Multidisciplinary Rehabilitation Approach Research Articles

Rehabilitation of oncological patients: a comparative analysis of clinical guidelines for managing oncological patients with renal parenchyma cancer, bladder cancer and female cancer in Russia, Europe, and USA

Backround. Current medicine pays significant attention to an integrated approach in managing cancer patients, from the stage of diagnosis to rehabilitation. Sections on rehabilitation have been added to respective guidelines to maintain the proper quality of life of patients and standardization of clinical protocols. Due to the different levels of medicine in Europe, Russia and USA, it is important to analyze guidelines for supporting oncological patients at the rehabilitation stage.Objective: to conduct a comparative analysis of guidelines for managing cancer patients.Material and methods. The search and selection of publications were performed according to PRISMA recommendations. In scientific databases PubMed/MEDLINE, Google Scholar, ScienceDirect, eLibrary as well as via search engines and the Rubricator of Clinical Guidelines of the Ministry of Health of Russia, 725 sources were found. After the selection procedure, 30 publications and guidelines were included in the review.Results. Rehabilitation programs are presented in many Russian, American and European guidelines for the support of cancer patients. In Russian guidelines for managing patients with renal parenchyma and bladder cancer, a significant emphasis is made on the pre-rehabilitation and using fast-track approach. A lot of attention is paid to therapeutic physical culture and instrumental methods. American and European guidelines are more detailed, in particular, protocols for the correction of certain adverse events are presented, psychological assistance and complex rehabilitation play an essential role. The absence of specialized rehabilitation program in Russian clinical guidelines for supporting oncogynecological patients, and universal character of protocols were noted. According to foreign guidelines, the rehabilitation of such patients is multidisciplinary and personalized, and is carried out in specialized centers.Conclusion. The review showed a number of deficiencies in Russian clinical guidelines. In certain documents, due attention is not paid to the provision of rehabilitation. It’s necessary to expand multidisciplinary approach in cancer patients' rehabilitation as well as the evidence base to improve Russian guidelines.

Reduction in preparatory brain activity preceding gait initiation in individuals with chronic ankle instability: A movement-related cortical potential study.

Evidence suggests that chronic ankle instability (CAI) is not merely a peripheral musculoskeletal injury but should be recognized as a neurophysiological dysfunction. This reflects a paradigm shift from focusing on peripheral structural changes to emphasizing the central nervous system. However, changes in cortical activity during functional activities remain poorly understood. Thus, this study aimed to compare preparatory brain activity during gait initiation (GI) through movement-related cortical potentials (MRCPs) in individuals with CAI and healthy subjects. The proactive components of MRCPs, including contingent negative variation (CNV) and event-related desynchronization (ERD), were measured using electroencephalography. The primary outcomes were late CNV amplitude, CNV peak amplitude, CNV peak time, and alpha/beta ERD. The results indicated that the late CNV amplitude was significantly lower in the CAI group compared to the healthy group at the Fz and Cz electrodes (P< 0.001). The CAI group also demonstrated lower CNV peak amplitude at the Fz, Cz, and Pz electrodes (P< 0.0025). Additionally, in the CAI group, signals peaked earlier at the Cz electrode (P= 0.002). Furthermore, alpha ERD at Pz was significantly lower in the CAI group than in the healthy group (P= 0.003), suggesting diminished preparatory brain activity during GI in CAI subjects. Recognizing CAI as a condition involving both peripheral and central dysfunctions highlights the importance of a multidisciplinary approach in treatment and rehabilitation. This approach should target brain activity in addition to peripheral structures, potentially leading to improved long-term outcomes for patients.

Interventional pain management practices in Pakistan: The role of Physical Medicine and Rehabilitation (PMR).

Chronic pain represents a complex, multifaceted challenge that surpasses the prevalence of commonly encountered disorders such as diabetes mellitus and hypertension. This condition exerts a substantial burden on healthcare systems due to its pervasive impact. While pain interventions and procedures constitute a crucial facet, they alone do not constitute a comprehensive solution. Nevertheless, the strategic and precise application of these procedures by well-trained and proficient physicians offers patients a swift route to resuming their normal activities, sparing them from protracted reliance on medications. Within the realm of Physical Medicine and Rehabilitation (PM&R), Interventional Pain Management (IPM) adopts a multidisciplinary rehabilitative approach, addressing all dimensions of pain syndromes. This approach culminates in enhanced functional outcomes and an improved quality of life. This concise review underscores the significance of this integrated approach, shedding light on various pain procedures routinely employed for diagnostic and therapeutic purposes. Within this context, we briefly explore the application of ultrasound and C-arm guided procedures. In conclusion, this review underscores the imperative nature of embracing a multidimensional approach to pain management, essential for seamlessly incorporating interventional pain management techniques into the broader domain of rehabilitation medicine.

COVID-19-Associated Cerebellitis: A Case Report and Rehabilitation Outcome.

The COVID-19 pandemic has brought attention to neurological complications, including cerebellitis, characterized by inflammation of the cerebellum. Despite its rare occurrence, cerebellitis has been associated with COVID-19 infection, albeit the pathogenic mechanisms remain unclear. We present the case of a 22-year-old male with acute onset ataxia and dysarthria during a SARS-CoV-2 infection. Diagnostic evaluations ruled out other causes, confirming cerebellitis. Treatment included steroid therapy, vitamin supplementation, physiotherapy, and intravenous immunoglobulins. Rehabilitation focused on enhancing balance, coordination, and daily activities. The patient showed significant improvement in functional abilities, with increased autonomy in daily activities and improved ambulation. Despite persistent mild symptoms, the multidisciplinary rehabilitation approach led to remarkable progress. This case underscores the importance of recognizing and managing neurological complications, such as cerebellitis, in COVID-19 patients. A comprehensive approach combining medical treatment and rehabilitation is essential for optimizing outcomes. Further research is needed to elucidate the pathogenesis and optimal management strategies for such complications.

Health-related quality of life and participation after inpatient rehabilitation of sepsis survivors with severe sequelae: a cohort study.

To describe health-related quality of life and participation after rehabilitation of severely affected sepsis survivors. Cohort study. Patients with severe sequelae after sepsis treated in a multidisciplinary rehabilitation pathway were included. Patient characteristics at the time of diagnosis, and the outcome 3 months after discharge from rehabilitation are described. At that time, health-related quality of life, social participation, and the rate of living at home were measured. Of the 498 patients enrolled, 100 severely impaired patients were transferred for a multidisciplinary rehabilitation approach. Fifty-five of them were followed up at 3 months. Descriptive and inference statistics showed that 69% were living at home with or without care. Health-related quality of life and participation scores were 0.64 ± 0.32 for the EQ-5D utility index and 54.98 ± 24.97 for the Reintegration of Normal Living Index. A multivariate regression model explaining health-related quality of life at 3 months included age, lower limb strength, and walking ability during rehabilitation (r2 = 0.5511). Participation at 3 months was explained by age, body mass index, lower limb strength, and duration of tracheal intubation (r2 = 0.6229). Patients who have experienced serious sepsis with severe sequelae can achieve a moderate level of quality of life and participation within a multidisciplinary pathway.

The impact of Kinesio Taping® on manual dexterity in Multiple Sclerosis: A double-blind, parallel-arm, pilot study

IntroductionA range of signs and symptoms that often impair up-per extremity function characterizes Multiple Sclerosis (MS). People with MS may have impairments that make some activities of daily living difficult and reduce functional independence. A multidisciplinary rehabilitation approach, combined with pharmacological treatment, can be helpful in improving hand and upper limb function in people with Multiple Sclerosis. The purpose of this study is to evaluate the effects of Kinesio Taping® in addition to upper limb-specific rehabilitation on dominant hand in people with Multiple Sclerosis. MethodsIn this pilot study, patients were divided into two groups according to clinical indications: the experimental group underwent application of Kinesio Taping®, while the control group of Inelastic-Tape, 3 times a week for 4 consecutive weeks. All patients were assessed at baseline (T0) and after 4 weeks (T1) with scales for manual dexterity, fine motor skills, strength and quality of life. Results: Statistical analysis showed that the hand-dominant function of the entire sample improved. Patients in experimental group achieved greater benefits in manual dexterity and the ability to perform activities of daily living. ConclusionIt would appear that Kinesio Tape® in addition to appropriate and individualized physical therapy is effective in improving some aspects of hand function.

Perspectives on fatigue management among veterans living with multiple sclerosis

BackgroundChronic fatigue is one of the most common, disabling, and least understood symptoms of many chronic health conditions including multiple sclerosis (MS). A multidisciplinary rehabilitative treatment approach is recommended for MS-related fatigue, but few people with MS have access to such treatment. In-person and telehealth cognitive behavioral therapy (CBT) for fatigue is an emerging acceptable and effective treatment for MS-related fatigue in civilians that has not been studied in Veterans with MS, a population that is more likely to be older, male, unemployed, and disabled. The present study aimed to understand how Veterans with MS (1) describe their fatigue and (2) manage their fatigue, and (3) perceive telehealth CBT for MS-related fatigue. MethodTwenty-four Veterans with MS completed semi-structured interviews and a brief survey. For descriptive purposes, the survey included questionnaires on demographics, fatigue, psychosocial functioning, depression, and pain. Thematic analysis with a combined deductive and inductive approach was used to analyze interview transcripts. ResultsThree themes emerged. First, “experience of MS fatigue as ‘one big tapestry’” described fatigue as deficits in physical and mental energy that were fluctuating and complex in their interaction with biological factors. Veterans described that MS fatigue negatively impacted daily activities of living, emotions, and cognitive functioning. Second, “managing MS fatigue through trial and error” revealed that Veterans expend significant time and effort learning and trialing fatigue management strategies based on their personal beliefs, military training/experiences, provider recommendations, and iterative learning. Most Veterans described energy management, relaxation, exercise, and adaptive thinking as helpful for managing fatigue. Interestingly, the helpfulness of medication for fatigue was highly variable, and none of the Veterans described medication as a standalone fatigue treatment. The third theme, “practicing flexibility with telehealth CBT for MS fatigue” revealed Veteran's enthusiasm about telehealth CBT for MS-related fatigue and highlighted the importance of flexible delivery to meet individual needs. ConclusionVeteran participants shared their experience of MS-related fatigue as well as management strategies that are consistent with previous research in civilians with MS fatigue. Notably, Veterans’ preference for flexible nonpharmacological intervention can inform adaptation of telehealth CBT for Veterans with MS fatigue.

New horizons in comprehensive rehabilitation of patients with melanoma: improved outcomes through an integrated approach to immunotherapy

Abstract. The article discusses issues of a comprehensive rehabilitation approach for patients with melanoma when treated with immunotherapy. By focusing on innovative treatments, the study highlights the need to integrate nutritional support, physical therapy, magnetic therapy and psychological support to improve quality of life and enhance the effectiveness of immunotherapy regimens. Purpose. The study aims to evaluate the impact of a multidisciplinary rehabilitation program on improving physiological functions, psychoemotional well-being and the impact on the overall antitumor response, which together can improve the quality of life of patients with melanoma. Materials and methods. The study included 135 patients diagnosed with melanoma who received a course of immunotherapy. In the study group (the main group), a complex of rehabilitation techniques was used (magnetic therapy, physical therapy, nutritional support, psychological support), while in the control group, patients did not undergo an accompanying comprehensive rehabilitation program. Treatment effectiveness was assessed in accordance with iRECIST 1.1 criteria. To assess the quality of life, the Russian version of the EORTC QLQ-C30 questionnaire was used. The severity of adverse events was assessed according to CTCAE 5.0 criteria. Results. Patients from the main group who received comprehensive rehabilitation support along with immunotherapy showed an improvement in their general physical condition and a decrease in the intensity of some side effects of treatment. Patients in the control group who received only standard immunotherapy also showed changes in their health status, but these changes were less pronounced compared to the main group. Adverse events during treatment occurred in 55 % of patients in the main group and in 74 % in the control group. Patients in the main group noted an improvement in quality of life by 25 %, while in patients in the control group this figure was 12 %. An 18 % improvement in general condition was noted by patients in the main group, while patients in the control group noted an 8 % improvement in general condition. Conclusion. Implementation of a multidisciplinary rehabilitation approach, including nutritional support, physical therapy exercises, magnetic therapy, and psychological support, demonstrates significant improvements in symptom management and quality of life in melanoma patients undergoing immunotherapy.

New horizons in comprehensive rehabilitation of melanoma patients: improved outcomes through an integrated approach to immunotherapy

Abstract. The article discusses the importance of a comprehensive rehabilitation approach for melanoma patients when treated with immunotherapy. By focusing on innovative treatments, the study highlights the need to integrate nutritional support, physical therapy, magnetic therapy, and psychological support to improve quality of life and enhance the effectiveness of immunotherapy regimens. Purpose of the study: to evaluate the impact of the multidisciplinary rehabilitation program on physiological functions, psycho-emotional well-being, general antitumor effect, and quality of life of patients with melanoma. Materials and methods. The study included 135 patients diagnosed with melanoma who received a course of immunotherapy. In the study group (the main group), a complex of rehabilitation techniques (magnetic therapy, therapeutic exercises, nutritional support, psychological support) was used, while in the control group, the patients did not undergo the accompanying comprehensive rehabilitation program. Treatment effectiveness was assessed in accordance with iRECIST 1.1 criteria; to assess the quality of life, the Russian version of the EORTC QLQ-C30 questionnaire was used. Results. The patients of the study group showed an improvement in their general physical condition and a decrease in the intensity of some side effects of treatment. The patients in the control group also showed changes in their health status, but they were less pronounced compared to the study group. Adverse events during treatment occurred in 55 % of the patients in the study group and in 74 % of the patients in the control group. The patients in the study group noted an improvement in quality of life by 25 %, while in the patients in the control group this indicator was 12 %. An 18 % improvement in general condition was noted by the patients in the study group, while the patients in the control group noted an 8 % improvement in general well-being. Conclusion. The implementation of the multidisciplinary rehabilitation approach, including nutritional support, therapeutic exercises, magnetic therapy, and psychological support, demonstrates significant improvements in symptom management and quality of life in melanoma patients undergoing immunotherapy.

REhabilitation Approaches in CHildren with cerebellar mutism syndrome (REACH): An international cross-disciplinary survey study.

Pediatric cerebellar mutism syndrome (pCMS) can occur following resection of a posterior fossa tumor and, although some symptoms are transient, many result in long-lasting neurological deficits. A multi-disciplinary rehabilitation approach is often used in cases of pCMS; however, there have been no clinical trials to determine gold standards in rehabilitation practice in this population, which remains a research priority. The purpose of this study was to identify and compare intervention practices used in pCMS throughout the disciplines of occupational and physical therapy, speech-language pathology, and neuropsychology across geographic regions. A 55-question e-survey was created by an international multidisciplinary research group made up of members of the Posterior Fossa Society and sent to rehabilitation professionals in pediatric neuro-oncology centers in the US, Canada, and Europe. Although some differences in the type of intervention used in pCMS were identified within each discipline, many of the targeted interventions including dose, frequency, and intensity were similar within disciplines across geographic regions. In addition, there were common themes identified across disciplines regarding challenges in the rehabilitation of this population. These results provide a foundation of current practices on which to build future intervention-based clinical trials.

Obstacles and Facilitators in Daily Living Activities Among Persons with Spinal Cord Injury: A Systemic Review

Introduction: This systematic review aimed to investigate the level of participation, obstacles, and facilitator factors that influence activities of daily living among persons with spinal cord injury (SCI). Methods: A comprehensive search was conducted in four online databases, namely Google Scholar, PubMed, OT Seeker, and Cochrane Library covering the ten-years period from January 2012 to December 2022. Inclusion criteria encompassed original published studies in English focusing on daily activities, work, participation, obstacles, and facilitators in persons with SCI. Non-peer review sources (e.g., abstracts, grey literature, preprints), and studies unrelated to occupational therapy were excluded. The selected studies were assessed for quality using McMaster University Occupational Therapy Evidence-Based Practice critical review form. Results: Out of the 678 articles identified, ten studies were included after the screening, exploring participation in daily living activities, employment, return to work, leisure activities, family tasks, and community mobility among persons with SCI. Obstacles and facilitators influencing participation in activities of daily living were classified using the International Classification of Functioning, Disability, and Health (ICF) framework. This review highlighted that long-term participation is challenging for persons with SCI, affected by obstacles such as body functions, pain, low self-esteem, and environmental and social factors. Conclusion: The findings underscore the importance of adopting a multidisciplinary rehabilitation approach to enhance participation in daily activities for persons with SCI. Occupational therapy plays a significant role in improving participation levels among persons with SCI.

Lumbar Dorsal Root Ganglion Pulsed Radiofrequency for Spinal Stenosis with an Atypical Fluoroscopic Neurogram: A Case Study

Background: We present a case of an atypical fluoroscopic neurogram pattern for complex chronic axial low back pain during a lumbar dorsal root ganglia (DRG) pulsed radiofrequency stimulation. Case Report: A 70 year old female with a history of complex chronic axial low back pain with radicular leg pain. Initially her pain was described as intermittent, burning, and sharp with an intensity of 9/10 on the Numeric Rating Scale (NRS). This pain worsens with ambulation, lumbar extension, turning, weight bearing and spinal loading activities. MRI imaging noted lumbar anterolisthesis, moderate to severe central spinal stenosis, and mild bilateral neural foraminal space narrowing. From these findings, her pain is likely secondary to components of sacroiliac (SI) joint dysfunction, lumbar facetogenic pain, lumbar radiculitis, and spinal stenosis with neurogenic claudication. A multimodal and multidisciplinary rehabilitation approach involving minimally invasive interventional procedures and medication management was implemented with varying pain relief. She responded to L5 transforaminal epidural nerve root injections, SI joint prolotherapy, and sacral lateral branch radiofrequency ablation. She completed bilateral L5 DRG pulsed radiofrequency stimulation, which did not provide radicular pain relief. We performed a unilateral L4 DRG pulsed radiofrequency stimulation, which revealed an atypical L4 fluoroscopic neurogram pattern. At the 3 month follow up she reported the pain severity to have a NRS between 7-8/10. At 4 months, the pain severity was reported to have a NRS between 4-6/10 with subjective improvements with her daily activities. Conclusion: In a normal transforaminal epidural fluoroscopic neurogram, the anteroposterior view should demonstrate contrast spread medially around the pedicle and laterally following the exiting nerve root. In the case of this patient the combined anatomical presentation of anterolisthesis, central spinal canal stenosis, and circumferential disc bulging are all potential reasons for insufficient contrast passage resulting in the atypical neurogram.

The Impact of Pulmonary Rehabilitation on Mental Health and Quality of Life in Patients With Chronic Obstructive Pulmonary Disease (COPD): A Narrative Review.

Chronic obstructive pulmonary disease (COPD) is a complex, prevalent, debilitating, and degenerative disease that affects a large population, and the treatment options for the patients are limited. Although progress has been made in COPD pathogenesis, etiology, and management, there is still an unmet need to develop novel therapies. COPD management has recently seen a focus on a multidisciplinary pulmonary rehabilitation approach to help patients manage the disease better. This review primarily focuses on the role of pulmonary rehabilitation as a novel therapeutic strategy for treating and managing COPD, which is known to decrease patients' quality of life. Disease management and the beneficial effects of pulmonary rehabilitation in COPD are discussed. Subsequently, different methods that are employed in pulmonary rehabilitation are examined, including oxygen therapy, exercise, meditation, and education, emphasizing how they can help patients better manage COPD. Pathophysiology and the effect of pulmonary rehabilitation on the cellular level, such as the release of perforins and Th1 and Th17 cytokines, are also explored. The link between exercise and meditation during pulmonary rehabilitation therapy, which promotes repairing affected organs, is emphasized. Future perspectives on personalized medicine and its use in conjunction with pulmonary rehabilitation are also outlined. In conclusion, pulmonary rehabilitation holds significant promise for the management of COPD by addressing the present limitations of treatment. However, further research is essential to overcome and optimize treatment strategies for COPD patients.

Effects of inpatient energy management education and high-intensity interval training on health-related quality of life in persons with multiple sclerosis: A randomized controlled superiority trial with six-month follow-up.

Fatigue is one of the most frequent symptoms in persons with multiple sclerosis (pwMS) and impacts health-related quality of life (HRQoL). A multidisciplinary rehabilitation approach is recommended for the treatment of fatigue in pwMS. However, high-quality evidence exists only for unimodal interventions, such as physical therapies/exercise or energy/fatigue management programmes. The primary objective of the current study was to test the hypothesis that a combination of inpatient energy management education (IEME) and high-intensity interval training (HIIT) is superior to a combination of progressive muscle relaxation (PMR) and moderate continuous training (MCT) for improving HRQoL at 6-month follow-up in fatigued pwMS. A randomized (1:1) controlled superiority trial with fatigued pwMS >18 years of age, with Expanded Disability Status Scale (EDSS) score ≤6.5, recruited at the Valens clinic, Switzerland. Participants in the experimental group performed IEME twice and HIIT 3 times per week and those in the usual care group performed PMR twice and MCT 3 times per week, during a 3-week inpatient rehabilitation stay. Primary outcome was HRQoL (Physical and Mental Component Scales of the Medical Outcome Study 36-item Short Form Health Survey (SF-36)), assessed at entry to the clinic (T0), after 3 weeks' rehabilitation (T1) and 4 (T2) and 6 (T3) months after T0. Secondary outcomes included SF-36 subscales, fatigue (Fatigue Scale for Motor and Cognitive Functions (FSMC)), mood (Hospital Anxiety and Depression Scale (HADS)), self-efficacy for performing energy conservation strategies (Self-Efficacy for Performing Energy Conservation Strategies Assessment (SEPECSA)), self-perceived competence in activities of daily living (Occupational Self Assessment (OSA)) and cardiorespiratory fitness (peak oxygen consumption (VȮ2peak)). Data were analysed using a mixed model for repeated measures approach. A total of 106 pwMS (age (years): 49.75 (9.87), 66% female, EDSS: 4.64 (1.32)) were recruited. There were no significant group×time interaction effects in the primary and secondary outcomes. There were significant between-group differences in the pairwise comparisons of the group×time interaction in favour of the IEME+HIIT group at: (i) T1 in cardiorespiratory fitness (p=0.011) and SEPECSA (p=0.032); (ii) T2 in SF-36 mental health subscale (p=0.022), HADS anxiety subscale (p=0.014) and SEPECSA (p=0.040); (iii) T3 in SF-36 physical functioning subscale (p=0.012) and SEPECSA (p=0.003). IEME+HIIT was not superior to PMR+MCT regarding the effects on HRQoL (SF-36 Physical and Mental Component Scales) at 6-month follow-up in pwMS. However, there were significant between-group differences in favour of IEME+HIIT in physical functioning and mental health (SF-36 subscales), anxiety (HADS), cardiorespiratory fitness (VȮ2peak) and self-efficacy (SEPECSA) at different measurement time-points that need to be considered in clinical practice.

A Multidisciplinary Rehabilitation Approach to Chronic Pain Patients in the Post-COVID-19 Era

BACKGROUND: The global health care system has been shaken by the unprecedented pandemic. Chronic pain management has suffered through the pandemic due to lack of access and challenges in care delivery only to be faced by a new set of chronic pain conditions resulting from prolonged and persistent COVID-19 symptoms referred to as “long COVID syndrome.” OBJECTIVES: Long COVID is emerging as a complex and debilitating condition that occurs in a subpopulation of patients following acute COVID-19 infection. Our goals were to explore how to best treat and manage long COVID syndrome based on current experience. METHODS: This is a perspective rather than a systematic review. It is based on the limited available literature and current clinical experience. RESULTS: Although a few pharmacological agents have been proposed to mitigate symptoms, none have emerged to provide meaningful, long-term pain relief. Long COVID is associated with numerous and diverse symptoms. Risk factors for developing long COVID subsequent to acute COVID-19 remain unknown. Due to the multidimensional impact of long COVID chronic pain, a structured interdisciplinary rehabilitation model has been proposed to relieve pain, restore function, and maximize quality of life. LIMITATIONS: This is a perspective with an editorial point of view rather than a systematic literature study. Long COVID syndrome is a new condition, with which no clinicians have extensive experience. This is not a systematic review so there is no Preferred Reporting Items for Systematic reviews and Meta-Analyses diagram. This is not a clinical study so there was no need for institutional review board approvals. CONCLUSIONS: Treatment goals for the postviral syndrome of long COVID are multifaceted. In addition to pain control, patients may have functional deficits, cognitive issues, mental health issues, and reduced quality of life. Thus, a structured interdisciplinary rehabilitation model seems most appropriate to manage long COVID. KEY WORDS: Chronic pain, long COVID, pandemic, COVID-19, brain fog, fatigue, pain program, functional restoration, back pain, joint pain

The application of a multidisciplinary methodological approach to the training of physical therapists in the process of rehabilitation of a patient with a gunshot wound to the spinal cord

rehabilitation is one of the key areas of medicine, especially during periods of full-scale war, when militaries and civilians require long-term rehabilitation interventions. The use of a multidisciplinary approach in rehabilitation made it possible to expand the scope and opportunities of rehabilitation treatment and improve the recovery of patients. A physical therapist plays an important role in a multidisciplinary team and carries out rehabilitation measures to eliminate, stop or reduce pain, restore body functions, achieve a normal level of health, physical independence and activity, optimal physical condition and well-being. The training of qualified physical therapists is an important component of successful rehabilitation. The article presents the results of the cooperated work of specialists of the multidisciplinary team of the Military Medical Clinical Treatment and Rehabilitation Center of city Irpin, and physical therapy higher education applicants of the Department of Physical Rehabilitation and Sports Medicine of the Bogomolets National Medical University. The aim of the work was to improve the practical skills of physical therapy higher education applicants by integrating them into the work process of a multidisciplinary rehabilitation team for the rehabilitation of a patient with a gunshot wound to the spinal cord. Higher education applicants took part in the rehabilitation examination and had the opportunity to expand practical skills in this direction. The team of specialists conducted the following rehabilitation tests and obtained results - according to the ASIA scale, the degree of damage to the patient's spinal cord is complete - there is no sensitivity and motor function of the S4-S5 segments, according to the modified Rankin scale 5 points, which corresponds to severe functional disability; according to the Barthel index, 10 points, which corresponds to the patient's complete dependence on external assistance, according to manual muscle testing, the strength of the muscles of the upper shoulder girdle corresponded to 3 points - the full amplitude of movement against the force of gravity. On the basis of the obtained results, the multidisciplinary team determined the main violations according to the domains of the international classification of functioning, and in accordance with them, the higher education applicants developed the key goals of rehabilitation and methods that must be included in the rehabilitation process. Physical therapy higher education applicants conducted rehabilitation interventions aimed at improving patient mobility and self-care, prevention of bedsores, contractures, improvement of the musculoskeletal system, and increased tolerance to physical exertion. After six weeks of the rehabilitation process, repeated rehabilitation examinations were carried out, positive dynamics were admitted according to the Rankin scale, according to the Barthel index and manual muscle testing. The higher education applicants survey showed that while working in a multidisciplinary team, physical therapist higher education applicants managed to expand their knowledge, practical skills and acquire the necessary components for work and close interaction with all team members, to increase the effectiveness of rehabilitation measures for a patient with a spinal cord injury.

It Is Time for a Multidisciplinary Rehabilitation Approach: A Scoping Review on Stomatognathic Diseases in Neurological Disorders.

Patients affected by neurological disorders can develop stomatognathic diseases (SD) related to decreased bite force and quality of mastication, bruxism, severe clicking and other temporomandibular disorders (TMD), which deeply affect patients' swallowing, masticatory and phonation functions and, therefore, their quality of life. The diagnosis is commonly based on medical history and physical examination, paying attention to the temporomandibular joint (TMJ) range of movements, jaw sounds and mandibular lateral deviation. Diagnostic tools such as computed tomography and magnetic resonance imaging are used instead in case of equivocal findings in the anamnesis and physical evaluation. However, stomatognathic and temporomandibular functional training has not been commonly adopted in hospital settings as part of formal neurorehabilitation. This review is aimed at describing the most frequent pathophysiological patterns of SD and TMD in patients affected by neurological disorders and their rehabilitative approach, giving some clinical suggestions about their conservative treatment. We have searched and reviewed evidence published in PubMed, Google Scholar, Scopus and Cochrane Library between 2010 and 2023. After a thorough screening, we have selected ten studies referring to pathophysiological patterns of SD/TMD and the conservative rehabilitative approach in neurological disorders. Given this, the current literature is still poor and unclear about the administration of these kinds of complementary and rehabilitative approaches in neurological patients suffering from SD and/or TMD.

Management of acute aortic dissection in critical care.

Aortic dissections are associated with significant mortality and morbidity, with rapid treatment paramount. They are caused by a tear in the intimal lining of the aorta that extends into the media of the wall. Blood flow through this tear leads to the formation of a false passage bordered by the inner and outer layers of the media. Their diagnosis is challenging, with most deaths caused by aortic dissection diagnosed at post-mortem. Aortic dissections are classified by location and chronicity, with management strategies depending on the nature of the dissection. The Stanford method splits aortic dissections into type A and B, with type A dissections involving the ascending aorta. De Bakey classifies dissections into I, II or III depending on their origin and involvement and degree of extension. The key to diagnosis is early suspicion, appropriate imaging and rapid initiation of treatment. Treatment focuses on initial resuscitation, transfer (if possible and required) to a suitable specialist centre, strict blood pressure and heart rate control and potentially surgical intervention depending on the type and complexity of the dissection. Effective post-operative care is extremely important, with awareness of potential post-operative complications and a multi-disciplinary rehabilitation approach required. In this review article we will discuss the aetiology and classifications of aortic dissection, their diagnosis and treatment principles relevant to critical care. Critical care clinicians play a key part in all these steps, from diagnosis through to post-operative care, and thus a thorough understanding is vital.

Long COVID in the Belgian Defence forces: prevalence, risk factors and impact on quality of daily functioning

IntroductionLong COVID (LC) is a medical condition first described and documented through anecdotes on social media by patients prior to being recognised by WHO as a disease. Although >50 prolonged...

A Multidisciplinary Approach for Full-Mouth Rehabilitation in Oligodontia: A Clinical Report.

The absence of teeth in children due to congenital agenesis, syndromic or not, could lead to oral dysfunctions with general repercussions and sociopsychological problems. This case was a 17-year-old girl with severe nonsyndromic oligodontia who was missing 18 permanent teeth and had a class III skeletal pattern. It was challenging to provide functional and esthetically pleasing results in terms of temporary rehabilitation during growth and long-term rehabilitation in adulthood. This case report described the originality of the realization steps of oligodontia management, in 2 main parts. The osseous time by the LeFort 1 osteotomy advancement with simultaneous parietal and xenogenic bone grafting to improve a large bimaxillary bone volume, allowing future early implant placement by absence of growth of adjacent alveolar processes. The prosthetic rehabilitation with the conservation of natural teeth for proprioception and the use of a screw-retained polymethyl-methacrylate immediate prostheses to evaluate the needed vertical dimensional changes and make functional and esthetic results more predictable. This article could be retained as a technical note to manage this kind of case with the intellectual workflow and the difficulties encountered.