Physical Rehabilitation Approach Research Articles

Physiotherapy treatment approaches following stroke: major update of Cochrane systematic review of evidence

Introduction: Physiotherapists traditionally base stroke rehabilitation practice on global ‘approaches’ (e.g. Bobath and Motor Learning approaches). A 2007 Cochrane systematic review explored the effect of different physiotherapy approaches for stroke, but failed to include all foreign-language (particularly Chinese) trials. We aim to update this Cochrane review, restructuring to incorporate all current international evidence relating to effectiveness of physiotherapy treatment approaches. Method: Our Cochrane review update is based on searches of electronic databases (including CENTRAL, MEDLINE, EMBASE, CINAHL, AMED) from 2005-December 2012. Foreign-language abstracts have been translated. Two independent reviewers applied selection criteria with disagreements resolved by a third reviewer. Two review authors will independently categorise the interventions within identified trials, document methodological quality, and extract data. Cochrane risk of bias tool will be used to assess methodological quality. Data from included studies will be pooled within meta-analyses, calculating standardised mean differences and 95% confidence intervals, using a random-effects model, for disability, motor impairment and participation outcomes. Results: (June 2013) We considered 11,576 titles, screened 592 abstracts and included 75 new RCTs (n = 896, plus 13 awaiting assessment). 49/75 RCTs were completed in China. 38/75 RCTs compare a physical rehabilitation approach with no rehabilitation. Our updated review synthesises evidence from 95 trials (n = 10,048). Data extraction is ongoing and meta-analyses will be completed by October 2013. Conclusion: This major Cochrane review update substantially increases the volume of evidence, with trials including over 10,000 participants, providing the most comprehensive, up-to-date synthesis of international evidence relating to the effect of physiotherapy treatment approaches after stroke.

Components of rehabilitation of 18-22 years old patients with respiratory diseases

The paper describes the physical rehabilitation approach aimed at prevention respiratory diseases in young age. The goal of the research was development and experimental justification of physical rehabilitation program for students of higher educational establishments with respiratory diseases based on the use of cyclic exercise with increased intensity. It was found that the use of complex rehabilitation program resulted in the renewal of youth’s health, increase of performance and functional capacities of respiratory system, and development of basic physical abilities.

A service development to educate healthcare assistants about physical rehabilitation which focusses on independence in an inpatient hospice unit

Rehabilitation is a specialty in its own right, with a powerful emphasis on inter-professional working to help patients improve their independence. Due to medical advances people with life limiting illnesses...

A service development to educate healthcare assistants about physical rehabilitation in an in-patient hospice unit

Rehabilitation is a specialty in its own right, with a powerful emphasis on inter-professional working to help patients improve their independence. Due to medical advances people with life limiting illnesses...

Constraint-induced movement therapy to enhance recovery after stroke.

A therapeutic approach to rehabilitation of movement after stroke, termed constraint-induced (CI) movement therapy, has been derived from basic research with monkeys given somatosensory deafferentation. CI therapy consists of a family of therapies; their common element is that they induce persons with stroke to greatly increase the use of a more-affected upper extremity (UE) for many hours a day over a 2- to 3-week period. These therapies have significantly improved quality of movement and substantially increased amount of use of a more-affected UE in the activities of daily living in life situations. A number of neuroimaging and transcranial magnetic stimulation studies have shown that the massed practice of CI therapy produces a massive use-dependent cortical reorganization that increases the area of cortex involved in the innervation of movement of the more-affected UE. The intensity and schedule of delivery of this very efficacious therapy is quite different from that of more traditional physical rehabilitation approaches. As a result, to be clinically applicable, the CI therapy approach to rehabilitation will likely require a paradigm shift in the delivery of physical rehabilitation services.

Beyond the needle: expanding the role of anesthesiologists in the management of chronic non-malignant pain.

Beyond the needle: expanding the role of anesthesiologists in the management of chronic non-malignant pain.

Physical medicine and rehabilitation approaches to the management of myofascial pain and fibromyalgia syndromes

In summary, we have presented the physical medicine and rehabilitation medicine approaches for treating patients with fibromyalgia and the myofascial pain syndromes. The importance of approaching these patients from a holistic and multidisciplinary standpoint has been stressed, paying attention to the physical, emotional, spiritual and behavioural components of the presentation. Although fibromyalgia and the myofascial pain syndromes are two distinct conditions, they often overlap, and when they do the myofascial component should be treated first. However, the clinician should remember that pain, tissue dysfunction and disability from pain are all separate issues and should be treated as such. Treatment in all cases should be individualized and comprehensive. It is imperative to make the patient an active participant in his care and to establish mutually agreed upon goals at the outset of treatment. It is important to establish an adequate and appropriate home exercise programme to supplement formal treatment. A good home exercise programme should stress both stretching and strengthening. Formal treatment programmes should not be geared to pain relief alone but rather to restoration of function, and return to functioning lifestyles. The clinician has available a wide array of modalities and tools to control pain, but the major goal of all treatment programmes is to restore individuals to functional lifestyles and to promote both physical and emotional flexibility, balance and 'wellness'. It is often necessary to involve the family unit as an inherent and critical part of the treatment team, particularly with the patient who continues to be dysfunctional despite apparently appropriate treatment. Although treatment always starts at the tissue level, a good treatment programme must always be holistic in nature and treat the tissues, the patient as a whole, and his or her environmental stressors and contingencies as well.

The treatment of contractures of the hand using self-hypnosis

The successful treatment of a man with severe posttraumatic contractures of the hand using a combined psychological and physical rehabilitation approach is reported. The contractures had functional and organic components, as did the treatment, which involved teaching the patient self-hypnosis exercises and the use of a splint. The patient obtained virtually complete return of movement after 3 1/2 years of total disability. The importance of identifying and mobilizing rather than challenging the patient's motivation for recovery using a rehabilitation approach is discussed. Hypnosis can facilitate recovery in such psychosomatic disorders in patients with the requisite hypnotic capacity and motivation.

Physical Medicine and Rehabilitation Approaches in Spinal Cord Injury

Physical Medicine and Rehabilitation Approaches in Spinal Cord Injury

Book Review: Physical Medicine and Rehabilitation Approaches in Spinal Cord Injury.

Book Review: Physical Medicine and Rehabilitation Approaches in Spinal Cord Injury.

Pott’s Disease during Pregnancy – A Physical Medicine and Rehabilitation Approach to Improve Function: A Case Report

Objective: To assess the role of physical medicine and rehabilitation (PM&R) in an interdisciplinaryteam approach in managing a pregnant woman with Pott’s disease.Methods: A 24 year-old female in her 31st week of pregnancy (G2P0A1) with a diagnosis ofC4 tetraplegia AIS C and accompanying problems such as, premature ruptured of membrane,spondylitis tuberculous, cardiovascular compliance changes, weakness of all limbs, sensory deficit,severely dependent ADL (Barthel Index 60), and moderate depression. She was managed by aninter-disciplinary team. The short-term goals were saving the infant, protecting the spinal cordand its function and improving the psychological condition. The ultimate rehabilitation goals wereindependent ambulation, independent ADL, which increases the quality of life and helping her getback to work. Rehabilitation management included cervico-thoracal orthoses with FELR control forvertebral immobilization, mobilization exercises, active breathing exercises, ROM exercises of allof her limbs, improving cardiovascular endurance and sensory re-education.Results: During conservative therapy, the patient used a cervical collar brace and tuberculous drugscategory 1 except streptomycin. A caesarean section was performed on May 24th, 2013, followedby operative decompression and vertebral stabilization procedure with a pedicle and screw 1 weekafter (May 31st, 2013). Afterwards, the patient used cervico-thoracal orthoses with FELR control forvertebral immobilization. The histologic examination showed granulomatous inflamation supportedSpondylitis tuberculous. Within 3 months of physical medicine and rehabilitation management,the Barthel Index, which was initially 60 (Severe dependent Activity Daily Living/ ADL), became100 (independent ADL). Physical Medicine and Rehabilitation management included mobilizationexercises, active breathing exercises, ROM exercises of all of her limbs, improving cardiovascularendurance and sensory re-education. Overall, the increased quality of life of this patient reflected thesuccessful inter-disciplinary team management.Conclusion: The PM&R approach in the interdisciplinary team resulted in an optimal functionalrecovery of the patient with Pott’s disease during pregnancy.Keywords: Pott’s disease, pregnancy, physical medicine and rehabilitation, function