Rehabilitation Considerations Research Articles

Prioritise safety, optimise success! Return to rugby postpartum.

Pregnancy and childbirth involve substantial physical, physiological and psychological changes. As such, postpartum rugby players should be supported and appropriately prepared to return to the demands of rugby alongside the additional demands of motherhood. This review aims to discuss specific perinatal considerations that inform a rugby player's readiness to return-to-sport postpartum and present an approach to rehabilitation. Before engaging in full rugby training and matchplay, postpartum players should have progressed through the initial phases of rehabilitation and graded sports-specific training to prepare them for the loads they will be exposed to. Additional rehabilitation considerations include minimising deconditioning during pregnancy; medical concerns; the abdominal wall; the pelvic floor; perinatal breast changes, breastfeeding and risk of contact breast injury; body mass; nutritional requirements; hormonal considerations; athlete identity and psychological considerations; joining team training; return to contact and tackle training; evaluating player load tolerance and future research, policy and surveillance needs. A whole-systems, biopsychosocial approach following an evidence informed return-to-sport framework is recommended when rehabilitating postpartum rugby players. Health and exercise professionals are encouraged to use the perinatal-specific recommendations in this review to guide the development of postpartum rehabilitation protocols and resources.

Team Approach: Osseointegration Amputation Surgery.

» The purpose of this article was to review the multidisciplinary, team-based approach necessary for the optimal management of patients with limb loss undergoing osseointegration surgery.» In this study, we describe the interdisciplinary process of screening, counseling, and surgical and rehabilitation considerations with an emphasis on principles rather than specific implants or techniques.» Integrated perioperative management and long-term surveillance are crucial to ensure the best possible outcomes.» We hope this model will service as an implant-agnostic guide to others seeking to development an osseointegration center of excellence.

At the Basis of Brain Malformations: Brain Plasticity, Developmental Neurobiology, and Considerations for Rehabilitation

AbstractFrom early age in the human brain occurs plasticity process that influences its development. The functioning of the brain is governed by its neuronal connectivity and the synaptic dynamics of these connections. A neuron, over thousands of synapses, can receive a large number of inputs and produce different outputs leading to the consolidation and integration of memory. Synaptic plasticity is the set of experience-dependent changes in neuronal pathways that support acquired habits. It is the ability of the nervous system to reshape connectivity between neurons, changing the functional and structural organization of neuronal circuits that allows us to adapt to the multiple and continuous changes in the environment and leading to processes such as cognitive development and the ability to learn. Synaptic plasticity is mainly due to short- and long-term mechanisms. Short-term synaptic plasticity refers to changes in synaptic strength that occurs very quickly (from one-thousandth of a second to 5 minutes) and are temporary and decay over minutes (maximum 30 minutes). Long-term synaptic plasticity is defined by a long-lasting, activity-dependent change in synaptic efficacy, last from hours up to a lifetime (from 30 minutes to weeks, months, and years) and is thought to constitute the basis of learning and memory. A significant difference occurs in the nature of the change; short-term plasticity adds only a functional change, whereas long-term plasticity causes not only functional but also structural changes. Aside from genetic factors and metabolic processes, brain development is mediated also by environmental factors. Interaction with the environment plays a key role in the development and growth of neural networks and neuroplasticity. Environmental interactions that can modify and increase the development of neural networks and intelligence in children are several and are herein discussed.

Microcephaly and Its Related Syndromes: Classification, Genetic, Clinical, and Rehabilitative Considerations

AbstractMicrocephaly, a form of cortical cortex malformation, results from abnormal cellular production and proliferation, identified when the occipital frontal head circumference (OFC) falls two or more standard deviations (SDs) below the expected average for age, gender, and population. Severity is classified based on SD: mild (OFC < 2 SD) or severe (OFC < 3 SD). While microcephaly can lead to developmental delay, intellectual disability, epilepsy, and cerebral palsy, not all cases exhibit these issues. Classified as primary/congenital or secondary/postnatal, microcephaly can stem from genetic or acquired factors in both types. Congenital microcephaly origins vary, while secondary microcephaly is characterized by normal OFC at birth, followed by a decrease within the first year, often associated with progressive cognitive and motor impairments. Primary hereditary microcephaly (MCPH), or microcephaly vera, is genetically diverse, with 28 related genes (MCPH1 to MCPH28) encoding proteins linked to centrosomes and progenitor cell mitosis in the brain ventricle's neuroepithelium. Defects in deoxyribonucleic acid (DNA) repair pathways (e.g., NBN, FANCA, ATR, ATM genes) can lead to microcephaly by impairing DNA repair. Enzyme deficiencies in metabolic pathways may also contribute, causing toxic metabolite accumulation or essential metabolite loss (microcephaly of metabolic origin). Acquired congenital microcephaly may result from ischemic or infectious processes, drugs, radiation, maternal diseases during pregnancy, with damage influenced by fetal genetics, environmental interactions, developmental stage, and exposure intensity/duration. Diagnostic workup includes electroencephalogram, ophthalmological, auditory, magnetic resonance imaging, metabolic, echocardiogram, and infection screening tests, alongside genetic evaluations like cytogenetic studies, fluorescence in situ hybridization, comparative genomic microarray-hybridization, single-nucleotide microarray-polymorphism, and exome sequencing. Symptomatic treatment is available, and genetic counseling is crucial for affected families.

Intramedullary Kirschner Wire Fixation for Metatarsal Fractures: A Comprehensive Review of Treatment Outcomes.

Metatarsal fractures pose significant challenges in orthopedic practice, necessitating effective treatment methods to ensure optimal patient outcomes. This comprehensive review focuses on intramedullary Kirschner wire fixation as a promising intervention for metatarsal fractures. Beginning with an overview of metatarsal fractures and the imperative for effective treatments, the review delves into intramedullary fixation's definition, historical background, advantages, and disadvantages. Indications for its use in metatarsal fractures are discussed, providing a foundation for understanding its application. The surgical technique section outlines critical aspects, including patient selection criteria and preoperative planning. Before presenting a detailed step-by-step procedure for intramedullary Kirschner wire fixation, anesthesia considerations are explored. Emphasizing precision, fluoroscopic guidance, and meticulous postoperative care, this section provides insights for surgeons and healthcare practitioners. Considerations for rehabilitation follow, addressing postoperative care, expected recovery timelines, and physical therapy recommendations. Early mobilization, weight-bearing guidelines, and a structured rehabilitation program play pivotal roles in recovery. In the conclusion, key findings are summarized, highlighting the efficacy of intramedullary Kirschner wire fixation, its advantages, and recommendations for clinical practice. Additionally, areas for future research are identified, guiding further exploration and refinement of this surgical approach. This review is valuable for clinicians, researchers, and healthcare practitioners involved in metatarsal fracture management, contributing to the evolution of treatment strategies and improving patient care.

Evaluation of Failed ACL Reconstruction: An Updated Review.

Failure rates among primary Anterior Cruciate Ligament Reconstruction (ACLR) range from 3.2% to 11.1%. Recently, there has been increased focus on surgical and anatomic considerations which predispose patients to failure, including excessive posterior tibial slope (PTS), unaddressed high-grade pivot shift, and improper tunnel placement. The purpose of this review was to provide a current summary and analysis of the literature regarding patient-related and technical factors surrounding revision ACLR, rehabilitation considerations, overall outcomes and return to sport (RTS) for patients who undergo revision ACLR. There is a convincingly higher re-tear and revision rate in patients who undergo ACLR with allograft than autograft, especially amongst the young, athletic population. Unrecognized Posterior Cruciate Ligament (PLC) injury is a common cause of ACLR failure and current literature suggests concurrent operative management of high-grade PLC injuries. Given the high rates of revision surgery in young active patients who return to pivoting sports, the authors recommend strong consideration of a combined ACLR + Anterolateral Ligament (ALL) or Lateral extra-articular tenodesis (LET) procedure in this population. Excessive PTS has been identified as an independent risk factor for ACL graft failure. Careful consideration of patient-specific factors such as age and activity level may influence the success of ACL reconstruction. Additional technical considerations including graft choice and fixation method, tunnel position, evaluation of concomitant posterolateral corner and high-grade pivot shift injuries, and the role of excessive posterior tibial slope may play a significant role in preventing failure.

From Middle-Age to the Golden Years: Medical, Surgical and Rehabilitation Considerations to Maintain Exercise and Sports Activities with Knee Osteoarthritis

Abstract. The objective of the current concepts paper is increase the reader’s awareness and understanding of medical, surgical, and rehabilitation considerations for middle-aged patients with knee osteoarthritis who desire to preserve knee joint function and quality of life as they continue exercise and sport activities into their “golden years”.

Prevalence of musculoskeletal pain and dysfunction in electrical utility workers: Practical considerations for prevention and rehabilitation in the workplace.

This study assessed the prevalence and associations of musculoskeletal pain and dysfunction in electrical utility workers, with the aim of applying the findings to better prevent and rehabilitate workplace musculoskeletal disorders. Employees completed an online survey recording their musculoskeletal symptoms across nine anatomical locations for the preceding 12 months. A total of 565 employees, working across eight different electrical utility organisational work units, completed the survey. The study was collaborative and conducted in Australia's largest, wholly government owned electricity company. The study originated from the participating organisation wanting to better understand their musculoskeletal disorder (MSD) risks. Employees who experienced high job stress were 4.06 times (95% confidence interval [CI] = 1.78-9.29) more likely to report musculoskeletal symptoms in the shoulder compared with employees with lower reported job stress. Employees that perceived their work to have high physical demands report lower back musculoskeletal symptoms at 2.64 times the rate of those perceiving their job to be of low physical demand (95% CI = 1.44-4.84). There were significant differences in the lower back musculoskeletal symptoms according to work unit membership. Understanding the prevalence of MSDs is critical to implementing practical prevention and rehabilitation strategies in the workplace. This anonymous survey highlighted that a large proportion of electrical utility workers reported that musculoskeletal symptoms had impacted their ability to perform their job, housework and/or hobbies in the preceding 12 months. Early access to rehabilitation services is essential. However, many workers report barriers to disclosing MSDs; therefore, workplace rehabilitation services may need to be broadened to account for these barriers.

Hamstring Tendon Autograft Is Associated With Increased Knee Valgus Moment After Anterior Cruciate Ligament Reconstruction: A Biomechanical Analysis

Background: There is limited evidence related to the effects of autograft type on functional performance after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis: This study aimed to compare biomechanical outcomes during a drop vertical jump (DVJ) between patients with a hamstring tendon (HT) autograft, quadriceps tendon (QT) autograft with bone block, QT autograft without bone block, and bone–patellar tendon–bone autograft at 6 months postoperatively in an adolescent population. The authors’ hypothesized there would be differences in DVJ biomechanics between athletes depending on the type of autograft used. Study Design: Controlled laboratory study. Methods: Patients aged 8 to 18 years who underwent primary ACLR were included for analysis. Kinematic and kinetic data collected during a DVJ using a 3-dimensional computerized marker system were assessed at 6 months after ACLR and compared with the uninjured contralateral limb. Results: A total of 155 participants were included. There were no significant differences in terms of age, sex, or affected leg (P≥ .1973) between groups. The HT group was significantly associated with a larger knee valgus moment at initial contact compared with the QT group (28 × 10–2 vs −35 × 10–2 N·m/kg, respectively; P = .0254) and a significantly larger maximum hip adduction moment compared with the QT with bone block group (30 × 10–2 vs −4 × 10–2 N·m/kg, respectively; P = .0426). Both the QT with bone block (–12 × 10–2 vs −3 × 10–2 N·m/kg, respectively; P = .0265) and QT (–13 × 10–2 vs −3 × 10–2 N·m/kg, respectively; P = .0459) groups demonstrated significantly decreased mean knee extension moments compared with the HT group. Conclusion: The findings of this study suggest that utilizing an HT autograft resulted in a significantly increased knee valgus moment at initial contact compared with a QT autograft without bone block at 6 months after ACLR in adolescent patients performing a DVJ. A QT autograft was found to be associated with significantly decreased extensor mechanism function compared with an HT autograft. Clinical Relevance: This study adds unique kinematic and kinetic information regarding various ACLR autograft options and highlights the biomechanical deficits that should be taken into consideration in rehabilitation.

Fatty infiltration of gastrocnemius-soleus muscle complex: Considerations for myosteatosis rehabilitation.

Although previous studies have reported fatty infiltration of the gastrocnemius-soleus complex, little is known about the volumetric distribution and patterns of fatty infiltration. The purpose of this anatomical study was to document and quantify the frequency, distribution, and pattern of fatty infiltration of the gastrocnemius-soleus complex. One hundred formalin-embalmed specimens (mean age 78.1 ± 12.3 years; 48F/52M) were serially dissected to document the frequency, distribution, and pattern of fatty infiltration in the medial and lateral heads of gastrocnemius and soleus muscles. Fatty infiltration was found in 23% of specimens, 13 unilaterally (8F/5M) and 10 (5M/5F) bilaterally. The fatty infiltration process was observed to begin medially from the medial aspect of the medial head of gastrocnemius and medial margin of soleus and then progressed laterally throughout the medial head of gastrocnemius and the marginal, anterior, and posterior soleus. The lateral head of gastrocnemius remained primarily muscular in all specimens. Microscopically, the pattern of infiltration was demonstrated as intramuscular with intact aponeuroses, and septa. The remaining endo-, peri-, and epimysium preserved the overall contour of the gastrocnemius-soleus complex, even in cases of significant fatty replacement. Since the external contour of the calf is preserved, the presence of fatty infiltration may be underdiagnosed in the clinic without imaging. Myosteatosis is associated with gait and balance challenges in the elderly, which can impact quality of life and result in increased risk of falling. The findings of the study have implications in the rehabilitation management of elderly patients with sarcopenia and myosteatosis.

Displaced Posterior Cruciate Avulsion Fracture Fixation With Medial Collateral Ligament and Lateral Meniscus Injury Using Combined Open and Arthroscopic Methods

Tibial-sided posterior cruciate ligament avulsion fractures are challenging injuries that often occur concomitantly in the setting of multiligament knee and other soft-tissue injuries. There is no consensus on the optimal surgical approach or timing of treatment for these injuries. This Technical Note describes the fixation of a displaced posterior cruciate ligament avulsion fracture with concomitant grade 3 medial collateral ligament injuries and bucket-handle lateral meniscus tears using open and arthroscopic techniques. This method allows the surgeon to address multiple pathologies in a single stage, although it requires strategic planning and rehabilitation considerations.

Mineralogical, Petrological and Geochemical Characterisation of Chrysotile, Amosite and Crocidolite Asbestos Mine Waste from Southern Africa in Context of Risk Assessment and Rehabilitation

Derelict asbestos mine sites in South Africa pose a considerable risk to human, environmental and socio-economic health. Comprehensive mineralogical and geochemical datasets for the existing hazardous geological materials still exposed in Southern African derelict asbestos mines remain largely non-existent, as very little published and up-to-date literature is available. In this study, three representative types of asbestos mineral fibres from derelict asbestos mines in Southern Africa, namely chrysotile from Havelock mine, amosite from Penge mine and crocidolite from Prieska mine, are characterized mineralogically and geochemically to critically evaluate actual hazards in rural and asbestos-fibre-contaminated regions. The samples were examined using polarising light microscopy, X-ray fluorescence (major and trace elemental analysis), X-ray diffraction (including Rietveld refinement), specific surface area analysis and bio-durability testing. Data are discussed in view of their potential toxicities on both human health and the environment in the context of developing countries. Finally, information on the mineralogical and geochemical status of asbestos mine waste and its importance as baseline data for rehabilitation considerations is also evaluated.

Preferences for Rehabilitation in Persons with a History of Stroke: A Discrete Choice Experiment.

To investigate the preferences of persons with a history of stroke for various attributes of rehabilitation using a discrete choice experiment (DCE). Cross-sectional study. A web-based survey. A total of 600 adults with a history of stroke who were not asked whether or not they had participated in previous rehabilitation. None. Preference weights by attribute ie, treatment time (30 minutes, one hour, one and a half hours), treatment content (walking exercises, activities of daily living; ADL exercises), priority treatment of paralyzed limbs (upper extremity, lower upper extremity), treatment location (hospital visit, home visit), therapist gender, and out-of-pocket costs for stroke rehabilitation using discrete choice experiment. The most common self-reported diagnosis was cerebral infarction (408 patients, 68%). The mean age was 62.0 ± 9.8 years, and 515 (85.8%) were male. Of the five attributes, excluding out-of-pocket costs, the highest relative importance score was treatment location (0.331), followed by treatment time (0.304). Among the rehabilitation programs, the statistically significant coefficients calculated were one hour of therapy (0.173, 95% CI = 0.088-0.258), hospital visits (0.241, 95% CI = 0.180-0.303), and female therapists (0.186, 95% CI = 0.125-0. 247). No significant differences were obtained regarding the treatment contents or the paralyzed limb to be treated. A discrete choice experiment revealed that persons with a history of stroke prefer a one-hour hospital rehabilitation program with a female therapist, with cost being a major consideration for rehabilitation. The results of this study may provide useful information for rehabilitation professionals.

Matching patients with therapists in culturally diverse rehabilitation services during civil unrest.

A primary consideration in rehabilitation is the compatibility between clinicians and patients, where cultural diversity is a defining feature for both. The intricacies of cultural considerations in patient-clinician matching are heightened in areas of conflict and civil unrest. This paper presents three perspectives of the significance of cultural considerations in such assignments: patient-centred approach - prioritizing patients' preferences; professional-centred approach - clinicians' safety, social-emotional, and training needs; and utilitarian approach - what is best for the majority. A case study from an Israeli rehabilitation clinic is presented to exhibit the multifaceted considerations in patient-clinician matching within areas of conflict and civil unrest. The reconciliation of these three approaches in the context of cultural diversity is discussed, suggesting the benefit of a case-by-case strategy involving combinations of the three. Further research could examine how this might feasibly and beneficially optimize outcomes for all in culturally diverse societies in times of unrest.

Soil Characteristics and Fertility of the Unique Jarrah Forest of Southwestern Australia, with Particular Consideration of Plant Nutrition and Land Rehabilitation

The jarrah forest is a natural ecosystem with significant endemism in the flora and fauna. The forest stands on the western edge of the ancient Great Plateau of Western Australia on the granitic shield of the Yilgarn craton (2.5 Gya). The long-term migration of soluble iron and aluminium led to the formation of bauxite ore. The regolith ore is bound by surficial topsoil and deep pallid zone kaolinite clays, primarily used in land rehabilitation. We investigated the chemical fertility of the substrates, along with key physical properties. We found the capacity of these soils to provide a stable growth medium differed considerably in their ability to retain and supply nutrients. These substrates are deficient in nitrogen, phosphorus, and micronutrients. In the topsoil, 15% of total P is plant-available, while in the pallid zone layer, only 1% of total P is available. 31P-NMR showed no organic P in the pallid zone, whereas the topsoil had significant organic P and, consequently, a supply of phosphate ions. This shows the importance of organic P in the topsoil for ecosystem nutrition when inorganic fertilisers are not applied in state-of-the-art restoration schemes.

Graft-Specific Surgical and Rehabilitation Considerations for Anterior Cruciate Ligament Reconstruction with the Quadriceps Tendon Autograft.

Level 5.

Characteristics of alveolar bone loss in severe periodontitis and consideration of rehabilitation with implant

Severe periodontitis is the main cause of tooth loss in adults, with varying degrees of horizontal and vertical alveolar bone loss. In view of the complex alveolar bone defect, a suitable surgery planning should be made on the basis of fully nuderstanding the characteristics of alveolar bone defect in severe periodontitis and the key points of bone augmentation technique, so as to choose an appropriate method for reconstruction of alveolar bone and complete the implantation and restoration to ensure the integrity of dentition, which are important for the long-term stability of periodontal health. Based on clinical experiences and literature review, we summarizes the characteristics of alveolar bone loss in patients with severe periodontitis and the timing of implant placement after bone augmentation surgery, in order to provide reference for implant treatment of severe periodontitis.

A funkcionális halláscsökkenés felismerése és komplex diagnosztikája

Hearing loss is a sensory impairment that impairs speech understanding, communication and therefore the quality of life. Sometimes the patient's perceived loss of function is exaggerated; subjective and objective test results are inconsistent, the subjectively reported hearing loss is more significant, and in these cases functional hearing loss is considered. Our aim was to collect and retrospectively analyze cases with the diagnosis of functional hearing loss, in order to draw conclusions about the characteristics of functional hearing loss, the signs and conditions that may be of attention and the consideration of appropriate rehabilitation. Subjective tests were performed with pure-tone auditory threshold, speech understanding and communication tests, which were compared with the results obtained with objective impedance measurements, stapedial reflex tests, otoacoustic emission measurements, and brainstem evoked response recordings. Imaging studies, psychologist, psychiatrist, neurologist, neurologist and other co-specialists were involved as needed. We excluded cases of deception deliberately intended to obtain financial or other benefits. Between 2007 and 2022, 19 patients were diagnosed with functional hearing loss. The majority (17 cases) were female, the complaints were prevalent at a young age (10-41 years); the average age in the study population was 19.6 years, and the majority of patients (13 cases) were children aged 10-17 years. No organic cause was found in 11 cases, and in the remaining cases no detectable organic abnormality explained the extent of the hearing loss experienced by the patient. The degree of functional hearing loss varied (35-120 dB), with an average of 60,2 dB. Recognizing and diagnosing functional hearing loss is very difficult and requires a complex series of tests and professional cooperation. Without recognition, the patient may receive unjustified, even harmful and financially burdensome care, which may lead to the deterioration of his condition. Orv Hetil. 2023; 164(8): 283-292.

Heart transplantation and the role of inpatient rehabilitation: A narrative review.

Heart transplantation is a definitive treatment option for patients with end-stage heart failure. Medical and functional complications are common after this procedure, and rehabilitation is often needed postoperatively. Physiatrists caring for persons who have received a donor heart must appreciate the surgical background, the physiologic changes expected, as well as the potential medical complications for which they are at risk after heart transplantation. This review summarizes various topics in heart transplantation including the history of the procedure, exercise physiology and functional outcomes, postoperative medical therapy, medical complications, and special considerations for inpatient rehabilitation in this patient population.

Price reductions in hearing aids and access to audiologists, Israel.

Hearing rehabilitation with hearing aids is a complex process which requires professional expertise and the involvement of audiologists or hearing-care specialists. Professional care, however, requires extra resources, making it tempting to rely solely on technology and reduce the role of professional counselling. To reduce the out-of-pocket share for adults needing hearing rehabilitation, in 2011 the Israeli government tripled the subsidy for adult hearing aids by converting 3years of subsidies into a triennial, enlarged fund. Regulations for providing hearing rehabilitation and a set of rules for tenders for the supply of hearing aids were issued. Auditory diagnosis and rehabilitation are included in the Israeli national health insurance system. Before 2011, the annual government-funded subsidy for hearing aids was negligible; hearing aids were expensive and bought mostly with patients' own resources. A series of tenders for companies to supply hearing aids, aiming to control public and individual expenses, resulted in a large reduction in prices, which in turn raised the demand for hearing aids and increased public expenditure. As the price of hearing aids fell markedly, hearing rehabilitation is approaching a point of becoming limited to supplying hearing devices, while reducing the importance placed on professional elements of the rehabilitation course. Lowering out-of-pocket costs for patients should not be the only consideration in hearing rehabilitation. Our goal should be to control public expenditure but also provide affordable hearing aids with sufficient intervention of hearing-care specialists, to ensure access to advanced technologies and proper professional care.