Medical Training Therapy Research Articles

Applications of Augmented Reality in different domains

This paper provides a comprehensive review of augmented reality's (AR) applications in three key sectors currently witnessing a surge in AR adoption— entertainment, medicine, and retail. The study aims to underscore how AR enhances user experiences in these domains. The authors introduce AR, differentiating it from virtual reality, and discuss the requisite software and hardware technologies for implementing AR systems, along with various display types crucial for an enriched user experience. The paper also briefly touches upon the growth of AR in markets. In the entertainment sector, AR is showcased for its impactful applications in multiplayer gaming, PC games, broadcasting, and media recordings, contributing significantly to an enhanced gaming and entertainment experience. Transitioning to the medical field, AR proves invaluable in clinical healing, medical training, clinical teaching, surgery, and post-clinical therapy, demonstrating its diverse applications in healthcare for professionals and improved patient outcomes. The retail sector is explored, revealing how AR is reshaping advertising, marketing, fashion retail, and online shopping. AR's transformative role in providing engaging and interactive retail experiences, both in physical stores and online platforms, is discussed in detail. The paper concludes by outlining potential future AR applications and conducting a thorough analysis of its merits and drawbacks in the current landscape. This in-depth review serves as a valuable resource for understanding the evolving role of augmented reality across diverse industries, shedding light on its transformative impact on user experiences.

Medical Training Therapy in Oncology—A Neuro-oncological Perspective

Medical Training Therapy in Oncology—A Neuro-oncological Perspective

Pneumological Rehabilitation in Patients with Long Covid - Health Changes at the End of the Inpatient Rehabilitation Measure

Some people suffering from Covid-19 can be affected by persistent symptoms and long-term consequences of the disease (Long Covid) beyond their acute phase. Consequently, this can lead to restrictions in participation. Therefore, the focus is on medical rehabilitation in which Long Covid is treated as a new challenge. A prospective, exploratory observational study will be conducted. The written survey of Long Covid rehabilitants takes place at the beginning and end of the pneumological rehabilitation. The aim of the study is to describe the rehabilitation contents and goals, the subjective burdens, the social and occupational participation as well as the health-related changes. Among other factors, disease-specific symptoms, quality of life, participation, psychological impairments, fatigue, and performance were recorded. Long Covid rehabilitants (N=221) participate in the written survey. At the end of rehabilitation, the questionnaire survey indicated significant improvements in almost all outcome parameters with a large effect (p<0.01; ES between 0.76 (anxiety) and 1.30 (fatigue)). All corona symptoms, such as breathlessness on exertion, fatigue or lack of strength improved significantly at the end of rehabilitation. Moreover, the rehabilitants most frequently name the improvement of their health (92%), the increase of their performance (92%) and the improvement of the respiratory muscle strength (78%) as rehabilitation goals. In fact, these goals are achieved by 60 to 70%, significantly fewer rehabilitation patients reach the restoration of their ability to work (32%) or a better ability to concentrate (17%). Respiratory physiotherapy, endurance training and medical training therapy are described as most helpful. At the end of rehabilitation, 76% rated their rehabilitation success as good to excellent based on a single question. The first data of the study reveal that Long Covid rehabilitants are exposed to substantial burdens. Through medical rehabilitation, the patients experience medical and social support and experience significant improvements in all recorded health-related outcomes.

Effects of acupuncture and medical training therapy on depression, anxiety, and quality of life in patients with frequent tension-type headache: A randomized controlled study

To compare the effects of acupuncture and medical training therapy in combination or individually with usual care on quality of life, depression, and anxiety in patients with tension-type headache. In this single-center, prospective, randomized, controlled, unblinded trial, 96 adults (38.7(+/-13.3) years of age; 75 females/20 males/one dropout) with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups (n = 24). The treatment groups received six weeks of either acupuncture or medical training therapy as monotherapies or in combination (12 interventions each), or usual care. We assessed depressiveness (PHQ-9), anxiety (GAD-7), and health-related quality of life (SF-12) as secondary outcome parameters at baseline, six weeks, three months, and six months after initiation of treatment. Linear mixed models were calculated. Both, acupuncture (baseline to six-weeks change scores: mean: -2(standard deviation: 2.5 points), three months: -2.4(2.4), six-months -2.7(3.6)) and the combination of acupuncture and medical training therapy (-2.7(4.9), -2.2(4.0), -2.2(4.2)) (each within-group p < .05) significantly reduced depressiveness-scores (PHQ-9) to a greater extent than medical training therapy (-0.3(2.0), -0.5(1.6), -0.9(2.6)) or usual care alone (-0.8(2.9), 0.1(2.8), 0.2(3.6)). We found similar results with anxiety scores and the physical sum scores of the SF-12. No severe adverse events occurred. Acupuncture and the combination of acupuncture and medical training therapy elicit positive effects on depression, anxiety, quality of life, and symptom intensity in patients with episodic and chronic tension-type headache. Acupuncture appears to play a central role in mediating the therapeutic effects, underscoring the clinical relevance of this treatment. An additive benefit of the combination of both therapies does not appear to be relevant.Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.

Interprofessional collaboration in Austrian primary care: an analysis of requirements and challenges

Abstract Background Primary health care (PHC) is built on interprofessional collaboration (IPC) between health and social professions. According to international frameworks, interprofessional communication, client-centred care, collaborative leadership, role clarification, team functioning and interprofessional conflict resolution are essential for IPC. As of April 2022, 36 PHC units were registered in Austria. This study aims to explore the perspectives of health care professionals on IPC in PHC in Austria. Methods Between October 2021 and March 2022, 15 guided group interviews were conducted with a total of 57 representatives of the professional groups biomedical analytics, dietetics, medical training therapy, medicine, midwifery, nursing, occupational therapy, office assistance, orthoptics, pharmacy, physiotherapy, psychotherapy, radiology technology, social work and speech therapy. The data was analysed using qualitative content analysis according to Mayring. Results Interdisciplinary counselling and prevention services, monitoring, acute interventions and treatment of chronic diseases are seen as fields of action for increased IPC in PHC. Interprofessional relationships are established during joint home visits and weekly multiprofessional meetings, when communication is collegial. Challenges mentioned for the IPC in PHC were i.e. role ambiguity, lack of time for networking or unclear legal regulations. Taking over responsibility as well as the ability to delegate and to deal with conflict, a sense of justice and willingness to accept criticism are core competences required for IPC in PHC. Conclusions The interviewees aim to get more involved in PHC, but not all feel optimally prepared for the necessary collaboration in this setting. In their view, specific training content, focusing on the unique structure of PHC, the roles of all the involved professional groups and conflict management, is necessary to successfully shape IPC in the interest of the clients. Key messages

APPLICATION OF PATIENT FUNCTION RECOVERY AFTER RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT

ABSTRACT Introduction: The anterior cruciate ligament (ACL) is one of the important structures of knee joint stability. Objective: To investigate the application of medical training therapy (MTT) in the functional recovery of patients after anterior cruciate ligament reconstruction. Methods: Eighty patients who were treated in a secondary hospital were selected as the study subjects and were divided into a control group and an observation group according to a random number meter, with 40 cases per group. We compared Lysholm knee function scores, the range of motion (ROM), daily life capability (ADL scale), pain degree (VAS rating), knee stretch muscle score, and standing balance ability score of the two groups 3 months after intervention. Results: After intervention, the first time getting out of bed, the doctor-patient satisfaction score, and the average length of stay were better in the observation group than in the control group (P&lt;0.05). The excellent rate of knee function in the observation group was 92.50%, which was significantly higher than 70.00% in the control group (P&lt;0.05). Conclusions: MTT therapy can significantly improve knee the function and pain level of patients after anterior cruciate ligament reconstruction, shorten the length of hospital stay, promote rehabilitation, improve the therapeutic effect, and improve the quality of life of patients. Level of evidence II; Therapeutic studies - investigation of treatment results.

Supervised Skeleton-Based Reference Movement Adjustment

Abstract In Medical Training Therapy (MTT) the exact execution of training exercises developed by the therapist is crucial for the success of the therapy. Currently, a therapist has to treat up to 15 patients at the same time on an outpatient basis. The aim of this paper is to provide an assistance system that can evaluate both the quantity and the quality of the movement performed using a goal-oriented model which gives the patient direct recommendations for action through automated, machine-monitored feedback. To implement the therapeutic measures in a targeted manner, it is advantageous to transfer their knowledge to the patients. This would be possible by transferring the therapist's movement into a patient's movement. Under this assumption a movement sequence of the therapist is recorded and a movement reference frame is extracted with the help of a smart sensor, which is made available to the patient as a target movement. The assistance system records the patient's movement in real time, extracts the its skeleton and compares this movement with the reference. Due to anatomical body differences, the reference skeleton must be adapted to the current patient skeleton, otherwise no movement evaluation can take place. By adjusting the bone lengths and angles in the individual frames of the patient's movement the selected sequence can be compared and any movement deviations that occur can be projected in directly in real time onto the patient's 3D avatar as an error image. The patient tries to reduce the errors and in doing so comes closer and closer to the ideal movement of the therapist which guarantees the best possible therapy success.

Portable 3D Gait Analysis Assessment in MTT Treat Chronic Ankle Instability: A Retrospective Study.

Purpose Retrospective analysis of the effect of portable 3D gait analysis as an innovative evaluation method in the treatment with MTT on chronic ankle instability patient. Methods From January 1, 2019, to December 31, 2019, 56 cases of chronic ankle instability (CAI) were extracted from the medical record system of Shenzhen Longhua District Central Hospital. All the patients of 56 cases accepted the medical training therapy (MTT). As outcome parameters, the alterations of the Cumberland ankle instability tool (CAIT), foot and ankle ability measure (FAAM), were used before the treatment and after treatment; meanwhile, the portable apparatus 3D gait analysis was used to measure the gait parameters. Conclusion The results showed only ankle angle parameters Y-axis, maximum dorsiflexion during support period (°) had a significant difference, and the p value is 0.039. Meanwhile, the CAIT, FAAM, and most 3D gait analysis data had no significant difference. This particular statistical difference shows that CAI can be measured scientifically and objectively, although most measurement parameters have no change. These results make further reveal that the CAI patients are suffering with dynamic abnormality of ankle motion angle; this also provides us with a measurable and systematic evaluation reference plan for CAI treatment in the future.

Combination of acupuncture and medical training therapy on tension type headache: Results of a randomised controlled pilot study.

ObjectivesThe aim of this study was to compare the effects of acupuncture and medical training therapy alone and in combination with those of usual care on the pain sensation of patients with frequent episodic and chronic tension-type headache.DesignThis was a prospective single-centre randomised controlled trial with four balanced treatment arms. The allocation was carried out by pre-generated randomisation lists in the ratio 1:1:1:1 with different permutation block sizes.SettingThe study was undertaken in the outpatient clinic of Rehabilitation Medicine of the Hannover Medical School.Participants and interventions: Ninety-six adult patients with tension-type headache were included and randomised into usual care (n = 24), acupuncture (n = 24), medical training (n = 24), and combination of acupuncture and medical training (n = 24). One patient was excluded from analysis because of withdrawing her/his consent, leaving 95 patients for intention to treat analysis. Each therapy arm consisted of 6 weeks of treatment with 12 interventions. Follow-up was at 3 and 6 months.Main outcome measuresPain intensity (average, maximum and minimum), frequency of headache, responder rate (50% frequency reduction), duration of headache and use of headache medication.Clinical results: The combination of acupuncture and medical training therapy significantly reduced mean pain intensity compared to usual care (mean = −38%, standard deviation = 25%, p = 0.012). Comparable reductions were observed for maximal pain intensity (−25%, standard deviation = 20%, 0.014) and for minimal pain intensity (−35%, standard deviation = 31%, 0.03). In contrast, neither acupuncture nor medical training therapy differed significantly from usual care. No between-group differences were found in headache frequency, mean duration of headache episodes, and pain medication intake. At 3 months, the majority of all patients showed a reduction of at least 50% in headache frequency. At 6 months, significantly higher responder rates were found in all intervention groups compared to usual care.ConclusionsIn contrast to monotherapy, only the combination of acupuncture and medical training therapy was significantly superior in reduction of pain intensity compared to usual care.Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.

Ankle Ligament Injuries Based on Medical Images of Hip‐Hop Training and Research on Training Techniques

Ligament loss of the ankle joints is common. If it is not handled properly, it is easy to cause repeated sprains of the ankle joints. Usually, medical image examination will be the first choice for the diagnosis of ligament injury. This paper analyzes the ankle ligament injury of hip‐hop training based on medical images and studies the hip‐hop training skills, to explore the application method of medical images in ankle injury, and can provide some theoretical and practical references for other sports injuries. In this paper, several medical image‐related technologies such as texture feature extraction, main visual feature SAR method, and edge detection method are proposed. These technologies are applied to the study of ankle ligament injury, and an effective medical training therapy is determined by setting up the control group and the treatment group to observe the medical image display of each part of the ankle. Through the statistics of the clinical efficacy judgment standard results of patients in the treatment group and patients in the control group after two weeks of injury, it is found that the experimental results show that the cure rate, significant efficiency, and total effective rate of patients in the treatment group after two weeks are higher than those in the control group, and the total effective rate of the treatment group has reached 92.20%.

Multidisciplinary Pain Management of Chronic Back Pain: Helpful Treatments from the Patients' Perspective.

Multidisciplinary pain management programs (MPMP) for patients suffering from chronic back pain include a variety of treatment modalities. The patients’ perceived helpfulness of these treatment modalities remains unclear. The aims of this prospective observational cohort study were to assess (i) the patients’ perceived helpfulness of different treatment modalities, (ii) the influence of sociodemographic characteristics on the patient’s perspective and (iii) whether treatment outcomes are affected by helpfulness ratings. Treatment modalities of this three-week MPMP consisted of individual physiotherapy, group-based physiotherapy, relaxation therapy, aquatic therapy, back education, medical training therapy, biofeedback, psychological pain therapy and music therapy. The study comprised 395 patients. The main outcome was the patients’ perceived treatment helpfulness at the end of the program measured by a self-reported questionnaire ranging from 1 (not at all helpful) to 6 (extremely helpful). Secondary outcomes were treatment effects on pain, pain related disability, functional ability and level of depressive symptoms measured by self-reported questionnaires (NRS, PDI, FFbH-R, ADS-L). A total of 276 patients (22–64 years, 57% female) were available for overall analysis. Multivariate-analysis-of-variance- (MANOVA-) related results revealed that perceived treatment helpfulness (range 1–6) differed significantly between treatment modalities: individual physiotherapy (M = 5.00), group-based physiotherapy (M = 4.87), relaxation therapy (M = 4.6), aquatic therapy (M = 4.54), back education (M = 4.43), medical training therapy (M = 3.38), biofeedback (M = 3.31), psychological pain therapy (M = 3.15), music therapy (M = 3.02). Pain, pain related disability and levels of depressive symptoms significantly improved after the program (p < 0.001) whereas functional ability decreased (p < 0.01). Significant correlations were found between helpfulness ratings and sociodemographic data indicating that perceived treatment helpfulness was influenced by patient-related factors. Importantly, the degree of pain-related improvements was affected by the patients’ perceived treatment helpfulness. In conclusion, patients’ perceived treatment helpfulness differs significantly between treatment modalities and corresponds to treatment outcome.

The best from East and West? Acupuncture and medical training therapy as monotherapies or in combination for adult patients with episodic and chronic tension-type headache: study protocol for a randomized controlled trial

BackgroundThis study aims to evaluate the feasibility and efficacy of a complex health intervention, based on the combination of conventional Western medicine and traditional Chinese medicine (TCM), in an outpatient department of a university hospital for patients with frequent episodic or chronic tension-type headaches.Methods/designThis is a prospective randomized controlled pilot study with four balanced treatment arms (usual care, acupuncture, training, and training plus acupuncture). Each arm will have 24 patients. After the initial screening examination and randomization, a 6-week treatment period follows, with treatment frequencies decreasing at 2-week intervals. After completion of the intervention, two follow-up evaluations will be performed 3 and 6 months after the start of treatment. At predefined times, the various outcomes (pain intensity, health-related quality of life, pain duration, autonomic regulation, and heart rate variability) as well as the participants’ acceptance of the complex treatment will be evaluated with valid assessment instruments (Migraine Disability Assessment, PHQ-D, GAD-7, and SF-12) and a headache diary. The acupuncture treatment will be based on the rules of TCM, comprising a standardized combination of acupuncture points and additional points selected according to individual pain localization. The training therapy comprises a combination of strength training, endurance training, and training to improve flexibility and coordination. Besides descriptive analyses of the samples, their comparability will be assessed using an analysis of variance (ANOVA) or chi-squared tests. Analyses will be performed on an intention-to-treat basis. Potential interaction effects will be calculated using a repeated-measures ANOVA to test the primary and secondary hypotheses. In supplementary analyses, the proportion of treatment responders (those with a 50% reduction in the frequency of pain episodes) will be determined for each treatment arm.DiscussionThis trial may provide evidence for the additive effects of acupuncture and medical training therapy as a combination treatment and may scientifically support the implementation of this complex health intervention.Trial registrationRegistered on 11 Feburary 2019. German Clinical Trials Register, DRKS00016723.

Pediatric Rehabilitation Therapies Differ in Intensity: A Pilot Study to Highlight the Implications for Dose-Response Relationships.

When investigating dose-response relationships in rehabilitation studies, dose is often equated with duration of therapy. However, according to the American College of Sports Medicine, dose consists of the factors frequency, intensity, time, and type. Thereby, especially quantification of intensity needs improvement to have a more precise estimate of the dose. Thus, the aim was to investigate the intensity during mobility-focused, real-life pediatric rehabilitation therapies. Eleven participants (5 girls, 12.5 ± 2.1 yrs old) with neurological disorders and independent mobility wore accelerometers at wrists and ankles and a portable heart rate monitor during several of the following therapies: sports therapy, mobility-focused physiotherapy, medical training therapy, and robot-assisted gait training. Intensity of physical activity was quantified by activity counts (measured via accelerometers) and heart rate. Therapy duration did not correlate with intensity. At the same time, we found significant differences between intensities of different therapies. Different therapies elicit different levels of intensity in children with neuromotor disorders. Heart rate and activity counts are suited to estimate the intensity of a therapy and provide complementary information. We recommend against using the duration of a therapy as a proxy for the dose to make statements about dose-response relationships. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Appraise the importance of measuring the intensity of various types of inpatient rehabilitation therapy for determining the dose; (2) Describe the differences in intensities between different training forms and name factors that influence this intensity; and (3) Discuss the influence of the functional level of a patient on his/her potential to engage in physically intensive therapy sessions. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Individual Avatar Feedback Creation for Assisted Motion Control

Abstract In Medical Training Therapy (MTT), the precise execution of the training exercises is of decisive importance for the success of the therapy. Currently, a therapist has to treat up to 15 patients simultaneously on an outpatient basis. We propose, an assistance system, can evaluate both quantity and quality of the movement performed using a target-oriented model and give recommendations for action directly to the patient by means of feedback. An avatar in traffic light colours signals in which body region an error has occurred. The individualisation of the underlying three-dimensional avatar increases the willingness of the patients to participate in the exercises without the supervision of therapist. The monitored error frequency was decreased by 50% by the assistance system.

Feasibility and safety of rehabilitation after venous thromboembolism.

BackgroundVenous thromboembolism is a life-threatening disease. In survivors, different degrees of functional complaints need to be restored or prevented (eg, post-thrombotic syndrome, pulmonary hypertension). Therefore, rehabilitation after venous thromboembolism is recommended in Germany. However, a structured rehabilitation program has not been defined for this indication. Here, we present the experience of a single rehabilitation center.MethodsData from consecutive pulmonary embolism (PE) patients who were referred for a 3-week inpatient rehabilitation program from 2006 to 2014 were retrospectively evaluated.ResultsIn all, 422 patients were identified. The mean age was 63.9±13.5 years, the mean body mass index (BMI) was 30.6±6.2 kg/m2, and 51.9% were female. Deep vein thrombosis according to PE was known for 55.5% of all patients. We applied a wide range of therapeutic interventions such as bicycle training with monitored heart rate in 86.7%, respiratory training in 82.5%, aquatic therapy/swimming in 40.1%, and medical training therapy in 14.9% of all patients. Adverse events (AEs) occurred in 57 patients during the 3-week rehabilitation period. The most common AEs were cold (n=6), diarrhea (n=5), and infection of the upper or lower respiratory tract that was treated with antibiotics (n=5). However, three patients under anticoagulation therapy suffered from bleeding, which was clinically relevant in one. Four patients (0.9%) had to be transferred to a primary care hospital for non-PE-associated reasons (acute coronary syndrome, pharyngeal abscess, and acute abdominal problems). No influence of any of the physical activity interventions on the incidence of any AE was found.ConclusionSince PE is a life-threatening disease, it seems reasonable to recommend rehabilitation at least in PE patients with an intermediate or high risk. It is shown for the first time in this study that a standard rehabilitation program after PE is safe. However, efficacy and safety in the long term need to be studied prospectively.

Відновне лікування бійців антитерористичної операції засобами фізичної реабілітації після ампутації нижніх кінцівок

Purpose: the main approaches to the assignment of physical rehabilitation restorative treatment after lower limb amputations. Material and Methods: theoretical analysis and synthesis of modern scientific and methodological literature data on methods of comprehensive rehabilitation after lower limb amputations. Results: the features of the application of physical rehabilitation after lower limb amputations, tasks and presents the main approaches to the appointment of medical physical training, therapeutic massage and physical therapy in preparation for prosthetics. Conclusions: demonstrated that therapeutic physical training, therapeutic massage and physical therapy are effective means of physical rehabilitation of patients after lower limb amputations.

Systematic medical training therapy

Der Begriff Medizinische Trainingstherapie (MTT) ist inhaltlich in der wissenschaftlichen Literatur nicht allgemeingultig geklart. Wissenschaftliche Definitionen existieren hier fur die Wortkomponenten Training und Therapie, aus denen sich im Zusammenhang das inhaltliche Verstandnis fur die bestehenden wissenschaftlichen allgemeingultigen Definitionen systematisch zur MTT aus der Literatur herleiten lasst. Im vorliegenden Artikel werden daher – unter einem zuerst nominaldefinitorischen Ansatz – aus allgemeingultigen medizinischen Prinzipien und Definitionen Kriterien hergeleitet. Die Kriterien fur die Definition der MTT sind daher neutral und allgemeingultig erklart durch: Diagnosekriterien – zur Verordnung – inklusive definierter Indikation/Kontraindikation systematische Zuordnung erhobener Messungen (pathologischer vs. gesunder Zustand) begleitende Psychometrie (didaktische Intervention) begleitende wissenschaftliche Dokumentation (Methode und Effekte) Qualitatssicherung

Medizinische Trainingstherapie unter besonderer Berücksichtigung der osteoporotischen Wirbelsäule

Medical training therapy (MTT) plays a decisive role in maintenance and development of musculoskeletal health of humans in all phases of life. In childhood and adolescence it can contribute to the highest possible so-called peak bone mass and thus avoid or delay the appearance of osteoporosis for as long as possible, in view of increased life expectations. In young adults targeted MTT is well suited to improve performance and to maintain the maximum developed bone mass. The latter is also true for perimenopausal and postmenopausal women in whom MTT can compensate for the loss of bone mass due to hormone deficiency in comparison to those not in training. Elderly people who have possibly already suffered several fractures and who are in danger of becoming permanently dependent on external help due to increasing fragility can still improve muscle strength and mass by regular MTT even in advanced age. This will reduce or avoid the risk of falling and maintain the ability to be self-sufficient for as long as possible. In order to support this, rehabilitation measures even in-hospital, could be useful and should be especially promoted in line with the amendments to the social legislation effective from 1st April 2007 ("Rehabilitation before nursing").

Konservative Hämophiliebehandlung unter Berücksichtigung der Optimierung und Standardisierung

SummaryRehabilitation and physical therapy in the sense of functional health is based on the international classification of function. It takes in two considerations: function and structure of the body and their influence on personal and social activity. The integrative concept of joint function translates the basic concept of body function and structure on to the motion of the locomotive system. Stability needs motoric control. Motoric control and the integrated neural components are to be influenced through regulation of muscle tonus (massage, manual therapy, medical training therapy, electrotherapy and thermotherapy). The stability of the joint is controlled by the passive components. Passive structures are optimised through passive therapies like joint mobilisation. Active components of joint function are optimised through activation (medical training therapy, stabilisation, mono or multisegmental levels). Emotional and neuronal components can be triggered through kinesthetic exercises like PNF, Jacobsen relaxation, biofeedback training, mental training. Exact examination of the locomotive system will help finding all symptoms. This is how we individualise the therapy of symptoms and structures. The motion pattern generator shows us how to use the possibilities of functional influence on the motion pattern. We have a lot of afferent signals that need individualised functional therapy. This is why we need functional measurements like motion analysis on the basis of ultrasound. An other tool is the kinetic superficial EMG measurement of muscle function. We can use it to determine the status of the joint and it will lead to therapeutical decisions. All functional measurements will help to improve quality control of the physical therapy process. Even if the haemophilic patient is healthy he is not fit at all. Measurements of fitness will help us to improve special skills and establish the human being as a subject in society and environment. The main skill to be improved in haemophiliacs is coordination, strength of the stomach muscles and the vastus medialis and the flexibility of the hamstrings.

Quadsparing-Zugang bei Knietotalendoprothesenimplantation

Approach to the knee joint for total knee arthroplasty (TKA) with gentle soft-tissue handling. Primary TKA with range of motion>or=100 degrees, leg axis up to 10 degrees varus or valgus, body weight<100 kg. Contracted knees, leg axis>10 degrees varus or valgus, obesity, previous knee surgery except arthroscopic procedures, rheumatoid arthritis. Anterior midline incision. Soft-tissue preparation and capsule incision start at the upper tip of the patella and are continued distally along the medial patellar border ending at the tibial tuberosity. After opening of the joint, the patella is dislocated laterally without everting it. Exposure of the articular surface using a "mobile window". Preparation and insertion of the TKA components using special instruments. Wound closure in layers. Mobilization on crutches with full weight bearing starting on the day of surgery. Daily medical training therapy. Passive motion therapy continued twice a day. Low-dose heparin s.c. for 35 days after surgery. In a prospective randomized clinical study, 50 patients with a quadsparing (QS) approach were observed up to 3 months after surgery. In three patients, the use of large femoral components required an extended approach. During the hospital stay knee flexion was significantly greater in patients with the QS approach than in patients with the standard procedure (midvastus approach). There were no differences in implant positioning, Knee Society Score and complication rate between both groups. Use of the QS approach prolonged the duration of surgery by 25 min.