Multidisciplinary Rehabilitation Research Articles

Enabling local provision of assistive products in rural South India: an organisational survey of needs, barriers, and facilitators

Objective: Access to assistive products (APs) is essential to maximising function, participation, and inclusion of persons with disabilities. Challenges to AP access in low- and middle-income countries include stigma, costs, supply, and rehabilitation capacity gaps. This study aimed to examine AT access in the context of a low-resource setting in rural South India. Objectives were to examine rehabilitation professionals’ perceptions of AP needs, barriers and facilitators of AP provision, and AT knowledge.Methods: A descriptive study design with a 2-part online survey methodology was utilized. This study was conducted in April-September 2020 at a non-governmental organization (NGO) serving children and adults with disabilities in 3 districts of rural South India. Purposive sampling of NGO’s multidisciplinary rehabilitation professionals (N=62) was used. The survey was developed based on WHO’s Assistive Products List (APL). Barriers and facilitators were classified according to the principles of AT access. Analyses revealed acceptability, affordability, and availability as the top three barrier themes across disciplines, including poor acceptance by clients/families due to stigma, high AP costs, and a long waitlist for government-provided devices. Acceptability, affordability, and accessibility were the top three facilitator themes, including community awareness, availability of AP funding, client/family education, and AT service provision training.Impact: Our study identified key enabling strategies for AT access, aimed at reducing reported barriers. Enabling AP provision was determined to be multi-factorial, aimed at users/ families, service providers, organizations, communities, and policymakers. Local stakeholder groups are crucial to understanding challenges and opportunities to AP provision within a low-resource context.

Disparities in access but not outcomes: Medicaid versus non-Medicaid patients in multidisciplinary chronic pain rehabilitation

Purpose: There are known disparities in chronic pain severity, treatment, and opioid-related risks amongst individuals from lower socioeconomic status, including Medicaid beneficiaries, but little is known about whether Medicaid beneficiaries benefit in a similar way from multidisciplinary chronic pain rehabilitation. This study investigated differences in clinical outcomes between Medicaid and non-Medicaid beneficiaries who completed a 3-week multidisciplinary chronic pain rehabilitation program.Methods: Participants (N = 131) completed a broad range of clinical measures pre- and post-treatment including pain severity, pain interference, depression, anxiety, objective physical functioning, and opioid misuse risk. Patients with Medicaid were compared with non-Medicaid patients in terms of baseline characteristics and rate of change, utilizing two-factor repeated measures analyses of variance.Results: There were baseline characteristic differences, with Medicaid beneficiaries being more likely to be African American, have higher rates of pain, worse physical functioning, and lower rates of opioid use. Despite baseline differences, both groups demonstrated significantly improved outcomes across all measures (p<.001) and no significant difference in rate of improvement.Conclusions: Results suggest that pain rehabilitation is as effective for Medicaid recipients as non-Medicaid recipients. Patients with Medicaid are particularly vulnerable to disparities in treatment, so efforts to expand access to multidisciplinary pain treatments are warranted.

Uitbouw van vestibulaire revalidatie in een centrum voor ambulante revalidatie: behandelmethoden en resultaten bij patiënten met een unilaterale vestibulaire hypofunctie

Development of vestibular rehabilitation in an ambulatory care centre: treatment protocol and results in a group of 12 patients with a unilateral vestibular hypofunction Vestibular rehabilitation (VR) is recommended in patients with a unilateral vestibular hypofunction (UVH) or areflexia resulting from inflammatory, traumatic or other aetiologies. In this study, the authors describe the treatment protocol and discuss the results of individually delivered VR in combination with a home exercise programme in patients initiating therapy 2 months or more post-onset of a UVH. Retrospectively, the data were analysed of patients presenting with &gt; 25% hypofunction on caloric irrigation who were referred by an ear, nose and throat (ENT) specialist in the period of January 2021 until January 2023. The patients received individualized therapy sessions of 45 minutes in combination with a home exercise programme. The following outcome measures were used: Dizziness Handicap Inventory (DHI), Functional Gait Assessment (FGA), Foam Stance Eyes Closed (FSEC), Dynamic Visual Acuity Test-Non Instrumented (DVAT-NI) and comfortable gait speed. Twelve patients (9 men and 3 women) with a mean percentual hypofunction of 81% were included (6 right- and 6 left-sided). The study found clinically relevant improvements for DHI and FGA, based on the minimally clinically important difference (MCID) of these tests. The mean DVAT-NI and FSEC scores normalized towards an age-appropriate level. VR leads to clinically relevant changes on different outcome measures in UVH patients. A centre for ambulatory rehabilitation (CAR) where multidisciplinary rehabilitation for people with hearing loss is provided, is a suitable setting to offer VR because of the longstanding cooperation between ENT specialists and physiotherapists. Nevertheless, there are challenges that need consideration when implementing VR into a CAR.

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.

Psychological Distress Affects Performance during Exercise-Based Cardiac Rehabilitation.

It is known that psychosocial distress affects the morbidity and mortality of patients with cardiovascular disease of every age. The aim of this study was to produce novel information on how psychological distress can influence cardiovascular performance in patients after cardiac surgery undergoing multidisciplinary cardiac rehabilitation. Patients (n = 57) admitted after cardiac surgery for valvular or coronary disease underwent, within 5 days of admission, the Symptom Checklist-90-Revised (SCL-90-R) self-report questionnaire to measure psychiatric symptoms and the 12-item General Health Questionnaire (GHQ-12) to assess the level of psychological distress. The Positive Symptom Distress Index (PSDI) was measured to indicate the amplitude of symptom distress. Cardiovascular performance was assessed by a 6 min walking test (6MWT) at admission and discharge, and oxygen consumption (VO2 max) was derived. Within the SCL-90-R score, somatic symptoms (47.4%), depressive and anxiety symptoms (36.8% and 33.3%, respectively), symptoms of phobic anxiety (21.1%), and psychoticism (24.6%) were over-represented. As for the GHQ-12, 75.4% of the sample reported an abnormally negative perception of their health status. An inverse correlation was shown between the variation in 6MWT and SCL depression (p = 0.048), PSDI (p = 0.022), and the GHQ-12 (p = 0.040). Similarly, an inverse correlation was shown between the variation in the VO2 max, GHQ-12 (p = 0.041), and the PSDI (p = 0.023). Post-cardiac surgery cardiac rehabilitation was associated with increased symptoms of psychological discomfort, as compared with the general population. The amplitude of psychological distress, depression, and hostility are associated with limited improvement in performance. These data strengthen the need for psychological support during cardiac rehabilitation programs.

Multidisciplinary rehabilitation for Parkinson’s disease

Multidisciplinary rehabilitation for Parkinson’s disease

Oral health-related quality of life in elderly: an umbrella review of systematic reviews from a multidisciplinary rehabilitation point-of-view.

Poor oral health is highly prevalent among elderlies and may impact quality of life of elderly people. In this scenario, oral health has been often linked to general health and chronic disorders, including distinct features of frailty. The aim of the present umbrella review of systematic reviews was to assess the scientific literature on the correlation between oral health related quality of life (OHRQoL) and elderly to present a multidisciplinary approach to these complex patients. We performed a literature search of the databases Pub-Med/Medline, Scopus, Web of Science, and Physiotherapy Evidence Database electronic databases. Two independent reviewers performed the literature research from the inception to 25th November 2023 and screened the studies for eligibility. The search resulted in a total of 676 results eligible articles. After removal of duplicates and full-text screening, a total of 3 systematic reviews were considered to meet the inclusion criteria and were included for this review. Frailty is very common in elderly such as a poor oral health. In this scenario, malnutrition and bad lifestyle habits may affect not only the determinism of many systemic non-communicable diseases but also oral health quality. Taken together, the findings of this umbrella review of systematic reviews showed a strict correlation between the frailty, typical condition of ageing people, and a poor OHRQoL. Therefore, it is mandatory to implement the oral health prevention with specific protocols of oral rehabilitation to improve the OHRQoL in elderly.

The ROCK trial—a multidisciplinary Rehabilitation intervention for sudden Out-of-hospital Cardiac arrest survivors focusing on return-to-worK: a pragmatic randomized controlled trial protocol

IntroductionMost cardiac arrest survivors are classified with mild to moderate cognitive impairment; roughly, 50% experience long-term neurocognitive impairment. Postarrest challenges complicate participation in society and are associated with social issues such as failure to resume social activities and impaired return to work. The effectiveness of rehabilitation interventions for out-of-hospital cardiac arrest survivors are sparsely described, but the body of evidence describes high probabilities of survivors not returning to work, returning to jobs with modified job descriptions, returning to part-time employment, and often in combination with extensive unmet rehabilitation needs. Hence, there is a need to develop and test a pragmatic individual targeted intervention to facilitate return to work (RTW) in survivors of OHCA. The overall aim of the ROCK trial is to evaluate the effectiveness of a comprehensive individually tailored multidisciplinary rehabilitation intervention for survivors of OHCA on RTW compared to usual care.Methods and analysisThe ROCK trial is a two-arm parallel group multicentre investigator-initiated pragmatic randomized controlled superiority trial with primary endpoint measured 12 months after the cardiac arrest. Adult survivors who were part of the labour force prior to the OCHA and had at least 2 years until they are qualified to receive retirement state pensions are eligible for inclusion. Survivors will be randomized 1:1 to usual care group or usual care plus a comprehensive tailored rehabilitation intervention focusing on supporting RTW. After comprehensive assessment of individual rehabilitation needs, the intervention is ongoingly coordinated within a multidisciplinary rehabilitation team, and the intervention can be delivered for up until 12 months. Data for the primary outcome will be obtained from the national register on social transfer payments. The primary outcome will be analysed using logistic regression assessing RTW status at 12 months adjusting for the intervention and age at OHCA, sex, marital status, and occupation prior to OHCA.DiscussionThe ROCK trial is the first RCT to investigate the effectiveness of a rehabilitation intervention focusing on return to work after cardiac arrest.Trial registrationClinicalTrials.gov NCT05173740. Registered on May 2018

Examining the Benefits of Multidisciplinary Rehabilitation Intervention for Stroke Patients

Background: Stroke is the second leading global cause of death and disability, affecting 80 million survivors with residual symptoms. Rehabilitation, involving an interdisciplinary team approach, plays a crucial role in enhancing functional recovery, addressing deficits in fine motor skills, cognition, and communication through customized therapies, as highlighted in a randomized controlled trial comparing integrated rehabilitation approaches to conventional physical therapy for stroke recovery. Methods: The study was a randomized controlled trial comparing integrated rehabilitation approaches with conventional rehabilitation in post-stroke patients aged 40-60 years over a four-month period. Conducted in a multidisciplinary rehabilitation center, the study included 90 participants, with 45 in each group. The experimental group received integrated rehabilitation involving tailored physical therapy to enhance balance, occupational therapy targeting fine motor skills, and speech therapy addressing swallowing and communication issues. The control group underwent conventional rehabilitation primarily focusing on physical therapy, omitting integrated approaches like occupational and speech therapy. Results: The analysis of the findings had revealed that interdisciplinary rehabilitation program yielded a significantly better results p&lt;0.05 in improving patients’ conditions. The findings provided evidences that all outcome measures that were balance, fine motor function and swallowing and dysphagia were significantly improved p&lt;0.05 both at within and between the group analyses after four months of integrated rehabilitation program. Conclusion: The interdisciplinary rehabilitation programme that included physical, occupational, and speech therapies producednoticeably better outcomes than the conventional rehabilitation methods. The results highlight how well the integrated strategy works to improve swallowing/dysphagia, fine motor function, and balance outcomes. Keywords: Physical Therapy, Occupational Therapy, Post-stroke Patients, Speech Therapy

Multidisciplinary rehabilitation with a focus on physiotherapy in patients with Post Covid19 condition: an observational pilot study.

There is a lack of interventions that treat the Post-Covid-19 Condition (PCC) itself. Accordingly, treatment guidelines recommend physiotherapy interventions to alleviate symptoms and enhance functioning. In cases where unimodal treatments prove ineffective, non-organ-specific multidisciplinary bio-psycho-social rehabilitation (MBR) programs are a suitable option. In a pilot observational study with assessments at the entry and end of treatment we aimed to evaluate the feasibility of a 3-week day clinic MBR program and explore its effects on physical functioning in PCC patients with fatigue and reduced physical capacity. Patient selection was based on an interdisciplinary assessment involving a physician, a psychologist and a physiotherapist. Feasibility was determined based on full participation (≥ 8 of 9days) and maintenance of stable endurance in the 6-Minute Walk Test (6MWT). From 37 patients included in the study, 33 completed the MBR (mean age: 43 ± 12years, 73% female). Four patients discontinued the MBR, with two of them having reported deterioration of PCC symptoms. The 6MWT showed a numerical improvement from 501 ± 97m to 512 ± 87m, although it did not reach statistical significance. These results support the feasibility of outpatient MBR with a focus on active physiotherapy interventions in PCC patients with fatigue. This study aligns with previous research supporting the effectiveness of physiotherapy and rehabilitation in PCC patients. However, further research is needed to address possible different treatment responses and varying treatment approaches in subgroups of PCC patients.

Rehabilitation Programs for Older Surgical Patients in the Postoperative Period

In recent years, Russia has seen an increase in the proportion of older patients receiving surgical care. In the majority of cases, an older patient is burdened with multiple long-term conditions (MLTC) and geriatric syndromes. To improve the consensus clinical and / or functional outcomes after surgery, rehabilitation measures are required in the postoperative period. In this review, spanning the last 10 years, the value of rehabilitation programs for older and oldest-old patients was assessed. The clinical effectiveness of multidisciplinary rehabilitation measures in the postoperative period is analyzed.

THE MULTIDISCIPLINARY BIOPSYCHOSOCIAL REHABILITATION PROGRAMME FOR PATIENTS WITH CHRONIC SPINAL PAIN: OUTCOMES WITH WORK STATUS AS THE PRIMARY FOCUS.

To assess the efficacy of the multidisciplinary biopsychosocial rehabilitation programme for chronic spinal patients as to work status, physical functioning, pain intensity, health-related quality of life and the psychosocial domain. This is a retrospective, single-centre, observational cohort study. A total of 209 subjects (mean age 41.5 ± 11.4 years) with chronic spinal pain participated in the rehabilitation programme. Evaluations were conducted through standardized questionnaires at baseline and at the end of the rehabilitation programme. Patients were more likely to be at work. Sick leave and work VAS changed significantly. Patients in blue-collar jobs are less likely to return to work. Pain intensity, physical functioning, health-related quality of life and lumbar and cervical range of motion improved significantly. The multidisciplinary biopsychosocial rehabilitation programme for chronic spinal patients improved the rate of return to work. In daily clinical practice, attention must be given to reducing mobility issues in daily life in order to get patients back to work. The occupational therapist should give patients with blue-collar jobs sufficient attention early in the programme in order to achieve a higher rate of return to work.

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.

Characteristics and clinical outcomes of pediatric patients following massive bowel resection: A retrospective cohort study

BackgroundMassive bowel resection (MBR), defined as residual small bowel < 25 % of expected length-for-age based on established norms, is a rare entity. Traditionally, children who have undergone MBR have higher mortality and less probability of achieving enteral autonomy compared to patients with less substantial bowel loss. The primary objective of this study was to determine the characteristics and clinical outcomes of pediatric patients following MBR. Secondary objectives included comparing patients who achieved enteral autonomy to those who remained parenteral nutrition (PN)-dependent to determine characteristics associated with PN independence. MethodsRetrospective cohort study of patients following MBR managed by our multidisciplinary intestinal rehabilitation program between January 1, 2006 and December 31, 2017, with an observation period ending December 31, 2021. Results61 patients with MBR fulfilled study inclusion criteria. 21 patients (34.4 %) achieved enteral autonomy while 40 patients (65.6 %) did not. Patients who achieved enteral autonomy had a greater percentage of residual small bowel (22 % vs 13 %, P < 0.01) and colon (100 % vs 50 %, P < 0.01). They were more likely to have an ICV (73.2 % vs 15 %, P < 0.01) and less likely to undergo STEP procedure (14.3 % vs 37.5 %, P = 0.02). 18 patients in the cohort without enteral autonomy achieved greater than 50 % enteral nutrition. In this cohort, the overall transplant rate was 9.8 % and mortality rate was 11.5 %. ConclusionSeveral important advancements have occurred over the last two decades that have allowed more patients to reach their adaptive potential and mitigate complications of prolonged PN following MBR. Overall outcomes are better than previously reported.

Multidisciplinary physical rehabilitation program of individuals with spinal muscular atrophy in an inclusive school setting.

Spinal muscular atrophy (SMA) is a neuromuscular ailment that leads to the deprivation of motor neurons in the spinal cord, producing denervation and muscle weakness. This case report explains how a patient with type 2 SMA used a therapeutic exercise rehabilitation program in a school environment. Motor functions were assessed by Gross Motor Function Measure-88 (GMFM-88), Manual Muscle Testing (MMT), and Hammersmith Functional Motor Scale (HFMS), which is validated and reliable. This study employed a repeated pre-test post-test measures design. During a year of treatment sessions, the child underwent twice weekly 45-minute physical therapy sessions for 48 weeks. The research was carried out between March 2022 and February 2023. The purpose of the intervention, which comprised a variety of therapeutic workouts, was to enhance physical function and gross motor abilities in an age-appropriate manner. The intervention utilized in this study led to improvements in GMFM-88, HFMS, and MMT total scores. The results of this case study showed that a child with type 2 SMA aged nine had successfully improved their gross motor skills and muscle strength.

Relationship between independence in activities of daily living at discharge and physical activity at admission of older postoperative hip fracture rehabilitation inpatients: A retrospective case-control study.

Hip fractures are associated with a reduction in activities of daily living (ADL) and require long-term care. The physical activity of patients with hip fractures is temporarily impaired immediately after surgery, causing difficulty in the measurement of physical activities at the time of rehabilitation admission. This study examined the relationship between ADL at discharge and light- and moderate-intensity physical activity at the time of rehabilitation admission by determining a cut-off value predicting ADL independence. This retrospective case control study analyzed 43 postoperative hip fracture patients aged ≥65years admitting into inpatient rehabilitation. ADL at discharge was assessed using the Functional Independent Measure motor items (FIM-m). The duration of physical activity at the time of rehabilitation admission was measured using an activity tracker equipped with an accelerometer. Prehospital frailty was evaluated using Clinical Frailty Scale. The relationship between these variables was examined using Spearman's product-moment correlation coefficient. Differences in physical activity between patients requiring and not requiring assistance with ADLs were examined using the analysis of covariance. A receiver operating characteristic curve of the need for ADL assistance at discharge was constructed from the duration of physical activity. The duration of physical activity at the time of rehabilitation admission was related to FIM-m at discharge. The cut-off value of the duration of physical activity for predicting the need for ADL assistance at discharge was 135s, with a sensitivity of 83.3% and specificity of 68.4% (area under the curve: 0.76). The duration of physical activity at the time of rehabilitation admission may be a factor that can quantitatively predict the risk of requiring assistance with ADLs at discharge in older hip fracture patients. The duration of light-and-moderate intensity physical activity may be a component of multidisciplinary inpatient rehabilitation to improve patients' ADL.

Jugulotympanic paraganglioma: A cause of sequential cranial nerve fallout and obstructive hydrocephalus

Abstract A 46-year-old male presented with a longstanding history of a sequential cranial nerve fallout. Following extensive imaging which included contrast enhanced computed tomography, computed tomography angiography, and diagnostic digital subtraction angiography, a diagnosis of jugulotympanic paraganglioma was made. The tumour was found to be locally invasive, encapsulating major neurovascular structures and ultimately inaccessible. Furthermore, the clinical presentation was complicated by acute obstructive hydrocephalus secondary to tumour mass effect. Given the rarity of the condition and unusually extensive presentation, neurosurgery alongside a multidisciplinary team collaborated to formulate a management plan aimed at maximizing functional outcome and minimizing intraoperative morbidity. A decision was made to perform palliative surgical debulking procedure followed by multidisciplinary care and rehabilitation. The patient demised in the care of his family prior to any further intervention.

Feasibility of a Novel Geriatric Rehabilitation Program for People With COPD-induced Malnutrition and Muscle Wasting: A Qualitative Study.

Background and Purpose: Patients with COPD-induced malnutrition and muscle wasting are often frail. Consequently, traditional rehabilitation may be even counterproductive due to energy costs and there is a need for specialized rehabilitation programs, which are lacking for these patients. We developed such a program, which includes resistance training, following Nonlinear Periodized Exercise principles and physical energy management, in combination with a restriction of physical activities. The purpose of the study was to investigate the feasibility and the potential effects of this program. Methods: Patients who are eligible for the program are those with COPD gold III/IV and a fat free mass index below standard. We conducted a qualitative feasibility study and interviewed both patients and healthcare professionals (HCPs), using a deductive approach. The open interviews were qualitatively analyzed focussing on six areas of Bowens' feasibility model: acceptability, demand, implementation, practicality, limited efficacy, and integration. Results and discussions: Seven patients and seven HCPs were interviewed. For patients, key factors that helped to adhere to the program were knowledge about energy management, alternative skills to cope with COPD, and social support. They found the program beneficial. However, several patients considered a limitation of walking and ADL activities challenging. HCPs considered the program feasible and beneficial especially for those patients who accept they need a behavior change and who adhere to the program. For HCPs, key factors were the consistent approach and coaching skills of the multidisciplinary team members, and the monitoring role of the nurses. The limitation of physical activity and endurance training deviates from existing geriatric rehabilitation programs which propagate functional activity and training. Still, evidence from the current study suggests that our tailored approach for these patients might be more appropriate and also potentially effective without harm for physical function. Conclusions: Our novel, multidisciplinary rehabilitation program is considered feasible and clinically relevant by both patients and healthcare professionals. The next step is to explore its effects on muscle strength, physical functioning, and quality of life.

Реабилитационный диагноз у недоношенных детей с перинатальной патологией нервной системы на основе Международной классификации функционирования

Aim. To determine the main categories of the International Classification of Functioning, Disability and Health that constitute a rehabilitation diagnosis in a premature infant with perinatal lesions of the nervous system. Key points. One of the urgent tasks in the formation of a unified approach to the rehabilitation and habilitation of premature babies when they are transferred from the first or second stage of rehabilitation is to assess the child's rehabilitation status and establish a rehabilitation diagnosis. For this purpose, we used the International Classification of Functioning, Disabilities and Health. Studied domains include nervous system structures; vision and related functions; hearing and vestibular functions; neuromuscular and movement-related functions; skeletal, digestive, and metabolic functions; child mobility; and environmental factors. The article describes a clinical case of a 9.5-month-old patient, born at 30 weeks' gestation, who was admitted to a rehabilitation course at a day hospital with a complaint of delayed motor development. After establishing the rehabilitation diagnosis, the infant's average rehabilitation potential was determined and a favourable rehabilitation prognosis was predicted on the basis of the rehabilitation results. The positive effect of the rehabilitation activities was associated with the emergence of new skills and improvement in the rehabilitation status of the child. Conclusion. Formulating a rehabilitation diagnosis involves assessing the patient's current situation, which makes it possible to set rehabilitation goals, form a multidisciplinary rehabilitation team, justify the use of rehabilitation methods and evaluate the outcome of rehabilitation interventions. Keywords: premature children, rehabilitation diagnosis, rehabilitation potential, International Classification of Functioning, psychological development.

Exposure to Adverse Childhood Experiences Predicts Increased Neurobehavioral Symptom Reporting in Adults with Mild Traumatic Brain Injury.

The objective of this study was to understand whether exposure to adverse childhood experiences (ACEs) before 18 years of age predicts increased neurobehavioral symptom reporting in adults presenting for treatment secondary to persistent symptoms after mild traumatic brain injury (mTBI). This cross-sectional study identified 78 individuals with mTBI from 2014 to 2018 presenting for treatment to an outpatient multidisciplinary rehabilitation clinic. Neurobehavioral symptom inventory (NSI-22) scores were collected on admission, and ACEs for each patient were abstracted by medical record review. A linear regression model was used to assess if an individual who experienced at least one ACE before age 18 resulted in significantly different neurobehavioral scores compared with those not reporting any history of an ACE before age 18. Participants who reported at least one ACE before age 18 had significantly increased NSI-22 scores on admission to the rehabilitation clinic compared with patients without history of ACEs (mean difference 10.1, p = 0.011), adjusted for age and gender. For individuals presenting for treatment after mTBI, a history of ACEs before age 18 was associated with increased neurobehavioral symptoms.