Approach For Restoration Of Function Research Articles

Ab. No. 122 Functional Restoration Approach in the Management of Complex Regional Pain Syndrome (Crps) Caused By Onychomycosis: A Case Report

Introduction: The objective of this case report is to highlight the importance of incorporating functional restoration approach in the physiotherapy management of CRPS. The significant pain and disability associated with CRPS is not only biomedically faceted but frequently encompasses psychosocial aspects too. Physiotherapy management should address both these aspects. The functional restoration approach emphasizes gradual progression, starting with pre-sensorimotor cortices activation, then advancing to functional tasks. Methods: This is a case review of a 61 year old man with history of Onychomycosis presenting with left shoulder, wrist and hand stiffness and pain 6 months post the infection. Patient also presented with fear of movement and was reported to have had not used the arm functionally for daily activities since the onset of the infection. Patient is a k/c/o intentional tremors since 25 years. The functional restoration approach included patient education, desensitization using kinetic sand, followed by movement with Mulligan’s technique and graded functional activity by perpetual training over subsequent sessions. Pre and post assessments after a 3-week intervention included Kinesiophobia, Function, Pain, ROM, and grip strength. Additionally, the Archimedes spiral test was used to gauge tremor severity as a secondary outcome. Results: Post-intervention, positive changes were observed in outcome measures: a 16% decrease in Tampa Scale of Kinesiophobia, 10% improvement in Michigan Hand Outcome, 7% in grip strength, and 7% and 8% in wrist and shoulder ROM, respectively. The Archimedes spiral test also showed a notable improvement. Conclusion: The approach demonstrated improvement in Function, pain, and Kinesiophobia, with notable changes in range of motion, grip strength, and tremors as well. Implication: Functional restoration approach is a comprehensive method of managing CRPS since it addresses the syndrome’s multifaceted nature. Simultaneous assessment of biopsychosocial components aids in tracking progress and predicting better outcomes.

Physical Therapy Outcome Measures for Assessment of Lower Extremity Chronic Pain-Related Function in Pediatrics

To assess the clinical utility of 5 physical therapy (PT) outcome measures in quantifying functional changes in pediatric lower extremity chronic pain treated at a hospital-based interdisciplinary rehabilitation center. This was a cross-sectional study with retrospective review of 173 individuals, 8 to 18 years old, treated from June 2008 to 2013. The measures used were the Timed Up and Go, Timed Up and Down Stairs, Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, 6-minute walk test, and Lower Extremity Functional Scale. Participant performance was correlated with demographic characteristics, the Functional Disability Index, Multidimensional Anxiety Scale for Children, Child Depression Inventory, and Canadian Occupational Performance Measure. Scores from all 5 PT measures showed significant improvement following treatment. Functional Disability Index correlated to every PT measure except the 6-minute walk test. This study supports the clinical use of these PT measures to track functional progress after rehabilitative treatment of lower extremity chronic pain-related disability.

Cortical control of intraspinal microstimulation: Toward a new approach for restoration of function after spinal cord injury.

Approximately 6 million people in the United States are currently living with paralysis in which 23% of the cases are related to spinal cord injury (SCI). Miniaturized closed-loop neural interfaces have the potential for restoring function and mobility lost to debilitating neural injuries such as SCI by leveraging recent advancements in bioelectronics and a better understanding of the processes that underlie functional and anatomical reorganization in an injured nervous system. This paper describes our current progress toward developing a miniaturized brain-machine-spinal cord interface (BMSI) that converts in real time the neural command signals recorded from the cortical motor regions to electrical stimuli delivered to the spinal cord below the injury level. Using a combination of custom integrated circuit (IC) technology for corticospinal interfacing and field-programmable gate array (FPGA)-based technology for embedded signal processing, we demonstrate proof-of-concept of distinct muscle pattern activation via intraspinal microstimulation (ISMS) controlled in real time by intracortical neural spikes in an anesthetized laboratory rat.

Focused Review of Interdisciplinary Pain Rehabilitation Programs for Chronic Pain Management

Interdisciplinary pain rehabilitation programs (IPRPs) are based on a functional restoration approach to treating complex chronic pain conditions. With a greater appreciation for a biopsychosocial approach to more effectively manage patients with chronic pain has come the development of more comprehensive treatment programs with less of a biomedical emphasis (i.e., interventional therapy, unimodal physical therapy, and passive modalities) and more of a biopsychosocial one. Interdisciplinary programs involve the use of multiple disciplines such as physical and occupational therapy, pain psychology, medical pain management, vocational rehabilitation, relaxation training, and nursing educations. Multiple psychometric tools are used in the assessment process and along treatment to better assess outcomes. This article will examine components of IPRPs, discuss desirable features of successful programs and teams, and more closely review four established outpatient pain programs in the United States. A greater understanding of the unique features and shared values of successful programs will help one better understand how these programs can be more widely used and available. The review will also highlight common psychometric outcomes tools used in assessing patients and monitoring outcomes. Most importantly, the review will help to answer a common question, even among pain physicians: "What goes on in those chronic pain programs?"

Effects of intravenous administration of human umbilical cord blood stem cells in 3-acetylpyridine-lesioned rats.

Cerebellar ataxias include a heterogeneous group of infrequent diseases characterized by lack of motor coordination caused by disturbances in the cerebellum and its associated circuits. Current therapies are based on the use of drugs that correct some of the molecular processes involved in their pathogenesis. Although these treatments yielded promising results, there is not yet an effective therapy for these diseases. Cell replacement strategies using human umbilical cord blood mononuclear cells (HuUCBMCs) have emerged as a promising approach for restoration of function in neurodegenerative diseases. The aim of this work was to investigate the potential therapeutic activity of HuUCBMCs in the 3-acetylpyridine (3-AP) rat model of cerebellar ataxia. Intravenous administered HuUCBMCs reached the cerebellum and brain stem of 3-AP ataxic rats. Grafted cells reduced 3-AP-induced neuronal loss promoted the activation of microglia in the brain stem, and prevented the overexpression of GFAP elicited by 3-AP in the cerebellum. In addition, HuUCBMCs upregulated the expression of proteins that are critical for cell survival, such as phospho-Akt and Bcl-2, in the cerebellum and brain stem of 3-AP ataxic rats. As all these effects were accompanied by a temporal but significant improvement in motor coordination, HuUCBMCs grafts can be considered as an effective cell replacement therapy for cerebellar disorders.

Functional Restoration for a Chronic Lumbar Disk Extrusion With Associated Radiculopathy

The effectiveness of functional restoration (FR) for patients with lumbar disk herniation with associated radiculopathy (LDHR) is unclear. This case report describes how an FR program was used to rehabilitate a patient with such an injury. The patient was a 26-year-old female child care worker with a 12-month history of back pain and a 4-month history of unremitting left leg symptoms. She had clinical and radiological evidence of an L5-S1 disk extrusion with associated left S1 radiculopathy. Interventions. The patient completed a 9-week FR program supervised by a physical therapist. Exercises then were continued more independently for a 2-year period at a public gymnasium. Following 9 weeks of supervised FR, the patient demonstrated marked improvement in symptoms and functional ability, and resolution of neurological signs. Fourteen months after commencing FR, a follow-up magnetic resonance imaging scan demonstrated resolution of the L5-S1 disk extrusion and relief of S1 nerve root compression. Functional improvements continued and were maintained 2 years following the start of intervention. A patient with chronic LDHR who underwent FR made significant improvements. Research is needed to determine the efficacy of an FR approach for treating such patients.

The Management of Secondary Gain and Loss in Medicolegal Settings: Strengths and Weaknesses

Individuals with chronic illness and disability are among the most difficult patients to treat. The health-care provider is faced with an array of physical, psychological, and social factors, requiring adoption of a biopsychosocial approach to treatment. This approach necessitates consideration of the benefits for the patient of remaining ill and disabled. These benefits have been termed the "secondary gains" of illness, and they may serve to perpetuate disability and illness behavior. This paper focuses on secondary gain and loss issues in patients with chronic, nonprogressive illness associated with chronic disability, who are evaluated and treated in medicolegal settings. In working with this population of patients, the health-care provider is faced not only with the usual secondary gains of illness (e.g., escape from family responsibilities), but must also deal with the myriad of secondary gain issues unique to medicolegal settings (e.g., seeking financial compensation). Consequently, identifying and managing secondary gain issues can be quite challenging. A model for managing these issues is presented here,following a more general discussion of secondary gain and related concepts. This model has proven very useful when incorporated into an effective rehabilitation program, such as the functional restoration approach to treating chronic musculoskeletal disorders. However, shortcomings of this model for managing secondary gain have become apparent. These shortcomings, and methods for overcoming them, are discussed. The overall purpose of this paper is to improve the health-care provider's ability to identify and manage both simple and complex secondary gain issues.

Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain.

Chronic low back pain is, in many countries, the main cause of long term disability in middle age. Patients with chronic low back pain are often referred for multidisciplinary treatment. Previous published systematic reviews on this topic included no randomised controlled trials and pooled together controlled and non-controlled studies. To assess the effect of multidisciplinary bio-psycho-social rehabilitation on pain, function, employment, quality of life and global assessment outcomes in subjects with chronic disabling low back pain. We searched MEDLINE, EMBASE, PsychLIT, CINAHL, Health STAR, and The Cochrane Library from the beginning of the database to June 1998 using the comprehensive search strategy recommended by the Back Review Group of the Cochrane Collaboration. INTERVENTION specific key words for this review were: patient care team, patient care management, multidisciplinary, interdisciplinary, multiprofessional, multimodal, pain clinic and functional restoration. We also reviewed reference lists and consulted the editors of the Back Review Group of the Cochrane Collaboration. randomised controlled trials comparing multidisciplinary bio-psycho-social rehabilitation with a non-multidisciplinary control intervention. Adults with disabling low back pain of more than three months in duration. Patients had to be assessed and treated by qualified professionals according to a plan that addresses physical and at least one of psychological, or social/occupational dimensions. Only trials which reported treatment effect in at least one of pain, function, employment status, quality of life or global improvement. Exclusion: Pure educational interventions (back schools) and pure physical interventions were excluded. Selection, data extraction and quality grading of studies was done by two independent reviewers using pre-tested data forms. Study quality was assessed according to the scheme recommended by the Back Review Group of the Cochrane Collaboration. Trials with internal validity scores of five or more in a ten point scale were considered high quality. Discrepancies between reviewers were resolved by consensus or by a third reviewer. Given the marked heterogeneity in study settings, interventions and control groups we decided not to pool trial results in a meta-analysis. Instead, we summarized findings by strength of evidence and nature of intervention and control treatments. The evidence was judged to be strong when multiple high quality trials produced generally consistent findings. It was judged to be moderate when multiple low quality or one high quality and one or more low quality trials produced generally consistent findings. Evidence was considered to be limited when only one randomised trial existed or if findings of existing trials were inconsistent. Ten trials (12 randomised comparisons) were included. They randomised a total of 1964 patients with chronic low back pain. There was strong evidence that intensive multidisciplinary bio-psycho-social rehabilitation with a functional restoration approach improved function when compared with inpatient or outpatient non-multidisciplinary treatments. There was moderate evidence that intensive multidisciplinary bio-psycho-social rehabilitation with a functional restoration approach improved pain when compared with outpatient non-multidisciplinary rehabilitation or usual care. There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary bio-psycho-social intervention. Some trials reported improvements in work readiness, but others showed no significant reduction in sickness leaves. Less intensive outpatient psycho-physical treatments did not improve pain, function or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care. Few trials reported effects on quality of life or global assessments. The reviewed trials provide evidence that intensive multidisciplinary bio-psycho-social rehabilitation with a functional restoration approach improves pain and function. Less intensive interventions did not show improvements in clinically relevant outcomes.

Multidisciplinary rehabilitation for chronic low back pain: systematic review

Objective: To assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with chronic low back pain.Design: Systematic literature review of randomised controlled trials.Participants: A total of...

Cell replacement strategies for neurodegenerative disorders.

Cell transplantation has over the last two decades emerged as a promising approach for restoration of function in neurodegenerative diseases, in particular Parkinson's and Huntington's disease. Clinical trials have so far focused on the use of implants of embryonic mesencephalic tissue containing already fate-committed dopaminergic neuroblasts with the capacity to develop into fully mature dopamine neurons in their new location in the host brain. However, the recent demonstration that immature neural progenitor cells with multipotent properties can be isolated from both the developing and adult CNS and that these cells can be maintained and propagated in culture, has provided a new interesting tool for restorative cell replacement and gene transfer therapies. Embryonic stem cells, obtained from the early stages of embryonic development, and neural stem cells, obtained from the developing brain, may provide renewable sources of cells for therapeutic purposes, and could eventually offer a powerful alternative to primary fetal CNS tissue in clinical transplantation protocols. The purpose of this review is to discuss the prospects of the emerging progenitor cell technology for cell replacement and restorative therapies in neurodegenerative diseases, and consider some of the critical issues that must be solved in order to make progenitor cells useful in studies of brain repair.

Neurogenesis in postnatal rat spinal cord: a study in primary culture.

Spinal cord injuries result in paralysis, because when damaged neurons die they are not replaced. Neurogenesis of electrophysiologically functional neurons occurred in spinal cord cultured from postnatal rats. In these cultures, the numbers of immunocytochemically identified neurons increased over time. Additionally, neurons identified immunocytochemically or electrophysiologically incorporated bromodeoxyuridine, confirming they had differentiated from mitotic cells in vitro. These findings suggest that postnatal spinal cord retains the capacity to generate functional neurons. The presence of neuronal precursor cells in postnatal spinal cord may offer new therapeutic approaches for restoration of function to individuals with spinal cord injuries.

The functional restoration approach for chronic spinal disability

The functional restoration approach to treating chronic spinal disability consists of a medically directed, interdisciplinary team approach to physical reconditioning and a cognitive-behavioral "crisis intervention" procedure for dealing with related psychosocial problems. One- and two-year follow-up studies have demonstrated the clinical efficacy of this approach. The present article describes this approach and summarizes the research documenting its success in treating patients with chronic spinal disability. This article also highlights the pitfalls in misunderstanding and misrepresenting the components of the functional restoration approach when evaluating treatment efficacy.

Management of the Patient with Chronic Low Back Pain: The Functional Restoration Approach

This article discusses the patient with chronic disabling low back pain who has been refractory to all other forms of passive and reactivation treatment but who shows an ongoing desire to overcome disability. The article outlines the patient and the disability system that surrounds him or her, the measurement of function used to identify deficits of physical capacity, and the treatment program used to advance the patient to the highest possible functional level. Outcome monitoring as an adjunct to functional restoration is also discussed.