Proper Rehabilitation Program Research Articles

An Extraordinary case report: Bilateral pure perilunate dislocation

Introduction: Perilunate dislocation of the carpus is an unusual injury, requiring high-energy trauma. The simultaneous bilateral form is so rare that is worthy of report, with only a few cases mentioned in the literature. We present the case of a patient with an open volar dislocation of the right wrist associated with a closed dorsal dislocation of the left wrist and distal radioulnar subluxation. Case report: A 30-year-old, right hand dominant male, suffered injuries to both wrists after being involved in a high-speed car accident. Examination of the patient revealed diffuse swelling and tenderness to both wrists with a lacerated wound over the dorsum of right wrist. Anteroposterior and lateral X-rays of both wrists were obtained, which showed bilateral perilunate pure dislocations: volar in the right side and dorsal the left side combined with a dorsal subluxation of the distal radioulnar joint. Discussion: Perilunate dislocations are relatively rare injuries involving approximately only 7% of all injuries of the carpus. It is often overlooked in primary evaluations, approximately 25% of perilunate injuries were missed. A better comprehension of the injury's mechanism and its full extent has led to better management strategies. It is recommended in the literature, that the best treatment of these injuries is open reduction, restoration of carpal bones relationship, repair of the ligaments and a proper rehabilitation and physiotherapy program.

Swimming Anatomy and Lower Back Injuries in Competitive Swimmers: A Narrative Review.

Competitive swimmers are at high risk of overuse musculoskeletal injuries due to their high training volumes. Spine injuries are the second most common musculoskeletal injury in swimmers and are often a result of the combination of improper technique, high loads on the spine in strokes that require hyperextension, and repetitive overuse leading to fatigue of the supporting trunk muscles. The purpose of this review is to summarize the current evidence regarding swimming biomechanics, stroke techniques, and common injuries in the lumbar spine to promote a discussion on the prevention and rehabilitation of lower back injuries in competitive swimmers. From a PUBMED/MEDLINE search, 16 articles were identified for inclusion using the search terms "swimming," "low back" or "lumbar," and "injury" or "injuries." Narrative review. Levels 4 and 5. The trunk muscles are integral to swimming stroke biomechanics. In freestyle and backstroke, the body roll generated by the paraspinal and abdominal muscles is integral to efficient stroke mechanics by allowing synergistic movements of the upper and lower extremities. In butterfly and breaststroke, the undulating wave like motion of the dolphin kick requires dynamic engagement of the core to generate repetitive flexion and extension of the spine and is a common mechanism for hyperextension injuries. The most common lower back injuries in swimming were determined to be lumbar strain, spondylolysis and spondylolisthesis, facet joint pain, and disc disease. Most overuse swimming injuries can be treated conservatively with physical therapy and training adjustments. Managing swimmers with low back pain requires a basic knowledge of swimming technique and a focus on prevention-based care. Since most swimming injuries are secondary to overuse, it is important for providers to understand the mechanisms underlying the swimming injury, including an understanding of the biomechanics involved in swimming and the role of spine involvement in the 4 strokes that assist in stabilization and force generation in the water. Knowledge of the biomechanics involved in swimming and the significant demands placed on the spinal musculoskeletal system will aid the clinician in the diagnosis and management of injuries and assist in the development of a proper rehabilitation program aimed at correction of any abnormal swimming mechanics, treatment of pain, and future injury prevention. B. Recommendation based on limited quality or inconsistent patient-oriented evidence.

Short-Term and Long-Term Therapeutic Results of Deep Flexor Tendon Repair in Zone II in Patients Referred to Imam Khomeini Hospital, Ahvaz, Southern Iran.

Hand injury as an important concern for the surgeon and the patient requires proper and timely treatment to prevent complications such as infection and adhesions, and with a proper rehabilitation program, the patient returns to maximum function as soon as possible. We aimed to investigate the short-term and long-term treatment results of deep flexor tendon repair in in zone II. This retrospective study was performed on 34 patients with 45 injured fingers in the zone II referred to Ahvaz Imam Khomeini Hospital, Ahvaz, Iran during 2017-2019. The results of deep flexor tendons repair in two groups, immediate and delayed primary repair were assessed. The mean age of the patients was 27.76 years. There was no significant remarkable between male and female in the incidence of complications such as infection, tendon rupture and adhesions. 29.4% (n=10) had poor outcome, 8.8% (n=3) had fair outcome, 29.4% (n=10) had good outcome and 32.4% (n=11) had excellent outcomes. 26.5% had adhesion and infection rate was 11.8%. Among surgeons, there is consensus for the primary repair of tendon injury, but there was no significant difference between the results of immediate and delayed primary repair. Although physiotherapy has been suggested as an effective factor in improving hand function, its positive effect on the range of motion of the fingers has not been proven.

Musculoskeletal involvement: COVID-19 and post COVID 19.

The worldwide pandemic of coronavirus disease 2019 (COVID-19) was known to predominantly affect the lungs, but it was realized that COVID-19 had a large variety of clinical involvement. Cardiovascular, gastrointestinal, neurological, and musculoskeletal systems are involved by direct or indirect mechanisms with various manifestations. The musculoskeletal involvement can manifest during COVID-19 infection, due to medications used for the treatment of COVID-19, and in the post/long COVID-19 syndrome. The major symptoms are fatigue, myalgia/arthralgia, back pain, low back pain, and chest pain. During the last two years, musculoskeletal involvement increased, but no clear consensus was obtained about the pathogenesis. However, there is valuable data that supports the hypothesis of angiotensinconverting enzyme 2, inflammation, hypoxia, and muscle catabolism. Additionally, medications that were used for treatment also have musculoskeletal adverse effects, such as corticosteroid-induced myopathy and osteoporosis. Therefore, while deciding the drugs, priorities and benefits should be taken into consideration. Symptoms that begin three months from the onset of the COVID-19 infection, continue for at least two months, and cannot be explained by another diagnosis is accepted as post/long COVID-19 syndrome. Prior symptoms may persist and fluctuate, or new symptoms may manifest. In addition, there must be at least one symptom of infection. Most common musculoskeletal symptoms are myalgia, arthralgia, fatigue, back pain, muscle weakness, sarcopenia, impaired exercise capacity, and physical performance. In addition, the female sex, obesity, elderly patients, hospitalization, prolonged immobility, having mechanical ventilation, not having vaccination, and comorbid disorders can be accepted as clinical predictors for post/long COVID-19 syndrome. Musculoskeletal pain is also a major problem and tends to be in chronic form. There is no consensus on the mechanism, but inflammation and angiotensin-converting enzyme 2 seem to play an important role. Localized and generalized pain may occur after COVID-19, and general pain is at least as common as localized pain. An accurate diagnosis allows physicians to initiate pain management and proper rehabilitation programs.

Efficacy of Caregivers Training in Rehabilitation of Stroke Survivors in Bangladesh: A Quasi-experimental Study.

A proper rehabilitation program may prevent post-stroke neurological, structural, and functional disabilities. We aimed to evaluate the efficacy of caregiver training in the rehabilitation of stroke survivors and compare rehabilitation interventions done by the therapist. This quasi-experimental study was conducted among 67 stroke survivors divided into group A (home-based exercise by family caregivers; n=33) and group B (hospital-based supervised exercise by a physiotherapist; n=34). Family caregivers were trained according to "The London Stroke Carers Training Course." The functional independence measure (FIM) evaluated all patients after three months of physiotherapy. Results:The mean age of the participants in group A and group B were 56.85 ± 11.49 and 58.65 ± 16.92 years, respectively, where most of the patients in both groups were male. In group A, 17 (51.5%) participants had left-sided involvement, while in group B, 17 (50.0%) participants had left-sided involvement. There was no significant statistical difference in FIM between groups A and B at baseline (p=0.532). At three months, the mean FIM of the participants in group A (98.54 ± 11.85) was significantly higher than in group B (89.85 ± 8.15) (p=0.001). A quasi-significant difference was observed between the right (18.41 ± 9.37) and the left (23.42 ± 11.68) hemisphere involvement regarding mean improvement of FIM (p=0.057). Therapeutic approach provided by trained caregivers was found to be more effective and efficient than that done by a physiotherapist.

Quality of Life and Life after Amputation among Amputees in Lagos, Nigeria.

Amputation is a life-changing surgical procedure that can cause significant disruptions in the quality of life of an individual. This study aimed to evaluate the quality of life of patients with limb amputations in Lagos. This was a cross-sectional study carried out among amputees recruited from two tertiary institutions and roadsides in Lagos state. A structured interviewer-administered questionnaire was used to collect data on demography, medical history, and postamputation health status. Also, a short form (SF-12V2) health questionnaire was used to assess their quality of life. Two hundred and fifty-four (254) subjects with extremity amputation, aged 18-75 years with a mean age of 47.82 ± 11.53 years were studied. The male-to-female ratio was 1.4:1. The commonest age group of the amputees was 45-60 years (52%). The commonest indication for amputation was diabetic gangrene (126 [49.6%]) and trauma (90 [35.4%]). Postamputation, 98 (38%) were employed, and 117 (75%) of those unemployed resorted to begging as a means of livelihood. While 57 (22.4%) used prostheses frequently, 68 (26%) did not want prostheses as they supposed that it negatively affected their begging business. Female amputees have a statistically significantly better quality of life than males in the physical (r = 0.03) and mental components (r = 0.04). A proper rehabilitation program, the use of prostheses, and adequate employment opportunities would improve the quality of life of amputees.

International Roughness Index Modeling For Jointed Plain Concrete Pavement Using Artificial Neural Network

Climate attributes such as precipitation, extreme temperature, and freeze-thaw cycles along with traffic loads cause pavement distresses. The maintenance need for pavements is decided based on the pavement condition rating such as International Roughness Index (IRI). Generally, an IRI rating less than 2.68 m/km is acceptable, and a rating greater than 2.68 m/km is considered unacceptable and classified as “very poor” condition of the pavement. It is imperative to be able to accurately predict pavement conditions to prepare proper Maintenance and Rehabilitation (M&R) programs for the pavements. This study aims to develop IRI models that can successfully estimate the IRI values for Jointed Plain Concrete Pavement (JPCP) considering the M&R history of the pavements using Artificial Neural Networks (ANNs) approach. The study was carried out with the database collected from Long Term Pavement Performance (LTPP) program. The variables used for the ANN model development are initial IRI, pavement age, concrete pavement thickness, equivalent single axle load (ESAL), climatic region (wet-freeze, wet non-freeze, dry-freeze, dry non-freeze), construction number (CN), and several climatological data. After utilizing various ANN model structures, the best performing ANN model resulted in promising statistical measures (i.e. R2 = 0.87). The IRI prediction model can successfully estimate the increase of IRI values with the increase of ESAL value over time. The IRI prediction model can also estimate the decrease of IRI value after maintenance and rehabilitation. The predicted IRI values with good accuracy will help the local and state agencies to prepare for M&R programs for JPCP pavements and allocate a projected budget accordingly.

Современные методы восстановительного лечения пациентов после артроскопической реконструктивной пластики передней крестообразной связки коленного сустава: обзор литературы

Introduction The leading method for treating patients with injuries of the anterior cruciate ligament is its reconstruction. Although this operation is a common procedure, the issues of rehabilitation have not been fully studied. The aim of study Collection and analysis of available published studies on current methods of rehabilitation treatment after arthroscopic reconstruction of the anterior cruciate ligament. Materials and methods We analyzed the publications that were devoted to current methods of rehabilitation treatment of patients after arthroscopic reconstruction of the anterior cruciate ligament. The materials were searched for in the PubMed and Web of Science databases using the keywords “anterior cruciate ligament reconstruction”, “anterior cruciate ligament rehabilitation”. Inclusion criteria were compliance with the general topic, relevance, introduction of new rehabilitation treatments. Studies published earlier than the last 10 years were excluded. Results The analysis found that the main rehabilitation treatments used in patients after reconstruction of the anterior cruciate ligament are of protective character (wearing a functional orthosis or other immobilizing appliance, dosed walking with crutches) and physical activity (complex of exercises, swimming). The most effective way to prevent contractures is early activation of the limb and the maintenance of muscle tone. In turn, the main task of immobilization is prevention or relief of pain. Our study proposes the authors’ methods of rehabilitation which can be used for restorative treatment and accelerate the process of ligament repair. The work includes rehabilitation procedures performed at home after reconstruction of the anterior cruciate ligament under the supervision of a rehabilitation instructor. Discussion Rehabilitation of patients after reconstruction of the anterior cruciate ligament is a necessary complement to surgical treatment. Fast recovery of patients and a full return to an active lifestyle depend on a proper rehabilitation program.

Conservative management vs. surgical repair in degenerative rotator cuff tears: a systematic review and meta-analysis.

To analyze the available evidence comparing the clinical and functional outcomes of physiotherapy vs. surgical repair in the management of degenerative rotator cuff tears (RCTs), and to perform a meta-analysis to clarify the possible superiority of one approach vs. the other. A literature search was carried out on the PubMed, Scopus and Web of Science databases on May 30th, 2020, to identify all the randomized trials comparing surgery to conservative management of degenerative rotator cuff tears. The following data were extracted from each included study: patients' demographics, study design and level of evidence, follow-up times, treatment groups, evaluation scores adopted, overall clinical findings. The quality of the trials was assessed using the Cochrane Risk of Bias Assessment. A total of 7 studies, including 326 patients and dealing with conservative treatment vs. surgical repair for rotator cuff tears, were included in this study. Although surgery provided superior results both in terms of VAS (p=0.017) and Constant score (p<0.0001) compared to conservative management at 1 year follow-up, this superiority did not reach the "minimal clinical important difference". Otherwise, a few data are available about long-term outcomes, thus there is insufficient evidence about the role of surgery to prevent the progression of tendon wear. A proper rehabilitation program is able to provide similar results compared to surgery at a short term follow-up in degenerative RCTs. Further long term data are necessary to understand if tendon repair might have a protective role towards worsening of degeneration thus providing better clinical outcome than conservative management.

A rare case of spinal epidural abscess: diagnostic challenges and rehabilitation outcomes

Introduction: Spinal epidural abscess is a rare clinical entity with considerable morbidity. Even with prompt diagnosis and treatment, many patients are left with persistent residual neurological deficits. Case report: The purpose of this article is to report a rare case of primary pyogenic spinal epidural abscess. The patient admitted to our clinic because of lumbar pain of increasing severity and fever. Case management consisted of surgical and medical treatment with antibiotics. Postoperatively, with proper rehabilitation program, he markedly improved. Conclusions: Despite a correct management, spinal epidural abscess is associated with a high degree of morbidity and mortality. Proper treatment, rehabilitation programs and long-term follow-up is critical for a better outcome.

Comparing the Kinematics of the Lower Limb Joints in Jump-Landing Maneuver Among Soccer Players With and Without Histories of Anterior Cruciate Ligament Reconstruction

Background: Jumping and landing are common activities in soccer, i.e., associated with Anterior Cruciate Ligament (ACL) injuries in the players, especially when experiencing fatigue. The current study aimed to compare the kinematics of the lower limb joints in jump-landing maneuver among soccer players with and without a history of anterior cruciate ligament reconstruction. Methods: Among active soccer players in the provincial league level in Hamedan Province, Iran, 12 individuals with the intact knee (control group), and 12 individuals with 6 to 24 months post anterior cruciate ligament reconstruction (experimental group) were selected by convivence sampling method as the study participants. During the jump-landing task, the range of motion and the joints' angle at the contact instance were measured before and after performing plyometric fatigue protocol using the Vicon motion capture system. Multivariate Analysis of Variance (MANOVA) at a significance level of P&lt;0.05 was used for intergroup comparisons. Results: Plyometric fatigue did not affect most of the kinematic variables before and after fatigue experience. Besides, only the hip range of motion revealed a significant difference between the study groups (P=0.38). Conclusion: Fatigue had more effect on some variables in individuals with ACL reconstruction, including the left and right hips angles. Moreover, there was a significant difference in some variables between the study groups; the range of motion of the left hip, the contact angle of the right hip before fatigue experience, and the contact angle of the right and left hips after fatigue. In general, a proper rehabilitation program is recommended for athletes with ACL reconstruction to reduce the risk of recurrence of jumping movements in exercise.

Paving the way for a better understanding of the pathophysiology of gait impairment in myotonic dystrophy: a pilot study focusing on muscle networks

BackgroundA proper rehabilitation program targeting gait is mandatory to maintain the quality of life of patients with Myotonic dystrophy type 1 (DM1). Assuming that gait and balance impairment simply depend on the degree of muscle weakness is potentially misleading. In fact, the involvement of the Central Nervous System (CNS) in DM1 pathophysiology calls into account the deterioration of muscle coordination in gait impairment. Our study aimed at demonstrating the presence and role of muscle connectivity deterioration in patients with DM1 by a CNS perspective by investigating signal synergies using a time-frequency spectral coherence and multivariate analyses on lower limb muscles while walking upright. Further, we sought at determining whether muscle networks were abnormal secondarily to the muscle impairment or primarily to CNS damage (as DM1 is a multi–system disorder also involving the CNS). In other words, muscle network deterioration may depend on a weakening in signal synergies (that express the neural drive to muscles deduced from surface electromyography data).MethodsSuch an innovative approach to estimate muscle networks and signal synergies was carried out in seven patients with DM1 and ten healthy controls (HC).ResultsPatients with DM1 showed a commingling of low and high frequencies among muscle at both within– and between–limbs level, a weak direct neural coupling concerning inter–limb coordination, a modest network segregation, high integrative network properties, and an impoverishment in the available signal synergies, as compared to HCs. These network abnormalities were independent from muscle weakness and myotonia.ConclusionsOur results suggest that gait impairment in patients with DM1 depends also on a muscle network deterioration that is secondary to signal synergy deterioration (related to CNS impairment). This suggests that muscle network deterioration may be a primary trait of DM1 rather than a maladaptive mechanism to muscle degeneration. This information may be useful concerning the implementation of proper rehabilitative strategies in patients with DM1. It will be indeed necessary not only addressing muscle weakness but also gait-related muscle connectivity to improve functional ambulation in such patients.

Results of flexor tendon grafting with early active mobilization

Objective The aim was to evaluate the results of early active motion regimen after hand flexor tendon grafting. Background The application of proper postoperative rehabilitation program is an integral part to achieve good results after hand flexor tendon grafting. The aim of application of early, active mobilization rehabilitation program is to limit adhesion formation which limits active motion. Patients and methods Twenty-three fingers were managed by flexor tendon grafting and assessed from February 2015 till August 2016 at Menoufia University Hospital. In all, 17 fingers had two stages tendon grafting and six fingers had single-stage tendon grafting. Early active mobilization rehabilitation regimen was applied for all patients. Postoperative assessment was done by the American Society for Surgery of the Hand system, Strickland system, Buck-Gramcko method, and LaSalle formula. Results Final assessment was done at 6 months postoperatively and the results were as follows: good (52.17%), fair (39.13%), and poor (8.7%) according to the American Society for Surgery of the Hand system. According to the Strickland system, the results were excellent (13.04%), good (34.78%), fair (39.13%) and poor (13.04%). According to the Buck-Gramcko score, the results were excellent (21.7%), very good (17.4%), good (39.1%) good, fair (8.7%), and poor. (13.1%) According to LaSalle formula, the results were excellent (34.78%), good (52.17%), fair (8.7%), and poor (4.4%). Complications were adhesion formation (8.7%), infection (8.7%), flexor pulley rupture (4.3%), graft rupture (4.3%), and tourniquet palsy (4.3%). Conclusion The results were found to be affected by sex, dominance of affected hand, affected tendon(s), flexor pulley integrity, type of procedure, and by the type of tendon graft.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P49. Effects of lower extremity fatigue and gender on unanticipated landing performance in a recurrent low back pain population

BACKGROUND CONTEXT Recurrent low back pain (rLBP) commonly affects the recreational and professional athlete alike, and correlation between rLBP and lower extremity injury has been well established. Previous data have shown strong correlation between a history of back pain and altered landing mechanics, trunk and lower extremity kinematics and kinetic factors all associated with increased lower extremity injury. Additionally, there has been direct proven correlation between neuromuscular core training programs and a decrease in lower extremity ligamentous injuries. Fatigue has also been proven to negatively affect trunk and lower extremity neuromuscular control, which may predispose to lower extremity injury. Well reported gender differences in lower extremity kinetics and kinematics are also known to alter propensity for injury. The complex interplay between these various factors is continuously being studied. Proper understanding of these risk factors for spine and leg injuries is imperative in establishing proper neuromuscular control rehabilitation and training programs to mitigate the risks of lower extremity injury, especially in patients with a history of low back pain. PURPOSE To determine the effects of fatigue and gender on trunk and knee mechanics, neuromuscular control, and ground reaction force (GRF) during drop vertical jump (DVJ) following by unanticipated landing or cutting in a population with rLBP. STUDY DESIGN/SETTING A prospective concurrent control cohort study. PATIENT SAMPLE Thirty-two adults with rLBP. OUTCOME MEASURES 3D knee and trunk motion, knee moments, and GRF. METHODS All test patients were fitted with a full body marker set. Surface EMG electrodes were placed bilaterally on trunk and lower extremity muscles. Each patient performed multiple 0.30 m DVJ landing and cutting in nonfatigued and fatigued conditions. RESULTS Fatigue altered landing mechanics with differences in landing performance between genders. For DVJ trials, females had greater knee internal rotation at initial contact (p=.001). Maximum knee flexion was reduced, but knee adduction (p=.026) and internal rotation (p=.009) and trunk flexion (p=.003) were greater at maximum knee flexion. Similar differences were also found during the cutting trials, with the addition of less trunk side flexion (p=.008) in females at maximum knee flexion. Females had smaller knee flexion moments (p=.021) during the DVJ. Fatigue resulted in less trunk flexion (p=.027) at initial contact for the DVJ, and greater trunk extension (p=.038) and trunk side flexion (p=.035) at maximum knee flexion, smaller maximum vertical GRF on the right leg, and maximum knee adduction moment when cutting. CONCLUSIONS Females with rLBP land differently than males and may have increased exposure to biomechanical factors that can contribute to lower extremity injury. Fatigue similarly alters landing and increases exposure to those same factors in this population. The majority of gender and fatigue related differences were consistent for unanticipated landing and cutting activities, which may better simulate actual sports activity. Armed with additional information of movement behaviors associated with increased lower extremity injuries, practitioners can design neuromuscular control training programs for women with rLBP and for men and women during fatigued conditions that serve a protective function and decrease the potential of ACL and other lower extremity injuries.

Subjective and psychological well-being in Parkinson's Disease: A systematic review.

The aim of this review is to summarize studies investigating subjective and psychological well-being in patients with Parkinson's disease (PD). A systematic and integrative review according to PRISMA criteria was performed with a literature search from inception up to September 2017 in multidisciplinary databases (PubMED, Scopus, Web of Knowledge) by combining together key words related to PD and well-being. Studies were included if: their full-text was available; they involved PD patients; focused on the selected positive dimensions; written in English. Case studies, conference proceedings, abstract, dissertations, book chapters, validation studies and reviews were excluded. Data extracted from the studies included sample characteristics, the positive dimension investigated, type of measure, study aims, design and results. One reviewer extracted details and commented results with other reviewers. The studies' quality was assessed following Kmet, Lee, and Cook. Out of 1425 studies extracted, 12 studies (9 quantitative, 2 qualitative, 1 mixed methods) involving 2204 patients with PD were included. Most of the studies had a cross-sectional design and/or evaluated the effect of physical rehabilitation on well-being. Articles documented that the illness could impair well-being for its progressive impact on patients' motor autonomy. Preserving motor and musculoskeletal functioning facilitate patients' experience of well-being, social contribution and the maintenance of their job. Research on positive resources in PD is still scarce compared to other chronic illnesses. The few available investigations suggest the need of preserving motor abilities by proper rehabilitation programs for maintaining and/or promoting patients' well-being and life engagement.

Cognitive Impairment in Dialysis and Non-Dialysis Patients Suffering from Chronic Renal Failure and Comparing Them with a Control Group

Background: Chronic renal failure and its end-stage disease are one of the most important causes of death and disability, and its prevalence is increasing in the world. This disease can cause many complications in the patients with end- stage renal disease. Objectives: The present study aimed at comparing cognitive impairment in patients with end- stage renal disease (ESRD) and chronic renal failure (CRF) with a control group. Methods: In this cross-sectional study, 85 ESRD, dialysis dependent patients, 200 CRF patients, non-dialysis dependent, as well as 180 patients with high blood pressure or diabetes as control group who referred to Kowsar hospital during 2015 and 2016 were studied. The Persian version of the mini mental status examination (MMSE) questionnaire was used to collect data. It was completed by one of the skilled and trained nurses. Results: The results revealed that 28.2% of ESRD, 1% of CRF patients, and 0.6% of control group patients had severe cognitive impairment. Cognitive health score in ESRD group was lower than that in CRF (P < 0.001) and control group (P < 0.001). In addition, cognitive health score of CRF patients was lower than that in the control group (P = 0.005). ESRD patients had significantly higher impairment in time and place orientation, calculation, recall, language, and repetition compared to control and CRF groups (P < 0.001), but there were no significant differences between control and CRF groups. With respect to complex commands, the control group had a significantly lower impairment, but the other 2 groups were not significantly different in this regard. The three experimental groups were not significantly different in per-test stage. Conclusions: ESRD patients have severe cognitive impairment compared to CRF patients. Therefore, it is recommended that these patients be examined cognitively and proper rehabilitation programs be considered for them.

Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction

Elbow injuries in overhead athletes, particularly ulnar collateral ligament (UCL) injuries to baseball pitchers, continue to increase in number. The reasons for these injuries are multifactorial but typically result from a combination of severe and repetitive valgus elbow stress from pitching large volumes and throwing at peak velocities. These factors and the severity of medial elbow injuries to the UCL complex make it critical to employ a proper criteria-based rehabilitation program in combination with a well-structured set of return-to-play criteria. Together, the rehabilitation process and return-to-play program provide a set of guidelines that help ensure a safe and effective process to aid in returning a throwing athlete back to unrestricted competition as efficiently as possible. This article provides the reader with a 4-phased, criteria-based rehabilitation program for the athlete following UCL reconstruction and a structured set of return-to-play guidelines. The return-to-play progression is a 3-step process that assists in advancing an athlete back to unrestricted competition via a performance, practice, and play sequence. This program uses specific criteria and activities to progress a throwing athlete from high-level performance training, to controlled practice participation and then finally back to play. The program uses not only specific steps but also a combination of testing parameters both subjective and objective to guide the return through the entire rehabilitation process from UCL reconstruction surgery back to unrestricted symptom-free throwing.

Squat-to-stand test in functional assessment of stable chronic obstructive pulmonary disease patients.

Background:Assessment of functional status is vital for proper therapy and rehabilitation programs in chronic obstructive pulmonary disease (COPD) patients. Traditionally, 6 min walk test (6MWT) has been used but it by itself may not reflect the total functional status in these patients as it poorly correlates to the disease severity. A sit-to-stand test (STST) has been proposed as a better alternative to 6MWT but to test their ability to stand from the squatting position, i.e., a squat-to-stand test (SqTST) will be more appropriate in rural patients.Material and Methods:All patients, diagnosed to have stable COPD, after exclusion of asthma and other respiratory or nonrespiratory diseases were evaluated by applying 6MWT, STST, and SqTST in them. Data so obtained were statistically analyzed.Results:Ninety patients and twenty healthy controls were studied. Sixteen, 24, 23, and 27 of the patients were classed as COPD risk category A, B, C, and D, respectively. The mean post bronchodilator forced expiratory volume in 1st second (PB FEV1) and body mass index (BMI) were significantly lower in category D as compared to the rest. The cutoff values for 6MWT, STST, and SqTST were derived as 184M, 11, and 07, respectively. 6MWT correlates poorly to disease severity (P = 0.109) but there was a strong correlation between disease severity and SqTST and STST (P = 0.000).Conclusion:SqTST is a feasible and effective tool to assess functional status of COPD patients residing in rural areas. BMI is an important surrogate marker of the functional status in these patients.

Assessment Of Selection Criteria For Anterior Cruciate Ligament Reconstruction

Abstract Aim: To assess the need and advisability of anterior cruciate ligament reconstruction (ACLR). Methods: We assessed 85 subjects with a mean age of 28 years (SD 10, range 15-57) who had been assigned to ACLR at the Regional Orthopedic Center in Lodz, Poland. All subjects completed a questionnaire covering sport activity, injury mechanism, experience of knee stability, a way they were assigned for ACLR and expectations of surgery. Preoperative assessment of the knee was made with the Knee injury and Osteoarthritis Outcome Score (KOOS). Satisfactory preoperative clinical knee outcome was defined as the lower threshold for the 95% CI of 18–34-yearold males and corresponded to the KOOS score above 90 for Pain, 84 for Symptoms, 91 for ADL, 80 for Sports/ Recreation, and 81 for QOL. The activity level was determined with the Tegner activity scale. We considered subjects to be eligible for the operation if they fulfilled the newly established criteria: 1) pre-injury activity level ≥ 7 according to Tegner, depending on sport discipline performed, and a will to return to professional sport activity following ACLR and/ or 2) residual knee instability regardless of six-weeks structured exercise program and 3) pre-injury activity level ≥ 4 according to Tegner and/or knee instability regardless of structured exercise program in adolescents. Results: New criteria for ACLR were fulfilled by 44% of the study group. Part of the subjects had satisfactory preoperative clinical knee outcome in the KOOS subscales for Pain, Symptoms and ADL. Subjects scored significantly higher in the KOOS subscales Pain, and KOOS ADL (mean 73 and 79 points respectively) than in the KOOS subscales Sports/Recreation and Quality of Life (mean 47 and 38 points, respectively (P ≤ 0.001). Conclusions: Our findings indicate that more than a half of subjects who are eligible for ACLR according to our inclusion’s criteria could be operated on in vain. Patient’s education, adequate assessment of clinical symptoms, ability to perform activities of daily living and a proper rehabilitation program could decrease the number of subjects assigned to ACLR.

ABSTRACT 819

Background and aims: Spinal cord injury without radiological abnormality (SCIWORA) often occurs in the skeletally immature cervical and thoracic spine. In this report we discribe a girl who had prolonged weaning because of SCIWORA. Methods: Case Report: 2 year-old girl was hit by a car while running a road. Cervikal X-ray and CT scan of the brain and CT scan of the chest was normal. She was unable to move her limb and leg. She had abdominal breathing, defecation, and urinary incontinence. MRI of the cervical spine showed atropic spinal cord from C5 toT1. The smallest anterior posterior diameter was 10 mm. The patient needed ventilator support for 2 weeks and she had extubation failure one time. After high dose steroid therapy and proper rehabilitation program for 2 weeks extubation accomplished. Results: Discussion: Pediatric spinal injuries are uncommon. SCIWORA occurs most often in pediatric population and accounts for up to 2/3 of severe cervical injuries in children of< 8 years of age. Spinal cord injury in children frequently occurs without fracture or dislocation. The mechanism of neural injury probably related to intersegmental displacements of the spinal cord when subjected to flexion, extension, and distraction forces. The physician attending to a multiply injured child must be aware that children, may have a spinal cord injury.