Medical Training Therapy Research Articles

A real time hyperelastic tissue model

Real-time soft tissue modeling has a potential application in medical training, procedure planning and image-guided therapy. This paper characterizes the mechanical properties of organ tissue using a hyperelastic material model, an approach which is then incorporated into a real-time finite element framework. While generalizable, in this paper we use the published mechanical properties of pig liver to characterize an example application. Specifically, we calibrate the parameters of an exponential model, with a least-squares method (LSM) using the assumption that the material is isotropic and incompressible in a uniaxial compression test. From the parameters obtained, the stress–strain curves generated from the LSM are compared to those from the corresponding computational model solved by ABAQUS and also to experimental data, resulting in mean errors of 1.9 and 4.8%, respectively, which are considerably better than those obtained when employing the Neo-Hookean model. We demonstrate our approach through the simulation of a biopsy procedure, employing a tetrahedral mesh representation of human liver generated from a CT image. Using the material properties along with the geometric model, we develop a nonlinear finite element framework to simulate the behaviour of liver during an interventional procedure with a real-time performance achieved through the use of an interpolation approach.

Vergleich dreier ambulanter Therapieformen zur Behandlung chronischer Rückenschmerzen - Ergebnisse einer multizentrischen, clusterrandomisierten Studie

The AOK Baden-Württemberg health insurance fund initiated a study on the outpatient rehabilitation of patients with chronic low back pain, aimed at improving the treatment concept for its insurees with chronic low back pain (START). This model project was scientifically guided by the Hochrhein-Institute in Bad Säckingen. The paper compares the effectiveness of Enhanced Outpatient Physiotherapy (Erweiterte Ambulante Physiotherapie, EAP), Outpatient Rehabilitation (Ambulante Rehabilitation, AR) and Medical Training Therapy (Medizinische Trainingstherapie, MTT) in patients with low back pain. In seven regions in Baden-Württemberg, one of these three intervention forms was provided to the patients. A total of 1,274 patients were included in the study. The AOK Baden-Württemberg patients receiving treatment in one of the three intervention forms were seriously restricted in both the physical dimension of their health status and in their physical mobility in everyday life and at the workplace. Besides, they frequently reported considerable psychosocial strain. The three interventions led to significant and relevant decreases in pain intensity and to an improved health-related quality of life. There were no significant differences between the various treatments in terms of effectiveness. The patients shared an equally high satisfaction with the treatment received. In MTT, the total therapy length of 15 weeks was by far longer than in AR and EAP (about 5 and 8 weeks). Unlike AR and, in parts, EAP, patients may continue to work while participating in MTT. Therefore an immediate therapy start within a week was more likely possible in MTT (59 %) than in AR (10 %) or EAP (23 %). In evaluating the results a number of restrictions have to be considered. Nevertheless, based on our research findings, the following can be concluded: MTT is a suitable therapy concept in patients with low back pain characterized by a rapid start and-- compared to the other two concepts-- by lower therapy costs. MTT might represent a meaningful therapy element also in new forms of provision such as integrated services. Patients showing severe psychosocial strain should be assigned to an interdisciplinary therapy as it is provided by inpatient and outpatient rehabilitation facilities. For effective differential assignment to the various programmes, realization of a standardized rehab assessment is an important precondition.

アウトペーシャント・リハビリテーションセンター、メディカルトレーニングセラピーの紹介

アウトペーシャント・リハビリテーションセンター、メディカルトレーニングセラピーの紹介

Die ultraschalltopometrische Quantifizierung der Wirbelsäulenform und der Halteleistungsfähigkeit für die Evaluation verschiedener Muskelkräftigungsprogramme in der Therapie von Rückenschmerzen

The aim of this study was the evaluation of the effectiveness of different muscle strengthening programs in the therapy of back pain. 102 male longshoremen aged from 29 to 63 years with chronic back pain since > two years, matched by pain intensity and functional limitations, were randomized to three test groups (TG) and one control group (CG). The test persons carried out a program for intensified muscle strengthening over a period of six months one to two times weekly in a therapeutic practice (TG1), in a health club (TG2) and in a gymnastic group (TG3). The CG did not complete any intervention. Ultrasound topometry for recording spinal configuration and postural capacity as well as the determination of pain intensity and functional limitations were used as instruments of assessment. The data obtained for the CG remained virtually unchanged over the period of investigation. In contrast a decrease of pain intensity and functional limitations could be proved for all TG. Furthermore, the training programs induced both an improved postural capacity while performing the arm-raising test and an increasingly erect sagittal spinal profile. The power of effectiveness was on a homogeneous level for the medical training therapy (0.41), the fitness training (0.4) and the spinal gymnastics (0.41). The three muscle strengthening programs investigated have equally favorable effects on the parameters evaluated and are qualified as effective strategies in the therapy for chronic spinal discomforts.

Fibromyalgia

Within clinical practice fibromyalgia is diagnosed according to the classification criteria of the American College of Rheumatology. The examination of the tender points is still to be standardized. By using additional diagnostic criteria fibromyalgia changes into a polysymptomatic syndrom with multiple functional and psychic symptoms. The prevalence of FMS is estimated to range between 1,3-4,8% in the general population. Relative hypocortisolism, sensory hypervigilance, adverse life experiences and psychiatric disorders are discussed as main pathophysiological mechanisms. There are no evidence-based guidelines of scientific societies for the management of fibromyalgia available. Patient education, medical training therapy, physical therapy (heat or cold) and relaxation therapy are recommended. There is a moderate evidence for the effectiveness of tricyclic antidepressants and aerobic training. The effectiveness of multicomponent therapy in fibromyalgia is still to be demonstrated.

Development of a guideline for rehabilitation of patients with low back pain-- phase 2: analysis of data of the classification of therapeutic procedures

Initiated by the Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte), the project is aimed at developing an evidence-based guideline for rehabilitation of patients with low back pain (LBP). Guideline development will be based on a systematic review of the literature, an analysis of the treatment procedures currently employed in rehabilitation, inclusion of the patients' perspectives as well as consultation of experts' panels of clinically experienced physicians and therapists. Formulation of the guideline will then be carried out in a structured consensus building process. This article is focused on analysing the present situation with regard to the treatments received by patients insured by the BfA, using data from routine documentation according to the Classification of Therapeutic Procedures (KTL, Klassifikation Therapeutischer Leistungen). The analysis is intended to provide indications of a basic need to implement a common guideline as well as, simultaneously, to explore possible deficits in present treatment practices, hence to define priorities requiring special attention in the framework of guideline development. As a result of a systematic literature review, the KTL-defined therapeutic procedures that had emerged as relevant in the rehabilitation of LBP patients were aggregated into so-called therapeutic modules which then formed the basis of the analysis. In all, more than 46,000 KTL-data of 2438 patients with a diagnosis of "low back pain" (M54.5 ICD-10) were included. In the rehab centres investigated, rehabilitation of patients with LBP follows a multidimensional, multiprofessional therapeutic strategy. More than 90 % of all patients receive treatments from the modules "medical training therapy", "health education", "physiotherapy", and "physical therapy". Treatments provided to a majority of the patients are massage (78 %), electrotherapy (67 %) as well as psychotherapy (68 %). Women more frequently than men receive therapies belonging to the "psychological treatments" and "occupational therapies" modules; younger patients receive more of the "training therapies", and more often. When treatments are compared across centres, a large variability in the therapeutic procedures provided becomes apparent. This high degree of variability suggests that development and implementation of a common clinical practice guideline for rehabilitation of patients with chronic low back pain should receive priority attention.

Role of physical activity for the prevention and rehabilitation of osteoporosis

The therapeutic exercises pursue preventive as well as rehabilitative aims within the osteoporosis therapy. The objective depends on whether an osteoporosis already occurred and it depends also on the respective stage of the osteoporosis. Aims and main points from the physiotherapy and sports therapy are: construction of the bone substance; receipt of the bone substance; pain alleviation; fall prophylaxis. To reach an optimal bone mineral content in recent years activities are necessary on which own body weight must be carried. In the later adult age the same activities in addition are necessary to reduce the natural reduction rate of bone mineral content to a minimum. With beginning or already occurred osteoporosis must those activities be operated with caution and restraint which have to do with abrupt interceptions of the body weight.The combination of medication and physical activities shows better therapy results as the respective measures alone. An important therapeutic aspect with older humans exists in the reduction of the fall risk and thus the fracture risk. In addition a muscle training - as for example in the medical training therapy - can raise the pain threshold, so that the pain sensitivity of the patients is improved.

Medical exercise therapy--indications, tips on individualized prescription

Medical training therapy (MTT) belongs to the active methods which can be used by physiotherapists under medical prescription. This dynamic method was originally developed by O. Holten in Norway but it has become extremely popular in patients and did also convince a large number of therapists; as a consequence of its success, its prescription increased progressively and actually replaced larger parts of the passive methods used before. The aims of MTT is to work in a pain free environment and increase both muscle resistance, strength and joint mobility as well. The technique does not have any absolute contraindication, but it has to be individually adapted to each single patient. A true advantage of MTT is certainly that the active training sessions can be done in small well controlled groups of patients. As it does also apply for other types of currently used physical therapies, there are only restricted evidence-based proofs of efficacy and therefore scientifically sound studies are still needed in this field.

Medical training therapy in lumbar syndromes.

Chronic low back pain can be considered to be one of the most frequently treated and most costly diseases in modern industrial societies. Dysfunctions and imbalances of the spine-supporting muscles increase the risk of low back pain. Consequently preventive treatment and rehabilitation have to aim at preserving and restoring the full capacity of the spine-supporting muscles as well as training coordination and spine-friendly behaviour. In addition to various measures of pain therapy, physiotherapeutic treatment including neuro-physiotherapy, physical treatment (eg electrotherapy), balneotherapy and supportive behavioural training, medical rehabilitation therapy (MRT) ranks among the most effective ways of treating low back pain. MRT applies guidelines and methods of exercise methodology within medically indicated programmes of preventive treatment and rehabilitation. Various objectives of MRT are outlined with special regard to the stages of MRT treatment, emphasizing positive adaptation of the neuro-muscular system in the course of rehabilitation. Physicians are responsible for MRT diagnosis and control. Taking into account the base disorder and the progress of therapy physiotherapists and the physicians in charge determine MRT objectives and treatment strategies.