Intensive Physiotherapy Research Articles

A CLINICAL STUDY OF CRACKER BLAST INJURIES OF HAND

Firecracker-related injuries have been identied as one of the more important causes of burns. The predominance of hand involvement in such injuries is due to accidental blast during handling a cracker as well as the injury sustained when a person tries to shield himself from a cracker blast with his hands. This study was aimed at evaluation of cracker blast injuries with respect to demographics of affected population, etiology, type of injury and the entailed management. It was a retrospective study which encompassed a total of 50 admitted patients in the burns ward in a tertiary care hospital in South India from 01 Jan 2022 to 31 Dec 2022. The spectrum of injuries sustained was from simple laceration over hand to amputation of ngers. The most common surgical procedure performed was debridement couple with skin grafting. All the patients had a intensive physiotherapy sessions in the post op period. In conclusion, early debridement and wound coverage with post- operative splinting in the functional position is the key to management. By following safety precautions and by taking strict quality measures by the manufacturers, we can prevent these incidents and the disabilities that can occur due to them

GIRDLESTONE RESECTION ARTHROPLASTY OF THE HIP (GRA): OUTDATED PROCEDURE OR ACCEPTABLE OUTCOME?

Despite considerable legacy issues, Girdlestone's Resection Arthroplasty (GRA) remains a valuable tool in the armoury of the arthroplasty surgeon. When reserved for massive lysis in the context of extensive medical comorbidities which preclude staged or significant surgical interventions, and / or the presence of pelvic discontinuity, GRA as a salvage procedure can have satisfactory outcomes. These outcomes include infection control, pain control and post-op function. We describe a case series of 13 cases of GRA and comment of the indications, peri, and post-operative outcomes.We reviewed all cases of GRA performed in our unit during an 8 year period, reviewing the demographics, indications, and information pertaining to previous surgeries, and post op outcome for each. Satisfaction was based on a binary summation (happy/unhappy) of the patients’ sentiments at the post-operative outpatient consultations.13 cases were reviewed. They had a mean age of 75. The most common indication was PJI, with 10 cases having this indication. The other three cases were performed for avascular necrosis, pelvic osteonecrosis secondary to radiation therapy and end stage arthritis on a background of profound learning disability in a non-ambulatory patient. The average number of previous operations was 5 (1-10). All 13 patients were still alive post girdlestone. 7 (54%) were satisfied, 6 were not. 3 patients were diabetic. 5 patients developed a sinus tract following surgery.With sufficient pre-op patient education, early intensive physiotherapy, and timely orthotic input, we feel this procedure remains an important and underrated and even compassionate option in the context of massive lysis and / or the presence of pelvic discontinuity / refractory PJI. GRA should be considered not a marker of failure but as a definitive procedure that gives predictability to patients and surgeon in challenging situations.

Guillain-Barré syndrome AMSAN variant in a 90-year-old woman after COVID-19: a case report

BackgroundGuillain-Barré syndrome (GBS) is an inflammatory disease of the peripheral nervous system characterized by rapidly evolving polyneuropathy caused by autoimmune demyelination and/or axonal degeneration. Since SARS-CoV-2 outbreak, several GBS cases following exposure to coronavirus disease-2019 (COVID-19) have been reported in literature, raising the concern of the latter being a potential trigger event for GBS.Case presentationWe report the case of a 90-year-old Caucasian woman who was admitted to our hospital because of fatigue, worsening gait and leg strength, dysphonia, dysarthria and dysphagia, started 3 weeks after being exposed to COVID-19. Based on clinical presentation GBS was suspected, so she performed a lumbar puncture and electromyography, which confirmed the diagnosis of acute motor and sensory axonal neuropathy (AMSAN) variant. We administered high dose of intravenous immunoglobulin with slight neurological improvement. However, after 2 weeks of hospitalization with maximization of care, her physical condition worsen, manifesting severe frailty. The patient was discharged with home support services for managing parenteral nutrition and intense scheduled physiotherapy. A few days later, the patient experienced a further decline in her clinical condition and died at home.ConclusionsTo the best of our knowledge, we report the oldest woman with GBS AMSAN variant after COVID-19 described in the existing literature. Our case supports further research aimed at improving recognition, characterization and prompt management of neurological diseases related to COVID-19 in older patients.

Lifestyle and brain health in resilient, medically complicated geriatric outpatients: the importance of a multidisciplinary approach to treat anxiety and low mood, and to support wellness and independence

IntroductionFor medically complicated patients, symptoms of anxiety and low mood are at times normal and expected consequences of the physical and emotional impacts of living with a chronic illness or disability. In addition, medically complicated patients are at higher risk for infections and hospital stays, which can impact brain health and increase dementia risk (Alzheimer Association Conference, 2022). Untreated and undertreated anxiety and low mood can have major impacts on an individual's health, trust in their medical team and future medical outcomes (Alici and Levin, 2010), with treatment of medically complicated patients with psychiatric comorbidities typically necessitating a multidisciplinary approach including medication management and evidence-based psychotherapeutic approaches. The use of cognitive behavioral therapy, including behavioral activation and value-based goal setting, can be valuable in the treatment of anxiety and low mood, while supporting what is modifiable for lifestyle and brain health in patients with chronic medical conditions. Method/CaseThis case presentation will serve to highlight the impact of psychiatric medication management, CBT and motivation building approaches for lifestyle and brain health in a geriatric outpatient with paraplegia and multiple other medical conditions.This is a 71 y/o F with a past medical history of Acid reflux, Cardiomyopathy, history of recurrent UTIs, hypertension, OSA on CPAP, generalized anxiety disorder who reports mild depressive/anxiety symptoms starting in adolescence/early childhood, responding positively to therapy/treatment. Symptoms worsened after traumatic loss of lower body function (paraplegia) s/p ruptured spinal cord tumor (1980′s). Patient with marked resilience with positive response to medications/therapy throughout her adulthood. In her late 60’s (over the past 2-3 years), patient with increase in anxiety/low mood in the context of surgeries which have begun to limit her upper body function/mobility, weakness, potential loss of independence. Treatment with multiple medications. This patient was referred to for Cognitive Behavioral Therapy and the Brain Health Champion pilot program for further focus on anxiety treatment and lifestyle and brain health goal setting. ResultsThis case highlights the importance of team-based care in the treatment of anxiety, low mood, and brain health in medically complex geriatric outpatients. In this patient, losing function of her lower extremities in early adulthood gravely affected her lifestyle and independence. Her resilience and motivation, coupled with intense physical therapy led to good control of anxiety and a good quality of life. With aging and further medical/surgical injuries, her upper extremities which were her lifeline to independence, became affected, leading to marked increase in anxiety and numerous hospital stays increasing dementia and delirium risk factors. The addition of cognitive behavioral therapy (including behavioral activation and value-based goal setting) and motivation engagement strategies for lifestyle and brain health has been crucial in the response to treatment allowing this patient to improve her quality of life.

Management for Arthrofibrosis Following ACL Reconstruction

Introduction: Arthrofibrosis following ACL reconstruction is a debilitating complication. The incidence range from 2% to as high 35%. This Loss of motion not only cause of anterior knee pain but also inability to return to sports, and persistent weakness. The emergence of intra-articular scar tissue adhesions, or post-traumatic arthrofibrosis, may restrict the patient’s knee motion in the early postoperative period even though many factors may contribute to the development of motion loss. It might be difficult to manage motion loss once it has been diagnosed as a condition. Better understanding of the time of surgery, surgical technique improvement, and rehabilitation protocols showed less incidence of motion loss after ACL reconstruction. Case Presentation: A 46-year-old female complains of pain, stiffness, and decreased range of motion following arthroscopy ACL reconstruction of her left knee. Local examination showed diffused firm swelling over the anteromedial aspect of the knee and limitation of motion to mobilize the patella in all directions. Her bad rehabilitation program after surgery caused the main loss of her knee motion and the development of pain. Arthroscopic lysis of adhesions with manipulation under anesthesia was conducted. Following the surgery, graft observation was normal. A cyclops located between the infrapatellar pouch and medial gutter was observed and excised. Passive range of motion was also checked intra-operatively. Immediately after surgery, intensive physiotherapy was begun. The patient was very compliant with the rehabilitation program and the clinic follow-up schedule. Gradually, the patient started to regain her active full extension and flexion. Result: The functional outcome score showed improvement at the time of final follow-up, as did the average pain scores. Conclusion: Arthrofibrosis is multifactorial etiology. Knee joint ROM is better maximized by arthroscopic debridement and lysis of adhesions following arthrofibrosis after ACLR in conjunction with an intensive post-operative physical therapy plan.

Day II: Friday, March 24, 2023; 5.30 PM Plumeria 2: Physiotherapy in Musculoskeletal/ Neurological/ systemic disorders: AB No: 66 Functional Outcome with Therapeutic Application Of Non Invasive Brain Stimulation Along With Intense Physical Therapy Rehabilitation In An Individual With Clinical Presentation Of Locked In Syndrome (LIS)

Day II: Friday, March 24, 2023; 5.30 PM Plumeria 2: Physiotherapy in Musculoskeletal/ Neurological/ systemic disorders: AB No: 66 Functional Outcome with Therapeutic Application Of Non Invasive Brain Stimulation Along With Intense Physical Therapy Rehabilitation In An Individual With Clinical Presentation Of Locked In Syndrome (LIS)

Physiotherapy Perspective in the Rehabilitation of Traumatic Brachial Plexus Injury in a Patient with Polytrauma: A Case Report Emphasising an Early Approach

Traumatic peripheral nerve damage from Road Traffic Accidents (RTA) can cause severe impairment and loss of function in the upper and lower limbs. A significant portion of acute peripheral nerve injuries affects the upper limb, particularly the brachial plexus. The treatment for complete brachial plexus injury may involve surgery and intensive physiotherapy to help the nerves regenerate and reinnervate the muscles. A 17-year-old male was referred to the Neurology department from a primary healthcare centre after being involved in RTA that resulted in a fall on the right-side. Investigatory findings revealed a head injury with Subarachnoid Haemorrhage (SAH), fractures of the right tibia shaft, right clavicle lateral shaft, and right lower limb. Following surgery, the patient experienced difficulty in performing movements with the right upper limb, along with pain and tingling sensations. As a result, the patient was referred to physiotherapy. During physiotherapy, the patient received sensory re-education sessions lasting 15-20 minutes each, as well as bilateral training sessions lasting 20 minutes each, for a total of four weeks. Over the course of the treatment, the patient demonstrated overall improvement in hand function, including proper grasp and opposition. This improvement was reflected in the brachial assessment tool, Upper Extremity (UE) functional index, and functional independence measure. These positive outcomes underscore the importance of early neuro-physiotherapeutic rehabilitation for patients with brachial plexus injuries, as it can significantly enhance their overall well-being and quality of life.

Role of Physiotherapy Intervention in Adult Moya Moya Disease - A Single Case Study

Moya Moya disease is a progressive stenotic occlusive disease of the bilateral carotid bifurcations with the formation of fine collateral networks with an angiographic diagnosis. These abnormal blood vessels at the base of the brain were first described by the Japanese Takeuchi and Shimizu in 1957 as a cloudy cloudy plume of smoke leading to the term Moya Moya. To date the structured rehabilitation program for the patients with Moya Moya disease has not been well documented. This case report illustrates the effectiveness of the structured eight-week intensive rehabilitation program SEIRP in an individual rehabilitating with Moya Moya disease. A participant who was diagnosed with Moya Moya disease presented to us at the age of 33 years. The patient was evaluated using the shoulder pain and disability index SPADI Disability of arm shoulder and hand DASH Wolf motor test Berg balance scale and One Min-Step test. Physiotherapy intervention was done based on the impairments to improve motor function. The participant was given an intensive physiotherapy program which included a strengthening and functional exercise program for a period of eight weeks. Each treatment session lasted for about 60-90 minutes per day five days per week. SPADI DASH and Wolf motor test were administered two times in eight weeks. Pre-test total score of 101 46 were observed for SPADI and DASH respectively whereas Wolf motor test showed a score of 50 and 70 for the right and left hands respectively. Post the eight-week intervention SPADI and DASH total scores improved to 35 and 22 respectively. Wolf motor test score was 65 for the right hand and 74 for the left hand. This case report highlighted the importance and efficacy of a tailor-made structured protocol which is feasible and beneficial in improving the functional abilities of patients with Moya Moya disease.

Physiotherapy services in intensive care. A workforce survey of Australia and New Zealand

BackgroundIn Australia and New Zealand, there are currently no recommendations to guide staffing levels for intensive care unit (ICU) physiotherapy services, and there is limited information about the current services provided. ObjectivesThe objective of this study was to document the profile of intensive care physiotherapy services currently offered in Australia and New Zealand. MethodsA binational survey was distributed to physiotherapists. The survey sought information on staffing and service profiles for weekday, weekend, and after-hour services including on-call and evening shifts. ResultsEighty-six sites completed the survey, with responses primarily from Level 3 (47/86, 55%) and public ICUs (74/86, 86%). For weekday services, the ratio of full-time equivalent physiotherapy staff allocated per bed was similar between all intensive care levels (0.11 [0.08–0.15], p = 0.421). Thirty respondents (35%) were satisfied with their staffing and reported higher levels of physiotherapy staff per bed (0.15 [0.1–0.2], p < 0.001). Most sites reported lower levels of staffing for weekend services (76/86, 88%), and many physiotherapists indicated that they were not satisfied with this service (55/86, 64%). Most Level 2, Level 3, and paediatric ICUs had a designated senior physiotherapist, with similar levels of senior physiotherapy staff allocated per bed between all ICU levels (0.05 [0.03–0.08], p = 0.844). Few sites reported dedicated staff attributed to intensive care education, research, tracheostomy service, or outreach roles. On-call physiotherapy services were available in 49 of 86 (57%) hospitals surveyed; however, utilisation of the service by ICUs was mainly reported to be less than once per month (19/49, 39%). ConclusionsPhysiotherapy staffing ratios were similar across different ICU levels. While weekend services are available for most ICUs, staffing levels are reduced. Higher staffing ratios were associated with higher levels of satisfaction to complete professional roles and responsibilities.

A CASE OF COMBINED CENTRAL AND PERIPHERAL DEMYELINATION IN A PATIENT WITH PEDIATRIC MULTIPLE SCLEROSIS AFTER SARS-COV-2 VACCINATION

We present a case of combined central and peripheral demyelination in a patient with pediatric multiple sclerosis after the first dose of ChAdOx1-S (Chimpanzee Adenovirus Oxford 1) vaccination. The patient presented with ascending flaccid quadriparesis with respiratory failure that required mechanical ventilation. The lumbar puncture revealed albuminocytological dissociation, was negative for presence of JCV (John Cunningham Virus) in the CSF (Cerebrospinal Fluid) and ruled out other infections. A few days later he developed anisocoria and multiple new enlarging acute demyelinating lesions in the brain MRI (Magnetic Resonance Imaging). He was treated with intravenous immunoglobulin, corticosteroids and plasma exchange with gradual improvement. All other diseases were excluded via MR Spectroscopy, MR Angiography and serum and CSF laboratory investigations. Seven months later, the patient is under intense physiotherapy and is improving every day.

THE EFFECT OF SHORT DURATION BED REST AND TYPE 2 DIABETES MELLITUS ON ARTERIAL STRUCTURE AND FUNCTION IN OLDER ADULTS

Abstract Type 2 diabetes mellitus (T2DM) and inactivity individually accelerate changes related to vascular aging. These changes increase cardiovascular risk and contribute to morbidity and mortality in the elderly. It is unknown if T2DM and bed rest have an additive, deleterious effect on vascular structure and function in older adults. The objective of this study is to determine the magnitude of the effect of bed rest on vascular structure in older adults with T2DM compared to healthy controls and determine if resistance exercise is protective of this effect. So far, we have recruited T2DM (n=9) and healthy control (n=17) subjects (age: 67.0 ± 6.7 years) to undergo five days of bed rest. During bed rest, subjects were randomized to receive intensive bedside resistance exercise physical therapy or standard of care in-bed passive physical therapy. On bed rest days 1 and 5, popliteal artery diameter, area, blood velocity, and blood flow were measured using Doppler ultrasonography. Our preliminary data show that the T2DM, non-exercise group had significantly greater decreases in popliteal artery diameter (-0.59 mm ± 0.18) than the control, non-exercise group (-0.17 mm ± 0.11). Resistance exercise did not prevent artery size changes in either controls or T2DM. Resistance exercise showed a trend in preventing blood velocity and flow reduction in both T2DM and control groups. These preliminary data suggest that older adults with T2DM had greater structural popliteal artery changes compared to controls. Resistance exercise appears to help maintain blood flow by maintaining/increasing popliteal artery blood velocity, but not size.

Pain Course after Total Knee Arthroplasty within a Standardized Pain Management Concept: A Prospective Observational Study.

Joint replacement surgeries have been known to be some of the most painful surgical procedures. Therefore, the options for postoperative pain management are of great importance for patients undergoing total knee arthroplasty (TKA). Despite successful surgery, up to 30% of the patients are not satisfied after the operation. The aim of this study is to assess pain development within the first 4 weeks after TKA in order to gain a better understanding and detect possible influencing factors. A total of 103 patients were included in this prospective cohort study. Postoperative pain was indicated using a numeric rating scale (NRS). Furthermore, demographic data and perioperative parameters were correlated with the reported postoperative pain. The evaluation of postoperative pain scores showed a constant decrease in the first postoperative week (mean NRS score of 5.8 on day 1 to a mean NRS score of 4.6 on day 8). On day 9, the pain increased again. Thereafter, a continuous decrease in pain intensity from day 10 on was noted (continuous to a mean NRS score of 3.0 on day 29). A significant association was found between postoperative pain intensity and gender, body mass index (BMI), and preoperative leg axis. The increasing pain score after the first postoperative week is most likely due to more intensive mobilization and physiotherapy in the rehabilitation department. Patients that were female, had a low BMI, and a preoperative valgus leg axis showed a significantly higher postoperative pain scores. Pain management should consider these results in the future to improve patient satisfaction in the postoperative course after TKA.

Unique Presentation of Bing-Neel Syndrome With Co-existing Chronic Lymphocytic Leukemia.

Unique Presentation of Bing-Neel Syndrome With Co-existing Chronic Lymphocytic Leukemia.

Role of Cervical Spinal Magnetic Stimulation in Improving Posture and Functional Ambulation of Patients with Relapsing Remitting Multiple Sclerosis.

Balance impairment is one of the hallmarks of early MS. Proprioceptive deficit was found to be one of the main causes of this imbalance. The cervical enlargement has a strong proprioceptive system, with its projections to the reticular formation and the central pattern generators, helping in rhythmic pattern generation and alternate leg movements. Repetitive trans-spinal magnetic stimulation (rTSMS) is a noninvasive technique, which can trigger massive proprioceptive afferents. Therefore, it has the potential of improving proprioceptive deficits and motor control. Objective. To determine the effectiveness of repetitive cervical magnetic stimulation in improving functional ambulation of patients with relapsing remitting multiple sclerosis (RRMS). Design. Prospective sequential clinical trial. Setting. University and academic hospital. Participants. A total of 32 participants (N = 32) with RRMS. Interventions. Outpatient rehabilitation. The 32 patients received 10 sessions over two weeks of 20 Hz cervical spinal magnetic stimulation (SMS). Both groups were assessed at baseline, after 2 weeks, then one month later. Patients were enrolled as a control group at first and received Sham SMS, and then a wash out period of one month was done for all the patients, followed by a baseline assessment. Second, the same 32 patients rejoined as the active group, which received real magnetic stimulation. Both groups performed an intensive physical therapy program with the spinal magnetic stimulation. Main Outcome Measures. Extended Disability status score (EDSS), Timed up and Go test (TUG), Mini-Best test, dynamic posturography sensory organization composite score, and motor composite score. Results. Thirty-two RRMS patients with EDSS range from 1.5 to 6. They showed statistically significant difference between active and control groups in Mini-Best test score. We divided our patients according to EDSS into 3 subgroups: (a) mild: ≤2.5, (b) moderate: 3-5.5, and (c) severe: ≥6. Mild cases showed significant differences in EDSS score, TUG test, Mini-Best test, and dynamic posturography sensory composite scale. The effect size between the different patient subgroups was also measured and showed highly significant improvements in all measured parameters among our mild patients, indicating that this subgroup could be the best responders to cervical repetitive high-frequency magnetic stimulation. Moderate cases showed highly significant improvement in TUG score and Mini-Best test and significant change in EDSS score and the dynamic posturography sensory composite score. Severe cases showed only significant improvements in TUG, Mini-Best test, and sensory composite score. Conclusion. Cervical repetitive magnetic stimulation can help improve balance and functional ambulation and decreases the risk of falls in RRMS patients, especially in the mild, low disability cases.

Impact of surgical first excision delay on function for heat-press hand injury by the Quick-DASH questionnaire: Series over 20 years

BackgroundHeat-press hand burn leads to complex and severe lesions, with potentiation of thermal burn by the crushing mechanism. Management remains poorly codified, and the surgical strategies found in the literature remain contradictory. The objective of our study is to report our experience and define the first burn excision delay through functional evaluation with a Quick-DASH questionnaire. MethodsWe carried out a retrospective study of 20 burned hands by heat-press managed in our burn unit between 2002 and 2021. Following data were collected, at least one year after the accident: Quick-DASH score, which was our primary endpoint, injury assessment according to the Tajima's classification, overall surgical management, and impact on their professional activity. A descriptive statistical analysis of these data was performed followed by a univariate analysis to assess the correlation between delay to first surgical excision and the long-term functional result (Quick-DASH score and time before return to work). ResultsBurns were Tajima grade 1 (supra-fascial dermal burn) in 35 % of cases, grade 2 (exposure of subfascial structures) in 45 % and grade 3 (bone or joint exposure) in 20 %. There were no cases of bone fractures.We received 18 out of 20 questionnaires with no significant differences between those who send back or not. The median QuickDash score was 7.15 [IQR 0–52.25]. The first surgical excision was performed with a median of 8 days after the accident [min: 0; max: 20]. The median time before return to work was 24 weeks [IQR 17–42.25]. Only 11 patients (55 %) were able to go on the initial employment. Spearman test found a strong trend for a negative correlation between the time to the first excision and the QuickDash score (ρ = −0.46; r2 = 0.087; p = 0.053). ConclusionAccording to observations made in our unit and in agreement with Tajima, who first described heat-press injury, the first surgical excision should be performed approximately one week after the accident. Subsequent excisions may be performed to reassess the lesions and complete the debridement, with reconstruction to follow. Multidisciplinary management is still necessary, including early and intensive physiotherapy, psychological support, and assessment by an occupational physician.

What kind of patient benefits the most from an intensive physiotherapy after total hip replacement?

Abstract Background Hip replacement is a common orthopaedic surgery procedure that produces great improvement in the quality of life. Despite this, a globally standardized post-operative physiotherapy protocol still does not exist. The aim of this study is to identify the factors that influence the motor and functional outcome after early, intensive, hospitalized treatment. Methods A retrospective study was conducted in 2019 on 509 patients admitted to an Italian private clinic specialized in post-surgery rehabilitation, which applies an original bio-psycho-social-environmental protocol and individual rehabilitation plans. Data regarding each patient were collected from medical records: age, haemoglobin, Body Mass Index (BMI), Cumulative Illness Rating Scale (CIRS), Tinetti scale (TS) and Barthel scale (BS) at admission and discharge. The outcome was measured as the difference (Δ) between the values at discharge and admission of BS (ΔBS) and TS (ΔTS). We performed a univariate linear regression using STATA, to determine which factors influence the outcome. A p &amp;lt; 0.05 was considered statistically significant. Results Our sample (57.4% female) was 70.1 ± 10.4 years old. ΔBS was significantly influenced by motor performance at admission (BS: Coef. - 0.708, CI 95% [- 0.743 - - 0.673]; TS: Coef. - 1.697, CI 95% [- 1.849 - - 1.544]), global health conditions (CIRS Severity index: Coef. 4.925, CI 95% [1.037 - 8.814]) and age (Coef. 0.312, CI 95% [0.221 - 0,403]). ΔTS was significantly influenced by the same factors, BS: Coef. - 0.167, CI 95% [- 0.184 - - 0.149]; TS: Coef. - 0.667, CI 95% [- 0.703 - - 0.631]; CIRS Severity index: Coef. 1.254, CI 95% [0.012 - 2.511]; age: Coef. 0.090, CI 95% [0.061 - 0.120]. BMI and haemoglobin did not influence the studied outcomes. Conclusions Patients with worse health conditions, advanced age and lower motor performance at admission obtain a higher outcome. Key messages • A broader knowledge of rehabilitation influencing factors would provide higher outcomes. • The diffusion of individual rehabilitation plans would allow the achievement of better results.

Treatment Options of Temporomandibular Joint Ankylosis at a Tertiary Level Hospital in Bangladesh: A Two-Year Retrospective Analysis

Introduction: The study compares the surgical treatment options utilized to treat temporomandibular joint ankylosis at a tertiary level hospital in Bangladesh from 2016 to 2017. Materials and Methods: In this retrospective analysis, 18 patients (28 joints) were studied. History, radiological and physical examinations, and mouth opening were all part of the preoperative and postoperative evaluation. Age, sex, underlying cause, affected joint (s), surgery modality, complications, and follow-up durations were all taken into consideration. The data was analyzed using the SPSS 22.0 statistical software. The degree of mouth opening before and after different surgical techniques in different patient categories was compared using a one-way ANOVA followed by Tuky's HSD test. Results: Temporomandibular joint ankylosis was found to be in several forms (fibrous, fibro-osseous, and osseous), with trauma (61.11%) being the most common cause. The patients ranged in age from 5 to 30 years old, with females accounting for 55.55% of the total. The mean mouth opening significantly increased from 3.11 mm pre-operatively to 31.17 mm in the first month following surgery (p = 0.00001). In 55.55% of the instances, temporary facial nerve paresis occurred. Conclusions: Temporomandibular joint ankylosis can be successfully managed with early excision of the ankylotic mass, restoration of the ramus height by bone grafting, interpositional arthroplasty, and intensive physiotherapy. Update Dent. Coll. j: 2022; 12(2): 7-13

An Unusual Case of Swimmer Puppy Syndrome in Labrador Puppy

Swimmers puppy syndrome is an uncommon developmental deformity seen in neonatal puppies and kittens, in which animal's limbs, most commonly hind limbs, are splayed laterally, and because of that animals are unable to walk or stand. This condition may also affect the thoracic limb. It is also called flat pup syndrome, twisted legs, turtle pup, and splay leg. This condition is commonly seen in brachycephalic breeds having short legs and a broad thoracic cavity. When trying to walk, affected animals invariably stay in sternal recumbency and show swimmers-like movements and this movement is more commonly seen on the smooth surface. The exact cause of this condition is unknown but many predisposing factors are responsible, viz., slippery floor, delayed neuromuscular development, abnormal myelinization, genetic factor, weight gain exceeding skeletal muscle development, etc. This condition is commonly seen at the 1st to 7th week of age. Currently, there is no specific and set protocol for the treatment of Swimmer Puppy Syndrome. To our knowledge, the few case studies described therapies based on the implementation of temporary immobilizations utilizing eight-girdle or cuff bandages and intensive physical therapy. (Karcher et al., 2018).

Restoring a near anatomical hip joint in an 18 year old neglected hip fracture dislocation – A rare case report

Long standing neglected traumatic hip fracture dislocation is a rare clinical condition. Obliteration of the native acetabulum, soft tissue contractures, loss of femoral head congruity and associated hip fractures make this condition challenging to treat. We discuss a case of a middle-aged male presenting to us with pain, shortening and inability to bear weight on left lower limb for last 15 years. Clinical examination revealed an adduction deformity over the left hip, a globular swelling in the left gluteal region and a fixed equinus deformity over left ankle. Movements at the left hip hinted at restricted internal rotation and flexion. Pelvis radiographs revealed a neglected posterior hip dislocation with ipsilateral femur neck non union. Patient underwent initial upper tibial traction for 8 weeks followed by a hybrid Total Hip Arthroplasty. Postoperatively intensive physiotherapy was continued and with correction of the ankle equinus patient was able to ambulate. On five years follow-up, the patient was mobilizing independently, pain-free with a mild short limb gait and some residual foot drop.Treatment of neglected hip fracture dislocation can be challenging. Associated economic restraints may hinder clinicians from higher imaging and make the treatment even difficult. However, an anatomical reconstruction of hip by a total hip arthroplasty has yielded good functional outcomes in long standing neglected dislocations.’

Overview of the Current Literature on the Most Common Neurological Diseases in Dogs with a Particular Focus on Rehabilitation.

Simple SummaryThis paper aims to report an overview of the most common neurological diseases (intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism, and polyradiculoneuritis), with a main focus on rehabilitative options and outcomes, reported in recent veterinary literature. Literature seems to be positively oriented on the efficacy of the rehabilitation approach, reporting a careful and prudent choice of the protocol to be applied for the correct recovery of the patient. However, blinded, controlled, prospective studies are still necessary, above all for degenerative myelopathy, fibrocartilaginous embolism, and polyradiculoneuritis.Intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism and polyradiculoneuritis often affect dogs; and physiotherapy may improve the patient’s quality of life and/or reduce recovery times. The aim of this review was to evaluate the current scientific outcomes on these four neurological diseases and on their physiotherapy approaches. From the analysis of the published articles, it emerged that intervertebral disc herniation can be treated, with different rates of success, through a conservative or a surgical approach followed by physiotherapy. The literature is generally oriented toward the efficacy of the rehabilitation approach in this specific canine disease, often proposing intensive post-surgery physiotherapy for the most severe conditions with the absence of deep pain perception. When degenerative myelopathy, fibrocartilaginous embolism or polyradiculoneuritis occur, the existing literature supports the use of a physiotherapeutic approach: allowing a delay in the onset and worsening of the clinical signs in degenerative myelopathy, physical improvement, and, sometimes, complete remission during fibrocartilaginous embolism or acute idiopathic polyradiculoneuritis. However, papers on rehabilitation in dogs affected by polyradiculoneuritis are currently limited to single clinical cases and further blinded, controlled, prospective studies are still advisable for all four neurological diseases.