reality video game practice, on the one hand to improve patient compliance with the treatment, on the other hand can significantly improve their physical movement function, which is conducive for the patients′ quality of life and self-care ability. Key words: Virtual reality; Video game; Cerebral palsy; Motor function

Effects of individual and group exercise programs on pain, balance, mobility and perceived benefits in rheumatoid arthritis with pain and foot deformities.

[Purpose] To verify the effects of individual and group exercise programs on pain, balance, mobility and perceived benefits of rheumatoid arthritis patients (RA) with pain and foot deformities. [Subjects and Methods] Thirty patients with RA pain and foot deformity were allocated into two groups: G1: individual exercise program and G2: group exercise program. The variables analyzed were Numerical Rating Scale (NRS) for pain, Berg Balance Scale (BBS) for balance, Timed Up & Go Test (TUG) and Functional Reach (FR) for mobility, and Foot Health Status Questionnaire (FHSQ-Br) for perceived benefits. Both exercise programs consisted of functional rehabilitation exercises and self-care guidance aimed at reducing pain and improving balance and mobility. Intragroup comparisons of variables between A1 (pre-intervention) and A2 (post-intervention) were performed. [Results] Patients in both groups were similar in A1 (pre-intervention) in all the variables analyzed. Comparison between A1 and A2 for each variable showed improvement for G1 in the NRS, BBS, FR, TUG and in four out of ten domains of FHSQ-Br. G2 showed improvement in the NRS, BBS and eight out of ten domains of FHSQ-Br. [Conclusion] Both individual and group programs revealed benefits for patients with RA, however, group exercise programs showed better perception of benefits.

Effects of the application of ankle functional rehabilitation exercise on the ankle joint functional movement screen and isokinetic muscular function in patients with chronic ankle sprain

[Purpose] This study was conducted to investigate the effects of ankle functional rehabilitation exercise on ankle joint functional movement screen results and isokinetic muscular function in patients with chronic ankle sprain patients. [Subjects and Methods] In this study, 16 patients with chronic ankle sprain were randomized to an ankle functional rehabilitation exercise group (n=8) and a control group (n=8). The ankle functional rehabilitation exercise centered on a proprioceptive sense exercise program, which was applied 12 times for 2 weeks. To verify changes after the application, ankle joint functional movement screen scores and isokinetic muscular function were measured and analyzed. [Results] The ankle functional rehabilitation exercise group showed significant improvements in all items of the ankle joint functional movement screen and in isokinetic muscular function after the exercise, whereas the control group showed no difference after the application. [Conclusion] The ankle functional rehabilitation exercise program can be effectively applied in patients with chronic ankle sprain for the improvement of ankle joint functional movement screen score and isokinetic muscular function.

A novel cadaveric study of the morphometry of the serratus anterior muscle: one part, two parts, three parts, four?

The serratus anterior is portrayed as a homogeneous muscle in textbooks and during functional activities and rehabilitation exercises. It is unclear whether the serratus anterior is composed of subdivisions with distinctive morphology and functions. The purpose of this study was to determine whether the serratus anterior could be subdivided into different structural parts on the basis of its segmental architectural parameters. Eight formalin-embalmed serratus anterior muscles were dissected and the attachments of each fascicle documented. Orientation and size of each fascicle were measured and the physiological cross-sectional area (PCSA) calculated. Three subdivisions of the serratus anterior were identified. A new finding was the discovery of two distinctive fascicles attached to the superior and inferior aspects of rib 2. The rib 2 inferior fascicle had the largest PCSA (mean 1.6cm2) and attached, with the rib 3 fascicle, along the medial border of the scapula to form the middle division. The rib 2 superior and rib 1 fascicles attached to the superior angle of the scapula (upper division). Fascicles from ribs 4-8/9 attached to the inferior angle of the scapula (lower division). Mean fascicle angle relative to a vertical midline reference and PCSA for each division were 29° and 1.3cm2 (upper), 90° and 2.2cm2 (middle) and 59° and 3.0cm2 (lower). This novel study demonstrated the presence of morphologically distinct serratus anterior subdivisions. The results of this study will inform the development of optimal techniques for the assessment, treatment and rehabilitation of this architecturally complex muscle in shoulder and neck pain.

Feasibility study of a serious game based on Kinect system for functional rehabilitation of the lower limbs

Summary Introduction Conventional functional rehabilitation costs time, money and effort for the patients and for the medical staff. Serious games have been used as a new approach to improve the performance as well as to possibly reduce medical cost in the future for cognitive rehabilitation and body balance control. The objective of this present work was to perform a feasibility study on the use of a new real-time serious game system for improving the musculoskeletal rehabilitation of the lower limbs. Materials and methods A basic functional rehabilitation exercise database was established with different levels of difficulties. A 3D virtual avatar was created and scaled to represent each subject-specific body. A portable and affordable Kinect sensor was used to capture real-time kinematics during each exercise. A specific data coupling process was developed. An evaluation campaign was established to assess the developed system. Results The squats exercise was the hardest challenge. Moreover, the performance of each functional rehabilitation exercise depended on the physiological profile of each participant. Our game system was clear and attractive for all functional rehabilitation exercises. All testing subjects felt motivated and secure when playing the rehabilitation game. Discussion The comparison with other systems showed that our system was the first one focusing on the functional rehabilitation exercises of the lower limbs. Conclusions Our system showed useful functionalities for a large range of applications (rehabilitation at home, sports training). Looking forward, new in-situation exercises will be investigated for specific musculoskeletal disorders.

The treatment of patellofemoral arthroplasty for isolated patellofemoral osteoarthritis

Objective To explore the effect and factors of patellofemoral arthroplasty (PFA) for isolated patellofemoral osteoarthritis. Methods Data of 18 patients (3 males, 15 females) with isolated patellofemoral osteoarthritis underwent PFA from March 2006 to December 2014 were retrospectively analyzed. There were 3 males and 15 females with a mean age of 54 years (range, 46-74 years). It was strict to grasp the surgical indications according to the clinical symptoms, signs and imaging data preoperatively. 11 patients were operated with AVON patellofemoral prosthesis (Stryker Inc.) and the other 7 patients were operated with the Gender Solutions patellofemoral prosthesis (Zimmer Inc.). Active and passive functional rehabilitation exercise was encouraged at the early stage after operation. Visual analogue scale (VAS) was 5.33±0.99 (range, 4-7) and hospital for special surgery knee score (HSS) was 53.28±5.71 (range, 44-63) before operation. Results The mean duration of follow-up was 63.98 months (range, 6-104 months). VAS after operation for 1 and 3 months were 1.17±0.79 (range, 0-3) and 0.72±0.67 (range, 0-2), and the pain was almost relieved after 9 months. HSS after operation for 1, 3, 9 months were 70.06±6.33 (range, 61-80), 86.06±5.12 (range, 77-95) and 91.39±4.83 (range, 82-97). HSS score of the latest follow-up was 92.06±4.05 (range, 84-97), which was improved obviously from the preoperative ones. The excellent and good rate was 100% (excellent 15 cases, good 3 cases). The satisfactory rate was 94.4% (17/18). Only one case got slightly knee pain when walking up and down the stairs after 2 years, and the pain was relieved after being administered with NSAIDs and rest. No incision infection, rupture, prosthesis supported bone fracture, prosthesis loosening and other complication was occurred during the follow-up period in the other patients. Conclusion The clinical outcomes of PFA are strictly related to surgical indications, implant design and appropriate surgical technique. Therefore, based on the appropriate PFA implants, strict surgical indications, appropriate patients, excellent operation skills and actively functional rehabilitation exercise, PFA could treat the isolated patellofemoral osteoarthritis effectively. Key words: Osteoarthritis, Knee; Patellofemoral joint; Arthroplasty, replacement

Observation of curative effect of open reduction internal fixation combined with external fixation of intra-articular fractures of the distal radius

Objective To investigate the clinical effect internal fixation combined with external fixator incision in the treatment of intra-articular fractures of the distal radius.Methods 80 cases of intra-articular distal radius fracture patients underwent cut internal fixation combined with external fixator in the treatment of orthopedic were chosen,postoperative rehabilitation exercises,fracture healing after the removal of the external fixator.All patients were followed up for 8 months to 12 months,an average of 9.2 months.Results 80 patients were intraarticular fractures healed,the time required was 4 to 10 months,an average of 6.3 months.In accordance with the assessment of functional systems Dienst wrist,51 cases wrist function were excellent,21 cases were good,the good rate was 90％ (72/80).There were no clinical fractures common complication after surgery.Conclusion Open internal fixation combined with external fixator treatment of intra-articular fractures of the distal radius fractures not only makes reduction of fracture and immobilization satisfaction,but also conducive to the wrist of early postoperative functional rehabilitation exercise. Key words: Radius fractures ; Wrist joint; Fracture fixation, internal; External fixators

A damper driven robotic end-point manipulator for functional rehabilitation exercises after stroke.

Stroke survivors may benefit from robotic assistance for relearning of functional movements. Current assistive devices are either passive, limited to only two dimensions or very powerful. However, for reach training, weight compensation and a little assistance with limited power is sufficient. We designed and evaluated a novel three-dimensional robotic manipulator, which is able to support the arm weight and assist functional reaching movements. Key points of the design are a damper-based drive train, giving an inherently safe system and its compact and lightweight design. The system is force actuated with a bandwidth of up to 2.3 Hz, which is sufficient for functional arm movements. Maximal assistive forces are 15 N for the up/down and forward/backward directions and 10 N for the left/right direction. Force tracking errors are smaller than 1.5 N for all axes and the total weight of the robot is 25 kg. Furthermore, the device has shown its benefit for increasing reaching distance in a single-case study with a stroke subject. The newly developed system has the technical ability to assist the arm during movement, which is a prerequisite for successful training of stroke survivors. Therapeutic effects of the applied assistance need to be further evaluated. However, with its inherent safety and ease of use, this newly developed system even has the potential for home-based therapeutic training after stroke.

Replantation of hand multi-level severances with 17 segments

Traumatic injuries of the hand and fingers might be devastating with irretrievable functional and psychological consequences in injured individuals. We present a case of successful replantation of hand multi-level severances with 17 segments to address the best way of treatment of such injury.The patient was 18-year-old female with multi-level severances due to cutting injury. During the surgery, we adopted unifying coordination and grouping surgery. Moreover, we tried to improve the quality of vascular anastomosis with various measures and shorten operative time. Postoperatively, we closely observed the patient to effectively prevent and treat vascular crises. Furthermore, we acquired utmost hand function recovery through enhancing functional rehabilitation exercise. The case was followed-up regularly. As a result, the replanting palm and all fingers survived successfully. Abdominal pedicle flaps were used to repair the skin of the distal end portion of thumb and middle finger due to severe injury. At 5-year follow-up, the prehension function of the hand was restored and the patient was capable of general labour and normal activity with the replanted hand.This report demonstrated our experience of successful treatment of a rare and severe case of hand injury. Accordingly, we recommend grouping surgery, closely coordination, effective and comprehensive intra-operative and post-operative technical operations and treatments. Postoperative functional rehabilitation exercise can restore utmost hand function.

The influence of the initiation of an exercise programme on seroma formation and dehiscence following breast cancer surgery

To verify whether early (first post-operative day) or late initiation (after removal of the continuous suction drain) of a functional rehabilitation exercise programme influences the incidence of seroma formation and dehiscence for women after breast cancer surgery. Benefits of early implementation of an exercise programme initiated with women in the first days following breast cancer surgery are widely known. However, the safe initiation of the exercises is still a controversial issue and some authors correlate early initiation of the exercises with an increase in seroma formation. A prospective, randomised, controlled clinical trial. Seventy-seven women were randomly assigned to initiate the programme on post-operative day 1 (early group = 40) or after removal of the drain (late group = 37) and were monitored until the 45th post-operative day. Patients in the early group were instructed to perform the exercises daily at home, beginning on post-operative day 1, while those of the late group began the exercises after the drain was removed. The assessment for seroma formation and dehiscence was performed on post-operative days 7 and 45. There was no statistically significant difference regard to seroma formation between early group and late group. Also there was no association between the presence of dehiscence and early exercises. The early initiation of the exercises for women, following breast cancer surgery, constitutes a safe practice for the rehabilitation. However, these findings need to be further explored and confirmed in a larger sample. Studies showing evidence that early functional rehabilitation process is a safe practice for women having surgery for breast cancer, as well as the present research, are of interest to health professionals who care for these patients and contribute to the wider global clinical community.

Towards the development of a wearable feedback system for monitoring the activities of the upper-extremities

BackgroundBody motion data registered by wearable sensors can provide objective feedback to patients on the effectiveness of the rehabilitation interventions they undergo. Such a feedback may motivate patients to keep increasing the amount of exercise they perform, thus facilitating their recovery during physical rehabilitation therapy. In this work, we propose a novel wearable and affordable system which can predict different postures of the upper-extremities by classifying force myographic (FMG) signals of the forearm in real-time.MethodsAn easy to use force sensor resistor (FSR) strap to extract the upper-extremities FMG signals was prototyped. The FSR strap was designed to be placed on the proximal portion of the forearm and capture the activities of the main muscle groups with eight force input channels. The non-kernel based extreme learning machine (ELM) classifier with sigmoid based function was implemented for real-time classification due to its fast learning characteristics. A test protocol was designed to classify in real-time six upper-extremities postures that are needed to successfully complete a drinking task, which is a functional exercise often used in constraint-induced movement therapy. Six healthy volunteers participated in the test. Each participant repeated the drinking task three times. FMG data and classification results were recorded for analysis.ResultsThe obtained results confirmed that the FMG data captured from the FSR strap produced distinct patterns for the selected upper-extremities postures of the drinking task. With the use of the non-kernel based ELM, the postures associated to the drinking task were predicted in real-time with an average overall accuracy of 92.33% and standard deviation of 3.19%.ConclusionsThis study showed that the proposed wearable FSR strap was able to detect eight FMG signals from the forearm. In addition, the implemented ELM algorithm was able to correctly classify in real-time six postures associated to the drinking task. The obtained results therefore point out that the proposed system has potential for providing instant feedback during functional rehabilitation exercises.

전방십자인대 재건술 후 16 주간의 기능적인 재활운동 프로그램이 여성 축구선수의 슬관절 기능 회복에 미치는 영향

Anterior cruciate ligament reconstruction(ACLR) is a common sports injury, especially in active young females as well as women`s soccer player and purpose of ACLR functional rehabilitation exercise program was to recovery a function on knee joint. The purpose of this study was to examine functional capacity of patient who have had a ACLR and to investigate effect of a 16 wks functional rehabilitation exercise program on knee function recovery. Ten university women`s soccer player after ACLR(n=10) were recruited for this study. 16 wks rehabilitation exercise program consisted of 3-4 hrs, 5 times a week. For data analysis, the mean and standard deviation were estimated; independent-samples t-test and depependent-sample t-test carried out. The results of the present study were as follows: First, in 60°/sec and 180°/sec, there was significant change isokinetic related factors of the involved knee extensor on university women`s soccer player after ACLR on 16 wks time point. Second, Single and triple hop for distance after functional rehabilitation exercise increased significantly on involved leg at 16 wks time point. Third, Deficit ratio at extensor at 60°, 180° and BESS decreased significantly whereas Lysholm score increased significantly on involved leg at 16 wks time point. It would be concluded that 16 wks functional rehabilitation exercise program elicited many positive changes in the women`s soccer player after ACLR such as improvement of knee function. and It was concluded that an rehabilitation exercise program necessary for the patients after ACLR especially young women`s soccer player.

Clinical Application of rehabilitation exercise after breast cancer operation

Objective To study the clinical application of rehabilitation exercise after breast cancer. Methods 120 cases of breast cancer patients were randomly divided into rehabilitation group and control group with 60 cases for each group. According to different surgical methods and wound surface size,functional rehabilitation exercise training refining was carried out in rehabilitation group; there are four stages in all for the function of the healing exercise. The first stage is mainly to take exercise with elbow joint and head. The key to the second and the third stages is shoulder joints to train. The main part consists of the fingers climbing the wall and shoulder joints sport going on for the fourth stage. 12 days after surgery and before discharge, the recovery of limb function and shoulder were measured as well as the length of stay, fare and satisfaction, which are obviously better than those in control group. Results Rehabilitation exercise after breast cancer patients can improve limb abduction, flexion, extension, finger climb the wall function,the functional recovery of limb rehabilitation group and the length of stay, fare and satisfaction better than the control group. Conclusion Postoperative functional rehabilitation exercise of training to breast cancer patients can effectively enhance the recovery of limb function, help to balance mental pressure, improve quality of life and satisfaction, shorten the length of hospital stay and reduce hospitalization costs. Key words: Rehabilitation exercises; Breast cancer; , Modified radical mastectomy; Clinical Application; Limb function

Combined application of vascularized pedicled pectoralis major clavicular periosteal flap and locking plate fixation plus bone morphogenetic protein implantation in the treatment of clavicular defect and nonunion after operation

Objective To investigate the clinical characteristics of clavicular defect and nonunion after operation and evaluate the clinical effects of vascularized pedicled pectoralis major clavicular periosteal flap and locking plate fixation plus bone morphogenetic protein (BMP) implantation. Methods From January 2004 to April 2008, 12 patients (mean age, 42.8 years old) with clavicular defect and nonunion were treated in Zhongshan Hospital. The internal fixators were removed, and then fibrous scars and sclerotic bones were cleared. The clavicular detects were fixed with locking plate, with implantation of the BMP. The wound was covered with vascularized pedicled pectoralis major clavicular periosteal flap. Postoperative functional rehabilitation exercises were performed. Results All patients were followed up for 8-24 months (mean 1.2 years). The clinical results were evaluated by Constant-Murley scoring system. The clavicular defects were healed in all patients within 4-7 months, and the internal fixators were successfully removed from some of the patients. Conclusions Vascularized pedicled pectoralis major clavicular periosteal flap combined with locking plate fixation plus BMP implantation is effective in the treatment of clavicular defect and nonunion. Key words: Clavicle; Fracture fixation; internal; Bone morphogenetic proteins; Periosteal flap

Functional Rehabilitation Exercise Prescription for Golfers

Functional Rehabilitation Exercise Prescription for Golfers

The postoperative nursing and functional rehabilitation exercises for total knee replacement (TKR)

本文总结11例全膝人工关节置换(TKR)的术后护理和功能康复训练,重点介绍切口护理,并发症预防及功能康复护理.认为:全膝人工关节置换术后通过正确护理和一系列功能康复训练,体现TKR治疗价值。

A virtual-reality-based telerehabilitation system with force feedback.

A PC-based orthopedic rehabilitation system was developed for use at home, while allowing remote monitoring from the clinic. The home rehabilitation station has a Pentium II PC with graphics accelerator, a Polhemus tracker, and a multipurpose haptic control interface. This novel interface is used to sample a patient's hand positions and to provide resistive forces using the Rutgers Master II (RMII) glove. A library of virtual rehabilitation routines was developed using WorldToolKit software. At the present time, it consists of three physical therapy exercises (DigiKey, ball, and power putty) and two functional rehabilitation exercises (peg board and ball game). These virtual reality exercises allow automatic and transparent patient data collection into an Oracle database. A remote Pentium II PC is connected with the home-based PC over the Internet and an additional video conferencing connection. The remote computer is running an Oracle server to maintain the patient database, monitor progress, and change the exercise level of difficulty. This allows for patient progress monitoring and repeat evaluations over time. The telerehabilitation system is in clinical trails at Stanford Medical School (CA), with progress being monitored from Rutgers University (NJ). Other haptic interfaces currently under development include devices for elbow and knee rehabilitation connected to the same system.