Rehabilitation Department Research Articles

Microstomia- A Review Of Published Case Reports On The Proposed Management Of Microstomia

Introdcution: microstomia, or the reduction of oral opening, can indeed present challenges for patients across various contexts, from eating and speech to prosthetic treatment. It's essential for clinicians to understand the underlying causes and tailor their approach accordingly. By synthesizing existing evidence, this review aims to provide insights into the effectiveness and feasibility of different prosthetic interventions, thereby guiding clinicians in their decision-making process for optimal patient care. Materials and methods: published case reports and case series reporting on prosthetic rehabilitation of microstomia patients were included in the present review. Only cases with a reduction in the size of the oral aperture were included, and cases with reduced mouth opening with a normal oral aperture (e.g., oral submucous fibrosis, temporal-mandibular joint ankylosis, etc.) Were excluded. Case reports: (case report1) a 93-year-old woman without teeth was referred from the local hospital to the department of oral rehabilitation at the faculty of dentistry, university of otago, dunedin, new zealand. The woman's surgeries on her lower lip resulted in a significant reduction in the vertical opening distance between her upper and lower lips, now at 30 mm. This condition, known as microstomia. (case report 2) a 62-year-old male patient, completely without teeth, presented to the prosthodontic department due to functional difficulties. Discussion: a planned and step-by-step approach is crucial when dealing with cases of microstomia. The outcome greatly depends on the complexity of the case and the utilization of recommended materials and equipment hence, diagnosis and treatment planning play pivotal roles in the management process. Conclusion: although the utilization of flexible denture materials holds promise in enhancing patient comfort and treatment outcomes, further research is warranted to evaluate their long-term success rates. Longitudinal studies can furnish valuable insights into the durability, stability, and overall performance of these materials over time, assisting clinicians in decision-making and optimizing patient care.

Investigation of personality type and physical activity level in physiotherapy and rehabilitation department students

Aims: The aim of this study is to examine the relationship between personality types and physical activity levels among undergraduate students in the department of physiotherapy and rehabilitation. Methods: The participants’ physical activity levels were assessed using the short form of the International Physical Activity Questionnaire (IPAQ). To evaluate the participants’ personality traits, the Eysenck Personality Questionnaire-Revised/Short Scale was used. The relationship between individuals’ personality traits and physical activity levels was determined using Spearman’s rank correlation analysis. Results: The study included 180 undergraduate students from the department of physiotherapy and rehabilitation. The results revealed a strong correlation between severe metabolic equivalent (MET) (r: 0.246, p: 0.001), moderate MET (r: 0.196, p: 0.009) and total MET (r: 0.202, p: 0.007) with psychoticism. Additionally, a strong correlation was observed between extraversion and walking MET (r: 0.180, p: 0.017) as well as total MET (r: 0.196, p: 0.009). Conclusion: Students with personality traits of psychoticism and extraversion tend to be physically more active.This study shows that physical-activity levels may be predicted by personality traits on Turkish physiotherapy and rehabilitation students.

The Effect of Nomophobıa on Anxıety and Qualıty of Lıfe in Physıotherapy and Rehabılıtatıon Department Students

Objective. While smartphones provide convenience to individuals, they also cause many problems. One of these problems is smartphone addiction, known as nomophobia. The aim of our study is to investigate the impact of nomophobia on anxiety and quality of life among students in the Department of Physiotherapy and Rehabilitation.. Methods. The study included 211 students enrolled at Sakarya University of Applied Sciences, Department of Physiotherapy and Rehabilitation. Participants completed a data collection form to provide their demographic characteristics. They also completed the Turkish Nomophobia Scale to assess nomophobia levels, the Beck Anxiety Scale to evaluate anxiety levels, and the SF-36 Quality of Life Scale to measure their quality of life levels. Results. In our study, the nomophobia scale score was found to be 77.28. The distribution of the nomophobia scale according to the cut-off points is 30% mild, 45% moderate, and 25% extreme. We identified a statistically significant relationship between nomophobia and anxiety (p < 0.05). Additionally, there was a statistically significant association between nomophobia and quality of life parameters, excluding vitality/energy, mental health, and social functioning (p < 0.05). However, no statistically significant relationship was found between anxiety and quality of life. Conclusion. The anxiety levels of nomophobic individuals increase in parallel with their nomophobia, leading to a decrease in their quality of life. Necessary information should be provided and awareness should be raised in order to prevent nomophobia, which is especially common in the young population.

The relationship between ultrasound and electrodiagnostic findings in relation of the severity of carpal tunnel syndrome

IntroductionCarpal tunnel syndrome is the most common compression neuropathy. Grading the severity of carpal tunnel syndrome is an important factor in deciding on the type of treatment. This study aims to determine the relationships between the findings of the electrodiagnosis and ultrasonography methods based on the severity of carpal tunnel syndrome.MethodsIn this prospective clinical study, 50 patients (96 wrists) who were referred to the Physical Medicine and Rehabilitation Department of the Shohada Tajrish Hospital, Tehran, Iran (from March 2021 to November 2022) were studied. All patients with a history and clinical examination related to CTS underwent electrodiagnosis studies. Based on the results of electrodiagnosis, patients were divided into three groups: mild, moderate, and severe. All eligible patients underwent ultrasound at the cross-section of the wrist (at the level of the pisiform bone, the entrance of the canal) and the middle of the forearm.ResultsIn this study, the cross-sectional area of the median nerve was measured in 96 wrists of 50 patients with a mean age of 51.78 ± 9.80 years. The mean CSA of the median nerve in the mild, moderate, and severe groups was reported as 0.12 ± 0.03, 0.14 ± 0.02, and 0.21 ± 0.06, respectively. The mean WFR in different groups of CTS was reported as 1.85 ± 0.56, 1.93 ± 0.56, and 2.45 ± 0.49, respectively. A significant relationship between ultrasound findings, including CSA-inlet and WFR, and electrodiagnosis findings was presented (P value < 0.05).ConclusionBased on our findings, there is a statistically significant relationship between the sonographic findings, including the mean CSA-inlet and WFR, and the severity of CTS based on the electrodiagnosis study. Our findings revealed that as disease severity increases, sonographic parameters also increase significantly.

THE EFFECT OF A MODIFIED TENODESIS WRIST-HAND ORTHOSIS ON HAND FUNCTION IN PATIENTS WITH TETRAPLEGIA

BACKGROUND: An individual experiencing tetraplegia faces functional limitations due to impaired hand function. The use of an affordable tenodesis wrist-hand orthosis (WHO) can enable finger flexion with active wrist extension, thereby enhancing the three-jaw chuck grasp and overall hand functionality. OBJECTIVES: To assess hand function and satisfaction in patients with tetraplegia using a modified tenodesis wrist-hand orthosis (WHO), utilizing the Duruöz Hand Index (DHI) and the Orthotics and Prosthetics User Survey (OPUS) satisfaction with device and services subscales. METHODOLOGY: The study was conducted at a tertiary care center in central India, enrolling patients with tetraplegia admitted to the Department of Physical Medicine and Rehabilitation. A modified tenodesis wrist-hand orthosis (WHO) was designed using low-temperature thermoplastic components. Twenty-two individuals with a minimum wrist extensor power of grade 3/5 were included in the study. These patients were provided with the modified tenodesis WHO and underwent daily training sessions for a period of 2 weeks. Duruöz Hand Index (DHI) scores were assessed at baseline, 6 weeks, and 12 weeks post-enrolment. Patient satisfaction was evaluated using the Orthotics and Prosthetics User’s Survey (OPUS) satisfaction with device and services subscales. FINDINGS: The analysis of the DHI scores indicated a significant enhancement in functional abilities at both 6-week and 12-week follow-ups compared to the baseline assessment. Notably, the most substantial progress at 6 weeks follow-up was observed in tasks such as buttoning a shirt, while significant improvement at the 12-week mark was noted in activities like turning a key in a lock. The median OPUS device satisfaction score was 50, corresponding to a Rasch score of 68.8. Additionally, the median OPUS satisfaction score for services stood at 46, with a Rasch score of 72.7. Patients expressed the highest satisfaction levels with the courteous demeanor of the staff, prompt scheduling of appointments, and accurate fitting of the orthosis. CONCLUSION: The study findings indicate that the modified tenodesis WHO is an effective and satisfactory therapeutic device for improving hand function in patients with tetraplegia. The findings encourage further investigation and application of the modified tenodesis WHO in clinical practice. Layman's Abstract Individuals who are affected due to spinal cord injury (SCI) are often unable to perform the basic daily activities of life due to weakness. The hands are one of the most specialized parts of the human body and loss of its function can be incapacitating. Certain wrist hand orthoses (WHO) can aid such individuals by assisting the weak hand muscles. One such WHO is a tenodesis wrist hand orthosis. Modifications to the previously available tenodesis wrist hand orthosis were made to make it cheaper, lighter, and easier to manufacture. The effectiveness of this modified tenodesis WHO on improving hand activity and satisfaction in the individuals using it was assessed in this study which was conducted in a tertiary care center in central India. Twenty-two individuals with cervical SCI, who had some ability to extend their wrists against gravity, were admitted to the Physical Medicine and Rehabilitation department and enrolled in this study. Notable improvements were observed in functional tasks such as buttoning a shirt, opening a lock, eating with a fork, brushing teeth, and writing, with considerable satisfaction in those trained with the modified tenodesis WHO. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/42879/33253 How To Cite: Sonune S.P, Saha A, Joshi N.G, Pathak S, Bhadra P, Goel G. The effect of a modified tenodesis wrist-hand orthosis on hand function in patients with tetraplegia. Canadian Prosthetics &amp; Orthotics Journal. 2024; Volume 7, Issue 1, No.8. https://doi.org/10.33137/cpoj.v7i1.42879 Corresponding Author: Dr. Anyesha Saha,Affiliation: Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Saket Nagar, Bhopal (M.P.), India.E-Mails: saha.anyesha@gmail.com; anyesha.sr2023@aiimsbhopal.edu.inORCID ID: https://orcid.org/0009-0004-1574-0519

Cardiovascular disease history as a predictor for adverse outcomes in frail older adults admitted to acute geriatric settings: 12-month outcomes from an Australian frailty registry

Abstract Introduction Frailty is common in older adults with cardiovascular disease (CVD), with prevalence between 25-62% (1). The incidence of CVD increases with age, yet the outcomes of frail older adults with a history of CVD who present to acute geriatric settings, is not well understood. Purpose To report the association of CVD and rehospitalisation and/or mortality at 12 months in a cohort of frail older adults enrolled in an Australian frailty registry. Methods A convenience sample of participants enrolled in the frailty registry, with 12-month follow-up completed. The frailty registry is a prospective cohort study of adults admitted to the rehabilitation and aged care departments at two Australian hospitals. Frailty was assessed using the Clinical Frailty Scale (CFS), a score of 1-4 is ‘non-frail’, 5-6 is ‘mild-moderately frail’ and 7-9 is ‘severely frail’ (2). For this study, ‘CVD’ was defined as having a history of either heart failure, stroke, or atrial fibrillation. The cumulative incidence of first rehospitalisation and/or death during the first 12 months post discharge was estimated using one minus the Kaplan-Meier estimate of the survival function. Association between CVD (history of CVD, and type of CVD condition) and the composite endpoint were analysed. Adjusted Hazard Ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox models incorporating variables of interest and potential confounders. Results A total of 592 participants were included, median age was 82 years, 59% (n= 349) were female. The majority were frail with 50% (n= 295) classified as mild-moderately frail and 21% (n= 123) classified as severely frail. Almost half (45%, n= 265) had a history of CVD. The incidence of frailty (CFS score ≥5, mild-severely frail) was higher in those with CVD compared to those without CVD (76% vs 66%). A history of CVD was significantly associated with higher rate of first readmission or death within 12 months, compared to no history of CVD (p=0.017) (Figure 1). Of the three CVD conditions, heart failure was the only independent predictor of the composite endpoint (HR 1.60 [CI 1.14 -2.24], p=0.007). A CFS score of mild-moderately frail (HR 1.51 [CI 1.18 - 1.93, p=0.001) and severely frail were also independent predictors of the composite endpoint (HR 1.83 [CI 1.35- 2.48], p=&amp;lt;0.001) (Table 1). Conclusions A history of CVD has a significant impact on adverse outcomes in frail older adults admitted to acute geriatric settings. Frailty according to the CFS was independently predictive of rehospitalisation and mortality in this cohort. Heart failure was the only independent predictor of the composite endpoint. These findings underscore the importance of identifying and addressing CVD and in the context of frailty, emphasising the need for targeted interventions to improve outcomes in this vulnerable population.Figure 1.Table 1.

Assessment of Risk Factors of The Patients With Lateral Epicondylitis

Background: Lateral epicondylitis, is prevalent in the world of sports; however, this injury still causes confusion among healthcare professionals. Numerous studies have evaluated treatment options, but few have taken into consideration the extent to which tennis players, themselves, understand this ailment. Objectives: To identify the risk factors associated with lateral epicondylitis. Materials and methods: An observational case control study design was carried out among 120 patients attended at outdoor Department of Physical Medicine and Rehabilitation, BSMMU, Dhaka from April 2018 to march 2019. Sixty (60) patients with lateral epicondylitis as case group and another 60 patients without lateral epicondylitis as control group. Data was collected using a structured interviewer- administered questionnaire, enquiring about demographic data and details of risk factors. Result: The mean age was found 39.4:6.3 years in case group and 36.97.4 years in control group. Twenty- seven (45.0%) patients had more than 2 hours of use hand in case group and 12(20.0%) in control group. More than half (53.3%) patients had moderate VAS scale in case group and 9(15.0%) in control group, Nine (15.0%) patients were found past history of recurrent injury in case group and not found in control group. The difference was statistically significant (p&lt;0.05) between two groups. Patients having use hand more than 2 hours 3.273 (95% CI 1.453% to 7.36%) times more likely to developed lateral epicondylitis. Conclusion: Use of hand with repetitive wrist extension more than 2 hours was significantly associated with lateral epicondylitis. J Dhaka Med Coll. 2023; 32(1) : 77-84

Healthcare professionals' knowledge and perceptions of post-stroke rehabilitation in the peripandemic period: an online cross-sectional survey.

The COVID-19 pandemic has profoundly affected healthcare systems, particularly post-stroke rehabilitation centers. The elevated severity of strokes and delayed hospital admissions caused numerous hurdles to rehabilitation administration during the peri-pandemic period. This study surveyed healthcare professionals' knowledge and perceptions of post-stroke rehabilitation during this period. An online cross-sectional survey was administered from September 17, 2023 to February 23, 2024, utilizing the SurveyMonkey platform. The questionnaire included 30 questions addressing participant baseline characteristics, knowledge of definitions and experiences, post-stroke rehabilitation procedures, obstacles encountered during the peri-pandemic period, and the utilization of telerehabilitation. Only complete responses from health professionals were considered. This report utilized convenience sampling. Data were analyzed via descriptive statistics and chi-square tests, with a significance threshold of p < 0.05. A total of 79 health professionals, predominantly physiatrists, neurologists, and physiotherapists, from eight countries participated in the study. Over half of the participants (64.6%) indicated the existence of a dedicated department for post-stroke rehabilitation. Significant obstacles comprised an absence of advanced rehabilitative treatments (60.8%), inadequately skilled workers (50.6%), and restricted space for rehabilitation (46.8%). Telerehabilitation was regarded as a feasible option by 45.6% of participants; nonetheless, obstacles, including patients' telecommunication proficiency and the possibility of diagnostic inaccuracies, were acknowledged. Complementary therapies, such as music and dance therapy, received favorable evaluations from 67.1% to 63.3% of respondents, respectively. The pandemic reduced rehabilitation admissions due to infection concerns (75.9%) and increased multimorbidity cases among patients (48.1%). The study underscores the pandemic's negative effect on post-stroke rehabilitation, emphasizing the necessity for multidisciplinary, customized therapy and enhanced integration of telerehabilitation to overcome access barriers. Addressing obstacles regarding infrastructure, training, and access to advanced approaches, particularly in a post-pandemic context, is essential to improving rehabilitation outcomes.

The Efficacy of Exercise-Based Rehabilitation in Treating Ulnar Wrist Pain

Background: Exercise-based rehabilitation effectively treats ulnar wrist pain, enhancing pain relief, grip strength, and mobility. Targeted exercises lead to significant pain reduction and functional recovery. Aim of the study: This study aimed to assess the efficacy of exercise-based rehabilitation in treating ulnar wrist pain. Methods: This cross-sectional study was conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2023 to December 2023. This study includes 60 patients with ulnar wrist pain who were divided into two groups: Group A (30 patients) received rehabilitation therapy, and Group B (30 patients) received no therapy. Result: The mean age was 45.2 ± 10.5 years in Group A and 43.2 ± 9.7 years in Group B (P = 0.4466). Gender distribution was balanced, as were the mean pain durations (P = 0.7200). At baseline, Group A's mean VAS score was 7.8 ± 1.2 and Group B's was 7.6 ± 1.4 (P = 0.5548). After 12 weeks, Group A's pain score decreased significantly to 2.5 ± 0.7, while Group B's remained at 6.6 ± 1.2 (P &lt; 0.0001). Group A's grip strength increased from 18.5 ± 3.5 kg to 33.0 ± 2.8 kg, compared to Group B's 20.5 ± 3.8 kg (P &lt; 0.0001). Group A also showed greater wrist ROM and PRWE score improvements. Conclusion: This study concludes that exercise-based rehabilitation significantly reduces pain, enhances grip strength, and improves wrist range of motion in patients with ulnar wrist pain.

Exploration of Establishing Evaluation Indicators for Hand Trauma Rehabilitation Nursing Based on Delphi Method.

This study aimed to develop an evaluation index system for hand surgery rehabilitation nursing using the Delphi method. A survey questionnaire on evaluation indicators for hand surgery rehabilitation nursing was developed, and 18 professionals including orthopedic surgeons, orthopedic nursing, and rehabilitation departments were selected. The survey was conducted using the letter method, and a database was established to screen the items, forming a hand surgery rehabilitation nursing evaluation scale. The expert's positive coefficient, authority coefficient, and coordination coefficient were analyzed, and the mean, standard deviation, coefficient of variation, and weight coefficient were calculated. Based on the correlation assignment results, the Item-level Content Validity Index (I-CVI), Scale-level Content Validity Index (S-CVI), average S-CVI, Probability of random consistency (Pc), and corrected I-CVI Kendall's coefficient of concordance (K*) were determined. In the first round of expert inquiry, a total of 18 questionnaires were distributed, and 15 valid questionnaires were collected, with an effective response rate of 83.33%. In the second round, 15 questionnaires were distributed and 15 valid questionnaires were collected, with an effective response rate of 100%. The two rounds of expert evaluations yielded judgment scores of 0.91 and 0.95, with proficiency levels of 0.83 and 0.87 and authority coefficients of 0.87 and 0.91, respectively. The Kendall's W values for the two rounds were 0.313 and 0.224, respectively, with a statistically significant difference (p < 0.01). After screening, 23 indicators were retained, with a coefficient of variation ranging from 0.072 to 0.166. Among the third-level indicators, 12 had an I-CVI of 1.00, 4 had an I-CVI of 0.93, and 7 had an I-CVI of 0.87. The overall S-CVI was 0.80, with an average S-CVI of 0.95. The K* values for the 23 indicators ranged from 0.8662 to 1.0000. The evaluation index system for hand injury rehabilitation nursing based on the Delphi method is highly scientific, and is expected to be used to guide the clinical evaluation of hand injury rehabilitation nursing.

Impact of post-COVID symptoms on activity and participation of women and men

Post-COVID syndrome is affecting many organ systems and arises as a major public health problem with millions of cases worldwide. The primary aim of this study is the analysis of health problems, activity limitations and participation restrictions (ALPR) of participants with post-COVID symptoms and the investigation of correlations between these elements to derive statements about the rehabilitation need, also depending on sex. A retrospective cohort study was performed to collect longitudinal data from January 2022 to January 2023 using the Covid-19 Rehabilitation Needs Questionnaire (RehabNeQ). Patients completed the questionnaire at the Department of Rehabilitation- and Sports Medicine at Hannover Medical School. The 1st assessment included 307 study participants, of whom 54 showed up for the 2nd, 7 for the 3rd and one for the 4th assessment. Study participants with post-COVID symptoms also experience ALPR. The results show no significant difference in symptom intensity in women and men, but in intensity of ALPR. We found many correlations of varying degrees between various factors with ALPR. We found frequent correlations between fatigue and several ALPR. While these correlations apply to both sexes, we also found different correlations in women and men, indicating the different rehabilitation need of women and men.

The impact of rehabilitation on the recovery of executive functions in stroke patients with different location of the ischemic focus.

Cognitive dysfunction is part of the clinical picture of stroke. Most of the executive dysfunctions are diagnosed in the early stage of rehabilitation, a few weeks after the vascular incident. Coexistence of executive dysfunctions with other disorders in stroke patients may hinder patient's functions, slow down the rehabilitation process, and disrupt self-awareness, interpersonal communication, and professional activity in everyday life. Ninety patients after ischemic stroke were examined (right hemisphere stroke: N = 33, left hemisphere stroke: N = 57). The study group (N = 45) consisted of patients rehabilitated in the Department of Rehabilitation and Physical Medicine of the University Teaching Hospital of the Military Medical Academy in Lodz, Łódź, Poland, in whom a comprehensive neurorehabilitation program was implemented, consisting of motor and neuropsychological rehabilitation. The control group (N = 45) consisted of patients awaiting admission to the department, who were covered by comprehensive environmental rehabilitation including exercise therapy and neuropsychological therapy. Executive function was measured with 3 popular diagnostic tools: the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT part A, TMT part B), and the letter test and category test with the Verbal Fluency Test (VFT). The tests were carried out twice: the first time before the start of rehabilitation and 5 weeks later after its completion. Although patients with right-hemispheric stroke showed better improvement in executive functions, stroke location did not prove to have significant impact on how effective the rehabilitation was. Right hemisphere stroke patients showed greater improvement in restoring executive functions after rehabilitation compared to left hemisphere stroke patients. The location of the stroke did not significantly correlate with the efficiency of the rehabilitation setting. Int J Occup Med Environ Health. 2024;37(4).

Comparison between Effects of Intralesional Platelet Rich Plasma and Corticosteroid Injection on Pain and Functional Outcome in Patients with Lateral Epicondylitis of Elbow

Background: A debilitating and painful elbow problem is lateral epicondylitis. Objective: In this study, pain and functional outcomes were examined in relation to intralesional platelet-rich plasma (PRP) and corticosteroid injections patients with lateral epicondylitis. Methodology: This randomized experimental study was done in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2017 to February 2018. Thirty patients with diagnosed lateral epicondylitis, aged between 21- 60 years and had been ill for more than a month were enrolled and randomly assigned into two groups. In Group A received two doses of intralesional PRP injection, and Group B received two doses of intralesional corticosteroid injection. Pain and functional outcomes were evaluated by using a visual analog scale (VAS) for pain and a patient-rated tennis elbow assessment (PRTEE) questionnaire, respectively. In the lateral epicondylar region, intralesional PRP or corticosteroids were administered during the first (week 1=W1) and fourth (week 7=W7) treatment visits. Results: The findings revealed a statistically significant decline in pain over time, as well as improvements of functional outcomes in both groups as evidenced by significantly lower VAS scores and lower PRTEE scores up to 11 weeks post-injection. There was no discernible difference in progress between the two groups up until W1 to W9 scores, however at the eleventh week, group A showed greater improvement than group B (p&lt;00.5). Conclusions: Intralesional PRP injection is a promising therapy option for lateral epicondylitis, offering sustained pain relief and improved functional outcomes over time compared to corticosteroid injection. Journal of Monno Medical College June, 2024; 10 (1):30-35

MODERN VIEWS OF USE OF TELEREHABILITATION IN URINARY TRACT DYSFUNCTION IN PATIENTS WITH MULTIPLE SCLEROSIS

Multiple sclerosis is a chronic disease of the nervous system that often leads to various disorders, including urinary tract dysfunction. This significantly affects the quality of life of patients, causing physical and psychological complications. The term "bladder rehabilitation" summarizes treatment options aimed at restoring its function in patients with neurourological symptoms. A strong contraction of the sphincter of the urethra and/or pelvic floor, as well as anal dilatation, manipulation of the genital area, and physical activity reflexly inhibit urination. A comprehensive physical therapy program for patients with pelvic disoders includes pelvic floor vibration massage, training in proper breathing patterns, pelvic floor muscle relaxation and stabilization exercises and should last several months, during which the patient regularly visits the doctor. The pandemic and war have created barriers that affect almost every aspect of life, treatment and rehabilitation, especially for people with chronic neurological conditions. Traditional rehabilitation methods used to correct urinary tract dysfunction have their limitations, including difficulties in accessing specialists, especially in remote areas. This stimulates the development and implementation of telerehabilitation as an alternative approach. Telerehabilitation involves the use of digital technologies for the remote provision of medical services and patient monitoring. It allows doctors to monitor the condition of patients, provide recommendations and adjust treatment without the need for personal visits. Considering the existing data and our own clinical experience, we consider it appropriate to use telerehabilitation for the correction of disorders of the lower urinary tract, especially in the conditions of war, when access to rehabilitation centers may be difficult. In the department of medical rehabilitation of the University Clinic of the Kharkiv National Medical University, we successfully conducted telerehabilitation using Google Meet video conferencing for 10 patients with urinary incontinence on the background of multiple sclerosis, whose EDSS was no more than 4.0. When conducting online classes under the guidance of a physical therapist, patients noted a desire to strictly follow the recommendations and perform regular exercises. All patients kept a urination diary, according to which the frequency of urination was reduced by an average of 20-25%, which had a positive effect on their quality of life. Although our observations are not representative, in combination with existing studies, we consider telerehabilitation to be a promising direction in complex therapy and rehabilitation of this pathology. Conclusion The use of telerehabilitation for urinary tract dysfunction in patients with multiple sclerosis is a promising direction that requires further research. This approach can significantly improve the quality of life of patients, reduce the burden on the health care system and provide a more affordable and convenient treatment. A multidisciplinary team should be involved, including a neurologist, a urologist, a gynecologist, and a physical therapist to select the optimal tactics of drug treatment and physical therapy. A promising direction of further research is the development of standard protocols for conducting telerehabilitation for patients with lower urinary tract dysfunction against the background of multiple sclerosis and other pathologies.

Lower peak expiratory flow rate is associated with a higher risk of pneumonia in patients with stroke.

Low peak expiratory flow (PEF) rate is common in patients with stroke. Studies on changes in PEF rates in patients with stroke often have small sample sizes, limiting the generalizability of their findings. This study aimed to compare the PEF rates between patients who were post-stroke with or without pneumonia and age- and sex-matched healthy controls and explore the PEF-pneumonia association among stroke survivors. Prospective observational study. Department of Rehabilitation, the First Affiliated Hospital of Wenzhou Medical University. Initially, 809 patients with stroke undergoing inpatient rehabilitation were recruited. Data collected included the demographics, stroke history, the presence of dysphagia, and the PEF rates on admission. Logistic regression analysis was conducted to identify the PEF threshold as predictive of pneumonia after adjusting for confounders. Patients with stroke had a mean PEF rate of 243.89±139.38 L/min, significantly lower than that of the normal control group. The PEF rate was significantly lower in the pneumonia group than in the non-pneumonia group (P<0.001). Within the stroke cohort, the PEF rates were lower than the predicted rates (P<0.001). Older age, lower PEF(%),and dysphagia were associated with a higher pneumonia risk post-stroke per stepwise multivariate logistic regression analysis. Furthermore, the combination of these three significant predictors (PEF(%), swallowing function, and age) yielded an area under the curve of 0.857 .Regarding age, the cut-off point of ≥65.5 years was the optimal level to discriminate the presence of pneumonia among patients with stroke. For PEF%,the cut-off point of <60% was the optimal level to discriminate the presence of pneumonia among patients with stroke. For screening dysphagia, the patients with impaired safety only and those with impaired safety and efficacy faced a higher pneumonia risk. Patients with stroke exhibited significantly lower peak expiratory flow rates compared to healthy controls after adjusting for age and sex and when compared to their reference values. Decreased PEF rates were independently associated with pneumonia development during inpatient rehabilitation in post-stroke patients. This study suggests that low PEF rates may predict pneumonia and that the prevention of PEF rate decline may prevent pneumonia development.

Development and Implementation of an Evidenced-Based Practice (EBP) Educational Program for a Multidisciplinary Rehabilitation Department.

Describe the development and implementation of an evidence-based practice (EBP) training program for occupational and physical therapists in a large pediatric hospital. EBP is valued, but a known knowledge-to-practice gap between academic training and clinical practice limits routine use. This gap was addressed through an academic-clinical partnership to develop an EBP training program. Sixty-one therapists completed the program. Therapists demonstrated improved EBP skills, knowledge, and confidence following training and a positive trend in change score for clinical outcomes and decision-making scores was noted. Academic-clinical partnerships have a unique and valuable role to support professional EBP knowledge and skill development. Stakeholder support and engagement supported program development, execution, and meaningful outcomes. The knowledge-to-practice gap for EBP is a challenge to regular EBP use. The described program addressed this challenge and improved therapists' knowledge, skills, and confidence. It provides a model for professional development.

Comparative Analysis of Musculoskeletal Ultrasonography Versus MRI in Diagnosing Shoulder Injuries

This study aimed to compare the diagnostic accuracy and cost-effectiveness of musculoskeletal ultrasonography (US) versus magnetic resonance imaging (MRI) in detecting shoulder injuries. Conducted at the Department of Physical Medicine and Rehabilitation, BSMMU, Dhaka, Bangladesh, from January to June 2024, the study included 120 patients with suspected shoulder pathologies. Patients were evaluated using both US and MRI, and findings for rotator cuff tears, labral injuries, and tendonitis were analyzed. MRI demonstrated higher diagnostic accuracy across all conditions, with sensitivity rates of 95%, 91%, and 92% for rotator cuff tears, labral injuries, and tendonitis, respectively, compared to 88%, 79%, and 86% for US. Inter-rater agreement between US and MRI was substantial, with Cohen's Kappa coefficients of 0.75 for rotator cuff tears, 0.70 for labral injuries, and 0.73 for tendonitis. Cost-effectiveness analysis revealed that US was significantly more affordable, with an average cost of 15,000 Tk per patient compared to 60,000 Tk for MRI. Additionally, the time to diagnosis was shorter for US (2 days) than for MRI (7 days). Although US required slightly more additional interventions (13.3% vs. 8.3%), this difference was not statistically significant. The findings suggest that while MRI is more accurate, US is a cost-effective and time-efficient alternative, particularly valuable in resource-limited settings.

Legal regulation of rehabilitation in the field of health care

The article notes that the law guarantees everyone the right to health care and medical assistance. A full-scale invasion calls for the development and updating of legal acts on ensuring a person’s right to medical assistance, in particular, to the provision of rehabilitation services. It is noted that rehabilitation assistance is aimed at a number of main areas, firstly, at supporting the functions of the patient’s body during the exacerbation of chronic diseases. Secondly, for warning, early diagnosis of disorders of the organs and systems of the patient’s body. The third direction is aimed at full or partial restoration of damaged organs or systems and compensation of lost functions of affected organs or systems. The fourth direction is related to the prevention and reduction of the degree of disability. The author emphasizes that the lack of competent and effective medical rehabilitation in Ukraine is a multifactorial problem: there is an insufficient number of inpatient and outpatient rehabilitation departments; lack of medical personnel - rehabilitation specialists, psychologists; there is not enough rehabilitation equipment; there is a need for adequate educational programs for physicians. In the article, the author emphasizes that one of the tasks of the state is to help persons with disabilities realize their constitutional rights; implementation of state policy in the field of rehabilitation of persons with disabilities, support for their integration into society, and the full-scale war on the territory of Ukraine causes an increasing urgency and need for the rehabilitation of persons injured as a result of hostilities. Such factors of the population’s health, such as the increase in morbidity, injuries, temporary loss of working capacity, premature mortality of the population require the development of the rehabilitation medicine market of Ukraine and its legal regulation. The article notes that the positive aspects are the development of new medical rehabilitation technologies, including those based on telemedicine and IT technologies, the preparation of new professional standards for medical rehabilitation at the modern level in accordance with international recommendations. All this requires the effective functioning of the system, which first of all requires the improvement and development of regulatory and legal support in the field of rehabilitation.

Precision in Progress: Unraveling the Clinimetric Properties of Beery-Buktenica Developmental Test of Visual-Motor Integration in Children With Cerebral Palsy Across Diverse Motor Severities

BackgroundIn the realm of pediatric cerebral palsy (CP), visual motor challenges often overshadow a child's developmental journey. This study delves into the responsiveness and crucial benchmarks, specifically the minimal clinically important difference (MCID), of the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) among children with varying motor severities. MethodEighty-eight children with CP (50 males, 38 females; aged three to 12 years) with Gross Motor Function Classification System (GMFCS) levels I to III were recruited from the rehabilitation department of Chang Gung Memorial Hospital in Taiwan. Each participant received the Beery VMI tests at baseline and at one-year follow-up. The standardized response mean (SRM) was calculated to determine the responsiveness of Beery VMI, and a distribution-based approach was used to estimate MCID. ResultsThe Beery VMI exhibited remarkable responsiveness across GMFCS levels I to III (SRM = 0.98-2.36). MCIDs for Beery VMI varied across severities, with ranges of 2.93 to 4.41 (0.2 S.D.), 7.31 to 11.49 (0.5 S.D.), and 11.70 to 18.38 (0.8 S.D.). Notably, in the visual perception subset, MCIDs were 3.93 to 4.03 (0.2 S.D.), 9.83 to 10.07 (0.5 S.D.), and 15.73 to 16.11 (0.8 S.D.). In the supplemental motor coordination subtest, MCIDs spanned 1.67 to 4.87 (0.2 S.D.), 4.18 to 12.17 (0.5 S.D.), and 6.68 to 19.47 (0.8 S.D.). ConclusionsBeery VMI demonstrates robust responsiveness in children with CP. Motor-severity-tailored MCIDs offer a guide for clinicians and researchers, hinting at treatment efficacy. Particularly, lower change scores in VMI and motor coordination subtests may signal effective interventions for moderate motor disability over mild cases.

Evaluating the Effectiveness of Transtibial Prosthetic Socket Shape Design Using Artificial Intelligence: A Clinical Comparison With Traditional Plaster Cast Socket Designs

ObjectiveTo investigate the feasibility of creating an artificial intelligence (AI) algorithm to enhance prosthetic socket shapes for transtibial prostheses, aiming for a less operator-dependent, standardized approach. DesignThe study comprised 2 phases: first, developing an AI algorithm in a cross-sectional study to predict prosthetic socket shapes. Second, testing the AI-predicted digitally measured and standardized designed (DMSD) prosthetic socket against a manually measured and designed (MMD) prosthetic socket in a 2-week within-subject cross-sectional study. SettingThe study was done at the rehabilitation department of the Radboud University Medical Center in Nijmegen, the Netherlands. ParticipantsThe AI algorithm was developed using retrospective data from 116 patients from a Dutch orthopedic company, OIM Orthopedie, and tested on 10 randomly selected participants from Papenburg Orthopedie. InterventionsUtilization of an AI algorithm to enhance the shape of a transtibial prosthetic socket. Main Outcome MeasuresThe algorithm was optimized to minimize the error in the test set. Participants’ socket comfort score and fitting ratings from an independent physiotherapist and prosthetist were collected. ResultsPredicted prosthetic shapes deviated by 2.51 mm from the actual designs. In total, 8 of 10 DMSD and all 10 MMD-prosthetic sockets were satisfactory for home testing. Participants rated DMSD-prosthetic sockets at 7.1 ± 2.2 (n=8) and MMD-prosthetic sockets at 6.6 ± 1.2 (n=10) on average. ConclusionsThe study demonstrates promising results for using an AI algorithm in prosthetic socket design, but long-term effectiveness and refinement for improved comfort and fit in more deviant cases are necessary.