Rehabilitation Practice Research Articles

Current views on preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia: An online-based cross-sectional survey.

Preoperative rehabilitation is an important stage to both physically and mentally prepare patients for anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation. This study aimed to investigate the current preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia. This was an online-based cross-sectional survey. A total of 114 physical therapists completed the survey. The survey consisted of 16 mandatory questions about management strategies, prescribed exercises, patients' physical and psychological concerns, and discussions about nonoperative management. The majority of the respondents used the following preoperative interventions: education (89.5%), closed kinetic chain exercises (66.7%), stretches (63.2%), open kinetic chain exercises (61.4%), proprioceptive exercises (59.6%), cold (56.1%), and activity modification advice (52.6%). More than half of the respondents would recommend patients awaiting ACLR to complete the exercises 2 to 4 times weekly (56.1%) for up to 8 weeks (80.7%) before ACLR. The respondents (73.7%) reported that patients awaiting ACLR did not receive preoperative rehabilitation due to 2 primary factors: the orthopedic team did not refer patients to rehabilitation specialists, and there was a lack of awareness about preoperative rehabilitation. Most therapists (86%) would discuss conservative management if a patient returned to their preinjury level of function before surgery. The surveyed physical therapists reported using various interventions and preoperative rehabilitation lengths with patients awaiting ACLR. The majority of the therapists indicated that patients awaiting ACLR did not receive preoperative rehabilitation. Future studies are needed to establish a consensus on the optimal preoperative rehabilitation program.

The Priority Goals and Underlying Impairments Contributing to Goal-Related Problems of People with Parkinson's Disease Receiving a Community-Based Rehabilitation Program.

Goal setting is a core rehabilitation practice in Parkinson's disease (PD). Targeting therapy towards specific goals leads to greater improvements in performance and psychosocial outcomes. Goal setting in PD is feasible, and although the nature of goals has been described in previous studies, the underlying impairments related to goals have not been described. Understanding the nature of goals ensures that interventions for people with PD are aligned with their needs and priorities. Understanding the underlying impairments highlights which symptoms have the biggest impact on daily life and is necessary for planning appropriate interventions to target them. To describe the nature of the goals of people with PD; the underlying impairments related to goals; and to compare differences between high and low priority goals. Deductive content analysis was used to map goal statements to the international classification of function (ICF) activity and participation category and to map therapist field notes detailing the primary underlying impairment to the ICF Body Functions category. These results were then compared across goal priority rankings. 88 goals of 22 people with PD were analysed. We found that people with PD set diverse goals across all chapters of the ICF Activity and Participation category, with "self-care" goals making up the highest proportion of goals. The primary underlying impairment related to the goals was predominantly related to impairments in "mental functions" under the Body Functions category. Regardless of goal priority, most goal-related underlying impairments were found to be in the "mental functions" category. The goals of this sample of community-dwelling people with PD highlight their diverse needs and priorities. These findings indicate that nonmotor symptoms, namely, executive dysfunction and amotivation most commonly impact the performance of and participation in activities of greatest importance to people with PD. This trial is registered with ACTRN12621001483842.

Representation of child and youth participation within the Unified Medical Language System (UMLS)

Purpose To examine (1) how much participation is represented in the benchmark Unified Medical Language System (UMLS) resource, and (2) to what extent that representation reflects the definition of child and youth participation and/or its related constructs per the family of Participation-Related Constructs framework. Materials and methods We searched and analysed UMLS concepts related to the term “participation.” Identified UMLS concepts were rated according to their representation of participation (i.e., attendance, involvement, both) as well as participation-related constructs using deductive content analysis. Results 363 UMLS concepts were identified. Of those, 68 had at least one English definition, resulting in 81 definitions that were further analysed. Results revealed 2 definitions (2/81; 3%; 2/68 UMLS concepts) representing participation “attendance” and 18 definitions (18/81; 22%; 14/68 UMLS concepts) representing participation “involvement.” No UMLS concept definition represented both attendance and involvement (i.e., participation). Most of the definitions (11/20; 55%; 9/16 UMLS concepts) representing attendance or involvement also represent a participation-related construct. Conclusion(s) The representation of participation within the UMLS is limited and poorly aligned with the contemporary definition of child and youth participation. Expanding ontological resources to represent child and youth participation is needed to enable better data analytics that reflect contemporary paediatric rehabilitation practice.

Botulinum toxin A injection for post-stroke upper limb spasticity and rehabilitation practices from centers across Asian countries.

Describe real-life practice and outcomes in the management of post-stroke upper limb spasticity with botulinum toxin A (BoNT-A) in Asian settings. Subgroup analysis of a prospective, observational study (NCT01020500) of adult patients (≥18 years) with post-stroke upper limb spasticity presenting for routine spasticity management, including treatment with BoNT-A. The primary outcome was goal attainment as assessed using goal-attainment scaling (GAS). Patients baseline clinical characteristics and BoNT-A injection parameters are also described. Overall, 51 patients from Asia were enrolled. Rates of comorbid cognitive and emotional problems were relatively low. Patients tended to have more severe distal limb spasticity and to prioritize active over passive function goals. Most (94.1%) patients in the subgroup were treated with abobotulinumtoxinA. For these patients, the median total dose was 500 units, and the most frequently injected muscles were the biceps brachii (83.3%), flexor carpi radialis (72.9%), and flexor digitorum profundus (66.7%). Overall, 74.5% achieved their primary goal and the mean GAS T score after one treatment cycle was 56.0 ± 13.0, with a change from baseline of 20.9 ± 14.3 (p < 0.001). The majority (96.1%) of Asian patients were rated as having improved. In the Asian treatment setting, BoNT-A demonstrated a clinically significant effect on goal attainment for the real-life management of upper limb spasticity following stroke.

The Design of a Speech Recognition-Based Finger Training Rehabilitation Device: Mechanical and System Aspects

This research introduces a novel speech recognition-based control system for finger rehabilitation aimed at addressing the inefficiencies and prolonged recovery periods commonly associated with traditional stroke rehabilitation methods. The system enables stroke patients to engage in finger exercises while simultaneously providing real-time feedback on the finger's angle, speed, and position. This feedback is invaluable for rehabilitation physicians, offering critical data for assessing and refining rehabilitation strategies. The system architecture is composed of three main components: the hardware circuitry, a lower-level computer control system, and a voice recognition-based human-computer interaction system, all integrated with a finger movement perception system. Employing the Hidden Markov Model (HMM) for pattern recognition in the voice interaction component, the system has undergone simulation testing to verify its effectiveness. The findings confirm that the speech recognition-based rehabilitation training system meets all design expectations, providing a safe, reliable, and promising approach for enhancing finger rehabilitation practices.

Assessment of rehabilitation practices during hematopoietic stem cell transplantation in the United States: a survey.

Rehabilitation therapy is important to treat physical and functional impairments that may occur in individuals receiving physically taxing, yet potentially curative hematopoietic stem cell transplants (HSCT). However, there is scarce data on how rehabilitation is delivered during HSCT in real-life setting. Our objective is to assess the rehabilitation practices for adult patients hospitalized for HSCT in the United States. A 48-question online survey with cancer centers with the top 10% HSCT volumes (per American registries). We obtained data on patient characteristics, rehabilitation therapy details (timing, indication, administering providers), physical function objective and subjective outcome measures, and therapy activity precautions. Fourteen (out of 21) institutions were included. Rehabilitation therapy referrals occurred at admission for all patients at 35.7% of the centers for: functional decline (92.9%), fall risk (71.4%), and discharge planning (71.4%). Participating institutions had physical therapists (92.9%), occupational therapists (85.7%), speech language pathologists (64.3%) and therapy aides (35.7%) in their rehabilitation team. Approximately 71% of centers used objective functional measures including sit-to-stand tests (50.0%), balance measures (42.9%), and six-minute walk/gait speed (both 35.7%). Monitoring of blood counts to determine therapy modalities frequently occurred and therapies held for low platelet or hemoglobin values; but absolute neutrophil values were not a barrier to participate in resistance or aerobic therapies (42.9%). Rehabilitation practices during HSCT varied among the largest volume cancer centers in the United States, but most centers provided skilled therapy, utilized objective, clinician and patient reported outcomes, and monitored blood counts for safety of therapy administration.

Rehabilitation Practices Not Maximized

Rehabilitation Practices Not Maximized

Adaptive Position Constrained Assist-as-Needed Control for Rehabilitation Robots

In rehabilitation practice, motivating patients with neurological injuries to actively increase muscle activity and ensure their safety are important. Therefore, this study proposed a position-constrained assist-as-needed (AAN) control method for rehabilitation robots. A human-robot interaction system with position constraints was first established based on prescribed performance. Aiming at implementing the AAN strategy, the robot assistance level metric (RALM), a constructed global continuous differentiable function incorporating dead-zone and saturation characteristics, was introduced to quantify the robotic assistance and facilitate seamless operation. To bridge the gap between the position constraints and the AAN strategy, a sliding manifold was constructed for the constrained human-robot dynamic system, where RALM was regarded as a weight factor to achieve a human-dominated mode, a robot-dominated mode, and their smooth transition, regarded as a human-robot shared mode. The stability of the closed-loop system was guaranteed by using the Lyapunov theory, and the proposed controller was verified by several physical experiments on a knee exoskeleton driven by pneumatic muscles (PMs).

Sport-based psychosocial interventions for people suffering from severe mental disorders: EASMH pilot actions from 4 European Countries

IntroductionThe European Alliance for Sport and Mental Health (EASMH) is a partnership of scientific institutions, charity associations and sport organizations, funded by EU-Erasmus+. It aimed at developing good clinical practice in psychiatric rehabilitation through sport-based interventions as an integration of pharmacological and psychological therapies. Within the framework of the EASMH projects, several actions have been promoted including an assessment of the dissemination of sport-based interventions, a training course for specialized coaches and the implementation of pilot actions in four European Countries.ObjectivesTo briefly describe EASMH pilot actions performed in Finland, Italy, Romania and United Kingdom, where trained coaches delivered sport-based interventions to patients with severe mental disorders.MethodsAfter completing pilot actions, charity associations and sport organizations belonging to EASMH network described general and specific aims, sport activities, composition of staff, timing and tools for assessing the outcomes.ResultsIn Italy, “Crazy for Rugby”, including adolescents and young patients, and “Not only headshots”, a football project for adults with severe mental disorders were performed. In UK, a football-based activity called “Imagine Your Goal” and a walking-football program for participants aged more than 40 were delivered. In Romania, two courses including gymnastics, yoga and pilates called “Get fit!” were provided. Different team sport-based activities were implemented in Finland, where “Multiple Sport Group” and “Rehabilitating Sports” aimed at increasing patients’ autonomy. Assessment of psychopathological, social, cognitive and sport/fitness outcomes confirmed the overall beneficial effects of sport on mental health.ConclusionsPilot actions represent the final step of EASMH project, which showed improvement of mental health outcomes by also delivering sport-based rehabilitation to patients with severe mental disorders. Institutions and stakeholders are now called to promote the implementation of such initiatives on a broader scale.Disclosure of InterestNone Declared

Effectiveness of the online-based comprehensive cognitive training application, Smart Brain, for community-dwelling older adults with dementia: a randomized controlled trial.

The fourth industrial revolution has brought about developments in information and communication technologies for interventions in older adults with dementia. Currently, most interventions focus on single interventions. However, community-dwelling older adults with dementia require comprehensive cognitive interventions, and clinical studies analyzing the effects of comprehensive interventions based on randomized controlled trials are lacking. The aim of the study was to examine the effects of an information and communication technology-based comprehensive cognitive training program, Smart Brain, on multi-domain function among community-dwelling older adults with dementia. This was a two-group, randomized, controlled trial. This study was conducted at participant's home. We analyzed older adults with dementia. Participants were randomly allocated to either the intervention group (N.=30) or the control group (N.=30). Older adults with dementia in the intervention group received 8 weeks of Smart Brain comprehensive cognitive training using a tablet, whereas the control group received a similar tablet but without the training. We measured the outcomes at baseline, and at 4 and 8 weeks. Cognitive function, depression, quality of life, balance confidence, physical ability, nutrition, and caregiver burden were compared between groups. In the intervention group, cognitive function statistically increased from baseline to both week 4 (2.03; 95% CI 1.26 to 2.81) and week 8 (2.70; 95% CI 1.76 to 3.64). Depression was statistically different from week 0 to week 8 (-1.67, 95% CI -2.85 to -0.48). Physical ability statistically increased from baseline to both week 4 (-0.85; 95% CI 1.49 to -0.20) and week 8 (-1.44; 95% CI -2.29 to -0.59). Nutrition statistically increased from baseline to both week 4 (0.67; 95% CI 0.05 to 1.28) and week 8 (1.10; 95% CI 0.36 to 1.84). Smart Brain significantly improved cognitive function, reduced depression, and enhanced physical and nutritional status in older adults with dementia. This demonstrates its potential as an effective non-pharmacological intervention in community-based dementia care. Smart Brain's personalized approach, which integrates user-specific preferences and expert guidance, enhances engagement and goal achievement in dementia care. This enhances self-esteem and clinical outcomes, demonstrates the application's potential to innovate rehabilitation practices.

Rehabilitation for adult patients undergoing extracorporeal membrane oxygenation.

Current information on the latest rehabilitative practices is limited, with previous reviews only covering data up to October 2021, and some considering only patients on awake ECMO or with COVID-19. This review aims to present a concise overview of the latest findings on rehabilitation and highlight emerging trends for patients undergoing ECMO support. This integrative review was conducted by searching the National Library of Medicine - PubMed database. Two different search strings "extracorporeal membrane oxygenation" AND "rehabilitation" and "extracorporeal membrane oxygenation" AND "physiotherapy" were used to search the published literature. Articles that did not describe rehabilitation techniques, editorials, conference proceedings, letters to editor, reviews and research protocols were excluded. Studies conducted on pediatric populations were also excluded. The search process was completed in December 2023. Thirteen articles were included in the final analysis. Eight hundred and thirty-nine patients aged between 27 and 63years were included; 428 were men (51%). In 31% of the included studies, patients had COVID-19; nevertheless, rehabilitative activities did not differ from non-COVID-19 patients. In most studies, rehabilitation commenced within the first 48-96h and consisted of progressive exercise and out-of-bed activities such as sitting, standing and walking. Current practice focuses on rehabilitative protocols that incorporate exercise routines with progressive intensity, greater emphasis on out-of-bed activities, and a multidisciplinary approach to patient mobilization.

Yaşlanmada Bilişsel Egzersiz ve Rehabilitasyon

Aging is a life stage in which progressive deterioration occurs in biological, psychological, and socio-cultural processes. Therefore, along with all the other changes observed in aging, cognitive change is inevitable. In older adulthood, the speed of processing information, the ability to remember contextual information such as where and when events occur, and executive function performance are impaired. Moreover, this change in cognitive processes causes the deterioration of functionality in daily life. Although it is well known that physical activity, nutrition, and social support play a key role in preventing the adverse effects of aging, the impact of cognitive training and rehabilitation have been relatively less studied. This review aims to examine cognitive training and rehabilitation practices applied to different cognitive processes (episodic memory, working memory, executive functions, attention and processing speed) to help compensate for or regain cognitive functions that are impaired in older adults. In this context, the effectiveness of the practices, the transfer of gains to different cognitive areas, and whether they are preserved for long periods were examined. The contribution of conscious and systematic practices, such as cognitive training and rehabilitation, in reducing the adverse effects of aging has been discussed.

Fantasy football points capture performance declines in National Football League offensive skill players following an ankle injury

BackgroundThe ankle is one of the anatomic sites most frequently injured in National Football League (NFL) players. Ankle injuries have previously been shown to have long-lasting negative impacts, and have been associated with impaired athletic performance. The aim of this study was to use fantasy football points as a metric to evaluate the impact of ankle injuries on NFL offensive skill player performance. MethodsAn open-access online database was used to identify NFL players who sustained ankle injuries from 2009 to 2020. Another public online database was used to determine fantasy points and other performance metrics for injured offensive skill players in the seasons before and after their ankle injury. Injured players were matched to a healthy control by position, age, and BMI. Paired T-tests were performed to evaluate performance metrics before and after the ankle injury. An ANCOVA was performed to assess the effect of return to play (RTP) time and injury type on fantasy performance. Results303 players with ankle injuries were included. Fantasy output, including average points per game (PPG) and total fantasy points accrued in one season, significantly decreased in the season following a player's ankle injury (p < 0.0001). In running backs, tight ends, and wide receivers, performance significantly decreased in every metric evaluated (p < 0.0001). In quarterbacks, there was no significant change in performance, except for a decrease in the number of games played (p = 0.0033) and in the number of interceptions thrown (p = 0.029). ConclusionAssessing fantasy football output revealed a decrease in player performance in the season following an ankle injury, especially in route-running players. These results can be used to inform injury prevention and rehabilitation practices in the NFL.

Comparative global analysis of stroke rehabilitation recommendations across income levels

ObjectiveSuccessful implementation of stroke rehabilitation guidelines demands high-quality practice standards tailored to targeted sociodemographic contexts. The primary objective is to determine the quality differences in post-stroke rehabilitation practice guidelines (PGs), when comparing high-income countries (HIC) and low or middle-income countries (LMIC). Study Design and SettingWe conducted a scoping review of PGs in English or Spanish, published between 2012 and 2021, and providing recommendations on post-stroke rehabilitation. We used Search engines, databases, guideline libraries, gray literature, and references from previous reviews on post-stroke rehabilitation as sources of evidence. Quality assessment of PGs was performed using 6P’s, ELSE, IOM, and AGREE II instruments. We evaluated each item using a scale between 0 to 3, based on the confidence of adherence to the standard. For AGREE II, we followed the instruction manual for scoring. At least two reviewers were independently involved in every step of the process. A cloud-based spreadsheet was used to chart data. We compared the results of PGs originating from HIC with those from LMIC. ResultsThe inclusion criteria were met by 35 documents, which were subjected to evaluation. The study included 21 documents from HIC and 14 from middle-income countries (MIC). No manuscripts from low-income countries were available for inclusion in the study. The quality of PGs from MIC was found to be lower, in terms of methodological rigor and adherence to international recommendations for guidelines development. PGs from both groups of countries failed to include all target audiences and stakeholders (according to the 6P’s criteria) and integration of ethical, legal, social, and economic considerations. ConclusionThere are gaps in the quality and availability of stroke rehabilitation guidelines worldwide, especially in LMIC. Designing and providing financial support for the implementation of high-quality guidelines will contribute to more effective implementation strategies in stroke rehabilitation programs and lead to improved patient outcomes.

Photographic narrative as a factor in overcoming witness trauma

The research aims to explore the multifunctional potential of photography in overcoming the traumatic experience of witnessing violence and brutality. The paper presents how photography can be used in rehabilitation practices for those who have lived through war. It outlines the tendencies of the modern digital information environment (cross-media, interactivity) that enhance the "restorative" functions of photography in overcoming psycho-emotional and socio-cultural crisis reactions.&#x0D; It has been found that photography’s narrative nature can enhance the viewer’s experience of interacting with their emotions and memories, while also providing a therapeutic effect by mitigating the pain of reflecting on cruelty. The article uses examples of war-related content to demonstrate how storytelling technology can provide a variety of tools for audience participation in the development of collective restorative experiences, particularly through photographic flash mobs.&#x0D; The structural-functional method was used to work with factual material and identify the role of war photography in the discourse of trauma/post-trauma, clarifying its therapeutic potential. It is well-established that photographs can serve as a means of recording and providing evidence of a crime, facilitating the expression of collective identity and social cohesion. Similarly, the sharing of unprofessional, user-generated visual content on social media can be seen as a form of testimony that elicits strong public reactions. Photography plays a key role in helping people to go through the grieving process by perpetuating and honouring the dead, constructing ‘places of memory’ and ‘portraits of grief’.&#x0D; The study aims to determine the role of photography in shaping the visual environment, in which the act of ‘seeing’ constructs a system of restorative practices to overcome the negative psycho-emotional consequences of traumatic events provoked by war.

The carbon footprint of epidural steroid injections: A pilot study.

Epidural steroid injections are common procedures in physical medicine and rehabilitation practice. However, their environmental impact has not been characterized. The primary aim is to estimate and compare the carbon footprint of two standard injection kits used to perform epidural steroid injections at a single academic institution. Secondary objectives were (1) to create a step-by-step guide for estimating the carbon footprint of materials and (2) to survey physicians on practice patterns and identify areas for improvement. Pilot study. Academic medical center. N/A. N/A. Carbon emissions measured in CO2 equivalents (CO2 eq). Using guidance from the Greenhouse Gas Protocol, the carbon footprint of the two kits was estimated by taking the sum of carbon emissions resulting from the production of the kit materials and the carbon emissions resulting from the waste disposal of the kit materials. The carbon footprint of the transforaminal epidural steroid injection (TFESI) kit was estimated at 1.328 kg CO2 eq. The carbon footprint of the interlaminar epidural steroid injection (ILESI) kit was estimated at 2.534 kg CO2 eq. For both kits, the carbon emissions resulting from the production of the kits were greater than the emissions resulting from disposal. The survey of interventionalists performing TFESI revealed all respondents required materials in addition to those provided in the standard epidural kit. Despite this, kit materials were typically wasted in 62% of respondents. Creating a methodology for quantifying carbon emissions is the first step to reducing carbon emissions. Once emissions are measured, the health care industry can determine the most effective strategies for reducing its impact. Our analysis has shown that it is feasible to perform emissions calculations and delineates a clear method with publicly available resources. Solutions to reduce epidural injection carbon footprint waste may include improved kit customization.

Pilot study: Effect of Developmental Dysplasia of the Hip on the Gait and Feet Posture

Background: The objective of this pilot study was to assess the effect of Developmental Dysplasia of the Hip (DDH) on gait, in pediatric participants, between the age of one to four years. Few studies are investigating the effect of DDH on the walking pattern within the pediatric rehabilitation practice. From an early age, children are developing a longitudinal foot arch. Constantly changing pediatric foot posture must be assessed. Gait pattern and foot posture are one of the most common parental concerns.&#x0D; Methods: The retrospective review of gait analysis, performed on 410 lower limbs, took place in King Abdullah Specialized Children Hospital (KASCH) in Riyadh, Kingdom of Saudi Arabia, from April 2020 until September 2020. All participants were diagnosed with DDH by pediatric orthopedics physicians in KASCH. Gait analysis was done by a physical therapist twice within three months, using The Wee Glasgow Gait Index (WeeGGI) and foot assessment was done once using Foot Postural Index (FPI-6). The WeeGGI compares eleven gait parameters. Each parameter has a choice of three figures, where each one has a clear explanation and/or value. The FPI-6 evaluates the foot as multi-segmental complex, in double leg support, characterizing pronation with + (plus) and supination with - (minus) numbers. Scoring is 2 (two) points in all six factors it is divided into rearfoot and forefoot assessment in transverse, frontal/transverse, frontal, and sagittal planes.&#x0D; Results: From all gait analyses (n=410). We included only 292 (71%) lower limbs with DDH and had to exclude 60 (15%) after hip surgery, 30 (7%) with another diagnosis, 18 (4%) without conservative treatment of DDH, and 10 (3%) with age above 48 months. According to the scoring of the Wee Glasgow Gait Index within the optimum/normal limits (score 0 - zero), we had 50 (17%), mild deviation (score 1-11) 236 (81%), and gross deviation (score 12-22) had 6 (2%) limbs within first gait analysis. With second gait analysis, 40% of lower limbs were within optimum/normal limits, 60% with mild deviation in gait, and zero within gross deviation. Every limb assessment for gait had the Foot Postural Index as well. Within normal limits (0 till +5) we had 143 (49%) feet, pronation (+6 till +9) was presented in 97 (33%) and high pronation (more then +10) had 52 (18%) pediatric feet. This sample did not present supination (-1 till -4) or high supination (-5 till -12). Limping was observed within 102 (35%) of the legs. The frequency of W-sitting presented in 47% of the results. The first and second gait analysis suggest an effect of DDH on the gait with a small difference between the right and left leg, although the left side was affected more within both gait analyses.&#x0D; Conclusion: Pathological gait pattern with DDH was detected in 83% within the first gait analysis, 60% within the second gait analysis, and Foot Postural Index revealed pronation of 51% feet. Among Saudi participants, a relatively high effect of DDH on gait patterns is reported in this pilot study.&#x0D; Keywords: DDH, gait, FPI-6, physiotherapy, WeeGGI.

Characterizing clinical patterns of physical therapy activities for post-stroke spasticity in stroke rehabilitation: looking into the "Black Box".

Physical therapy is considered to be an adjunctive therapy for the management of post-stroke spasticity. The insight of this study is to observe the current clinical practices of rehabilitation for post-stroke spasticity. For this purpose, an observational cross-sectional study was conducted. Data was collected by a standardized therapy documentation form for spasticity management. Fifty physiotherapists filled out that form. Almost all of them used subjective measures (modified Ashworth scale) for spasticity assessment and functional independence measure for level of independence. Readings were taken in the first, second, and third blocks of six-hour duration. Results showed that 42 (83.5%) physiotherapists measured spasticity at the initial session, while 47(94.6%) reported various multiple rehabilitation treatment preferences for spasticity management. Disparities exist in therapeutic management for post-stroke spasticity throughout rehabilitation which are mainly based on physiotherapists' clinical expertise. However, a better understanding of current trends in physical therapy clinical practices will assist in tailoring strategies to upgrade management for post-stroke spasticity.

Development of a full-Scale approach to predict overlay reflective crack

ABSTRACT Resurfacing a moderately deteriorated Portland cement concrete (PCC) pavement with asphalt concrete (AC) layers is considered an efficient rehabilitation practice. However, reflective cracks may develop shortly after resurfacing because of discontinuities (e.g. joints and cracks) in existing PCC pavement. In this paper, a new accelerated full-scale testing approach was developed to study reflective crack growth in AC overlays. Two hydraulic actuators were used to simulate a moving dual-tire assembly with a loading rate of more than five-thousand-wheel passes per hour. A load cycle consists of three steps, simulating a tire approaching, moving across, and leaving a PCC discontinuity. Experiments were conducted to compare the reflective crack behaviour of two overlay configurations. Both test sections were fully cracked in less than an hour. The initiation and propagation of reflective cracks were explicitly documented using crack detectors in conjunction with a camera. The proposed full-scale testing protocol offers a repeatable and efficient approach to systematically investigate the effects of various overlay configurations, thus enabling the identification of optimal design against reflective cracking.

Post-Caesarean Rehabilitation: Evaluation Of Practices

Background: Early Rehabilitation, "Fast-Track Surgery," or Enhanced Recovery After Surgery (ERAS) protocols have shown significant benefits in various surgical procedures, including caesarean sections. These protocols aim to expedite recovery, reduce hospital stays, and minimize complications through a multidisciplinary approach. Despite their proven effectiveness, the implementation of such protocols in post-caesarean recovery remains uneven and warrants further investigation. Objective: This study aims to evaluate the current practices of early post-caesarean rehabilitation, focusing on pain management, early nutritional intake, mobilization, and mother-child bonding to identify gaps and opportunities for improvement. Methods: A prospective observational multicenter study was conducted between January and April 2021 at the Maternity and Neonatology Center of Tunis and the Principal Military Hospital of Tunis. The study involved 170 parturients undergoing caesarean section under spinal anesthesia, excluding those with contraindications. Data were collected using a standardized form, covering demographic details, medical history, surgical and anesthesia details, and post-operative recovery metrics, including pain assessment (VAS scores), timing of first oral intake, mobilization, and mother-child bonding. Statistical analysis was performed using SPSS version 25. Results: The average age of parturients was 30 ± 5 years. A majority (73%) of caesarean sections were planned, with surgery durations mostly within one to two hours. Post-operative pain management revealed that 73% of parturients reported a VAS ≤ 2 at the 3rd hour, but 77% experienced a VAS ≥ 4 by the 6th hour. Early oral intake was initiated by 66% of parturients before the 6th hour for liquids and before the 12th hour for light meals. The urinary catheter was removed before the 12th postoperative hour in 56% of cases. Early mobilization was achieved by 67% of parturients before the 12th hour, and 82% were breastfeeding naturally, with 79.7% satisfaction with care. Conclusion: The study highlights the partial implementation of ERAS protocols in post-caesarean recovery, pinpointing areas for improvement, particularly in pain management, early oral intake, and mobilization. A standardized approach to early post-caesarean rehabilitation could significantly enhance maternal and neonatal outcomes, reduce complications, and improve patient satisfaction.