Successful Recovery Research Articles

Navigating recovery in childhood OCD: a qualitative analysis of barriers and facilitators

ObjectiveThe objective is to examine barriers and facilitators to recovery in children and adolescents with obsessive-compulsive disorder (OCD) using a qualitative approach.MethodsTen semi-structured interviews were conducted, audio-recorded, and analyzed using thematic analysis. Findings were validated through investigator triangulation, peer validation and member check.ResultsBarriers to recovery were internal—lack of awareness; poor motivation to seek treatment; and perceived stigma, or external—poor parental support; parental anxiety; inadequate awareness in schools; social misconceptions about illness; myths about medication; and frustrations in treatment processes. Facilitators were internal—will and determination; self-discipline; keeping calm; sense of purpose, and external—general awareness; parental support; peer support; and good therapeutic engagement.ConclusionsTo the best of our knowledge, this is the first study to explore barriers and facilitators to recovery in-depth in pediatric OCD. Findings underscore the importance of tailored interventions, robust support networks, and cultural sensitivity for successful recovery outcomes.

Recovery effects of the long-term cryopreserved Anammox sludge by adjusting the sludge amount

ABSTRACT Anammox process was one of the most promising nitrogen removal technologies. This study investigated the recovery performance of Anammox sludge after 83 days of cryopreservation in two reactors (R1 and R2). Reactor R1 utilized Anammox sludge pretreated with low-substrate simulated wastewater prior to long-term cryopreservation, and successful recovery was achieved by discharging sludge under ammonia nitrogen concentrations of 100 mg/L. The total nitrogen removal efficiency (TNRE) reached 70.0% on day 48. Reactor R2 used Anammox sludge pretreated with high-substrate simulated wastewater before cryopreservation. At an ammonia nitrogen concentration of 100 mg/L, the TNRE reached 87.0% on day 18. After increasing the ammonia nitrogen concentration to 300 mg/L and discharging sludge, the TNRE reached 84.6% on day 38. When the ammonia nitrogen concentration was elevated to 500 mg/L, system performance deteriorated. Recovery was unsatisfactory when the ammonia nitrogen concentration was reduced back to 300 mg/L. Finally, adding Anammox sludge restored the TNRE to 85.6% after 35 days of operation. The results suggest that adding Anammox sludge is essential for nitrogen removal recovery in reactors under high ammonia nitrogen concentration inhibition, while sludge discharge is crucial when free ammonia (FA) is present. This study provides a simple and effective strategy for recovering the activity of Anammox sludge after long-term cryopreservation.

Overview of Achilles Tendon Injury Treatment

Achilles tendon rupture is a prevalent injury, particularly among middle-aged individuals who participate in high-demand athletics. This article reviews the anatomy, risk factors, diagnosis, and current treatment strategies for Achilles tendon rupture, with a focus on surgical and non-surgical approaches. The traditional open repair technique is still a widespread surgical approach that uses a large incision to reconnect the tendon directly. However, complications and infections may occur, so percutaneous or mini-open techniques can be changed depending on the patient's condition. Various suture techniques, such as Bunnell, Modified Kessler, and Tsuge, have been evaluated in clinical settings, with braided polyester sutures demonstrating superior biomechanical performance over monofilament polydioxanone sutures. Despite the effectiveness of surgical intervention, non-surgical treatment remains an option for specific patient populations, though it is associated with a slightly higher re-rupture rate. Postoperative rehabilitation is crucial for restoring function, with early weight-bearing and mechanical stimulation playing key roles in successful recovery.

A novel property to modify weighted [formula omitted] minimization for improved compressed sensing

Weighted l1 minimization schemes are common methods to achieve compressed sensing (CS). However, they fail in the presence of inaccurate prior knowledge or improper scaling of weights due to inappropriately assigned large weights causing large and destructive errors in signal recovery. This paper proposes a theory-based algorithm to identify and correct such destructive weights for each signal entry. The enhancement is achieved through a novel sparsity-inducing property (SIP) which establishes a necessary condition for successful signal recovery. SIP outperforms existing properties such as coherence, restricted isometry property, and nullspace property by indicating which signal entries fail to be recovered. This unique advantage enables us to correct destructive weights that do not satisfy the SIP condition, making signal recovery successful where it previously failed. Results from many numerical experiments demonstrate that our proposed method can improve the signal recovery capability, robustness, and stability of the weighted l1 minimization for a wide range of applications, including sparse and compressive signal recovery, noise-aware recovery, sparse error correction, fast image acquisition, and sub-Nyquist sampling.

Short-Term Results of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) Repair: A Single Centre Study

This retrospective case series reviews outcomes for 12 patients who underwent Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) repair at our hospital from July 2018 to June 2023, following ethical approval. Diagnoses were confirmed via echocardiography, angiography, or CT angiography, excluding those with additional anomalies or prior surgeries. Data collected included patient demographics, preoperative symptoms, left ventricular ejection fraction, and mitral regurgitation severity. Surgeries involved median sternotomy with modified left coronary perfusion and cardioplegia. Key outcomes assessed were success rates, recovery times, early complications, and improvements in cardiac function. Results showed a mean age of 8.5 ± 2.1 months and a mean weight of 8.41 ± 1.2 kg, with 75.9% male patients. Preoperative symptoms included tachypnea, growth failure, and irritability, with an initial left ventricular ejection fraction of 28%. Post-surgery, the success rate was 100%, with significant improvements in left ventricular ejection fraction to 45% and reduced mitral regurgitation. The study highlights the importance of early diagnosis and effective surgical management of ALCAPA, especially in cases involving non-facing coronary origins. Keywords: ALCAPA, Congenital Heart Defect, Coronary Artery Anomalies, Echocardiography Left coronary artery

Comparative analysis of the efficacy of oblique lateral interbody fusion versus transforaminal lumbar interbody fusion in the treatment of lumbar disc herniation

Lumbar disc herniation (LDH) often necessitates surgical intervention when conservative treatments fail. Oblique Lateral Interbody Fusion (OLIF) and Transforaminal Lumbar Interbody Fusion (TLIF) are two commonly used techniques for treating LDH, each offering distinct surgical approaches. This study aimed to compare the efficacy of OLIF versus TLIF in terms of pain relief, functional outcomes, spinal alignment correction, fusion success, and postoperative recovery. A retrospective study was conducted on 133 patients who underwent either OLIF (n = 68) or TLIF (n = 65) between January 2020 and December 2022. Data on patient demographics, pain and functional outcomes (measured by Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), radiological outcomes (sagittal and coronal Cobb angles, apical vertebra deviation), fusion and collapse rates, and postoperative recovery (ambulation time and hospitalization duration) were collected. Statistical analysis was performed using t-tests and chi-square tests, with significance set at P < 0.05. Both groups demonstrated significant postoperative improvements in pain and functional outcomes. OLIF resulted in significantly better long-term pain reduction (VAS 1.99 ± 0.67 vs. 2.29 ± 0.92, P = 0.03) and greater spinal alignment correction, particularly in sagittal Cobb angle and apical vertebra deviation (P < 0.001). The fusion rate was similar between OLIF (97.92%) and TLIF (96.61%, P = 0.56), but OLIF had a lower collapse rate (8.33% vs. 18.64%, P < 0.001). OLIF also facilitated faster postoperative recovery, with earlier ambulation and shorter hospitalization time (P < 0.001 for both). While both OLIF and TLIF are effective for treating LDH, OLIF offers superior long-term pain relief, better spinal alignment correction, reduced collapse rates, and faster recovery. These findings suggest that OLIF may be a more advantageous option for patients requiring lumbar interbody fusion.

A short-term home with long-term potential: temporary aquatic habitat additions to support macroinvertebrate colonisation

ABSTRACT River restoration projects often focus on water quality and riparian vegetation, assuming this will result in direct improvements to ecological health. However, successful recovery of aquatic communities likely requires additional steps targeting habitat beneath the water surface. We trialled the addition of simple, instream habitat units as a practicable short-term restoration tool targeting aquatic macroinvertebrate communities. Habitat units were built from readily available, biodegradable materials. They were deployed at three sites around Auckland with differing hydromorphology and surrounding land use, enabling evaluation of both the efficacy of installation and impacts on biodiversity. Additional macroinvertebrate sampling (Surber and drift collection) was conducted to assess community responses following habitat unit addition. All habitat units showed significant increases in macroinvertebrate densities and taxon richness compared to the surrounding existing habitat. However, the most marked increases in abundance may be attributable to inundation of habitat units by pre-existing tolerant taxa capitalising on the increase in available habitat, rather than successful colonisation by additional taxa. This work highlights the potential of small-scale, short-term habitat additions as a restoration tool. This approach facilitates evaluation of restoration potential, informing design and implementation of more permanent restoration measures in future.

FISIOTERAPIA APLICADA NO PROCESSO CICATRICIAL DE CESÁREAS: REVISÃO DA LITERATURA

Physiotherapy plays an important role in the recovery process after a cesarean sec tion, where it works by promoting an adequate healing process, reducing all discomfort, aiming at elasticity, preventing a hypertrophic scar and mainly, improving the physical function of patients. It is important that physiotherapy is personalized according to individual needs and carried out as soon as possible, as early initiation of physiotherapy and adherence to the guidelines provided are essential for a successful recovery after a cesarean section. In this process, we can use massage and tissue mobilization techniques, where the application of gentle mas sages and mobilization techniques will help reduce tension in scar tissues, promoting blood circulation and helping to break down adhesions that may form during the process. of healing. In conjunction with manual therapies, we can use physical therapeutic resources, where the physiotherapist will work, for example, with low-intensity laser therapy, which can accelerate the healing process, reduce inflammation and alleviate discomfort in the area. of the incision. Other physical modalities, such as therapeutic ultrasound and electrotherapy, can also be applied to promote healing and reduce pain.

Successful recovery of anterior interosseous nerve palsy caused by blunt trauma at the forearm level: a case report

Anterior interosseous nerve syndrome (AINS) is typically characterized by dysfunction of the pure motor branch of the median nerve, primarily affecting the flexor pollicis longus and the flexor digitorum profundus (FDP) of the index finger, and occasionally involving the FDP of the middle finger and the pronator quadratus. Although various etiologies such as compressive neuropathy and isolated neuritis have been proposed, the most recent review describes AINS as a form of neuralgic amyotrophy. Its treatment remains a matter of debate; the most frequently discussed approach is conservative treatment followed by surgical intervention above the medial epicondyle level if recovery is not achieved. In the case described herein, a hematoma resulting from blunt trauma at the forearm level compressed the anterior interosseous nerve (AIN), with clinical features and diagnostic findings very similar to those of typical AINS. Early surgical removal of the hematoma led to complete recovery without complications. Despite the current understanding of AINS pathophysiology and treatment, this case emphasizes the need to consider the possibility of AIN palsy due to forearm lesions. We report on the clinical course and successful treatment of this case to highlight this important consideration.

Heavy Metal Pollution and Solutions for Its Control: General Aspects with a Focus on Cobalt Removal and Recovery from Aqueous Systems

Heavy metal pollution is a worldwide and stringent concern following many decades of industrialization and intensive mining without (in some cases) consideration for environmental protection. This review aims to identify the existing and emerging techniques for heavy metals (HM) removal/recycling from water and wastewater, with an emphasis on cobalt. Unlike many other heavy metals, cobalt has not been considered a detrimental element for the environment and human beings until recently. Thus, several methods and applicable techniques were evaluated to identify the best treatment approaches applicable to cobalt-polluted water and wastewater. The most feasible depollution methods adapted to the source, environment, and economic conditions were investigated and concluded. The operations and processes presented in this paper are conventional and innovative as well, including precipitation, membrane separation, with emphasis on ultrafiltration (UF) and nanofiltration (NF), but also reverse osmosis/forward osmosis (RO/FO), sorption/chemisorption processes, flotation/mechanical separation operations combined with coagulation/flocculation, photocatalysis, and electrochemical processes. For each one, depending on the frequency of use, physicochemical mechanisms and optimal operational conditions were identified to carry out successful cobalt removal and recovery from aqueous environments.

ОСОБЛИВОСТІ ПСИХОЛОГІЧНОГО ІМУНІТЕТУ УКРАЇНСЬКИХ КОМБАТАНТІВ ТА ЧЛЕНІВ ЇХНІХ РОДИН: ТЕОРЕТИЧНІ АСПЕКТИ

The article is devoted to the analysis of the problem of psychological immunity of active Ukrainian military personnel and their families. The psychological immune system is a multidimensional but integrated unit of personal resources of resilience and adaptive capacities, also called "psychological antibodies", which provide immunity against stress and traumatic events. Under martial law, the Ukrainian military is the most important asset in countering armed aggression. Their psychological immunity can ensure effective stress management and protect them from possible psychopathology. Promotion of resources (psychological antibodies) will help active military personnel, as well as their family members, to use and overcome their traumatic experiences, stress and negative influences in a useful and productive way, including creating support networks, learning new skills, and achieving combatant goals during combat missions. It is justified that the return of a vital sense of security for successful recovery and functioning depends on the presence of psychological immunity not only among servicemen, but also among their families as a center of rehabilitation potential. The three-component structure of psychological immunity according to A.Olakh is described, which includes: the approach-conviction subsystem, the monitoring-creation-execution subsystem and the self-regulation subsystem. These subsystems make it possible to recognize one's environment, search for and activate the necessary resources for constructive interaction with it, and maintain emotional equanimity. Based on the experience of communicating with active military personnel, veterans, and members of their families, the authors propose to add a fourth component to the existing structural model - the spiritual and value subsystem. The allocation of this component is due to the peculiarities of Ukrainian identity and the specifics of the Russian-Ukrainian war. This component includes the spiritual self, the values of patriotism, moral qualities and religiosity (as an internal need to believe).

Mobile Accelerometer Applications in Core Muscle Rehabilitation and Pre-Operative Assessment.

Individual physiotherapy is crucial in treating patients with various pain and health issues, and significantly impacts abdominal surgical outcomes and further medical problems. Recent technological and artificial intelligent advancements have equipped healthcare professionals with innovative tools, such as sensor systems and telemedicine equipment, offering groundbreaking opportunities to monitor and analyze patients' physical activity. This paper investigates the potential applications of mobile accelerometers in evaluating the symmetry of specific rehabilitation exercises using a dataset of 1280 tests on 16 individuals in the age range between 8 and 75 years. A comprehensive computational methodology is introduced, incorporating traditional digital signal processing, feature extraction in both time and transform domains, and advanced classification techniques. The study employs a range of machine learning methods, including support vector machines, Bayesian analysis, and neural networks, to evaluate the balance of various physical activities. The proposed approach achieved a high classification accuracy of 90.6% in distinguishing between left- and right-side motion patterns by employing features from both the time and frequency domains using a two-layer neural network. These findings demonstrate promising applications of precise monitoring of rehabilitation exercises to increase the probability of successful surgical recovery, highlighting the potential to significantly enhance patient care and treatment outcomes.

In Vitro Initiation, Regeneration, and Characterization of Plants Derived from Mature Tetraploid Floral Explants of Date Palm (Phoenix dactylifera L.)

A stable tetraploid date palm mutant with the potential for increased fruit size was recovered from a sectorial di-tetraploid chimera via the in vitro culture of flower explants. Callus was induced using 2,4-D, followed by shoot regeneration on a medium containing NAA and BAP and rooting with IBA. Regenerated plantlets, confirmed as tetraploid via flow cytometry, were acclimatized and grown for six years. The leaves of tetraploids exhibited significantly wider petiole bases, thicker rachis and spines, broader leaflets, and a more intense green leaf color compared to diploids. However, leaf length, spine count, and overall leaf number were reduced. This is the first report of successful tetraploid recovery from a chimeric date palm, demonstrating the potential of this technique to generate novel germplasm and highlighting the phenotypic differences associated with tetraploidy in this species.

Distinct pathways for evolution of enhanced receptor binding and cell entry in SARS-like bat coronaviruses.

Understanding the zoonotic risks posed by bat coronaviruses (CoVs) is critical for pandemic preparedness. Herein, we generated recombinant vesicular stomatitis viruses (rVSVs) bearing spikes from divergent bat CoVs to investigate their cell entry mechanisms. Unexpectedly, the successful recovery of rVSVs bearing the spike from SHC014-CoV, a SARS-like bat CoV, was associated with the acquisition of a novel substitution in the S2 fusion peptide-proximal region (FPPR). This substitution enhanced viral entry in both VSV and coronavirus contexts by increasing the availability of the spike receptor-binding domain to recognize its cellular receptor, ACE2. A second substitution in the S1 N-terminal domain, uncovered through the rescue and serial passage of a virus bearing the FPPR substitution, further enhanced spike:ACE2 interaction and viral entry. Our findings identify genetic pathways for adaptation by bat CoVs during spillover and host-to-host transmission, fitness trade-offs inherent to these pathways, and potential Achilles' heels that could be targeted with countermeasures.

Vegetation Recovery Patterns at Jeongseon Alpine Stadium, Mount Gariwang, in the Republic of Korea, After the PyeongChang 2018 Winter Olympics

This study assessed vegetation recovery at Jeongseon Alpine Stadium, Mt. Gariwang, 5 years after the 2018 PyeongChang Winter Olympics to aid in restoration planning. A total of 50 quadrats were surveyed across undisturbed areas, forest edges, and damaged areas at different altitudes. Species occurrences were recorded using a tabulation method to identify characteristic and differential species based on disturbance type. Importance value analysis showed that tree layers were present only in undisturbed areas at all altitudes, while shade-intolerant species, such as Amur choke cherry (P. glandulifolia), had high importance in the subtree layer in low-altitude damaged areas and mid-altitude forest edges. Species diversity was higher in forest edges at medium and high altitudes, whereas control areas exhibited higher diversity at low altitudes. DCA ordination revealed distinct community groupings based on altitude and disturbance type, indicating community heterogeneity. The study found rapid vegetation recovery in damaged areas and forest edges, driven by shade-intolerant species. Restoration efforts should prioritize these species to support successful recovery.

MANEJO DE FERIDAS EM COELHO ATRAVÉS DO USO DA PELE DE TILÁPIA LIOFILIZADA

The study addresses the importance of treating skin lesions in veterinary medicine, with an emphasis on wound healing in rabbits with pododermatitis, including the use of Nile tilapia skin as a therapeutic alternative for grafting after debridement of necrotic ulcers. Skin lesions can be caused by trauma, bites or other causes, compromising vital skin functions, such as protection and defense against infections. Tilapia skin is rich in type I collagen and has been highlighted as an accessible and effective biomaterial in the treatment of wounds, stimulating cell regeneration and healing. The work reports the case of a rabbit, named Paçoca, diagnosed with ulcerative pododermatitis in the left pelvic limb, a chronic condition that can lead to serious complications. The clinical signs of the pathology are pain, abdominal and limb alopecia, edema, ulcerative lesions, loss of joint mobility with the presence of osteolytic reactions. Pododermatitis in rabbits is often related to factors such as cage floor quality, excess weight, and sedentary lifestyle. The rabbit’s treatment included debridement of necrotic tissue and the application of tilapia skin as a graft. The tilapia skin was prepared through a rigorous sterilization and preservation process, involving immersion in specific solutions and the application of antibiotics. The use of this skin as an occlusive dressing helped stimulate growth factors essential for skin regeneration, such as fibroblasts and keratinocytes. The use of this biomaterial proved effective in the treatment of wounds with significant tissue loss, avoiding the need for sutures and promoting healing through the formation of new tissue. Postoperative follow-up included the use of antibiotics and anti-inflammatories, and treatment with tilapia skin contributed to the successful recovery. The study highlights the effectiveness of the biomaterial in the management of skin wounds in rabbits, especially in the recovery of lesions caused by ulcerative pododermatitis. Therefore, after treatment, the rabbit presented good healing, the wound evolved positively, with formation of granulation tissue and epithelialization.

Management of Acute Compartment Syndrome During the Al Haouz Earthquake - Department of Reconstructive and Aesthetic Plastic Surgery, CHU Mohammed VI, Marrakech

On September 8, 2023, a devastating earthquake struck the Al Haouz region of Morocco, causing significant injuries, including cases of acute compartment syndrome (ACS), a surgical emergency. This report presents a case of a patient from the earthquake, treated for ACS at Mohammed VI University Hospital in Marrakech. The patient, who suffered limb trauma from debris crushing, presented with rhabdomyolysis and signs of ACS in the left upper and lower limbs. Clinical findings included functional impairment, "Coca-Cola" urine, and high creatine kinase levels (60,000), accompanied by renal failure. Decompression surgery (aponevrotomies) was performed to relieve intracompartmental pressure, followed by a directed healing protocol using the "shoe-lace" technique for wound closure. Post-operative management included antibiotics, hemodialysis for acute renal failure, nutritional support, and motor rehabilitation. Complications, such as surgical site infection and hematoma, were addressed with revision surgery and adjusted antibiotic therapy. Despite these challenges, the patient showed significant clinical improvement and resumed normal activity within three months post-operatively. This case highlights the critical importance of timely surgical intervention in ACS, particularly in disaster settings. Early diagnosis, prompt fasciotomy, effective wound management, and multidisciplinary care are essential to prevent severe complications, such as septic wounds or amputation, and ensure successful recovery.

Complete suspension culture of human induced pluripotent stem cells supplemented with suppressors of spontaneous differentiation

Human induced pluripotent stem cells (hiPSCs) are promising resources for producing various types of tissues in regenerative medicine; however, the improvement in a scalable culture system that can precisely control the cellular status of hiPSCs is needed. Utilizing suspension culture without microcarriers or special materials allows for massive production, automation, cost-effectiveness, and safety assurance in industrialized regenerative medicine. Here, we found that hiPSCs cultured in suspension conditions with continuous agitation without microcarriers or extracellular matrix components were more prone to spontaneous differentiation than those cultured in conventional adherent conditions. Adding PKCβ and Wnt signaling pathway inhibitors in the suspension conditions suppressed the spontaneous differentiation of hiPSCs into ectoderm and mesendoderm, respectively. In these conditions, we successfully completed the culture processes of hiPSCs, including the generation of hiPSCs from peripheral blood mononuclear cells with the expansion of bulk population and single-cell sorted clones, long-term culture with robust self-renewal characteristics, single-cell cloning, direct cryopreservation from suspension culture and their successful recovery, and efficient mass production of a clinical-grade hiPSC line. Our results demonstrate that precise control of the cellular status in suspension culture conditions paves the way for their stable and automated clinical application.

Complete suspension culture of human induced pluripotent stem cells supplemented with suppressors of spontaneous differentiation.

Human induced pluripotent stem cells (hiPSCs) are promising resources for producing various types of tissues in regenerative medicine; however, the improvement in a scalable culture system that can precisely control the cellular status of hiPSCs is needed. Utilizing suspension culture without microcarriers or special materials allows for massive production, automation, cost-effectiveness, and safety assurance in industrialized regenerative medicine. Here, we found that hiPSCs cultured in suspension conditions with continuous agitation without microcarriers or extracellular matrix components were more prone to spontaneous differentiation than those cultured in conventional adherent conditions. Adding PKCβ and Wnt signaling pathway inhibitors in the suspension conditions suppressed the spontaneous differentiation of hiPSCs into ectoderm and mesendoderm, respectively. In these conditions, we successfully completed the culture processes of hiPSCs, including the generation of hiPSCs from peripheral blood mononuclear cells with the expansion of bulk population and single-cell sorted clones, long-term culture with robust self-renewal characteristics, single-cell cloning, direct cryopreservation from suspension culture and their successful recovery, and efficient mass production of a clinical-grade hiPSC line. Our results demonstrate that precise control of the cellular status in suspension culture conditions paves the way for their stable and automated clinical application.

USO DE TERAPIAS MANUAIS NA REABILITAÇÃO DA FASCITE PLANTAR: UMA REVISÃO SISTEMÁTICA.

Fasciitis is an inflammation of the plantar fascia, a structure that helps support the medial arch of the foot and is designed to absorb much of the impact. Plantar fasciitis can result from a number of factors, including excessive stress and overload, which can result in inflammation, stress fractures of the calcaneus, compressive neuropathy of the plantar nerves, and more. The aim of this study is to to elucidate how manual therapies can be effective in the treatment of plantar fasciitis. In its preparation, a literature review was carried out to evaluate the effectiveness or not of manual therapies in the treatment of plantar fasciitis, the databases used were: Pubmed, SciElo and PEDro , in Portuguese and English, in the period from January 2019 to December 2024. Ten studies were included to be analyzed in this systematic review, and it showed that manual therapy provides significant benefits, such as reducing pain and improving the function of patients with plantar fasciitis. In conclusion, this study offers valuable insight into how an integrated approach can benefit patients with plantar fasciitis . The findings reinforce the need for personalized treatments, emphasizing that combining different modalities may be key to successful recovery. However, there have been few scientific articles on these manual techniques, so it is worth highlighting the importance of encouraging further studies.