Rehabilitation Of Adult Patients Research Articles

Evaluation of optimizing Monteggia fracture-dislocation care: surgical innovations, radiological insights, and functional rehabilitation in adult patients

Background: Monteggia fractures, rare in adults, involve proximal ulna fracture and radial head dislocation. Managing these injuries poses challenges, fueling historical debates and driving advancements in internal fixation. Watson Jones' frustration highlights the ongoing pursuit of effective surgical approaches for optimal outcomes and functional limb restoration. his study aims to evaluate Monteggia fracture-dislocation treatment by analyzing radiological outcomes for structural insights and alignment post-surgery. Methods: This prospective observational study, conducted at Swapno general hospital, Mirpur-2, Dhaka, Bangladesh from 1st January 2021 to 31 January 2024, enrolled 30 patients with radiologically confirmed Monteggia fracture-dislocation. Surgical procedures involved creating an interval, anatomical reduction, and fixation, with regular follow-ups assessing outcomes, including range of motion, X-rays, and VAS scores, while statistical analysis utilized SPSS version 23. Results: The highest frequency percentage in the age distribution was observed among individuals aged 41-45, constituting 20% of the total sample, while the lowest frequencies were recorded in the 31-35 and >51 age groups, each representing 10% of the sample. Physical assault emerged as the leading cause of injury, accounting for 40% of cases, followed by road traffic accidents at 36.66% and falls at 23.33%. In terms of final outcomes, the majority of patients (43.33%) achieved a good outcome, while the lowest percentage (10%) resulted in poor outcomes. Conclusions: In conclusion, addressing Monteggia fracture-dislocation in adults requires navigating inherent complexities. Modern internal fixation methods prove impactful, emphasizing the need for precise classification and stable anatomical reduction.

The Effect of Teach-Back on Readmission Rates in Rehabilitation Patients.

Thirty-day readmissions often occur in rehabilitation patients and can happen for many reasons. One of those reasons is when patients do not fully understand how to effectively manage their health after discharge. The purpose of this evidence-based quality improvement project was to determine if implementing the teach-back intervention from the Agency for Healthcare Research and Quality's (AHRQ) Health Literacy Universal Precautions Toolkit would impact 30-day readmission rates among adult rehabilitation patients. Data were collected from the electronic health record of rehabilitation patients. The comparative group included all rehabilitation admissions for 8 weeks prior to the intervention. The implementation group was composed of the rehabilitation admissions for 8 weeks post-implementation. All patients were then followed for 30 days postdischarge to capture readmissions. The total sample size was 79 ( n = 43 in the comparative group, n = 36 in the implementation group). There was a 45% decrease in the mean percentage of the 30-day readmission rate in the implementation group as compared with the comparative group. Based on the results, using the teach-back intervention from AHRQ's Health Literacy Universal Precautions Toolkit may impact 30-day readmission rates.

Daily Speaking Time and Voice Intensity before and after Hearing Aid Rehabilitation in Adult Patients with Hearing Loss

Introduction: Hearing loss (HL) strongly impacts communication abilities and impairs social interactions. Moreover, it modifies the vocal parameters of affected patients. The effects of hearing rehabilitation through hearing aids (HA) on the vocal production of patients suffering from HL have not been thoroughly analyzed in the literature. The aim of this study was to use the ambulatory phonation monitor (APM), a portable vocal dosimeter, to evaluate the variations in the vocal production of a group of patients suffering from moderate-to-severe HL treated with HA and the relationship between such modifications and quality of life (QoL). Materials and Methods: Twenty-six patients suffering from a variable degree of HL and treated with HA have been enrolled. Each of them underwent an evaluation before and 4 months after rehabilitation with HA. The analysis of daily voice production was carried out with the APM, while subjective QoL data were collected through the Speech, Spatial, and Qualities questionnaire (SSQ) and the International Outcome Inventory for Hearing Aids (IOI-HA). The differences in phonatory measurements and subjective evaluations before and after HA rehabilitation were assessed using Wilcoxon signed rank test. The Spearman correlation test was used to analyze the correlation between phonatory measurements, auditory measurements, and SSQ scores. Results: Significant differences in the APM parameters before and after HA rehabilitation were found. After 4 months of HA use, we recorded a significant increase in phonation time and percentage of phonation time and a significant decrease in average amplitude in dB SPL. We also found a significant increase in the SSQ scores after HA rehabilitation. Finally, we were able to detect low but significant correlations between phonatory measurements and SSQ results. Conclusions: The APM proved to be a useful instrument in the evaluation of the benefits of HA and its measurements can be used as indicators of the participation in communication and social life of patients with HL, which are strongly related to QoL.

Rehabilitation of Adult Patients with Pulmonological Manifestations of Long COVID: a Review

INTRODUCTION. The most common symptoms in patients who have had a new coronavirus infection (COVID-19) are associated with pulmonary lesions (shortness of breath, chest pain, cough) and the same complaints persist in the majority of those suffering from long COVID the occurrence and prevalence of which in the population is inextricably linked with the number recovered from COVID-19.
 AIM. To study the current state of the problem of diagnosis, treatment and rehabilitation of patients with pulmonological manifestations of long COVID at the stage of a specialized rehabilitation hospital in order to formulate basic practical recommendations for the management of this category of patients.
 MATERIALS AND METHODS. During the period from January 1, 2021 to December 1, 2022, we performed a systematic search of the MEDLINE, Cyberleninka, and eLIBRARY.RU databases on the topic of pulmonary manifestations of long COVID and methods of their rehabilitation in adult patients that gave 678 matches. After further filtering steps according to the methodology outlined in the PRIZMA guidelines, we selected 60 publications for the final analysis.
 RESULTS. Pulmonary manifestations of long COVID, including, first of all, shortness of breath, rank second after fatigue in terms of frequency of occurrence in long COVID. Diagnostic findings include radiologic pulmonary tissue changes recorded in a proportion of patients under one year, restrictive abnormalities on spirometry, and impaired pulmonary diffusion capacity. Many patients who have had COVID-19 recover quite quickly, but some of them have a long-term symptom complex of dyspnea and physical fatigue, for which rehabilitation in a specialized centers is indicated.
 The most effective treatment is possible with the involvement of a multidisciplinary rehabilitation team in the rehabilitation process and the appointment of rehabilitation programs created in accordance with the conceptual basis of respiratory rehabilitation, including, first of all, a wide range of methods of therapeutic physical culture.
 The most effective treatment is possible by involving a multidisciplinary rehabilitation team in the rehabilitation process and prescribing rehabilitation programs designed in accordance with the conceptual framework of respiratory rehabilitation, including, above all, a wide range of therapeutic physical education techniques.
 CONCLUSION. Current knowledge of the clinical picture, diagnosis, treatment and rehabilitation measures in long COVID is constantly reassessed and expanded. This literature review gives an analysis of research papers focused on the treatment and rehabilitation of pulmonary manifestations in adults, combining the etiopathogenetic and syndromic approaches characteristic of the “classical Russian therapeutic” and, closest to it, the “German” schools. The information extracted both from documents published by World Health Organization (WHO) and from local Russian and European clinical guidelines will allow a specialist engaged in the rehabilitation of adults with pulmonary manifestations of long COVID to create an effective and personalized individual rehabilitation plan for each patient.

Clinic-Electrophysiologic Correlations in Rehabilitation of Adult Patients with Traumatic Brachial Plexus Lesions

Nerve-transfer surgery is the treatment of choice for traumatic brachial plexus injuries (tBPIs). Combined electromyography (EMG) follow-ups and results obtained by transcranial magnetic stimulation (TMS) may provide useful follow-up of rehabilitation outcomes of elbow flexion in C5-C7 tBPIs. A total of 11 patients with complex tBPIs, operated by the Oberlin surgical technique, were assessed clinically (British Medical Research Council’s score—MRC) and by EMG + TMS after undergoing neuromuscular electrical stimulation and proprioceptive neuromuscular facilitation. Dynamometer quantitative muscle strength (DQMS) was also assessed for overall grip strength evaluation. Six patients continued rehabilitation three times a week, whereas five patients did not follow recommendations for continuous physical therapy (PT). All patients were assessed after 6 months as planned. Following a 6-month PT protocol, clinical improvements correlated with decreases of the Motor Evoked Potential (MEP) latency recorded at the first dorsal interosseous muscle, biceps brachii, and cortical level in the sublot group with continuous PT protocol compliance. We obtained significant amelioration of MEP latency and needle EMG signs of amelioration in these six patients. These cases also correlated to the MRC improvement in elbow flexion, as well as DQMS parameters. TMS parameters also mildly and inconstantly improved in the other five patients who limited themselves just to PT after surgery; however, there was no correlation with the EMG findings or MRC scaling. PT influences the cortical representation within the motor area of the upper limb when performed continuously. The electrical signals within the motor cortex promote the utility adherence to long-term PT protocols.

Сlinico-biomechanical foundation of necessity of rehabilitation in adult patients with hereditary limb-girdle muscular dystrophy, type I: clinical case

Modern approach to rehabilitation of patients with limb girdle muscular dystrophy of type I are discussed in this article. Authors thoroughly investigated the clinical picture of limb-girdle muscular dystrophy, pathogenesis of this disease and the main principles of its treatment. On the example of the concrete patient authors considered the clinical picture of the limb-girdle muscle dystrophy and also the biomechanical and energetic parameters of walking. Authors demonstrated, that essential disturbance of the locomotor function is seen in this patient, what is revealed in remarkable diminution of the mean walking velocity, in severe transformation of the temporal structure of walking, in reduction of amplitude of movements at some joints of the lower extremities and increase of amplitude at the other joints, in displacement of all extreme values to the right along the temporal axis, in remarkable weakening of the support and push functions of the lower extremities, in change of the form of the vertical component Rz of ground reaction force from two-peaked to the triangular, in expressed diminution of moments of muscle forces at the joints of the lower extremities. Authors also point out, that it is necessary to carry out regular courses of rehabilitation in such patients with the purpose to improve the locomotor function. Besides, it is very expedient to retrace systematically changes of the biomechanical and innervative structure of walking. On the grounds of investigation of structure of walking of patient with limb girdle muscular dystrophy authors revealed necessity of ortheses and the subsequent application of functional electrical stimulation of muscles during walking. On the basis of realization of the trial sessions authors for the first time determined the main correctional influences, necessary for these patients and also peculiarities of the amplitude and, especially, temporal programs of functional electrical stimulation of muscles in such patients. Patient herself notes greater stability during walking, possibility of walking greater distance without fatigability. The received results give foundation for the further planning of the course of rehabilitation in such patients.

Validation of the CaReQoL asthma: a patient reported outcome measure for monitoring the perceived effects of pulmonary rehabilitation in adult patients with severe refractory asthma

BackgroundThe CaReQoL Asthma assesses the care-related quality of life outcomes of pulmonary rehabilitation retrospectively in patients with severe asthma. The questionnaire comprises five domains (physical functioning; social functioning; coping with asthma; knowledge about asthma; medication).AimTo investigate construct and criterion validity of the CaReQoL Asthma, as well as its responsiveness and minimal important change (MIC), in comparison with other health measures (AQLQ, ACQ and FEV1).MethodsEighty three adults with severe refractory asthma filled out the CaReQoL Asthma at 6 and 12 months after a 12-week personalized multidisciplinary pulmonary rehabilitation program in a tertiary asthma centre, either in Switzerland or The Netherlands. Construct validity and responsiveness were assessed by testing pre-defined hypotheses about associations with changes in AQLQ, ACQ and FEV1 scores. Criterion validity and MIC was assessed using Global Perceived Effect (GPE). Factor analyses, Cronbach’s alpha, Spearman's correlations, paired t-tests and Student–Newman–Keuls tests were performed.ResultsCronbach’s alphas of the questionnaire domains ranged from 0.82 to 0.95. Good construct validity and responsiveness were found; 84% of the assessed correlations confirm pre-defined hypotheses and reflect both weak and moderate to strong correlations. Good criterion validity was also identified, with CaReQol scores discriminating better than other health measures between levels of GPE at 6 months post-rehabilitation. The MIC for the total score was estimated at 0.84.ConclusionThese study results suggest that the CaReQoL Asthma is a valid and responsive instrument and shows to be a comprehensive and tailored questionnaire for evaluating and monitoring outcomes of pulmonary rehabilitation in patients with severe refractory asthma. In order to further substantiate the reliability and validity of the CaReQoL Asthma, as well as to monitor outcomes of pulmonary rehabilitation in patients with severe asthma, it is recommended to use the CaReQoL Asthma in addition to other disease specific instruments.

Electronic Means of Communication as a Means of Remote Speech Therapy for Adult Stroke Survivors

The article discusses the types of strokes, general statistics and prevalence of strokes in the world and in Ukraine. The survey and tendencies to occurrence in younger people were carried out; the factors of stroke occurrence in young people have been studied. Statistics on the uneven distribution of strokes by gender were analyzed. It has been determined that women are at higher risk of suffering a severe or fatal stroke than men. The main reasons for such statistics are indicated. The main types of speech and language impairments that can occur after cerebral circulatory disorders are analyzed. The leading signs of aphasia, apraxia and dysarthria in adults have been identified. The definition of progressive apraxia of speech is revealed. It is established that these disorders occur due to damage to the language areas of the brain. The advantages of using electronic means of communication in speech-language therapy during quarantine restrictions and martial law in Ukraine are revealed. Software and messengers were characterised, such as Google Meet, Zoom, Teams, and Skype, that are used during distance and/or face-to-face sessions with a speech language pathologist. The main advantages of using these programs and the requirements for a speech language pathologist in the use of electronic means of communication are described. The concept of "social networks" and their impact on the rehabilitation of adult patients is revealed. The positive aspects of using social networks with adults during speech-language therapy, in particular Instagram and Facebook, are highlighted. Mobile applications are described as an additional means of restoring various aspects of speech, language and higher mental functions. It is noted that the current situation in the country, taking into account quarantine restrictions and martial law, can not provide full, continuous and quality speech language therapy in these cases, which leads to the conclusion that the lack of effectiveness of using exclusively traditional methods and techniques to compensate speech and language disorders caused by stroke, and encourages further search for ways to improve it by electronic means of communication. The author sees the need for a research aimed at studying the use of electronic means of communication in speech language therapy for people who have suffered a stroke.

The effectiveness of non-invasive brain stimulation techniques combined with arm rehabilitation in adult patients after stroke - An overview of reviews

The effectiveness of non-invasive brain stimulation techniques combined with arm rehabilitation in adult patients after stroke - An overview of reviews

The development of a Self-Rated ICF-based questionnaire (HEAR-COMMAND Tool) to evaluate Hearing, Communication, and Conversation disability: Multinational experts' and patients' perspectives.

An instrument that facilitates the advancement of hearing healthcare delivery from a biomedical model to a biopsychosocial one that underpins the International Classification of Functioning, Disability, and Health framework (ICF) brief and comprehensive Core Sets for Hearing Loss (CSHL) is currently unavailable. The objective is to describe the process of developing and validating a new questionnaire named the HEAR-COMMAND Tool created by transferring the ICF CSHL into a theory-supported, practically manageable concept. A team from Germany, the USA, the Netherlands, and Egypt collaborated on development. The following ICF domains were considered; "Body Functions" (BF), "Activities and Participation" (AP), and "Environmental Factors" (EF). The development yielded English, German, and Arabic versions. A pilot validation study with a total of 109 respondents across three countries, Germany, Egypt, and the USA was conducted to revise the item terminology according to the feedback provided by the respondents. The questionnaire included a total of 120 items. Ninety items were designed to collect information on the functioning and 30 items inquiring about demographic information, hearing status, and Personal Factors. Except for the "Body Structures" (BS) domain, all the categories of the brief ICF CSHL were covered (a total of 85% of the categories). Moreover, the items covered 44% of the comprehensive ICF CSHL categories including 73% of BF, 55% of AP, and 27% of EF domains. Overall, the terminology of 24 ICF-based items was revised based on the qualitative analysis of the respondents' feedback to further clarify the items that were found tod be unclear or misleading. The tool highlighted the broad connection of HL with bodily health and contextual factors. The HEAR-COMMAND Tool was developed based on the ICF CSHL and from multinational experts' and patients' perspectives with the aim to improve the execution of audiological services, treatment, and rehabilitation for adult patients with HL. Additional validation of the tool is ongoing. The next step would be to pair the tool with BS categories since it was excluded from the tool and determine its effectiveness in guiding hearing health care practitioners to holistically classify categories influencing hearing, communication, and conversation disability.

Rehabilitation of Adult Patients with Primary Brain Tumors

Rehabilitation of Adult Patients with Primary Brain Tumors

Suspend or amend? Randomized controlled trial on neuropsychological rehabilitation for epilepsy: A COVID-19 impact.

COVID-19 caused devastating effects of human loss and suffering along with disruption in clinical research, forcing reconceptualization and modification of studies. This paper attempts to outline the steps followed and detail the modifications undertaken to deal with the impacts of the pandemic on the first ongoing randomized controlled trial on effectiveness of neuropsychological rehabilitation in adult patients with drug-resistant epilepsy in India. All modifications were based on evolving guidelines and circumstantial context and were planned, reviewed and approved by important stakeholders. Results obtained from the trial need to be interpreted and analysed within this context. These modifications have implications for wider outreach of neuropsychology services in India.

Evaluating the impact of therapy support workers on provision of rehabilitation in adult patients receiving veno-venous extracorporeal membrane oxygenation

Purpose: The purpose of this project was to explore the use of Therapy Support Worker roles in enhancing rehabilitation provision for critically ill adult patients within Intensive Care, in terms of patient outcomes, service performance indicators, and patient experience.

Possibilities of psychological and psychiatric rehabilitation of adult patients after orthognatic surgery

Possibilities of psychological and psychiatric rehabilitation of adult patients after orthognatic surgery

Rehabilitation of Adult Patients with Primary Brain Tumors: A Narrative Review.

Rehabilitative measures have been shown to benefit patients with primary brain tumors (PBT). To provide a high quality of care, clinicians should be aware of common challenges in this population including a variety of medical complications, symptoms, and impairments, such as headaches, seizures, cognitive deficits, fatigue, and mood changes. By taking communication and family training into consideration, clinicians can provide integrated and patient-centered care to this population. This article looks to review the current literature in outpatient and inpatient rehabilitation options for adult patients with PBTs as well as explore the role of the interdisciplinary team in providing survivorship care.

Nutritional improvement is associated with better functional outcome in stroke rehabilitation: A cross-sectional study using controlling nutritional status.

To investigate the relationship between changes in nutritional status and the functional outcome of adult post-stroke patients hospitalized for rehabilitation. A cross-sectional study. Post-stroke patients (n = 134) who were admitted to aconvalescent rehabilitation ward. On admission and discharge, the nutritional status of each subject was assessed using the "controlling nutritional status" system. Activities of daily living were assessed using the Functional Independence Measure (FIM). Patients were divided into 2 categories: (i) those whose nutritional status improved or remained normal during the rehabilitation; and (ii) all others. The median age of patients was 65.5 years. Although there were no significant differences between the 2 categories in most characteristics, the FIM efficiency was significantly higher (0.230 in the improved category and 0.133 in the other; p < 0.001). Multiple linear regression analysis showed that the improved category as a variable was independently associated with greater FIM efficiency (p < 0.001). Improvement or maintenance ofnutritional status was associated with better functional recovery in post-stroke rehabilitation in adult patients of all ages.

Before-after evaluation of patient length of stay in a rehabilitation context following implementation of an electronic patient journey board

PurposeTo investigate whether the installation of electronic patient journey boards in an inpatient adult rehabilitation centre in Victoria, Australia, is associated with shorter lengths of stay for admitted adult rehabilitation patients. MethodsA retrospective before-after analysis of 3 259 adult inpatient rehabilitation episodes from 2013 to 2018 was performed, analysing case-mix adjusted lengths of stay. ResultsA reduction in case-mix adjusted length of stay of 4.1 days per episode (95 % confidence interval: 2.0–6.4 days) was found. The corresponding reduction in hospital costs was estimated to be $3 738 per episode (95 % confidence interval $2 398–$4 983). ConclusionsInstallation of electronic patient journey boards was associated with shorter lengths of stay in an inpatient adult rehabilitation centre. Additional research is needed to 1) provide further evidence of the causal effect of the boards on length of stay, and 2) investigate the mechanisms by which they reduce lengths of stay (e.g., increased currency of information, changes to procedures, remote viewing) in rehabilitation settings.

Reliability and validity of on-road driving tests in vulnerable adults: a systematic review.

The on-road driving test is considered a ‘gold standard’ evaluation; however, its validity and reliability have not been sufficiently reviewed. This systematic review aimed to map out and synthesize literature regarding on-road driving tests using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Cochrane Library, PubMed, CINAHL, and Web of Science databases were searched from initiation through February 2018. All articles addressing reliability or validity of on-road driving tests involving adult rehabilitation patients were included. The search output identified 513 studies and 36 articles, which were included in the review. The Washington University Road Test/Rhode Island Road Test, performance analysis of driving ability, test ride for investigating practical fitness-to-drive, and K-score demonstrated high reliability and validity in regard to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. The Washington University Road Test/Rhode Island Road Test and test ride for investigating practical fitness-to-drive were analyzed based on Classical Test Theory techniques, and performance analysis of driving ability and K-score were analyzed based on Item Response Theory techniques. The frequency of studies were Washington University Road Test/Rhode Island Road Test (n=9), Test Ride for Investigating Practical fitness-to-drive (n=8), performance analysis of driving ability (n=4), and K-score (n=1). From the viewpoint of accuracy and generalization, the Washington University Road Test/Rhode Island Road Test, test ride for investigating practical fitness-to-drive, and performance analysis of driving ability were identified as highly qualified concerning on-road driving tests. However, the ability to assess real-world driving depends on various environmental conditions.

220.4: Results of Medical and Surgical Rehabilitation of Adult Patients with Type III Intestinal Failure in a comprehensive unit: Is it possible to predict intestinal rehabilitation?

220.4: Results of Medical and Surgical Rehabilitation of Adult Patients with Type III Intestinal Failure in a comprehensive unit: Is it possible to predict intestinal rehabilitation?

Rehabilitation of adult patients with severe-to-profound hearing impairment – why not cochlear implants?

Background: In Sweden, an estimated prevalence of adult patients with severe-to-profound hearing loss is 0.2%, which corresponds to roughly 20,000. We know little about the use of cochlear implants (CIs) in this population and why not most of them are not offered CI.Objectives: To investigate the reasons for no rehabilitation with CI among this patient group.Materials and methods: Data were collected from 1076 patients in the Swedish Quality Register of Otorhinolaryngology. A baseline questionnaire and the reason for no CI, was evaluated.Results: Only 14.5% of the patients started a CI investigation, and 8.5% were rehabilitated with CI. Significantly more women (56.5%) than men received CI. The most common reasons for not receiving CI, were hearing reason (30.5%), indicating satisfaction with technical equipment, and unknown reason (25%). The oldest patient group (81–100 years old) had the highest risk for unknown reasons. Patients receiving extended audiological rehabilitation (53.5%) had a significantly lower risk for unknown reasons.Conclusions: It is worrying that the oldest patient group (81–100 years old) seemed to have fewer chances to start a CI investigation. An extended audiological rehabilitation increased the chances that professionals would discuss CI.Significance: This study shows that surprisingly few patients are offered CI despite their severe-to-profound hearing loss.