Rehabilitation Method For Patients Research Articles

Funktionelle Magnetstimulation als „schmerzlose“ Variante der künstlichen Bewegungsinduktion bei Lähmungen

It is known in the rehabilitation of central pareses that functional electrical stimulation (FES) of the muscles can induce movement and accomplish training in patients. The main limitations of this method are that patients with preserved sensation experience pain and the reflexes triggered by FES. Therefore the application of the largely "painless" magnetic stimulation (FMS) of the muscles would be a potential alternative in the rehabilitation of patients with partially preserved sensation. As the generation of high force and power levels is considered to be an essential requirement of effective rehabilitation strategies, we have shown in previous work that FMS with large surface magnetic coils fitted to the thigh can generate about 2.5 times higher isometric forces in patients with preserved sensation, than can FES. The goal of the present pilot study was to prove that the mechanical power generated by functional magnetic stimulation is superior to that produced by electrical stimulation too. We have measured the mechanical torque, the power, the accomplished work and the kinematics in 4 healthy control subjects, who performed pedalling propelled by FMS and FES until complete muscular exhaustion, using a cycling test-bed under isotonic conditions (constant resistance). We have proved that the generated work, mean power, cadence and smoothness of pedalling essentially depend on peak torque and power. Furthermore, we found evidence that smoother pedalling could be achieved using magnetic, compared to electrical stimulation because of the higher peak torques that were generated by FMS. This study supports the concept that peripheral magnetic stimulation is an appropriate rehabilitation method for patients with central pareses and preserved sensory apparatus because FMS is less painful than electrical stimulation.

Muscle, tendons, and bone: structural changes during denervation and FES treatment

<title/>Objectives: This paper describes a novel approach to determine structural changes in bone, muscle, and tendons using medical imaging, finite element models, and processing techniques to evaluate and quantify: (1) progression of atrophy in permanently lower motor neuron (LMN) denervated human muscles, and tendons; (2) their recovery as induced by functional electrical stimulation (FES); and (3) changes in bone mineral density and bone strength as effect of FES treatment.Methods: Briefly, we used three-dimensional reconstruction of muscle belly, tendons, and bone images to study the structural changes occurring in these tissues in paralysed subjects after complete lumbar-ischiadic spinal cord injury (SCI). These subjects were recruited through the European project RISE, an endeavour designed to establish a novel clinical rehabilitation method for patients who have permanent and non-recoverable muscle LMN denervation in the lower extremities. This paper describes the use of segmentation techniques to study muscles, tendons, and bone in several states: healthy, LMN denervated-degenerated but not stimulated, and LMN denervated-stimulated. Here, we have used medical images to develop three-dimensional models and advanced imaging, including computational tools to display tissue density. Different tissues are visualized associating proper Hounsfield intervals defined experimentally to fat, connective tissue, and muscle. Finite element techniques are used to calculate Young’s modulus on the patella bone and to analyse correlation between muscle contraction and bone strength changes.Results: These analyses show restoration of muscular structures, tendons, and bone after FES as well as decline of the same tissues when treatment is not performed. This study suggests also a correlation between muscle growth due to FES treatment and increase in density and strength in patella bone.Conclusion: Segmentation techniques and finite element analysis allow the study of the structural changes of human skeletal muscle, tendons, and bone in SCI patient with LMN injury and to monitor effects and changes in tissue composition due to FES treatment. This work demonstrates improved bone strength in the patella through the FES treatment applied on the quadriceps femur.

Use of orthoses in the process of restoration of the locomotor function in elderly patients with osteoarthrosis of joints on a single lower extremity

Twenty-three patients with amputation defects of their lower extremities and accompanying osteoarthrosis of joints on the saved extremity were examined. All the patients revealed indications for orthotic treatment. The authors studied the intensity of pain syndrome, a level of restoring of motor functions, and ability to self-service. The purpose of the present work consisted in restoring the ability to move in the patients. Two groups of patients were examined: the first group included the cases which, for different reasons, did not undergo orthotic treatment of the saved extremity and were provided only with prostheses, the second group underwent both prosthetic and orthotic treatment. Results of the examinations showed, that 63.6 % of patients from the second group could move and become independent of their people. At the same time, 41.6 % of patients from the first group did not master walking at all, and 50 % could hardly move on crutches. Thus, orthotic treatment of the single lower extremity was an effective method of rehabilitation for patients with amputation defects of one extremity with osteoarthrosis of joints on the other lower extremity.

Motor Imagery Ability in Patients With Early- and Mid-Stage Parkinson Disease

Background. Motor imagery has recently gained attention as a promising new rehabilitation method for patients with neurological disorders. Up to now, however, it has been unclear whether this practice method can also be successfully applied in the rehabilitation of patients with Parkinson disease (PD). Objective. This study aimed to investigate whether the motor imagery ability of patients with PD is still intact despite basal ganglia dysfunctioning. Methods. A total of 14 patients with early- and mid-stage PD (Hoehn and Yahr 1-3) and 14 healthy controls were evaluated by means of an extensive imagery ability assessment battery, consisting of 2 questionnaires, the Chaotic Motor Imagery Assessment battery, and a test based on mental chronometry. Results. PD patients performed the imagery tasks more slowly than controls, but the motor imagery vividness and accuracy of most patients were well preserved. Conclusions. These results are promising regarding the potential use of motor imagery practice in the rehabilitation of patients with PD.

Effect of Long-Term Climbing Training on Cerebellar Ataxia: A Case Series

Background. Efficient therapy for both limb and gait ataxia is required. Climbing, a complex task for the whole motor system involving balance, body stabilization, and the simultaneous coordination of all 4 limbs, may have therapeutic potential. Objective. To investigate whether long-term climbing training improves motor function in patients with cerebellar ataxia. Methods. Four patients suffering from limb and gait ataxia underwent a 6-week climbing training. Its effect on ataxia was evaluated with validated clinical balance and manual dexterity tests and with a kinematic analysis of multijoint arm and leg pointing movements. Results. The patients increased their movement velocity and achieved a more symmetric movement speed profile in both arm and leg pointing movements. Furthermore, the 2 patients who suffered the most from gait ataxia improved their balance and 2 of the 4 patients improved manual dexterity. Conclusion. Climbing training has the potential to serve as a new rehabilitation method for patients with upper and lower limb ataxia.

Supporting rehabilitation training of COPD patients through multivariate sensor-based monitoring and autonomous control using a Bayesian network: prototype and results of a feasibility study

Repeated endurance training – supervised by an expert – is one of the most effective rehabilitation methods for patients with chronic obstructive pulmonary disease (COPD) to improve physical function. Monitoring of vital signs in combination with an automatic intelligent training control and emergency detection facilitates supervised training without the physical presence of an expert as well as training optimisation through individualisation. The aim of this study is the development of a suitable analysis and control method for this purpose. Healthy volunteers and patients with COPD were equipped with body sensors during ergometer training to enable measuring their vital signs continuously. Depending on these values, the exercise load of the ergometer was controlled automatically using a Bayesian network. The network, trained with expert knowledge and training data, is embedded in our system by using Java application programming interface. Extensive tests in a laboratory setting have proved safe usage of our prototype. In a case study, evaluation during training sessions with patients with COPD took place. Due to the automatic control the patients' vital signs ranged inside the predefined optimal thresholds for at least 95% of the time. Furthermore, our results suggest an increase of the training efficiency compared with the conventional method (constant exercise load).

The scope and algorithm of instrumental physiotherapy programs at the hospital stage of rehabilitation of patients with stable angina pectoris

Optimization of the list of physiotherapeutic methods for rehabilitation of patients with stable angina of effort provided a basis for the rationale and the development of an algorithm of instrumental physiotherapy programs. The algorithm permits to avoid negative effect of environmental physical factors on the human body.

Role of mitochondrial variation in maternally inherited diabetes and deafness syndrome

Maternally inherited diabetes and deafness syndrome is caused by the mitochondrial deoxyribonucleic acid mutation 3243 A>G (where A = adenine and G = guanine). The degree of heteroplasmy of the mitochondrial deoxyribonucleic acid may correlate with the rate of progression of the hearing loss. This has important implications for counselling patients with this pathology. Cochlear implantation is a successful method of rehabilitation for patients with hearing loss as part of this syndrome.

Assisted Movement With Enhanced Sensation (AMES): Coupling Motor and Sensory to Remediate Motor Deficits in Chronic Stroke Patients

Background. Conventional methods of rehabilitation in patients with chronic, severe motor impairments after stroke usually do not lessen paresis. Objective. A novel therapeutic approach (assisted movement with enhanced sensation [AMES]) was employed in a medical device phase I clinical trial to reduce paresis and spasticity and, thereby, to improve motor function. Methods. Twenty subjects more than 1 year poststroke with severe motor disability of the upper or lower extremity were studied. A robotic device cycled the ankle or the wrist and fingers at 5°/s through ±17.5° in flexion and extension while the subject assisted this motion. Feedback of the subject's active torque was displayed on a monitor. Simultaneously, 2 vibrators applied a 60 pps stimulus to the tendons of the lengthening muscles, alternating from flexors to extensors as the joint rotation reversed from extension to flexion, respectively. Subjects treated themselves at home for 30 min/day for 6 months. Every other day prior to treatment, the therapy device performed automated tests of strength and joint positioning. Functional testing was performed prior to enrollment, immediately after completing the protocol, and 6 months later. Functional tests included gait and weight distribution (lower extremity subjects only) and the Stroke Impact Scale. Results. Most subjects improved on most tests, and gains were sustained for 6 months in most subjects. No safety problems arose. Conclusion. The AMES strategy appears safe and possibly effective in patients with severe chronic impairments. The mechanism underlying these gains is likely to be multifactorial.

A role of tiotropium bromide in different methods of physical rehabilitation in patients with COPD

COPD is characterized not only by pulmonary pathology but also by systemic disorders leading to abrupt reduction in physical tolerance causing a significant decrease in the patients' quality of life (QoL). Training of upper and lower limb muscles along with breathing training, training of respiratory muscles using respiratory training devices and adequate drug therapy can improve physical tolerance of COPD patients. The aim of this work was to compare different methods of physical rehabilitation under the therapy with tiotropium bromide (TB). The study involved 45 patients with severe and very severe COPD (the mean age, 64.5 ±11.0 yrs) randomized into 3 groups: the 1st group patients took inhaled corticosteroids (ICS), short-acting b-agonists and TB, the 2nd group patients were treated with the same medications plus respiratory muscle training with Threshold IMT, PEP, and the 3rd group received the same medications plus skeletal muscle training. The study continued for 3 months and included 3 active visits with testing of lung function (LF) and respiratory muscle strength (Pi, Pe), 6-minute walking test (6-MWT), evaluation of QoL using the SF-36 questionnaire and of dyspnea using MRC scale. As a result, all groups have improved QoL, LF, respiratory muscle strength, and 6-minute walk distance after 3-month treatment. The best values of QoL and 6-MWT were seen in the 3rd group. The greatest improvement for the 2nd group patients was noted in LF and respiratory muscle strength. The 1st group also improved all the parameters. Therefore, we can not exclude the effect of TB on physical tolerance in COPD patients. We conclude that combined application of respiratory and skeletal muscle training and drug therapy including TB is the optimal treatment for COPD patients.

Hemodynamic and hormonal responses to a short-term low-intensity resistance exercise with the reduction of muscle blood flow

We investigated the hemodynamic and hormonal responses to a short-term low-intensity resistance exercise (STLIRE) with the reduction of muscle blood flow. Eleven untrained men performed bilateral leg extension exercise under the reduction of muscle blood flow of the proximal end of both legs pressure-applied by a specially designed belt (a banding pressure of 1.3 times higher than resting systolic blood pressure, 160-180 mmHg), named as Kaatsu. The intensity of STLIRE was 20% of one repetition maximum. The subjects performed 30 repetitions, and after a 20-seconds rest, they performed three sets again until exhaustion. The superficial femoral arterial blood flow and hemodynamic parameters were measured by using the ultrasound and impedance cardiography. Serum concentrations of growth hormone (GH), vascular endothelial growth factor (VEGF), noradrenaline (NE), insulin-like growth factor (IGF)-1, ghrelin, and lactate were also measured. Under the conditions with Kaatsu, the arterial flow was reduced to about 30% of the control. STLIRE with Kaatsu significantly increased GH (0.11+/-0.03 to 8.6+/-1.1 ng/ml, P < 0.01), IGF-1 (210+/-40 to 236+/-56 ng/ml, P < 0.01), and VEGF (41+/-13 to 103+/-38 pg/ml, P < 0.05). The increase in GH was related to neither NE nor lactate, but the increase in VEGF was related to that in lactate (r = 0.57, P < 0.05). Ghrelin did not change during the exercise. The maximal heart rate (HR) and blood pressure (BP) in STLIRE with Kaatsu were higher than that without Kaatsu. Stroke volume (SV) was lower due to the decrease of the venous return by Kaatsu, but, total peripheral resistance (TPR) did not change significantly. These results suggest that STLIRE with Kaatsu significantly stimulates the exercise-induced GH, IGF, and VEGF responses with the reduction of cardiac preload during exercise, which may become a unique method for rehabilitation in patients with cardiovascular diseases.

The use of mime therapy as a rehabilitation method for patients with facial nerve paresis

Since 1980, patients with sequelae of peripheral facial nerve paresis have been treated with mime therapy at the physiotherapy department of the University Medical Centre in Nijmegen, which aims to rehabilitate facial expression. Mime therapy was developed by Jan Bronk (a mime actor) and Pieter Devriese (an otolaryngologist) in the 1970s, using the principles of mime for patients suffering from either lack of facial movement or uncontrolled movements. Both therapists and patients reported benefits of mime therapy; most importantly, an improved symmetry of the face. There is a belief within the profession that evidence-based treatment is required to scientifically substantiate physiotherapy. A detailed description of the mime therapy treatment is essential for performing a randomized controlled trial, which is currently underway. This article aims to comprehensively describe the historical development and clinical characteristics of mime therapy and to give insight into its usefulness as a tool in the treatment of patients with facial nerve paresis.

Lower limb joint moment during walking in water

Purpose: Walking in water is a widely used rehabilitation method for patients with orthopedic disorders or arthritis, based on the belief that the reduction of weight in water makes it a safer medium and prevents secondary injuries of the lower-limb joints. To our knowledge, however, no experimental data on lower-limb joint moment during walking in water is available. The aim of this study was to quantify the joint moments of the ankle, knee, and hip during walking in water in comparison with those on land.Method: Eight healthy volunteers walked on land and in water at a speed comfortable for them. A video-motion analysis system and waterproof force platform were used to obtain kinematic data and to calculate the joint moments.Results: The hip joint moment was shown to be an extension moment almost throughout the stance phase during walking in water, while it changed from an extension- to flexion-direction during walking on land. The knee joint moment had two extension peaks during walking on land, whereas it had only one extension peak, a late one, during walking in water. The ankle joint moment during walking in water was considerably reduced but in the same direction, plantarflexion, as that during walking on land.Conclusions: The joint moments of the hip, knee, and ankle were not merely reduced during walking in water; rather, inter-joint coordination was totally changed.

Cochlear implantation in patients with cochlear malformations.

To report operative findings, postoperative course, and postimplantation performance in patients with cochlear malformations who underwent cochlear implantation. Case study and intervention study (before-after trial). Minimum follow-up of 12 months; average follow-up of 24 months. Academic tertiary referral center. Six patients, including five children who underwent implantation at ages 3.5 to 13 years and one adult who underwent implantation at age 27 years. malformations included common cavity deformity (n = 1), cochlear hypoplasia (n = 2), and incomplete partition (n = 3). All patients with cochlear malformations who underwent implantation at the University of Michigan, Ann Arbor, are included, selected from a group of 196 patients so treated since 1986. Implantation with a standard multichannel cochlear implant. Operative findings described include round window and facial nerve anatomy and cerebrospinal fluid leak. Postoperative roentgenographic findings, electrode activation, and reason for non-use of electrodes were investigated. Standard tests of speech perception were used to compare preoperative and postoperative performance for each subject. Operative findings included round window abnormalities (three patients), anomalous facial nerve (one patient), and cerebrospinal fluid leak (three patients). No surgical complications occurred. A minimum of 10 electrodes were activated for all patients. Electrode thresholds and discomfort levels were variable for several months after implantation. All patients demonstrated improved performance after implantation. Four subjects demonstrated open-set speech perception. Two other subjects, whose poor language skills precluded administration of standard tests, showed increased awareness of environmental sounds and increased vocalization after implantation. Cochlear implantation can be a successful method of rehabilitation in patients with congenital deafness who have cochlear malformations.

Long-Term Survivors of the "Locked-In" Syndrome: Patterns of Recovery and Potential for Rehabilitation

We studied four men, each of whom survived over 3 years after being "locked-in" owing to pontine infarction. Their pontine lesions were evident with magnetic resonance imaging, but not with computed tomography. All showed a characteristic pattern of recovery from the motor deficit with rapid return of eye-hand control and slow but sustained limb improvement. Despite pseudobulbar affect, all made an emotion adjustment to their severe deficits and showed a strong desire to live. Physicians should be aware of the special needs and methods for rehabilitation of patients who are clinically "locked-in."

Rehabilitation of the visually handicapped with advanced macular degeneration. A follow-up study at the Low Vision Clinic, Department of Ophthalmology, University of Linköping.

Hundred-and-twenty patients with advanced macular degeneration (senile, disciform, and hereditary forms), which could not be helped in a satisfactory way by simple magnifying aids, were studied for an average of 5 years (a minimum of 3 years), during which they had access to a full range of low vision rehabilitation measures including advanced optical aids and educational methods for training in the use of these aids and in the utilization of residual vision. The mean age of the patients was 72 years. They were all in a mental condition enabling them to understand and follow instructions. Just over half the patients were obliged to learn from the outset how to utilize peripheral retina, i.e. through eccentric viewing, high magnification low vision aids and very short reading distances, a mean of 4.4 cm, which demand specially qualified educational methods for low vision training. (A second group of 198 patients with macular degeneration was handled by the optician alone because either macular degeneration was moderate and the patients could manage with simple optical aids, or the patients were in such a bad mental condition, obvious already from the referral documents, that they were unable to use sophisticated aids in spite of the fact that they would have needed them with regard to their poor vision.) Telescopes were the most frequent aid used for distance, having a mean magnification of 4.6 X. Among the aids for reading, the most common were increased near additions and hyperocular lenses, having a mean power of 22.6 dioptres (magnification 5.7 X). Aids were also furnished for intermediate distance and for 'spot use'. The mean number of series of visits was 2.5 and the number of training sessions (1 h) per series of visits was 3.0. Mean visual acuity improved from 0.18 to 0.64 with aids and training on the first series of visits, and reached 0.53 by the last series. The number of patients able to read TV titles increased from 6.7% to 57.5% and was 49.2% after the last series of visits. The number of individuals able to read newspaper text increased from 0.8% to 92.5%. After the last series of visits, the number was still as high as 80.0%. The results show that the presented methods for rehabilitation of patients with macular degeneration through optical aids and educational methods for training in the utilization of these aids and of residual vision are outstandingly successful. The use of the individual's vision and his situation in life often improve dramatically.(ABSTRACT TRUNCATED AT 400 WORDS)

Human heart transplantation: Experience with twelve cases ∗

Transplantation of the human heart is rapidly becoming an accepted method for rehabilitation of patients with end-stage heart disease and incurable congenital defects. This report is concerned with 12 cases of human cardiac transplantation. All 11 patients receiving allografts survived operation with normal circulation provided by the transplanted heart. In 1 of these patients the lungs still attached to the heart were also transplanted. One xenograft (sheep's heart) was placed in a terminal patient in a desperate attempt to prolong life and resulted in failure from hyperacute rejection. Immunosuppressive therapy in all allograft recipients consisted of azathioprine, corticosteroids and antilymphocyte globulin (ALG). One patient died 54 hours later from pneumonia. In 1 moribund patient the transplanted heart functioned well for eight days, and death was secondary to preexisting disease. A 5 year old child had an uneventful early recovery and died suddenly eight days after operation with evidence of organ rejection. The 2 month old infant died 14 hours after transplantation of the heart and lungs. The remaining 7 patients have excellent hemodynamic function of their transplanted hearts up to four and a half months after operation. This experience confirms the feasibility of human heart transplantation.