Passive Motion Exercise Research Articles

MANUAL THERAPY TECHNIQUES FOR THE ACROMIOCLAVICULAR JOINT DYSFUNCTION – A NARRATIVE REVIEW

INTRO/BACK GROUND Ac joint dysfunction is a prevalent cause of shoulder discomfort. As far as we are aware, there are currently no published studies focused on the manual therapy management of AC joint dysfunction. However, manual physical therapy has proven successful in treating various other shoulder conditions. To address this, recent research has started to investigate whether manual techniques are more effective in treating ac joint dysfunction. OBJECTIVE Aim of this study on the literature review pointing on the available evidence for the manual therapy interventions in acromioclavicular joint dysfunction patients. METHODS Research involved a computerized data base used for searching articles were Science direct, Pedro, PubMed, goggle scholar search pertaining to studies that include the manual therapy among acromioclavicular joint dysfunction Patients RESULTS: These 10 studies were based on the inclusion exclusion criteria were included in this review the methods used in all these studies were strengthening exercises , transverse friction massage, joint mobilization, myofascial release techniques, active passive motion exercises, scapulothoracic exercises, peri joint muscle exercises, joint stability exercises with different sets of exercises for muscle activation and range of motion and function these manual therapy techniques aims to alleviate inflammation recover the shoulder pain free rom and restore the proper function of soft tissue and joint. CONCLUSION: We conclude from this review that a variety of manual treatment procedures have been shown to be useful and effective in treating patients with AC joint dysfunction. There is, however, a dearth of data on the use of manual therapy procedures or interventions to treat ac joint dysfunction. More investigation is required to determine the precise role that manual therapy strategies may play in managing ac joint dysfunction.

C3 (Clinical Case) Late Presentation of Radial Nerve Palsy Secondary to Extravasation of Peripherally Inserted Catheter in a Neonate: What Paediatricians Need to Know

Abstract Introduction/Background Peripherally inserted central catheters (PICC) are an essential and common procedure in neonatal intensive care units (NICUs). Peripheral nerve injuries secondary to PICC extravasation are a rare occurrence in neonates, who commonly recover with no sequalae. Rarely, extravasation results in compression and ischemia involving adjacent nerves, muscles or joints. Peripheral nerve injury may be induced by compression from tissue infiltration or irritation by the infiltrate. Timely diagnosis and treatment are essential to avoid complex or irreversible nerve damage, such as compartment syndrome, requiring extensive interventions. Isolated radial nerve injury in infants and neonates is limited to a few cases reported in the literature, which have been commonly related to in-utero compression or birth injury due to peripheral positioning. We report a late presentation of an isolated radial nerve injury secondary to PICC extravasation in a preterm infant, leading to neuropraxia and long-term impairment of hand function. Case Description An extreme preterm female infant (245/7 weeks’ gestation, 640 grams) was admitted to the NICU with a complex neonatal course. At 6 days after birth, a right antecubital PICC was inserted for vascular access and to provide parenteral nutrition. It was removed after 18 days following extravasation. Two months later, she developed a right wrist drop, flexed fingers, and edema of the right hand. Her right wrist flexion, elbow flexion, shoulder joint range of motion, and sensation remained intact. A Doppler study showed a small non-occlusive clot in the right brachial vein, attributed to the previous PICC. She was unable to voluntarily open her right hand or extend her metacarpophalangeal (MCP) or interphalangeal (IP) joints (see Figure A, below). Clinical diagnosis of radial nerve palsy was made, and she was referred to physiotherapy (PT) and occupational therapy (OT). Splinting, passive exercise and left-hand constraint resulted in some improvement of the right hand’s strength. At 12 months of age, she had left hand preference with limited active extension of right MCPs and IPs (Figure B). She received a Botox injection to the right-hand flexors to allow strengthening of the extensor muscles. Follow-up at 18 months showed full extension of the index and middle finger MCPs and IPs, but residual lag in ring and small finger IPs. Discussion To our knowledge, this is the first case report of isolated radial nerve injury in an infant following PICC extravasation and soft tissue infiltration. Interestingly, the clinical signs of radial nerve injury in this case presented almost two months after PICC extravasation. Additionally, the left-hand preference and limitation of the active extension of the fingers of the right hand remained at one year of corrected age. Given that this has exceeded the expected recovery time of radial nerve palsy, Botox injection was performed with good response and near age-appropriate development of fine motor skills at 18 months of corrected age. Paediatricians should be aware that the manifestation of potential nerve injury in neonates may have a delayed presentation. Neurology consultation to confirm the diagnosis and rule out other causes of muscle weakness, and referral to PT/OT, are crucial for managing infants and neonates with peripheral nerve injury because treatment is largely focused on splinting and passive motion exercise. Generally, radial nerve palsy carries a relatively good prognosis, with complete functional recovery within 1-6 months. The fact that this case developed long-term complications with impaired right-hand function, despite nerve recovery, raises concerns about the prognosis. Conclusion Peripherally inserted central venous catheters are an everyday procedure in the NICU. Radial nerve palsy secondary to venous catheter extravasation is rare in infants and neonates. Clinicians should be aware of the clinical signs of radial nerve palsy and initiate consultation and referral to physiotherapy and occupational therapy early. Families can be reassured of the good prognosis and functional recovery.

Implementation of Family Nursing Care for Clients with Rheumatoid Arthritis to Physical Mobility Disorders with Active and Passive Movement Exercises

Background: Rheumatoid Arthritis (RA) is a disease characterized by a chronic autoimmune inflammatory disorder or autoimmune response that causes weakening of the joints and synovial lining, especially in the hands, feet, and knees. Patients with RA often experience impaired physical mobility, a condition where a person cannot move freely due to conditions that hinder movement (activity). One of the interventions that can be given to RA patients is Range of motion (ROM) exercises, which are exercises performed to maintain or improve the perfection of the ability to move joints normally and completely to increase muscle mass and muscle tone. research to assess the effectiveness of implementing family nursing care with active and passive movement exercises against impaired physical mobility in Rheumatoid Arthritis sufferers in the work area of Taba Health Center, Lubuklinggau City, in 2022. Methods: This study uses a qualitative design with a case study approach to describe information descriptively. In-depth and explores nursing problems for families with rheumatoid arthritis with impaired physical mobility due to joint stiffness. Results: After implementation by giving active and passive motion exercises to both subjects (Mr. S and Mrs. E) for five consecutive days with a time of 10-15 minutes, both subjects said that stiffness in the extremities was reduced and the value of muscle strength increased to 5 and 4. Conclusion: Implementing nursing care with active and passive motion exercises can increase joint strength in clients with rheumatoid arthritis.

The Implementation of Range of Motion Exercises in Overcoming Impaired Physical Mobility in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a disease characterized by an autoimmune chronic inflammatory disorder or autoimmune response that causes weakening of the joints and lining of the synovial organs, especially in the hands, feet, and knees. This study aims to determine the implementation of nursing care with active and passive motion exercises for impaired physical mobility in patients with rheumatoid arthritis in the work area at Taba Health Center, Lubuklinggau City, in 2022. The method used is descriptive in the form of a case study with two clients experiencing rheumatoid disease as subjects. arthritis with impaired physical mobility problems that experience joint stiffness. The results showed that after being given active and passive motion training therapy, muscle strength increased. Implementation of nursing care with active and passive motion exercises can increase muscle strength in clients with rheumatoid arthritis. Because this motion exercise does not require costs and each movement can be done independently at home.

Evaluation of Different Robot-Assisted Ankle Muscle Strength Training Modes Based on Angle/Torque and sEMG Characteristics

Muscle strength training is to reduce muscle atrophy and increase muscle strength. For ankle joint, we developed six robot-assisted muscle strength training modes, namely, continuous passive motion (CPM), isotonic, isometric, isokinetic, centripetal and centrifugal exercise. The paper aims to evaluate the performance of different robot-assisted training modes based on angle/torque and surface electromyography (sEMG) characteristics. The sEMG characteristics were used to extract the features of the degree of muscle activation, while the angle/torque information were used to calculate the endurance ratio (ER), peak torque (PT) and torque acceleration energy (TAE). Experimental results showed that the level of the degree of muscle activation, PT and TAE in CPM were low, and ER was about 1. For isotonic exercise, isometric exercise and isokinetic exercise, most of the evaluation indexes including the degree of muscle activation, PT and TAE increased significantly compared with CPM (For isotonic exercise, ER is 1.09±0.25, r(LG) is 0.0538±0.0171, r(MG) is 0.0430±0.0116, r(SO) is 0.0642±0.0178; For isometric exercise, PT is 0.72±0.16, TAE is 2.15±0.51, r(TA) is 0.0532±0.0256; For isokinetic exercise, PT is 0.72±0.16, TAE is 1.99±0.82). The results reveal the different performances among different modes, thus lay a foundation for exploring subject-specific adaptive ankle muscle strength training strategies.

Effects of Different Orthoses on Neuromuscular Activity of Superficial and Deep Shoulder Muscles during Activities of Daily Living and Physiotherapeutic Exercises in Healthy Participants.

This study aimed to investigate the effects of different shoulder orthoses on the neuromuscular activity of superficial and deep shoulder muscles during activities of daily living (ADL) and physiotherapeutic exercises. Ten participants with healthy shoulders (31 ± 3 years, 23.1 ± 3.8 kg/m2) were randomized to receive a "shoulder sling", an "abduction pillow" and a "variably adjustable orthosis" on the dominant side. With each orthosis, they completed seven ADL with and four physiotherapeutic exercises without wearing the orthoses. An electromyographic system was used to record the neuromuscular activity of three superficial (trapezius, deltoid, pectoralis major) and two deep shoulder muscles (infraspinatus, supraspinatus) using surface and intramuscular fine-wire electrodes. The neuromuscular activity differs between the orthoses during ADL (p ≤ 0.045), whereby the "variably adjustable orthosis" mostly showed the highest activation levels associated with the worst subjective wearing comfort rated on a visual analog scale. In addition, differences exist between the physiotherapeutic exercises (p ≤ 0.006) demonstrating the highest activations of the infra- and supraspinatus muscles for assistive elevation and wipe across a table, middle for pendulum and lowest for continuous passive motion exercises. The neuromuscular activity of superficial and deep shoulder muscles differs between the orthoses during ADL and also between the physiotherapeutic exercises.

PELAKSANAAN EXERCISE THERAPY PADA KASUS POST OPERASI ANTERIOR CRUCIATE LIGAMENT

This study aims to determine the effect of exercise therapy in reducing pain, increasing joint range of motion (LGS), eliminating swelling/oedema and increasing muscle strength in postoperative anterior cruciate ligament (ACL) cases. This research is a qualitative research with a case study design, namely to determine the effect of exercise therapy in reducing pain, increasing joint range of motion (LGS), eliminating swelling/oedema and increasing muscle strength in postoperative anterior cruciate ligament (ACL) cases. The subjects in this study were patients who complained of stiffness and pain in the knees when moved. The research subject consisted of one person. Data were obtained by conducting interviews, observation and exercise therapy in cases of postoperative anterior cruciate ligament. The results showed that after doing physiotherapy intervention by doing exercise therapy it was known that exercise therapy could reduce pain, increase the range of motion of the joints (LGS), eliminate swelling/oedema and decrease muscle strength in cases of postoperative anterior cruciate ligament. After getting therapy 6 times using exercise therapy which includes passive motion exercises, active motion, static contraction exercises, exercises using a stationary bicycle and exercises using a stationary bicycle and walking exercises using crutches. The patient has experienced changes, but not too maximal. By giving these interventions can accelerate the healing factor.Keywords: exercise therapy, postoperative, anterior cruciate ligament

Effect of proprioceptive stimulation using a soft robotic glove on motor activation and brain connectivity in stroke survivors

Objective. Soft-robotic-assisted training may improve motor function during post-stroke recovery, but the underlying physiological changes are not clearly understood. We applied a single-session of intensive proprioceptive stimulation to stroke survivors using a soft robotic glove to delineate its short-term influence on brain functional activity and connectivity. Approach. In this study, we utilized task-based and resting-state functional magnetic resonance imaging (fMRI) to characterize the changes in different brain networks following a soft robotic intervention. Nine stroke patients with hemiplegic upper limb engaged in resting-state and motor-task fMRI. The motor tasks comprised two conditions: active movement of fingers (active task) and glove-assisted active movement using a robotic glove (glove-assisted task), both with visual instruction. Each task was performed using bilateral hands simultaneously or the affected hand only. The same set of experiments was repeated following a 30 min treatment of continuous passive motion (CPM) using a robotic glove. Main results. On simultaneous bimanual movement, increased activation of supplementary motor area (SMA) and primary motor area (M1) were observed after CPM treatment compared to the pre-treatment condition, both in active and glove-assisted task. However, when performing the tasks solely using the affected hand, the phenomena of increased activity were not observed either in active or glove-assisted task. The comparison of the resting-state fMRI between before and after CPM showed the connectivity of the supramarginal gyrus and SMA was increased in the somatosensory network and salience network. Significance. This study demonstrates how passive motion exercise activates M1 and SMA in the post-stroke brain. The effective proprioceptive motor integration seen in bimanual exercise in contrast to the unilateral affected hand exercise suggests that the unaffected hemisphere might reconfigure connectivity to supplement damaged neural networks in the affected hemisphere. The somatosensory modulation rendered by the intense proprioceptive stimulation would affect the motor learning process in stroke survivors.

The Effect of Progressive Dynamic Balance Training on Physical Function, The Ability to Balance and Quality of Life Among Elderly Women Who Underwent a Total Knee Arthroplasty: A Double-Blind Randomized Control Trial.

Total knee arthroplasty (TKA) is used to treat end-stage osteoarthritis. However, this surgical procedure affects the mechanical receptor function and impairs the ability to balance. Dynamic balance training has been reported to improve stability and self-confidence and safely yield increased physical activity. This study aimed to investigate the effect of dynamic balance training on physical function, the ability to balance and quality of life among patients who underwent TKA. Thirty-eight participants were assigned to either the progressive dynamic balance training (PDBT) with physical therapy group (n = 19) or the control group (n = 19). The experimental group undertook a dynamic balance program with physical therapy for 30 minutes per day, five times per week for six weeks, while the control group undertook physical therapy only. A continuous passive motion exercise was performed for 20 minutes after training by both groups. The outcomes were evaluated using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, pain pressure threshold (PPT), range of motion (ROM), Knee Outcome Survey-Activities of Daily Living (KOS-ADLS), Multifunction Force Measuring Plate, timed up and go (TUG) test and Short-Form Health Survey 36 (SF-36). Physical function (WOMAC Osteoarthritis Index, ROM and KOS-ADLS score) and the ability to balance (TUG test score, confidence ellipse area, path length and average velocity) significantly improved (p < 0.05) in the experimental group compared with the control group. In contrast, the physical component summary score for the SF-36 regarding quality of life significantly improved (p < 0.05); however, the mental component summary score for the SF-36 and PPT did not significantly differ between the groups. Therefore, we suggest that PDBT with physical therapy has positive effects on physical function, the ability to balance and quality of life among patients who underwent TKA.

EFFECTS OF FULL IMMERSION VIRTUAL REALITY TRAINING ON BALANCE AND KNEE FUNCTION IN TOTAL KNEE REPLACEMENT PATIENTS: A RANDOMIZED CONTROLLED STUDY

Background: Recently, new methods have emerged that encourage voluntary participation by allowing patients to perform tasks, including exercises or treatments, in a virtual reality (VR) environment. Aim: This study aimed to examine the effects of full immersion virtual reality training on balance and knee function in patients who had undergone total knee replacement. Design: Single blind randomized controlled trial. Setting: Department of Physical Therapy in a rehabilitation center. Population: A total of 30 elderly patients ([Formula: see text]65 years old) who had undergone total knee replacement. Methods: Participants were randomly allocated to an experimental group ([Formula: see text]) and a control group ([Formula: see text]). The experimental group received with a continuous passive motion machine, exercise therapy, and a full immersion VR training program; the control group received only with a continuous passive motion machine and exercise therapy. Biorescue was used to test static and dynamic balance ability, and the Timed Up and Go and Western Ontario and McMaster Universities tests were used to assess knee function. Paired [Formula: see text]-tests were used to examine differences by time in each group, and independent [Formula: see text]-tests were used to examine differences between the groups. Results: In terms of within-group differences by time, both the experimental group and the control group showed significant changes in the anterior, and posterior limits of stability in both sides; static balance; and knee function. In the between-groups comparison, among static balance tests, there was a significant difference in center of mass path length in the standing position with eyes open ([Formula: see text]); among dynamic balance tests, there were significant differences in left, right, anterior, and posterior limits of stability ([Formula: see text]). Conclusions: VR training produced better early balance ability and knee function than what was seen in the control group. We believe that VR training in initial post-operative rehabilitation of total knee replacement patients may increase the rate of recovery. Clinical Rehabilitation Impact: VR exercise programs are effective in early rehabilitation after total knee replacement, and have clinical value as inexpensive methods that can promote active participation.

Mood Responses to Passive and Active Motion Leg Cycling Exercise in Healthy Sedentary Young Adults.

Previous studies suggest that passive motion exercise (PME) may be useful for overcoming exercise limitations associated with a sedentary lifestyle, orthopedic disorders, and various other debilitating conditions. Negative mood response is one of the factors that limit a person's ability to exercise. Therefore, this study tests the hypothesis that the mood response associated with PME is not different than the mood response associated with active motion exercise (AME). Eight women and seven men participated in the study and were administrated the Profile of Mood States (POMS) during modes of PME and AME in a randomized order. Outcome of the POMS consisted of the total mood disturbance score [(feelings of tension + depression + fatigue + anger + confusion) − vigor]. ANOVA was used to determine significance of differences in total mood disturbance, oxygen uptake (V.O2), and middle cerebral blood flow velocity (MCAv) at baseline and immediately after 30-minute conditions of PME and AME. Postexercise total mood disturbance score was significantly decreased for both conditions (PME baseline 29.2 ± 5.2 vs. postexercise 16.4 ± 6.8, P < 0.05) and AME baseline 22.4 ± 4.4 vs. postexercise 13.1 ± 5.2, P < 0.05). These senses of changes in feelings were associated with significant physiological increases in V.O2 and MCAv during both PME and AME (P < 0.05). These results demonstrate that physiological and mood responses to passive and active motion cycling exercise are not different. Future studies should determine whether passive motion cycling exercise is a useful preventive medicine strategy for overcoming various disease-related exercise limitations and counteracting the adverse effects of sedentary lifestyles.

Outcomes of 200 digital flexor tendon repairs using updated protocols and 30 repairs using an old protocol: experience over 7 years.

We reviewed outcomes of 230 flexor tendon repairs in 27 thumbs and 203 fingers in Zone 1 and 2 over 7 years. In 2013, we used a 2-strand modified Kessler method followed by passive motion exercise in repairing flexor digitorum profundus tendon injuries in Zone 2 in 30 fingers; 24 fingers were followed, five (26%) had repair ruptures. Between 2014 and 2017, we used a 4- or 6-strand method to repair 111 flexor digitorum profundus tendons in Zone 2, followed by true early active motion. Two had repair ruptures. Among 101 fingers followed over 6 months, two fingers had tenolysis and 87 (87%) good or excellent outcomes. In 2018 to 2019, we used a 6-strand method to repair 42 flexor digitorum profundus tendons in Zone 2 with out-of-splint early active motion. None had repair ruptures or tenolysis. From 2014 to 2019, 27 flexor pollicis longus tendons were repaired in Zone 1 or 2, and 20 fingers had end-to-end flexor digitorum profundus repairs in Zone 1; none had repair ruptures or tenolysis. We conclude that a strong repair and true active motion are necessary for best outcomes of flexor tendon repairs in the thumb and fingers, and out-of-splint true active motion is safe.

Early Weight-Bearing Improves Cartilage Repair in an in vitro Model of Microfracture: Comparison of Two Mechanical Loading Regimens on Simulated Microfracture Based onFibrin Gel Scaffolds Encapsulating Bone Marrow Mesenchymal Stem Cells

Objectives: Microfracture of focal chondral defects produces fibrocartilage, which inconsistently integrates with the surrounding native tissue and possesses inferior mechanical properties compared to hyaline cartilage. Mechanical loading modulates cartilage during development, but it remains unclear how loads produced in the course of postoperative rehabilitation affect the formation of the new fibrocartilaginous tissue. The purpose of this study was to assess the influence of different mechanical loading regimens simulating weight-bearing or passive motion exercises on an in vitro model of microfracture repair based on fibrin gel scaffolds encapsulating mesenchymal stem cells (MSCs). Methods: Cylindrical cores were made in bovine hyaline cartilage explants and filled with either: (1) cartilage plug returned to original location (positive control), (2) fibrin gel (negative control), or (3) fibrin gel with encapsulated bone marrow-derived MSCs (BM-MSCs) (microfracture mimic). Constructs were then subjected to one of three loading regimens, including (1) no loading (i.e., unloaded) (2) dynamic compressive loading, or (3) rotational shear loading. On days 0, 7, 14, and 21, the integration strength between the outer chondral ring and the central insert was measured with an electroforce mechanical tester. The central core component, mimicking microfracture neotissue, was also analyzed for gene expression by real-time RT-PCR, glycosaminoglycan and dsDNA contents, and tissue morphology by histology. Results: Integration strengths between the outer chondral ring and central neotissue of the cartilage plug and fibrin + BM-MSC groups significantly increased upon exposure to compressive loading, compared to day 0 controls (p= 0.007). Compressive loading upregulated expression of chondrogenesis-associated genes (SOX9, collagen type II, and collagen type II: I, an indicator of more hyaline phenotype) in the neotissue of the fibrin + BM-MSC group, as compared to the unloaded group at day 21 (SOX9, p =0.0032; COL2A1, p &lt;0.0001; COL2A1/COL1A1, p = 0.0308,). Fibrin + BM-MSC constructs exposed to shear loading expressed higher levels of chondrogenic genes as compared to the unloaded condition, but not as high as the compressive loading condition. Furthermore, catabolic markers (MMP3 and ADAMTS 5) were significantly upregulated by shear loading (p = 0.0234 and p&lt; 0.0001, respectively) at day 21, as compared to day 0. Conclusion: Dynamic compressive loading enhanced neotissue chondrogenesis and maturation in a simulated in vitro model of microfracture, with generation of more hyaline-like cartilage and improved integration with the surrounding tissue. Early weight-bearing after microfracture may be beneficial in promoting the formation of more hyaline-like cartilage repair tissue, whereas range of motion exercise by continuous passive motion without weight-bearing might not be as effective, or even negatively affect the formation of the repair tissue during post-surgery rehabilitation.

Patellar tendon ruptures : Internal bracing and augmentation technique

To report asurgical technique for the treatment of patellar tendon ruptures augmented with an internal brace suture tape. Acute patellar tendon ruptures, fractures of the distal patellar pole, chronic insufficiency of the patellar tendon or revision surgery for failed repairs. Severe damage to the surrounding soft tissue. Local infection. Life-threatening conditions. Direct longitudinal anterior approach to the patellar tendon. Two parallel transosseous bone tunnels are drilled in the patella and tibial tuberosity with a2.4 mm drill bit. Two separate FiberTapes® (Arthrex, Naples, FL; USA) are shuttled through the proximal and distal bone tunnels around the tendon in "X" and "O"type configuration. Patellar height is reestablished under fluoroscopic control and both FiberTapes are tied down. Both tendon ends are debrided and readapted with absorbable sutures. Passive motion exercise to 90° of flexion from day1. Partial load to 20 kg of body weight with knee in locked full extension brace during first 2weeks. Isometric exercises from week3. Passive flexion to 110° from week4 (adapted to pain). Free active range of motion and weight bearing from week7. In more than 10 years of clinical application, positive results were continuously found in acute as well as chronic patellar tendon ruptures. These results are consistent with those in the current literature.

The inherent role of the multidisciplinary palliative care team on pain management: A critical review

Cancer pain and palliative care (PC) are recognized as significant international health issues. Treatment of pain and rehabilitation programs in PC are challenging. Rehabilitation is the process that helps a person to reach physical, psychologic, social and educational potential with physiologic, anatomic impairment, desires and life ambitions. Rehabilitation improves patients physical function, independence and pain management to improve quality of life and patients’ dignity. Update on the role of rehabilitation in PC by detailed view of rehabilitation treatment methods and their evidence for application into PC conditions. Databases of Cochrane Library, Google Scholar and Pubmed were search from January 2005–December 2016. There is few evidence that rehabilitation can impact function and pain management in PC. However, experience suggests that physical modalities should be applied early to minimize the generalized deconditioning and aid in the pain management, decreasing the need for pain medications. Physical modalities can be applied by health care providers. Passive, active, and active-assisted motion exercises and gentle strengthening exercises can aid in the maintenance of strength and joint range of motion. The prescription of assistive devices, and the teaching of compensatory techniques for mobility can aid in ambulation. There is also evidence that immune function may be improved by moderate exercise. A rehabilitation team has the ability to integrate physical aspects of treatment in a biopsychosocial model of pain into a comprehensive rehabilitation program for cancer patients. More research should focus on the role of rehabilitation and defining appropriate interventions.

Return to Play After Hip Arthroscopy: A Systematic Review and Meta-analysis

Background: The use of arthroscopic treatment for intra-articular hip pathology has demonstrated improved patient-reported outcomes (PROs) with a lower rate of complications, reoperation, and patient morbidity as compared with traditional methods. Although the use of this minimally invasive approach has increased in prevalence, no evidence-based return-to-play (RTP) criteria have been developed to ensure an athlete’s preparedness for sporting activities. Purpose: To determine if there exists sufficient evidence in the literature to support an RTP protocol and functional assessment after hip arthroscopy, as well as to assess the mean rate and duration of RTP. Study Design: Systematic review and meta-analysis. Methods: The search terms “hip arthroscopy,” “return to play,” and 10 related terms were searched in PubMed, Cochrane Library, Scopus, and Web of Science, yielding 263 articles. After screening, 22 articles were included. RTP timeline, rehabilitation protocols, and conditional criteria measures were assessed with previously established criteria. Pooled estimates were calculated for RTP rate and duration, and weighted mean scores were determined for PROs. Results: A total of 1296 patients with 1442 total hips were identified. Although 54.5% (12 of 22) of studies did not provide a guideline for RTP duration after hip arthroscopy, 36.4% (8 of 22) recommended a duration of 4 months, while 9.1% (2 of 22) recommended 3 months. The most frequently described postoperative rehabilitation protocols were weightbearing guidelines (15 studies) and passive motion exercises (9 studies). Only 2 studies satisfied the criteria for a sufficient RTP protocol, and 3 provided a specific replicable test for RTP. The mean RTP duration was 7.4 months (95% CI, 6.1-8.8 months), and the return rate was 84.6% (95% CI, 80.4%-88.8%; P = .008) at a mean ± SD follow-up of 25.8 ± 2.4 months. Mean modified Harris Hip Score (mHHS) improved from 63.1 to 84.1 postoperatively (+33.3%), while Non-arthritic Hip Score improved from 61.7 to 86.8 (+40.7%). A lower preoperative mHHS was significantly associated with a higher postoperative improvement (r = −0.95, P = .0003). Conclusion: Significant variability exists in RTP protocols among institutions owing to a lack of standardization. Despite a high overall rate of RTP and improvement in PROs after hip arthroscopy, the majority of rehabilitation protocols are not evidence based and rely on expert opinion. No validated functional test currently exists to assess RTP.

Development of portable elbow joint device for stroke patient rehabilitation

Abstract Stroke is a brain disease occurs when blood stops flowing to any part of the brain, damaging brain cells and causes joint stiffness. By doing continuous passive motion (CPM) exercise, the joint stiffness can be reduced and it

Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty

There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty. Yet, little consensus supports the effectiveness of these interventions. To systematically review and meta-analyze evidence of nonpharmacological interventions for postoperative pain management after total knee arthroplasty. Database searches of MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Web of Science (ISI database), Physiotherapy Evidence (PEDRO) database, and ClinicalTrials.gov for the period between January 1946 and April 2016. Randomized clinical trials comparing nonpharmacological interventions with other interventions in combination with standard care were included. Two reviewers independently extracted the data from selected articles using a standardized form and assessed the risk of bias. A random-effects model was used for the analyses. Postoperative pain and consumption of opioids and analgesics. Of 5509 studies, 39 randomized clinical trials were included in the meta-analysis (2391 patients). The most commonly performed interventions included continuous passive motion, preoperative exercise, cryotherapy, electrotherapy, and acupuncture. Moderate-certainty evidence showed that electrotherapy reduced the use of opioids (mean difference, -3.50; 95% CI, -5.90 to -1.10 morphine equivalents in milligrams per kilogram per 48 hours; P = .004; I2 = 17%) and that acupuncture delayed opioid use (mean difference, 46.17; 95% CI, 20.84 to 71.50 minutes to the first patient-controlled analgesia; P < .001; I2 = 19%). There was low-certainty evidence that acupuncture improved pain (mean difference, -1.14; 95% CI, -1.90 to -0.38 on a visual analog scale at 2 days; P = .003; I2 = 0%). Very low-certainty evidence showed that cryotherapy was associated with a reduction in opioid consumption (mean difference, -0.13; 95% CI, -0.26 to -0.01 morphine equivalents in milligrams per kilogram per 48 hours; P = .03; I2 = 86%) and in pain improvement (mean difference, -0.51; 95% CI, -1.00 to -0.02 on the visual analog scale; P < .05; I2 = 62%). Low-certainty or very low-certainty evidence showed that continuous passive motion and preoperative exercise had no pain improvement and reduction in opioid consumption: for continuous passive motion, the mean differences were -0.05 (95% CI, -0.35 to 0.25) on the visual analog scale (P = .74; I2 = 52%) and 6.58 (95% CI, -6.33 to 19.49) opioid consumption at 1 and 2 weeks (P = .32, I2 = 87%), and for preoperative exercise, the mean difference was -0.14 (95% CI, -1.11 to 0.84) on the Western Ontario and McMaster Universities Arthritis Index Scale (P = .78, I2 = 65%). In this meta-analysis, electrotherapy and acupuncture after total knee arthroplasty were associated with reduced and delayed opioid consumption.

A Preclinical Assessment of Early Continuous Passive Motion and Treadmill Therapeutic Exercises for Generating Chondroprotective Effects After Anterior Cruciate Ligament Rupture

Background: Anterior cruciate ligament (ACL) injury is a well-known risk factor for the development of posttraumatic osteoarthritis (PTOA). However, whether using continuous passive motion (CPM) with or without additional treadmill exercise (TRE) in early ACL injury might provide chondroprotective effects and further decrease the risk of PTOA has yet to be determined. Hypothesis: CPM may offer an enhanced chondroprotective effect, but TRE may attenuate that effect due to the mechanical stress on the joint and inflammatory cytokines in the joint. Study Design: Controlled laboratory study. Methods: Thirty adult New Zealand White male rabbits were randomly allocated to sedentary (SED), CPM, TRE, or CPM+TRE groups. Each rabbit underwent an ACL transection (ACLT) on the right knee, with the contralateral knee used as an internal control (sham). The 4 joint surfaces (ie, medial and lateral femoral condyles and tibial plateaus) were evaluated 4 weeks after surgery for gross appearance, histological characteristics, and quantitative osteoarthritis (OA) scores. Results: Overall, at the end of testing, the CPM group experienced the best protective therapeutic effects in all compartments. In gross appearance, CPM resulted in normal articular surfaces, while the TRE and SED groups exhibited surface abrasion. Histological analysis showed significant differences in articular cartilage status. The CPM group had significantly better histological OA scores (P < .01), corresponding to the smoothest cartilage surface and sound chondrocyte and collagen arrangement. This group also showed abundant glycosaminoglycan (GAG) content and a sound growth microenvironment, with significantly lower expression levels of the inflammatory cytokine tumor necrosis factor α and the apoptotic marker caspase 3. In contrast, the TRE and SED groups showed several features of damage: distinct graded cartilage abrasion; damaged collagen fibers, corresponding to noticeable collagen type X (osteoarthritic cartilage); reduced cartilage thickness; fewer cartilaginous cells; and the appearance of chondrocyte clusters. These groups also showed loss of GAG, corresponding to higher levels of inflammatory cytokines and apoptosis of articular chondrocytes. Furthermore, the CPM+TRE group displayed visible pathological changes in the superficial cartilage, indicating that early loading exercise may contribute to osteoarthritis. The sham treatment showed no difference in the changes in all compartments between groups. Conclusion: Immediate CPM therapy produces a superior in situ microenvironment for reducing the occurrence of PTOA after ACL injury without reconstruction in rabbits. Clinical Relevance: These data suggest that immediate application of CPM therapy may be necessary to create a sound microenvironment in joints and possibly to decrease the risk of PTOA without or while awaiting ACL reconstruction. In contrast, both early active loading exercise and inactivity lead to the development of PTOA.

Effects of Eccentric Exercise and Extracorporeal Shock Wave Therapy on Rehabilitation of Patients with Noncalcific Rotator Cuff Tendinopathy

Objective: In this study, in order to establish a more effective therapeutic model for the patients with chronic rotator cuff tendinosis, the authors attempted to compare the therapeutic effects of general physical therapy, eccentric contraction exercise, extracorporeal shock wave therapy (ESWT) and their combination for patients with noncalcific subscapular tendinosis. Methods: 120 patients with subscapular tendinosis Grade II tendinopathy were divided randomly into four groups: I-IV, with 30 patients in each group. In group I (GI): the patients received conventional rehabilitation program, which included 20 minute of local hot packs, 15 min interferential electrotherapy and 10 min of passive range motion exercise three times weekly for 8 weeks; in Group II: the patients received eccentric contraction exercise three times per day and a rehabilitation program as in GI; in GIII: the patients received ESWT therapy weekly except for a rehabilitation program as in GI; in GIV: they received three combination therapies including a conventional rehabilitation program, three rounds of eccentric contraction exercises per day and weekly ESWT for 8 weeks. The outcome measurements include visual analogue pain scale (VAS), range of shoulder motion, subscapular muscle peak torques, and proprioception of the affected shoulder. Results: The results showed that the combination therapy group GII-IV all had more improvement than the conventional rehabilitation program group I. However, the integrated therapy group IV had the best improvement over GII and GIII in pain reduction and improvement of range of motion, proprioception and muscle peak torques. Additionally, group III and IV had better improvement of range of motion and muscle peak torques than did GII. Conclusion: Eccentric exercise and ESWT had benefit in rehabilitation of patients with noncalcific subscapular tendinosis, and conventional rehabilitation combined with these two therapies will result in more therapeutic effects.