Application Of Physiotherapy Research Articles

Extracorporeal shock wave treatment for shoulder calcific tendonitis: a systematic review

The treatment of patients with calcific tendonitis is typically conservative, including physical therapy, iontophoresis, deep friction, local or systemic application of noninflammatory drugs, needle irrigation-aspiration of calcium deposit, and subacromial bursal steroid injection. If the pain becomes chronic or intermittent after several months of conservative treatment, arthroscopic and open procedures are available to curette the calcium deposit, and additional subacromial decompression can be performed if necessary. As an alternative, minimally invasive extracorporeal shock wave therapy (ESWT) has been postulated to be an effective treatment option for treating calcific tendinitis of the shoulder, before surgery. Herein we discuss the indications, mechanism of therapeutic effect, efficacy of treatment, and complications after ESWT application.

Role of physiotherapy in peri-operative management in total knee and hip surgery

Knee osteoarthritis (OA) is often associated with pain, functional impairment and various degrees of disability. Physiotherapy in combination with both aerobic and strength training exercises have shown positive effects in both the pre-operative and post-operative period. At the initial stages of osteoarthritis, physical therapy and education can improve the functional outcome and the participation of patients in daily activities. In the case of OA progression and when an operation is the only effective treatment, physiotherapy is very useful in enhancing self-esteem and minimising depression and anxiety for the forthcoming surgery. Post-operative intense physical therapy and Continuous Passive Motion (CPM) application offer remarkable benefits in terms of faster recovery, shorter hospital stay and increase of range of motion. Furthermore, home-based excercises following discharge from the hospital should be encouraged in order to optimise the final result. Although the entire mechanism remains unclear, physical exercise protocols may be beneficial for patients and the health system alike.

Function of Thalamus and Application of Physical Therapy

Function of Thalamus and Application of Physical Therapy

Meralgia Paresthetica After Liver Transplantation: A Case Report

The focal neuropathies after orthotropic liver transplantation (OLTx) have been well documented to date. Most injuries to the peripheral nervous system involve the peroneal nerve and brachial plexus. We report the first case of lateral femoral cutaneous nerve (LFCN) injury after OLTx. The patient presented with pain and numbness on the lateral aspect of the right thigh that had progressively worsened since operation. Electrodiagnostic studies were indicative for right meralgia paresthetica (MP). The symptoms of MP improved progressively after physical therapy applications during the first 3 months. The etiology of MP in this case is unclear. However, it may be considered that ascites, surgical mechanisms, and immunosuppressive therapy were possible causative factors.

Evidence based physiotherapy in gynecology

Methodical aspects of evidence based physiotherapy application in gynecology are considered in the article. Basis of methodology and advantage of evidence based physiotherapy for the proof of medical effects, choice of treatment strategy (or preventive maintanance) in patients with gynecological diseases are presented. The actual base of controlled trials of medical physical methods have been made last years in gynecology, and the basic directions of practical use of principles of evidence based physiotherapy are presented.

Доказательная физиотерапия в гинекологии

Methodical aspects of evidence based physiotherapy application in gynecology are considered in the article. Basis of methodology and advantage of evidence based physiotherapy for the proof of medical effects, choice of treatment strategy (or preventive maintanance) in patients with gynecological diseases are presented. The actual base of controlled trials of medical physical methods have been made last years in gynecology, and the basic directions of practical use of principles of evidence based physiotherapy are presented.

The Comparison of Two Different Physiotherapy Methods in Treatment of Lymphedema after Breast Surgery

The aim of this study was to compare two different physiotherapy methods in the treatment of lymphedema after breast surgery. This study was performed on 53 patients who had developed unilateral lymphedema after the breast cancer treatment. Twenty-seven patients served as the experimental group and were treated with complex decongestive physiotherapy (CDP) applications including lymph drainage, multi layer compression bandage, elevation, remedial exercises and skin care. Twenty-six patients in the control group were treated with standard physiotherapy (SP) applications including bandage, elevation, head-neck and shoulder exercises and skin care. Both groups were recommended a home program consisting of compression bandage exercises, skin care and walking. Patients were taken to a therapy program once a day; 3 days a week for 4 weeks. The range of motion, circumferential measurement, and volumetric measurement were assessed before and after treatment. The overall improving in the CDP group was shown to be greater than the SP group but when the evaluation results of both groups were compared before and after treatment, a significant statistical difference in edema according to circumferential and volumetric measurements results was found in favor of the CDP group (p < 0.05). In the patients with upper extremity lymphedema, the shoulder mobility can be increased and edema can be decreased by the use of complex physiotherapy programs.

The effect of physical therapy on balance of patients with Parkinson's disease.

Physical therapy can improve performance of balance tests in patients with Parkinson's disease. Parkinson's disease is a chronic progressive neurological disturbance with significant effect on movements, cognitive functions, autonomous systems and psychosocial activities. The effects of physical therapy are rarely reported and not sufficiently studied. This prospective study comprised 40 persons with stage III Parkinson's disease, according to aged over 50 years and 20 healthy controls of the same age. Patients were medically stable and had no other neurological deficits, postural hypotensia, visual disturbances or musculo-skeletal deficits. Balance tests before and after physical therapy were analysed according to. Balance tests in patients with Parkinson's disease resulted in significant differences of values for tandem stance, one leg stance, step test and external perturbation when compared to the controls, and between groups with and without falling tendency. Tandem stance, one leg stance, step test and external perturbation can be used for differentiation between groups with and without a tendency to fall. Physical therapy resulted in significant improvement of these tests in both the groups analysed. Systematic application of physical therapy, as part of team treatment, improves the balance of patients with Parkinson's disease.

Can the Internet be used as a medium to evaluate knee angle?

Telemedicine promises to revolutionize medical care delivery in rural and remote areas. The ability to accurately evaluate physical impairment via the Internet is important to the possible future provision of Internet-based physiotherapy. This study evaluated the reliability and validity of assessing knee range of motion via the Internet. Two therapists evaluated knee angle on a single subject via two methods of assessment: the Internet and the traditional method (face-to-face). Nine random positions of the knee were chosen with the principal examiner performing 20 face-to-face and two sets of 20 Internet measures in each position ( n=540). The secondary therapist performed Internet assessments only. The Internet connection was established at a readily available speed of 17 kbit/s. The Internet-based goniometer was found to be a valid tool for measuring both knee flexion and extension angles. It was shown to possess both high intra and inter-rater reliability. Difference average plots of the scores verified the consistency of measurement between both modes of assessment. The successful evaluation of the physical outcome measure of knee range of motion via the Internet assists the further development of Internet-based physiotherapy applications.

Postoperative rehabilitation in patients with peripheral nerve lesions

Injuries of extremities can be followed by various neuromuscular complications. Injury of peripheral nerves directly depended on the topographic localization of injury (fractures, cuts, contusions). The neuromuscular complications were diagnosed and under follow-up, based on clinical, x-ray, neurologic and neurophysiological findings. The timing of physical treatment and assessment of the necessary neurosurgical intervention depended on the obtained findings. After surgeries, we continued to apply physical treatment and rehabilitation. The aim of the paper was to assess the significance of proper timing for surgery and adequate postoperative rehabilitation, as well as treatment results, depending on the extent of peripheral nerve injury. Based on the study condocted in the period from 2000-2002, most surgeries were done on the ulnar nerve (4 pts), median nerve (4 pts), radial nerve (3 pts), peroneal nerve (2 pts) and plexus brachialis (3 pts). Paresis and peripheral nerve paralysis, associated with sensibility disorders, predominated in clinical features. In most patients surgery was done during the first 3-6 months after injury. In early postoperative Postoperative rehabilitation in patients with peripherial treatment positioning of extremities with electrotherapy were most often used in early postoperative treatment, Bioptron and dosed kinesitherapy. Depending on the neurophysiological findings, in later treatment stage we included electrostimulation, thermotherapy, kinesitherapy and working therapy, with the necessary application of static and dynamic orthroses. Study results showed that the success of treatment depended on the extent of injury, i.e. whether suture of liberalization of the nerve had been done, on the adequate timing of surgery, as well as on the adequate timing and application of physical therapy and rehabilitation. More rapid and complete functional recovery was achieved if the interval between injury and surgery was shorter, as well as physical therapy was applied early. Based on the analysis of the achieved results, we concluded that peripheral nerve lesions after fractures and contusions had better prognosis in relation to isolated sections of peripheral nerves, having in mind that these were mostly conductive block transfer and nerve stretching lesion, which do not leave sequelae after completed treatment After neurorrhaphies and applied therapy, motor and sensitive deficit mostly depended on good timing of surgery and continual psychiatric treatment. It is also important to point out the significance of team-work among neurosurgeon, neurologist and psychiatrist necessary in early detection and successful treatment of numerous sequelae and invalidity in patients with peripheral nerve lesions.

Espasticidade

O distúrbio de maior frequencia das desordens do neurônio motor superior é a espasticidade, caracterizada por uma hiperexcitabilidade dos reflexos miotáticos e cutâneos que fomentam o tônus muscular (hipertonia espástica). O propósito deste estudo foi fazer um levantamento literário analisando os aspectos neurofisiológicos e musculares possivelmente envolvidos na espasticidade e como a Toxina Botulínica do tipo A (TBA) age no controle e redução da espasticidade. Os resultados encontrados na literatura demonstram claramente melhora no tônus muscular de pacientes submetidos ao uso da TBA. Os testes que combinam a TBA e Fisioterapia, prevaleceram aos grupos de controle que foram somente submetidos à Fisioterapia ou a aplicação de TBA isolados. Ademais, estudos recentes sugerem a presença da TBA em circuitos do sistema nervoso central, provavelmente conduzida via fluxo axoplasmático retrogrado e transcitose. Os mecanismos envolvidos na espasticidade são ainda pouco compreendidos e os efeitos da TBA a longo prazo em humanos ainda não são bem conhecidos. Por este motivo, novas pesquisas deverão ser realizadas a fim de verificar a viabilidade e segurança de tratamentos empregando esta substância de efeito letal em seres humanos.

Clinical Application of Physiotherapy with a Cognitive?behavioural Approach in Low Back Pain

The aim of this study was to investigate the effects of an integrated physiotherapy and cognitive-behavioural programme for a patient with persistent low back pain and disability. Outcome as well as comparison to a physiotherapy exercise programme was made in a controlled single-case format. The participant was a 41-year-old woman with an 18-month history of low back pain and increasing disability. The assessment involved physical function and exercise performance, disability, self-efficacy, life satisfaction and coping strategies. There were considerable improvements in performance of exercises as well as in resumed everyday activities during the integrated programme, as compared to the exercise programme. There were also marked improvements in standardized measures of disability, functional self-efficacy, and life satisfaction. All results were maintained at the 1-year follow-up. The results suggest that clinical integration of physiotherapeutic and cognitive-behavioural interventions was more effective...

Whole-body cryotherapy in rehabilitation of patients with rheumatoid diseases--pilot study

Cryotherapy as a whole-body cold therapy (with cold air cooled by addition of nitrogen blown on the patients in an open cabin) for treatment of inflammatory rheumatic diseases already started in Bad Säckingen in 1986. In 1996, a new cold chamber (this time a closed chamber without any addition of nitrogen) based on compressor technology was introduced. The aim of our study was to test whether significant pain relief could be achieved by means of this cold therapy. Furthermore, we were interested in the practicability and acceptance of this new technique. Wellbeing during the treatment application and pain level were assessed using verbal and numerical rating scales. The sample consisted of 120 consecutive patients (75% women, age: 30-67 yrs, M = 52.6 yrs). These patients were suffering from primary fibromyalgia (40.7%), rheumatoid arthritis (17.3%), chronic low back pain (16.4%), ankylosing spondylitis (10.9%), osteoarthritis (9.1%), secondary fibromyalgia (3.6%) and other autoimmune diseases (1.8%) (mean duration of symptoms: 4 yrs). The patients were treated 2.5 minutes on average in the main chamber (mean temperature: -105 degrees C). The patients' statements concerning their pain level were analyzed by means of analyses of variance with repeated measures and paired-sample t-tests. The pain level after application of the cold therapy decreases significantly. The pain reduction lasts about 90 minutes. The initial pain level decreases during the whole time of treatment, no significant improvement, though, can be shown from the middle to the end of the four-weeks treatment. According to the results of our study, there is evidence that the whole-body cold therapy generates important short-term effects and somewhat weaker effects over the treatment period as a whole. Short-term pain reduction facilitates intensive application of physiotherapy and Occupational Therapy. The treatment procedure is practicable, and all in all well tolerated. From the patients' point of view, whole-body cold therapy is an essential part of the rehabilitation programme.

Conservative treatment measures in hemophilic arthropathy

Intraarticular bleeding and muscle bleeding occur spontaneously or as a result of trauma in hemophilia A or B. The most common sites for hemarthrosis are the knees joints, elbows and ankles joints. Resorption of intraarticular blood induces reactive hemophilic synovitis. Hyperplasia of the synovium can be followed by recurrent bleedings. These early reactions can change to a chronic synovitis and cause cartilage damage, finally resulting in a complete destruction of the joint. Since 1981 158 adults and 61 children with a hemophilia A or B were treated at the Center for hemophilic disorders Frankfurt in an interdisciplinary approach. Consequent prophylactic treatment with factor substitution can prevent the incidence of severe hemarthrosis. Minor joint bleedings are treated by adequate factor substitution, temporarily non-weight bearing of the extremity, application of ice-packs and physical therapy. More severe joint hemorrhages should be aspirated in order to reduce the acute synovitis. This is followed by a consequent physical therapy (joint and soft tissue techniques) and anti-inflammatory drugs. The goal is a sufficient muscular balance of the joint, the improvement of the coordination, and the proprioception. The chronic synovitis is less painful and poorly responses to conservative interventions. Local ice application, sytemic and local anti-inflammatory treatment support the physical therapy. Soft heel shock absorber, elastic and semi-rigid bandages prevent recurrent bleeding episodes by shock absorption and decrease of synovial impingement. Synovectomy is indicated in cases of chronic persistent synovitis. Radiosynoviorthesis (RSO), which is an alternative in certain cases, has been performed with great success in 12 cases in our hospital. In advanced arthropathy joint mobilization should be the emphasis of the physical therapy. Bandages, crutches and ortopaedic shoe devices improve the walking capacity.

Conservative management of hemophilic arthropathy

Intraarticular bleeding and muscle bleeding occur spontaneously or as a result of trauma in hemophilia A or B. The most common sites for hemarthrosis are the knees joints, elbows and ankles joints. Resorption of intraarticular blood induces reactive hemophilic synovitis Hyperplasia of the synovium can be followed by recurrent bleedings. These early reactions can change to a chronic synovitis and cause cartilage damage, finally resulting in a complete destruction of the joint. Since 1981 158 adults and 61 children with a hemophilia A or B were treated at the Center for hemophilic disorders Frankfurt in an interdisciplinary approach. Consequent prophylactic treatment with factor substitution can prevent the incidence of severe hemarthrosis. Minor joint bleedings are treated by adequate factor substitution, temporarily non-weight bearing of the extremity, application of ice-packs and physical therapy. More severe joint hemorrhages should be aspirated in order to reduce the acute synovitis. This is followed by a consequent physical therapy (joint and soft tissue techniques) and anti-inflammatory drugs. The goal is a sufficient muscular balance of the joint, the improvement of the coordination, and the proprioception. The chronic synovitis is less painful and poorly responses to conservative interventions. Local ice application, systemic and local anti-inflammatory treatment support the physical therapy. Soft heel shock absorber, elastic and semi-rigid bandages prevent recurrent bleeding episodes by shock absorption and decrease of synovial impingement. Synovectomy is indicated in cases of chronic persistent synovitis. Radiosynoviorthesis (RSO), which is an alternative in certain cases, has been performed with great success in 12 cases in our hospital. In advanced arthropathy joint mobilization should be the emphasis of the physical therapy. Bandages, crutches and ortopaedic shoe devices improve the walking capacity.

Acute Respiratory Distress Syndrome: Pathophysiology, current management and implications for physiotherapy

Acute respiratory distress syndrome (ARDS) is an intensive care condition first described more than three decades ago. Recent advances in the understanding of its pathology and management are reviewed. Of particular relevance to physiotherapists are the characteristic metabolic, haemodynamic and respiratory consequences of ARDS. These have implications for physiotherapy practice as chest physiotherapy has been demonstrated to have metabolic, haemodynamic and respiratory effects. Application of chest physiotherapy may exacerbate or attenuate these effects. However, there is a lack of research in this area. On the other hand, body positioning has enjoyed much attention recently. The prone position is strongly advocated as an inexpensive alternative to new mechanical ventilatory modes in improving oxygenation. Despite a large body of research on ARDS, it continues to carry a mortality rate of up to 70%. Therefore, there is a need for continuing research efforts on investigating its response to various therapeutic and supportive measures.

Physiotherapy for patients with chronic pain: An operant-behavioural approach

The aim of this study was to demonstrate a physiotherapy application of operant-behavioural theoretical principles for patients with chronic pain. The goals of treatment from this theoretical orientation were to decrease pain behaviours and suffering and to improve function. The treatment programme incorporated members from a number of disciplines, including physicians, physiotherapists and psychologists, over the course of 3 weeks. Four female patients with intractable, heterogeneous chronic pain complaints comprised the sample. Each subject was studied in a single-case format, using a multiple-baseline design. Standardised measures of function, exercise tolerance and pain were collected the first, second and third week of treatment for each subject. The data were analysed graphically. Clinically significant reductions in degree of suffering were noted for three subjects; pain intensity either increased or remained constant for all subjects. There were improvements in several of the function and exercise tolerance measures for three subjects between the first and third week measurements. The results of these case studies demonstrate the potential and efficacy of applying operant-behavioural principles to physiotherapy for reduction of suffering and improvement in physical functioning.

Biobehavioral factors affecting pain and disability in low back pain: mechanisms and assessment.

Patients with recurrent or persistent low back pain (LBP) and disability represent a formidable challenge to physical therapists. Classic models of disease and pain mechanisms do not adequately explain the commonly observed discrepancies between the extent of pathology and reported pain, or the level of pain and disability. Research over the past decade that considers the interactive role of biological, environmental, and psychological processes in pain and disability has supported the involvement of a number of biobehavioral factors in these conditions. Physical therapists and other health care providers have become more aware of these factors and their impact on the evaluation, treatment, and management of LBP. Despite this recognition, little information is available that translates the implications of this research to direct care within physical therapy practice. The purposes of this article are (1) to provide an operational definition of biobehavioral factors; (2) to review the role of these factors in the clinical presentation of LBP, functional limitation, and disability; (3) to identify commonly used approaches for their recognition and quantification; (4) to illustrate how an understanding of biobehavioral factors can assist the physical therapist in evaluation and treatment of patients with LBP; and (5) to identify certain gaps in current knowledge of the role of biobehavioral factors and their application in physical therapy. Given the central role assumed by many physical therapists in the management of LBP, acknowledging and addressing these factors in clinical practice should assist in the prevention of chronic LBP and disability, as well as potentially improve physical therapy interventions and management.

A survey of the prevalence and application of chest physical therapy in U.S. burn centers.

The purpose of this study was to determine the prevalence and application of chest physical therapy (CPT) in burn centers. Respiratory therapists primarily administered CPT, and suctioning and coughing were the most frequently used modalities. Further study of the efficacy of treatment techniques is needed to develop congruous standards for CPT after a burn injury.

Discordance Between Cardiopulmonary Physiology and Physical Therapy

Discordance Between Cardiopulmonary Physiology and Physical Therapy