Maximum Functional Potential Research Articles

Case Report: Standard rehabilitation protocol for complex tibial plateau fracture associated with fibular head fracture managed with plate osteosynthesis

Schatzker fracture belongs to the tibial plateau fracture. This fracture is frequently characterized by excessive trauma, such as a fall from a terrific height or an automobile collision. They are identified by a vertical break in the tibial plateau, which disturbs the joint surface and surrounding tissues. A schatzker type six fracture is a complex fracture that is difficult to manage conservatively and typically requires surgery to reestablish articular realignment and integrity. The purpose of this study is to examine the rehabilitation method and actual outcomes of a 41-year-old male patient who had a tibial plateau fracture as well as a fibular head fracture. This case study shows the need for a comprehensive rehabilitation program in assisting individuals with this specific fracture pattern to achieve their maximum functional potential. The patient undertook a rehabilitation program that comprised several therapy interventions such as range-of-motion training, enhancing power, balance and proprioceptive training, gait re-training, and pain control measures. To assess the patient's progress, objective measurements such as goniometry, muscular strength by manual muscle testing, functional outcome ratings, and patient-reported outcomes were employed. As demonstrated by the case study, a comprehensive treatment approach is required to properly treat tibial plateau fractures in conjunction with fibular head fractures. The patient achieved a considerable and favorable affiliation with the therapy techniques and the outcome measures rating.

Delirium Screening and Management in Inpatient Rehabilitation Facilities.

Delirium is an acute and fluctuating disturbance in cognition attention and awareness that is often a reflection of abnormal physiological condition of an individual. Delirium is highly prevalent among an older population and is associated with high mortality, poor medical and functional outcomes, and high healthcare cost. Delirium often has iatrogenic triggers, and it has been recognized as a quality indicator of healthcare organizations. Despite its high prevalence and significance, more than 50% of the delirium cases are underrecognized by healthcare professionals and remained untreated. Most patients in inpatient rehabilitation facilities are older adults with multiple risk factors for delirium including operation, intensive care stay, multiple co-morbidities, and impaired mobility. Early detection, intervention, and primary prevention of delirium will allow patients to avoid additional morbidities and reach their maximum functional potential during their rehabilitation stay. After the systematic implementation of delirium screening in our inpatient rehabilitation facility, we found that 10.3% of patients were screened positive for delirium at admission. This review discusses the systematic implementation of screening and intervention for delirium as well as the epidemiology of delirium to increase the awareness and guide clinical practice for clinicians in inpatient rehabilitation facilities.

Anthropometry, Body Composition, and Performance in Sport-Specific Field Test in Female Wheelchair Basketball Players.

Data on the physical and performance characteristics of female wheelchair basketball (WB) players are scarce. In several countries female WB players train and compete with male players on mixed teams due to the limited total population of players, which would otherwise lead to large territorial spread for each team. Any differences in terms of physical characteristics and/or WB skill proficiency between male and female WB players would be relevant to team performance in mixed teams. This work examined anthropometry, body composition, and performance in a set of sport-specific field tests in a sample of 13 female WB players representing about 40% of the eligible population in Italy across a range of functional point scores (Point). Point is assigned on an ordinal scale from 1.0 (i.e., players with minimal functional potential) through to 4.5 (players with maximum functional potential). Our female sample was then compared against twice as many (n = 26) Point-matched (±0.5 points) male players. The two groups were similar for age (P = 0.191; effect size [d] = 0.2), self-reported duration of injury (P = 0.144, d = 0.6), WB experience (P = 0.178, d = 0.5), and volume of training (P = 0.293, d = 0.4). The large majority of measured linear anthropometric variables (10/13) were lower in female players than males (0.001 < P ≤ 0.041). Skinfold-estimated percent body fat was higher (+7.6%) in females (30.7 ± 6.0%; P < 0.001, d = 1.3). Mean performance was worse in female than in males in six out of seven sport-specific field tests, scores being significantly lower in females for the maximal pass (7.5 ± 2.0 m for females vs. 10.4 ± 2.8 m for males; P = 0.002, d = 1.2) and suicide tests (55.8 ± 6.4 s for females vs. 45.4 ± 6.7 s for males; P < 0.001, d = 1.6). When performance in subgroups of females (n = 9) chosen across a range of Point was compared with that of males assigned 1.0 or 1.5 Point less (each n = 9), performance differences between male and female WB players were partially and completely eliminated, respectively. This work contributed new data for characterizing the physique and performance of female WB players. Further, the results suggested that when male and female athletes compete together in mixed teams, a 1.5 points subtraction from female players is needed to match the real gender difference in performance.

Reconstruction of the thumb amputation at the carpometacarpal joint level by groin flap and second toe transfer

IntroductionTraumatic loss of thumb at the carpometacarpal (CMC) joint level is very disabling to an individual. Pollicisation is the recommended technique of reconstruction for loss of thumb at this level. On occasions, injury to the rest of the hand or amputation of additional fingers may make pollicisation an impossible option. Microsurgical transfer of second toe is an option in such situations. Although many large series of toe transfers are available in the literature, no series deals exclusively with this subset of patients. Materials and methodsEight patients who had amputation of the thumb at or proximal to the CMC joint level were reconstructed by second toe transfer by us in the period 2002–2011. All had preliminary groin flap cover in the area of the thumb during the acute stage of treatment. Second toe with the metatarsal was transferred for thumb reconstruction after a mean duration of 3 months after flap cover. Patients were assessed for their ability to pinch, hold large objects and opposition achieved by Kapandji score. Average follow up is 4 years and 6 months with a minimum of 1 year. ResultsAll toe transfers survived. They reached their maximum functional potential by 1 year. All patients actively used the reconstructed thumb for day to day activities. Pinch was possible in all patients except two patients who did not have any fingers. Six of them registered grip strength of at least 50% of the opposite hand. When fingers were present, opposition was possible in all patients with Kapandji scores ranging from 5 to 8. Extent of usage was less in patients who did not have good function in other fingers. ConclusionSecond toe transfer is a viable option for reconstruction of thumb loss at or proximal to the CMC joint level. Proper planning of the preliminary flap cover determines the length of the thumb reconstruction. Strategic position of the transferred toe of adequate length and the functional status of the other fingers are important determinants of functional outcome.

Shoulder pain in hemiplegia: results from a national rehabilitation hospital in Turkey.

Shoulder pain is a common complication after stroke that can limit the patients' ability to reach their maximum functional potential and impede rehabilitation. The aim of our study was to examine the occurrence of hemiplegic shoulder pain in a group of Turkish patients and clarify contributing factors such as glenohumeral subluxation, reflex sympathetic dystrophy, tonus changes, motor functional level, limitation in shoulder range of motion, thalamic pain, neglect, and time since onset of hemiplegia. The effect of shoulder pain on the duration of rehabilitation stay was also identified. A total of 85 consecutive patients with hemiplegia admitted to a national rehabilitation center were evaluated for the presence of shoulder pain. A brief history of pain was taken for each patient, and each patient was evaluated by radiographic and ultrasonographic examination. The subjects with shoulder pain were compared with those without pain in regard to certain of the above variables. Of the 85 patients with stroke, 54 patients (54/85, 63.5%) were found to have shoulder pain. Shoulder pain was significantly more frequent in subjects with reflex sympathetic dystrophy, lower motor functional level of shoulder and hand (P < 0001), subluxation, and limitation of external rotation and flexion of shoulder (P < 0,05). Age was also a significant factor in the development of shoulder pain. We were unable to demonstrate a significant relationship between shoulder pain and sex, time since onset of disease, hemiplegic side, pathogenesis, spasticity, neglect, and thalamic pain. There was no prolongation of rehabilitation stay in patients with shoulder pain. These results indicate that shoulder pain is a frequent complication after stroke and that it may develop from a variety of factors. To prevent and alleviate shoulder pain, efforts should be directed toward proper positioning of the shoulder, range of motion activities, and the avoidance of immobilization.

Trophic consequences of differential performance: ontogeny of oral jaw‐crushing performance in the sheepshead, Archosargus probatocephalus (Teleostei, Sparidae)

Studies in the field of ecomorphology aim to delineate the role of anatomy in determining an organism's ecological niche. Although an extensive literature exists correlating trophic morphology with biological role, surprisingly little research has investigated the causal relationship between morphological variation and differential feeding performance. This study examines the possible role of oral jaw‐crushing performance in moulding diet in an ontogenetic series of sheepshead, Archosargus probatocephalus (Sparidae: Teleostei). By comparing potential niche, as determined by anatomical predictions of force production, with realized niche, as determined by field studies investigating prey use in the natural environment, we were able to assess to what degree maximal capabilities affected resource use. Evidence strongly suggested that oral jaw‐crushing force was an important determinant of diet in these fishes. All oral jaw elements, as well as force produced by the adductor mandibulae complex, scaled with positive allometry, which was consistent with the increase in hard prey taken. There was a significant correlation between increased force production and increased durophagous habit. Lastly, the force used to feed in nature increased at the same rate as the predicted maximum force generated by the adductor mandibulae complex. Studies such as this one speak directly to the relationship between maximum functional potential and actual patterns of resource use.

Evaluating Geriatric Team Care Programs

The use of a multidisciplinary service approach designed to give the geriatric patient the best opportunity to achieve maximum functional potential and a good quality of life has gained widespread acceptance. Despite this, the evidence to support the belief that a coordinated team approach is more effective than other traditional modes of intervention remains modest. In an effort to promote more frequent and more rigorous assessment of the care process and patient outcomes, this paper describes the steps involved in the implementation and evaluation of a geriatric team care program.

Shoulder pain in hemiplegia.

Development of a painful shoulder in the hemiplegic patient is a significant and serious problem, because it can limit the patient's ability to reach his or her maximum functional potential. Several etiologies of shoulder pain have been identified, such as immobilization of the upper extremity, trauma to the joint structures, including brachial plexus injuries, and subluxation of the gleno-humeral joint. A review of the literature explains the basic anatomy and kinesiology of the shoulder complex, the various etiologies of hemiplegic shoulder pain, and the pros and cons of specific treatment techniques. This knowledge is essential for the occupational therapist to evaluate effectively techniques used to treat the patient with hemiplegic shoulder pain. More effective management of this problem will facilitate the patient's ability to reach his or her maximum functional potential.

Visual Impairment is Not Blindness

□ Visual impairment is not necessarily blindness and the requirements of visually impaired persons are in many ways significantly different from those of blind persons. All too often agencies for the blind have not distinguished between these different requirements in providing services. The essential difference is that blind persons must rely on their other senses in order to function, while partially sighted persons must be helped to use whatever vision they have in coordination with their other senses. In providing services to partially sighted persons, the following basic principles should be considered: 1) Full service requires the cooperation of medical, physical, and behavioral specialists; 2) Services for partially sighted clients should be individualized on the basis of their differences in degree and quality of sight; 3) Whatever vision the client has should be augmented or strengthened through either mechanical or physical means; and 4) Clients should be helped to enhance their perception to its maximum functional potential.