Limb Conditions Research Articles

Case Report: Diabetic nephropathy aggravates the progression and prognosis of COVID-19-associated acute limb ischemia

Hypercoagulation is a hallmark of both the novel coronavirus disease (COVID-19) and type 2 diabetes mellitus (T2DM). It increases the risk for vascular thrombosis, including peripheral artery diseases. Among others, acute limb ischemia (ALI) is one of most common complications that requires immediate and prompt treatments to reduce morbidity and mortality. However, the complex interplay between COVID-19, T2DM and its complications (e.g., diabetic nephropathy), and ALI creates a great challenge in the management of the disease. Here, we present a case of a 59-year-old diabetic female with progressive pain in her left leg in the last five years, which was significantly intensified following COVID-19 diagnosis. Bluish coloration, numbness and functional impairments were observed during examinations with no palpable pulsation on left posterior tibial and dorsalis pedis arteries. The patient also had diabetic nephropathy (stage III), hypoalbuminemia, anemia and a urinary tract infection that complicated the management of the disease. Due to the excruciating pain and the worsening of the limb conditions, right leg revascularization and left leg amputation were performed at day 14 after admission. Following the surgeries, no more pain was observed and patient was discharged for further follow-up at the outpatient clinic.

Major Lower Extremity Amputations due to Diabetes Mellitus Complications

Background: Lower limbs ulcers and wounds, Charcot foot with the presence of peripheral neuropathy or peripheral vascular disease are common complications of the diabetes mellitus (DM). Major extremity amputations (below and above knee) are one of the common surgical procedures performed due to DM complications. Objective: To review the amputations performed due to diabetes mellitus (DM) complications with other associated illness, commonly isolated bacteria, and the demography of the patients in a public general hospital. Materials and Methods: We retrospectively reviewed the cases of above and below the knee amputations due to DM complications from January 2012 to December 2016. The age, gender, duration of DM anyone having, bacteria isolated, vascular condition of the lower limbs, other diseases anyone having, post-surgery wound conditions and status of the ambulation after surgery were analyzed. Results: A total of 53 amputations of the limbs of 51 patients were performed. Below knee amputations were performed on 43 (81.83%) limbs and male gender were 35(68.62%). The mean age of the patient was 57.6±12.01 years (range 31-91 years). The three most common bacteria isolated were Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter cloacae. About 85% of these bacteria were sensitive to commonly used first line of antibiotics like co-amoxiclav and ciprofloxacin. Fifty cases (98.03%) had diabetes for more than five years. End stage renal disease (ESRD) and ischaemic heart disease (IHD) were the other common co-morbidities observed. Conclusion: Major lower limb amputations (below and above the knee) due to uncontrolled blood sugar are common surgical procedures performed on DM. Majority of the bacteria were sensitive to commonly used first line of antibiotics but still 15% were not sensitive and bacteria isolation, sensitivity with the drugs were also important for the treatment of the infection.

Are Medial and Lateral Tibiofemoral Compressive Forces Different in Uphill Compared to Level Walking for Patients Following Total Knee Arthroplasty?

The purpose of this study was to determine how tibiofemoral joint compressive forces and knee joint-spanning muscle forces during uphill walking change compared to level walking in patients with total knee arthroplasty (TKA). A musculoskeletal model capable of resolving total (TCF), medial (MCF), and lateral (LCF) tibiofemoral compressive forces was used to determine compressive forces and muscle forces during level and uphill walking on a 10 deg incline for twenty-five post-TKA patients. A 2 × 2 (slope: level and 10 deg × limb: replaced and nonreplaced) repeated measures analysis of variance was used to detect differences in knee contact forces between slope and limb conditions and their interaction. Peak loading-response TCF, MCF, and LCF were greater during uphill walking than level walking for nonreplaced limbs. During uphill walking, peak loading-response TCF was smaller in replaced limbs compared to nonreplaced limbs with no change in MCF or LCF. Peak knee extension moment and knee extensor muscle force were smaller in replaced limbs compared to nonreplaced limbs during uphill walking. During level walking, replaced and nonreplaced limbs experienced rather equal joint loading; however, replaced limb experienced reduced joint loading during uphill walking. Differences in joint loading between replaced and nonreplaced limbs were not present during level walking, suggesting compensation from the replaced limb during the more difficult task. Uphill walking following TKA promotes more balanced loading of replaced limbs during stance; however, these benefits may come at the expense of increased loading on nonreplaced limbs.

FEATURES OF CONFORMATION TYPE OF COWS FIRSTBORN UKRAINIAN BLACK-AND-WHITE DAIRY CATTLE IN THEIR PHENOTYPIC RELATIONSHIP WITH MILK YIELD

Evaluation of animals for breeding Ukrainian Black-and-White dairy breed was carried out according to the method of linear classification of type in the breeding farms of LLC "Vladana" and the experimental farm of the Institute of Agriculture of the North-East of the NAAS (EF IANE). The estimation of cows in the herd of BF "Vladana" (83.8 score) on this set of milk-type traits in comparison with peers of the EF IANE (82.3 score) showed a significant advantage of the former with a highly reliable difference of 1.5 score (P <0.001). The average estimate at the level of 84.2 and 83.0 score in cows of the herd of SF "Vladana" and NAAS EF IANE indicated about fairly good development of their body. The best condition of limbs in animals of the herd BF "Vladana" with 83.5 score and slightly worse than in peers EF IANE (82.5 score) with a highly significant difference of 1.0 score (P <0.001) in favor of the former. Udder in animals of the breeding farm "Vladana" with an average grade of 84.7 score was on the 2.3 score higher (P <0.001) compared with peers in the EF IANE (82.4 score). In general, firstborn cows of controlled farms in the BF "Vladana" and EF IANE, which were classified according to the final type assessment, received an average score of 84.2 and 82.8 of 88 possible for animals of this age, which corresponded to the level on the international scale "Good Plus". The results of the estimation of first-born cows in the controlled farms show that the degree of the main descriptive traits development of conformation, provided by the method of linear classification, differed by significant intra-herd and inter-herd variability. A sufficient level of reliable positive relationship with milk yield was found both by group traits, except for limbs, and by the vast majority of descriptive traits of the conformation, with slightly higher correlation coefficients in cows of BF "Vladana". The determined phenotypic correlations between linear conformation traits and milk yield per lactation indicate about their reliability in the selection of cows by productivity.

Development of overuse musculoskeletal conditions after combat-related upper limb amputation: a retrospective cohort study

Study designRetrospective cohort study IntroductionService members who have sustained traumatic amputations are typically young and otherwise healthy. Beyond standard care, these individuals desire long, highly active, and relatively pain-free lifestyle, whether that is returning to active duty or transitioning to civilian life. Development of overuse musculoskeletal conditions could have a significant influence on quality of life for Service members with traumatic upper limb amputation. Purpose of the studyCompare one-year incidence of overuse musculoskeletal injuries in Service members with different levels of combat-related upper limb amputation to Service members with minor combat-related upper limb injuries. MethodsService members with deployment-related upper limb injury (N = 519), 148 major upper limb amputation (55 with amputation at or above elbow, 93 with amputation below elbow) and 371 minor upper limb injury were included in the study. Outcomes of interest clinical diagnosis codes associated with overuse conditions of the upper limb, neck and upper back, lower limb, low back pain, and all regions combined, one year before and one year after injury. ResultsOverall, the one-year incidence of developing at least one musculoskeletal overuse condition after upper limb amputation was between 60% and 65%. Service members with upper limb amputations were 2.7 to 4.7 times more likely to develop an overuse upper limb condition, 3.6 to 3.8 times more likely to develop a neck and upper back condition, 2.8 to 4.4 times more likely to develop a lower limb condition, and 3.3 to 3.9 times more likely to develop low back pain as compared those who sustained minor combat-related injuries. No significant differences in the odds of developing a musculoskeletal condition was found between the above elbow and below elbow amputation groups. ConclusionsIncidence of secondary overuse conditions is elevated in Service members with upper limb amputation and warrants focused research efforts toward preventative and rehabilitative interventions.

Evaluating lower limb kinematics and pathology with dynamic CT.

Evaluating musculoskeletal conditions of the lower limb and understanding the pathophysiology of complex bone kinematics is challenging. Static images do not take into account the dynamic component of relative bone motion and muscle activation. Fluoroscopy and dynamic MRI have important limitations. Dynamic CT (4D-CT) is an emerging alternative that combines high spatial and temporal resolution, with an increased availability in clinical practice. 4D-CT allows simultaneous visualization of bone morphology and joint kinematics. This unique combination makes it an ideal tool to evaluate functional disorders of the musculoskeletal system. In the lower limb, 4D-CT has been used to diagnose femoroacetabular impingement, patellofemoral, ankle and subtalar joint instability, or reduced range of motion. 4D-CT has also been used to demonstrate the effect of surgery, mainly on patellar instability. 4D-CT will need further research and validation before it can be widely used in clinical practice. We believe, however, it is here to stay, and will become a reference in the diagnosis of lower limb conditions and the evaluation of treatment options. Cite this article: Bone Joint J2021;103-B(5):822-827.

Dermatological diseases in seamen's lower extremity: a prevalence study.

Little is known about the impact of occupational seafaring on lower limb conditions. The aim of the study was to estimate the prevalence of dermatological diseases affecting the feet and lower extremities of seafarers, as well as the possible impact of working conditions on the development of the pathologies analysed. A prevalence study was performed through self-completed questionnaires at the "Instituto Social de la Marina" (ISM) centres at A Coruña, Ribeira, Noya and Cádiz (Spain). Sociodemographic, anthropometric and podiatric variables, as well as the type of maritime sector, duty on board and, working footwear, were studied (n = 137). The study has been approved by the Ethics Committee of the University of A Coruña (CE 13/2016). The average age of the study subjects was 45.71 ± 9.90 years and the number of years sailed was 20.31 ± 11.64 years. The most prevalent pathologies were mycosis (21.9%), helomas and tylomas (29.9%) and hyperhidrosis (17.5%). A statistically significant relationship was obtained between pruritus and scabies (p ≤ 0.000), xerosis (p ≤ 0.005), eczema (p ≤ 0.000), obesity (p ≤ 0.018) and psoriasis (p ≤ 0.005). A significant relationship was also found between onychocryptosis, and psoriasis (p ≤ 0.000). Frequency with which the study participants have visited the podiatrist was significantly related to the presence of helomas and tylomas (p ≤ 0.013) and hyperhidrosis (p ≤ 0.025). A high prevalence of diverse dermatological diseases has been found, revealing the importance of podiatric assessment in sea workers prior to boarding.

"I Don't Identify with It": A Qualitative Analysis of People's Experiences of Living with Complex Regional Pain Styndrome.

Complex regional pain syndrome (CRPS) is a painful limb condition known to cause significant disability and distress. However, little previous research has explored CRPS from a patient perspective. The present qualitative study aimed to describe the experiences of people living with CRPS. Forty-eight people with CRPS participated in this research. Participants completed a face-to-face or telephone interview about their perceptions and experiences of CRPS and completed three drawings to illustrate their experiences. Data were analyzed through reflexive thematic analysis, and images in drawings were grouped and coded by theme. Three overarching themes encapsulated the data, including that 1) people experience CRPS as a source of severe symptoms and emotional difficulties, 2) CRPS undermines personal and social identity, and 3) this results in psychological responses that protect against the emotional and social impact of severe symptoms. Psychological responses include: a) searching for an explanation, b) "nothing is my fault," emphasizing a lack of personal responsibility and personal control, and c) detaching the limb from the self. CRPS is experienced as highly threatening to physical ability, psychological state, and identity. In response to these threats, people may develop their own explanations for CRPS and may mentally detach themselves from responsibility, control, and the painful limb itself. Future research could explore the impact of these factors on psychological well-being and CRPS symptoms and outcomes.

Safety and effectiveness of ultrasound guided peripheral nerve blocks: Audit at tertiary care hospital.

To assess the safety and effectiveness of peripheral nerve blocks using ultrasound. The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of all patients who received peripheral nerve blocks as part of anaesthesia care between January 2015 and January 2017. The data included outcomes of peripheral nerve block effectiveness, complications and limb conditions after the block. Peripheral nerve block effectiveness was assessed by monitoring pain scores at rest and on movement, and the requirement of co-analgesia. Complications, like numbness, motor block, metallic taste, hypotension and respiratory depression, were also assessed. Data was analysed using SPSS 19. There were 299 patients who received ultrasound-guided peripheral nerve blocks. The overall mean age was 44.57±16.64 years. Of the total, 140 (47%) received transversus abdominis plane block, followed by supraclavicular block 49(16.7%). The most common complication in the recovery room was numbness 19 (6.2%). Overall, 70% patients remained pain-free, while 16% had moderate pain on movement 12 hours postoperatively. Ultrasound-guided regional anaesthesia was found to provide effective analgesia during and after surgery. Nerve blocks proved to be safe when used with ultrasound.

ω-3 Polyunsaturated Fatty Acids Facilitate the Repair of Peripheral Nerve Defects with Chemically Extracted Acellular Allograft in Rats.

Acellular allograft (ACA) improves the repair and reconstruction of long peripheral nerve defects. ω-3 Polyunsaturated fatty acids (PUFAs) carry a neuroprotective potential, and their effects on ACA bridging were elucidated. Thirty rats with long gap sciatic nerve defects (15 mm long) were randomly divided into three groups (n = 10): ACA, ACA + PUFAs, and autograft (AU). Limb condition, wet weight of tibialis anterior muscle (TAM), nerve electrophysiology, S-100, horseradish peroxidase (HRP), and percentage of splenic CD4+ and CD8 + T-lymphocytes were evaluated for 12 weeks after the operation. Rats in the AU and ACA + PUFA groups showed superior condition in affected limbs compared to the ACA group. At 12 wk after surgery, the wet weight of TAM in the ACA + PUFA group was higher than that in the ACA group (0.4519 ± 0.1185 vs. 0.3049 ± 0.1272; P < 0.01) but lower than that in the AU group (0.4519 ± 0.1185, 0.5628 ± 0.0092; P < 0.05). In all the three groups, sole irritation elicited withdrawal reflex, and S-100 staining was detected in plantar skin. Moreover, horseradish peroxidase staining was overt in both the ventral horn and dorsal root ganglion of the spinal cord. Nerve conduction velocity (m/s), amplitude of action potential (mV), or somatosensory evoked potentials in ACA + PUFAs (28.81 ± 1.04, 2.20 ± 0.27, 6.98 ± 0.29) were significantly different from that in the AU (35.71 ± 1.28, 1.81 ± 0.19, 8.15 ± 0.52; P < 0.05) and ACA (20.03 ± 1.94, 2.95 ± 0.36, 5.22 ± 0.53; P < 0.01) groups. The percentages of splenic CD4+ and CD8+ cells were similar among the three groups. Omega-3 PUFAs improve the bridging effect of ACA on long gap peripheral nerve defects by promoting neuroprotection without arousing an immune response.

The electromyographic activity characteristics of the gluteus medius muscle before and after total hip arthroplasty

The clinical outcomes of total hip arthroplasty are influenced by the correct muscle function that determines good, longterm and proper function of the artificial joint. The aim of the study was to analyze the electromyographic activity of the gluteus medius muscle in patients with hip osteoarthritis and after arthroplasty in various static weight bearing conditions, both on the affected and contralateral side. The prospective study involved 70 patients qualified for hip replacement. Patients underwent a surface electromyography of the gluteus medius muscle which involved the Trendelenburg test. The normalized results were obtained for both hips, preoperatively and 6 months after arthroplasty. The only muscle activity differences were found at a full load condition of lower limb. In the preoperative assessment, the activity of the gluteus medius muscle was greater on the side qualified for surgery. After arthroplasty and the rehabilitation period, the muscle activity on the operated side decreased and significantly increased on the contralateral side. Detailed analysis of the contralateral side revealed relationship with osteoarthritis. Previous hip arthroplasty of that side resulted in lower muscle activity, similar to fully functional joints. The activity characteristics of the gluteus medius muscle vary depending on the condition of the joint, and the characteristics change as a result of the surgical procedure performed on both the operated and contralateral sides. These dependencies should be taken into account in the rehabilitation process, especially at the side opposite to the operated one.

Patient and clinician experiences and opinions of the use of a novel home use medical device in the treatment of peripheral vascular disease - a qualitative study

BackgroundPeripheral vascular diseases have a significant impact on functional quality of life. Previous research has demonstrated the complex, limiting and costly economic implications of these conditions such as lower limb ulceration chronicity and ischaemic amputation. These complex, limb and life threatening conditions demand the development of novel interventions with objective research as part of that development. Hence, a novel intermittent negative pressure medical device in the form of a wearable boot (FlowOx™) was developed. As part of the development process, this study aimed to explore patient and clinician opinions of the boot.MethodsA qualitative approach was used to collect patient and clinician experiences in Norway. An advisory group informed the semi-structured questions used in seven patient interviews and one clinician focus group (n = 5). The data were recorded digitally and transcribed verbatim. Patient and clinician data were analysed as distinct groups using a thematic process.ResultsData analysis resulted in five themes from the patients which gave insight into; the impact of the disease process; practicalities of using the boot, positive experiences of use; perceived outcomes; reflecting on use. Six themes were created from the clinicians. These gave insight into; ideal outcomes and how to measure them; ways to potentially use the boot; using research in healthcare; positives of the device; observed effects and next steps; potential improvements to the device.ConclusionThis study provides insight into the experiences and opinions of FlowOx™. Patients and clinicians were positive about the device due to its ease of use. Those patients with peripheral arterial disease experienced significantly more benefit, especially for ischaemic ulceration than those with a chronic venous condition. Clinicians placed value on the patient reported outcomes in the treatment decision-making process. This preliminary study into experiences of FlowOx™ use provides valuable feedback that will inform design modification and ongoing research into implementation points and prospective user groups. FlowOx™ demonstrates potential as a conservative therapy offering users a convenient, home use, self-care management solution for improving symptomatic peripheral arterial disease and quality of life.

Occupational Therapy Intervention for Hemiplegie Shoulder Pain in Adults Post-Stroke: A Zimbabwean Perspective

ABSTRACT BACKGROUND: Stroke is a leading cause of disability in Zimbabwe. Hemiplegie shoulder pain (HSP), a secondary complication of stroke, impedes the functional recovery of the upper limb and occupational engagement. Occupational therapy intervention, comprising assessment and treatment, seeks to promote health and well-being through facilitating improvement in occupational engagement. There is a lack of documented evidence on occupational therapy intervention practices (i.e., assessment and treatment) of HSP in the context of Harare, Zimbabwe. To allow for an increased understanding of HSP management, this study explored occupational therapists' assessment and treatment practices of post-stroke HSP in Harare, Zimbabwe METHOD: This explorative study included six experienced occupational therapists from three public hospitals in Harare, Zimbabwe. Data were collected through semi-structured interviews and analysed using qualitative content analysis RESULTS: Data analysis revealed three themes, i.e., assessment of post-stroke HSP is all encompassing; key components of post-stroke HSP treatment practice and challenges in occupational therapy practice of post-stroke HSP in Harare CONCLUSION: Occupational therapy intervention practice for post-stroke HSP in Harare includes an eclectic approach, with preventative practices as a key component of treatment. Intervention should strive to be occupation-based and holistic encompassing considerations of environmental factors and the indicators of HSP Keywords: public health care, occupational therapy intervention, clinical practice, neurological upper limb conditions

Occupational Therapy Intervention for Hemiplegie Shoulder Pain in Adults Post-Stroke: A Zimbabwean Perspective

ABSTRACT BACKGROUND: Stroke is a leading cause of disability in Zimbabwe. Hemiplegie shoulder pain (HSP), a secondary complication of stroke, impedes the functional recovery of the upper limb and occupational engagement. Occupational therapy intervention, comprising assessment and treatment, seeks to promote health and well-being through facilitating improvement in occupational engagement. There is a lack of documented evidence on occupational therapy intervention practices (i.e., assessment and treatment) of HSP in the context of Harare, Zimbabwe. To allow for an increased understanding of HSP management, this study explored occupational therapists' assessment and treatment practices of post-stroke HSP in Harare, Zimbabwe METHOD: This explorative study included six experienced occupational therapists from three public hospitals in Harare, Zimbabwe. Data were collected through semi-structured interviews and analysed using qualitative content analysis RESULTS: Data analysis revealed three themes, i.e., assessment of post-stroke HSP is all encompassing; key components of post-stroke HSP treatment practice and challenges in occupational therapy practice of post-stroke HSP in Harare CONCLUSION: Occupational therapy intervention practice for post-stroke HSP in Harare includes an eclectic approach, with preventative practices as a key component of treatment. Intervention should strive to be occupation-based and holistic encompassing considerations of environmental factors and the indicators of HSP Keywords: public health care, occupational therapy intervention, clinical practice, neurological upper limb conditions

MINIMIZING THE ADVERSE EFFECTS OF WORK ENVIRONMENT IN UPPER LIMB: A LITERATURE REVIEW

Introduction: Occupational problems are highly prevalent and act as impediments to effective labor. As per the statistics by WHO, in the year 2003, it was seen that back injuries shared the highest proportion in occupational disorders (60%), followed by neck and upper limb. Body: In the upper limb, any joint, be it the shoulder, elbow, wrist or hand, can be affected. Variable structures ranging from the tendon, ligament, nerve or muscle can be involved leading to problems effectuating in the form of pain, tenderness, swelling, and functional deficits. Common problems seen are carpal tunnel syndrome, muscle sprain-strain, and osteoarthritis in joints, etc. Management: ULMSDS can be prevented by incorporating activity in daily life awhile also keeping a check on posture. At workplace, architectural adjustments and changes in physical and social environment can help prevention exacerbation of upper limb conditions. Regular rest intervals can also be included to avoid prolonged fixation of joints in one position. Conclusion: This paper focuses on ULMSDS in an attempt to improve the quality of life through various intervention strategies within the work organization thus enhancing work quality and output of the companies. Article visualizations:

Compression and tension behavior of the prosthetic foam materials polyurethane, EVA, Pelite™ and a combination of polyurethane and EVA: a preliminary study.

Materials with low-strength and low-impedance properties, such as elastomers and polymeric foams are major contributors to prosthetic liner design. Polyethylene-Light (Pelite™) is a foam liner that is the most frequently used in prosthetics but it does not cater to all amputees' limb and skin conditions. The study aims to investigate the newly modified Foam Liner, a combination of two different types of foams (EVA+PU+EVA) as the newly modified Foam Liner in terms of compressive and tensile properties in comparison to Pelite™, polyurethane (PU) foam, and ethylene-vinyl acetate (EVA) foam. Universal testing machine (AGS-X, Shimadzu, Kyoto, Japan) has been used to measure the tensile and compressive stress. Pelite™ had the highest compressive stress at 566.63kPa and tensile stress at 1145kPa. Foam Liner fell between EVA and Pelite™ with 551.83kPa at compression and 715.40kPa at tension. PU foam had the lowest compressive stress at 2.80kPa and tensile stress at 33.93kPa. Foam Liner has intermediate compressive elasticity but has high tensile elasticity compared to EVA and Pelite™. Pelite™ remains the highest in compressive and tensile stiffness. Although it is good for amputees with bony prominence, constant pressure might result in skin breakdown or ulcer. Foam Liner would be the best for amputees with soft tissues on the residual limbs to accommodate movement.

Quality of life following a lower limb reconstructive procedure: a protocol for the development of a conceptual framework

IntroductionLower limb conditions requiring reconstructive surgery can be either congenital or acquired from trauma, infection or other medical conditions. Patient-reported outcome measures (PROMs) are often used by healthcare professionals to...

The necessity for treatment paths for lower limb prosthetics : All that glitters is not gold!

Frequently occurring problems in the fitting of leg prostheses are either, for aprosthetic fitting, insufficiently resilient leg stumps or insufficiently adapted prostheses. For this reason, there has been ademand at the political level to establish treatment pathways and aquality standard for the care of people after leg amputations. How can ajoint, interdisciplinary approach to the provision of aids be developed? Does interdisciplinary care of amputees lead to an improvement in the quality of care? Acompendium "Quality standard in the field of lower extremity prostheses" was compiled and presented at the OT World in Leipzig in 2018. The basic principle is treatment pathways for the interdisciplinary care of all amputation levels of the lower extremities. The result is acompendium that represents the current "gold standard" in orthopaedic care after lower limb amputations. The compendium not only describes the treatment paths in detail but also makes demands on the quality of the result of the surgical amputation, as well as the goals of residual limb conditioning and the demands on the quality of the fitting of the prosthesis. Atraffic light system is used to make recommendations, restrictions and rejections, thus defining the gold standard. If all the professions involved (doctors, CPOs, physiotherapists) do not work separately but rather together with the necessary expertise and routine, the quality of care for amputees will improve, and at the same time, the health care system will become more cost efficient.

How is telehealth being utilized in the context of rehabilitation for lower limb musculoskeletal disorders: a scoping review

Background Telehealth services may decrease costs, improve efficiency, and increase access for health care delivery. Telehealth has been used extensively in rehabilitation of various cardiopulmonary and neurological conditions with high clinical efficacy. However, there appears to be limited information regarding the provision of telehealth for managing musculoskeletal lower limb disorders and injuries. Objective To determine for which lower limb conditions telehealth has been used, and to describe the delivery mode and the content of that telehealth, when provided by physiotherapists. Design Scoping review. Methods A computerized search of Cochrane Library, PEDro, Medline, Scopus, SPORTDiscus, Web of Science, PubMed, and CINAHL was conducted up to the 5 April 2020. A search strategy was developed and adapted to each database. Studies were included if they investigated assessment or rehabilitation of a lower limb musculoskeletal disorder and utilized real-time telehealth physiotherapy sessions. We included primary studies, randomized controlled studies, nonrandomized clinical trials, and agreement studies. Results Ten studies were included in the review, categorized into two groups: assessment (five studies), and intervention or rehabilitation (five studies) via telehealth. Seven of those studies included patients who had undergone hip or knee arthroplasty. Nine studies utilized synchronous internet-based videoconferencing and one study used phone interviews as the method of delivering assessment or rehabilitation information. Conclusion Telehealth was used as a means of assessment of a variety of lower limb conditions, while rehabilitation via telehealth was limited to patients with hip or knee arthroplasty.

Narrative designed proposals of mechanical or electro-mechanical optimization to the current wheelchairs used by people with severe locomotion restraints

The field of mechatronic/robotic wearable exoskeletons, specifically those designated for assistance/rehabilitation in severe neuro-/locomotor disabling conditions in the lower limbs, is considered to have a great potential for radically changing the harsh condition of wheelchairs users, by restoring their defining human traits: bipedal, vertical, stance and gait. But even the most advanced such complex devices, are not yet effectively able to largely replace the wheelchairs. Therefore, until the overall complete wheelchairs’ substitutes, will meet, in this purpose, all the necessary related requirements, we have determined, and accordingly, designed – from a double perspective: of professionals and of (a) consumer – a series of necessary and rather accessible/feasible, consistent: mechanical and electro-mechanical improvements, to the current common type of wheelchairs, in order to improve the global functioning, autonomy and consequently, the quality of life in the needing people, with severe mobility restraints. These, for now, narratively innovative concepts and specifically designed, practical/technological-constructive solutions, target 10 main kinds of beneficial outcomes, i.e. a decalogue and their derivatives to be expected (most of them previously imagined by us but not completely designed until now, two of them already achieved but which need updating and other four entirely new), that could result in an “all-in-one” product paradigm which, to our knowledge, is not available at present. This model of wheelchair we propose is, at the same time, modular, so a certain consumer can purchase/ be offered only his/her own case-specific needed optimization components of it