Rehabilitation Clinical Practice Research Articles

Knowledge, Barriers, and Future Directions of Vestibular Rehabilitation Practice in Neurorehabilitation: An Italian Survey.

Background/Objectives: Vestibular rehabilitation, an evidence-based physical therapy approach, plays a crucial role in managing and recovering from gaze and balance disorders, including those of central origin. This study, targeted at the community of Italian healthcare practitioners, is vital in understanding the application of vestibular rehabilitation in neurological disorders and in identifying knowledge gaps, barriers, and future directions. Methods: This is a cross-sectional study directed at healthcare professionals involved in neurorehabilitation in Italy. The survey consisted of 29 items grouped in 4 sections, which was estimated to take approximately 10 min to complete. The questions covered socio-demographic information, professional information, clinical practice, and future perspectives on vestibular rehabilitation. Results: Out of the 435 respondents, 290 completed the survey. Most of the respondents reported either no (32.87%) or little (42.91%) experience in vestibular rehabilitation. However, most participants (72.98%) recognized the importance of vestibular rehabilitation in treating neurological disorders. The most common condition treated was stroke (46.39%), while balance training (52.69%) and visual input exercises (26.35%) were the two most frequently used strategies. The main barriers to implementing vestibular rehabilitation in clinical practice were equipment cost and insufficient skills. Conclusions: Vestibular physical therapy is a promising complementary approach in neurorehabilitation. However, the study reveals a perceived lack of basic training in vestibular assessment and therapy. This suggests that more efforts are needed to bridge this knowledge gap and make necessary equipment more accessible.

Exploring the effects of anti-gravity treadmill training in musculoskeletal disorders: A systematic review

Musculoskeletal disorders (MSD) comprise a great variety of medical conditions, and the economic and sanitary burdens they cause are a major concern for the sanitary systems worldwide. Conventional rehabilitation is effective; however, with the rise of new technologies, it can be further improved. Anti-gravity treadmills are starting to enter the clinical rehabilitation practice of MSD due to their characteristics, which allow weight support while performing walking and running exercises. Thus, this systematic review aims to explore the effects and use of anti-gravity treadmills in MSD. A systematic search of literature was performed by collecting articles from PubMed, Scopus, and Web of Science on the use of anti-gravity treadmills in MSD management. The PEDro scale tool and the Joanna Briggs Institute checklist were used to assess the methodological quality of the included studies. Relevant data were collected in tables, and the primary outcomes were discussed narratively. Of the 185 articles screened, 11 were included in the qualitative synthesis. The findings of the selected articles encourage the use of anti-gravity treadmills in MSD rehabilitation to improve gait functionality, balance, pain relief rct, range of motion, and fracture healing. The protocols and outcomes evaluated showed high heterogeneity, and quantitative synthesis could not be performed. In conclusion, the anti-gravity treadmill proved feasible, safe, and well tolerated by individuals with different MSD, and greater improvements were seen in participants who performed anti-gravity exercises than in those who performed only conventional rehabilitation.

Cognitive effect of passively induced kinesthetic perception associated with virtual body augmentation modulates spinal reflex.

The virtual movement of an augmented body, perceived as part of oneself, forms the basis of kinesthetic perception induced by visual stimulation (KINVIS). KINVIS is a visually induced virtual kinesthetic perception that clinically suppresses spasticity. The present study hypothesized that central neural network activity during KINVIS affects subcortical neural circuits. The present study aimed to elucidate whether reciprocal and presynaptic inhibition occurs during KINVIS. Seventeen healthy participants were recruited (mean age: 27.9 ± 3.6 yr), and their soleus Hoffmann-reflexes (H-reflexes) were recorded by peripheral nerve stimulation while perceiving the dorsiflexion kinesthetic illusion in the right-side foot (seated in a comfortable chair). Two control conditions were set to observe the same foot video without the kinesthetic illusion while focusing on the static foot image. Unconditioned H-reflex and two types of conditioned H-reflexes were measured: Ia (reciprocal inhibition) and D1 (presynaptic inhibition). Reciprocal Ia and D1 inhibition of the soleus muscle was significantly enhanced during the kinesthetic illusion compared with the condition without kinesthetic illusion (a post hoc analysis using the Bonferroni test: Ia inhibition, P = 0.002; D1 inhibition, P = 0.049). This study indicates that kinesthetic illusion elicits an inhibitory effect on the monosynaptic reflex loop of Ia afferents, potentially inhibiting the hyperexcitability of the stretch reflex. These findings demonstrate that brain activity associated with visually induced kinesthetic illusions acts on spinal inhibition circuits. These insights may be valuable in clinical rehabilitation practice, specifically for the treatment of spasticity.NEW & NOTEWORTHY Neural effects in visual-induced kinesthetic illusion expand into the spinal reflex. Kinesthetic illusion inhibits the monosynaptic reflex in an antagonistic muscle via reciprocal and presynaptic inhibition. Visually induced kinesthetic illusion is a suitable treatment for spasticity in patients with stroke.

Effects of a Virtual Reality Game With Leap Motion Controller on Brain Activity Related to Attentional Function in Healthy Adults - A Pilot EEG Study.

Objective Virtual reality (VR) games with the Leap Motion Controller (LMC) are used in clinical practice for cognitive rehabilitation to improve attentional function. However, the effects of VR games using the LMC on brain activity related to attentional function have not yet been elucidated. This study aimed to elucidate the effects of a VR game with the LMC on brain activity related to attentional function. Methods This single-arm study included 15 healthy adults (mean age, 23.2 ± 0.9 years; seven females) and analyzed their electroencephalography (EEG) findings. We measured event-related potentials (ERPs) before and after the VR game with the LMC, and the α, θ, and β values during the VR game with the LMC. EEG measurements were based on the international 10-20 system, with dish electrodes placed at F3, F4, Fz, C3, C4, Cz, P3, P4, Pz, O1, and O2 using EEG caps. For statistical analysis, the N1 peak amplitudes before and after the VR game were compared using paired t-tests. In addition, the average amplitudes of α, θ, and β at 10-20 ms and 280-290 ms during the VR game were compared using paired t-tests only for positions that showed significant changes in the N1 peak amplitude before and after the VR game. Results After the VR game, the N1 peak amplitude was significantly greater at the F4 (pre: -4.51 ± 3.49 μV, post: -6.31 ± 2.60 μV, P = 0.010), Fz (pre: -4.68 ± 2.85 μV, post: -6.29 ± 2.17 μV, P = 0.033), and C4 (pre: -4.43 ± 3.94 μV, post: -6.24 ± 2.56 μV, P = 0.015) positions. During the VR game, the average amplitude of α at the F4 position (during a VR game of 10-20 ms: 7.86 ± 1.33 μV; during a VR game of 280-290 ms: 9.40 ± 2.69 μV, P = 0.010) was significantly higher at 280-290 ms. Conclusions The N1 peak amplitude, meaning selective attention, in F4, Fz, and C4 and the amplitude of α, meaning control interference of unwanted stimuli in a task, in F4 were increased in the post-VR game using LMC. VR games using the LMC may contribute to improvements in attentional function. Further studies are required to assess their applications in cognitive rehabilitation.

Accuracy of Physiotherapist Predictions for Independent Walking After Stroke

Background The use of prediction tools in stroke rehabilitation research and clinical practice is increasing, but it is not clear whether these prediction tools out-perform clinician predictions. Objective This study aimed to compare physiotherapist predictions for independent walking with the Time to Walking Independently after STroke (TWIST) prediction tool. Methods Adults with new lower limb weakness and unable to walk independently (Functional Ambulation Category [FAC] < 4) were recruited. At 1 week post-stroke, the treating physiotherapist was asked to predict whether their patient would achieve independent walking by 4, 6, 9, 12, 16, or 26 weeks, or remain dependent. Predictions were also made using the TWIST prediction tool, but not shared. Binary logistic regressions were conducted with the time independent walking was achieved as the dependent variable and independent variables were the physiotherapist and TWIST predictions. Results Ninety-one participants were included (median age 71 years, 36 [40%] female). Most participants (67 [74%]) were non-ambulatory (FAC = 0) at 1-week post-stroke. Thirty-seven physiotherapists were recruited. Physiotherapists made accurate predictions for time taken to achieve independent walking for 39 participants (43%). Prediction accuracy was not related to physiotherapist confidence or years of stroke-specific experience. TWIST out-performed physiotherapist predictions (Physiotherapists 76%-77%, TWIST 86%-88% accurate) for participants who achieved independent walking by 4, 6, and 9 weeks post-stroke. Accuracy of physiotherapist and TWIST predictions was similar for 16 and 26 weeks post-stroke. Conclusions The TWIST prediction tool is more accurate than physiotherapists at predicting whether a patient will achieve independent walking by 4, 6, or 9 weeks post-stroke, but not for 16 or 26 weeks post-stroke. TWIST may be useful to inform early rehabilitation and discharge planning. Clinical Trial Registration-URL: www.anzctr.org.au Unique Identifier: ACTRN12617001434381.

“But if you do not keep doing it, you won’t maintain”. A qualitative study on the perspectives of speech-language pathologists on maintenance of therapy gains in aphasia

ABSTRACT Background Maintaining therapy gains in the long term is necessary for therapy to be considered successful. Yet, this topic has received limited attention in aphasia rehabilitation research. Unfortunately, for some people with chronic aphasia, maintaining the gains achieved in therapy can be difficult and many experience reduced communicative functioning over time. Understanding the perspectives of speech-language pathologists (SLPs) on maintenance is vital. As key agents in aphasia therapy, their views are crucial for understanding current practice, identifying service gaps, and informing future research on the maintenance of therapy gains. Aim The aim of this research was to explore speech-language pathologists’ perspectives on maintaining therapy gains in chronic aphasia and to understand their beliefs about the factors that influence the maintenance of gains made during aphasia rehabilitation. Methods & Procedures In-depth semi-structured interviews were conducted with seven SLPs who worked with people with chronic aphasia. Inductive thematic data analysis was used to identify themes. Outcomes & Results Six themes were identified, representing SLPs’ beliefs about maintenance and their perceptions of factors important for preserving therapy gains in aphasia rehabilitation. These were: 1) Ongoing communication activity; 2) Meaningful person-centred goals; 3) The challenge of translating functional goals to participation; 4) Individual capacity and resource availability; 5) Home support; and 6) Services. The results illustrate the complexity and interplay of factors that may both facilitate and hinder the maintenance of therapy gains. Conclusions SLPs in this study believe that aphasia rehabilitation interventions should involve meaningful, personalised, enjoyable real-life experiences to optimise maintenance of therapy gains. Moreover, they believe that maintenance must be at the centre of aphasia rehabilitation research and clinical practice, requiring new models of care for chronic aphasia. These insights may provide direction for the development of future interventions and services to enhance long-term maintenance for people with chronic aphasia.

Validation of the Norwegian International Reading Speed Texts (IReST) in adult readers with normal vision

There is a lack of standardised reading tests in Norwegian suitable for adults and persons with visual impairment (VI). The International Reading Speed Texts (IReST) measure reading performance of longer paragraphs. The aim of this project was to translate and validate the IReST in Norwegian. Each of the German, English and Swedish IReST were translated into Norwegian. The translations were matched for length, linguistic difficulty, and structure, and piloted in five adults. Reading speed was assessed in 25 readers (41 years, SD = 10) with normal vision and the readings were recorded. Reading speeds were analysed for variability between texts and participants. There were no statistically significant differences between the ten texts (135 words, 765 characters [SD=18], word variation index 91.8% [SD = 0.9%]). Reading speed in adult readers was 204 (SD=31) words/min. There was no difference across texts for any of the participants (p&gt;0.05). Reading speed variance was 77.4% between subjects and 22.6% between texts. The Norwegian IReST is standardised and comparable to the international IReST tests. Reading speed falls within normative values in adult readers. The Norwegian IReST will be a valuable tool in assessing reading in clinical health care, rehabilitation and educational practice of adult and visually impaired readers and in reading research.

Designing studies and reviews to produce informative, trustworthy evidence about complex interventions in rehabilitation: a narrative review and commentary.

According to Cochrane Rehabilitation's recently published definition for research purposes, rehabilitation is inherently complex. Rehabilitation teams frequently implement multiple strategies concurrently, draw on input from a range of different health professionals, target multiple outcomes, and personalize therapeutic plans. The success of rehabilitation lies not only in the specific therapies employed, but also in how they are delivered, when they are delivered, and the capability and willingness of patients to engage in them. In 2021, the UK Medical Research Council (MRC) and the National Institute of Health Research (NIHR) released the second major update of its framework for developing and evaluating complex interventions. This framework has direct relevance to the development and implementation of evidence-based practice in the field of rehabilitation. While previous iterations of this framework positioned complex interventions as anything that involved multiple components, multiple people, multiple settings, multiple targets of effect, and behavior change, this latest framework expanded on this concept of complexity to also include the characteristics and influence of the context in which interventions occur. The revised MRC-NIHR framework presents complex intervention research as comprising the following four inter-related and overlapping phases: 1) development or identification of the intervention; 2) feasibility; 3) evaluation; and 4) implementation, with different methods and tools required to address each of these phases. This paper provides an overview of the MRC-NIHR framework and its application to rehabilitation, with examples from past research. Rehabilitation researchers are encouraged to learn about the MRC-NIHR framework and its application. Funders of rehabilitation research are also encouraged to place greater emphasis on supporting studies that involve the right design to address key uncertainties in rehabilitation clinical practice. This will require investment into a broader range of types of research than simply individual-level randomized controlled trials. Rehabilitation research can both learn from and contribute to future iterations of the MRC-NIHR framework as it is an excellent environment for exploring complexity in clinical practice.

Clinical Rehabilitation Practice Guidelines on Standing Balance Disorder in Patients with Stroke

Clinical Rehabilitation Practice Guidelines on Standing Balance Disorder in Patients with Stroke

Effects of Maitland mobilization technique on upper extremity function in stroke survivors with spasticity: An experimental study.

The recovery of upper limb function is of great significance for stroke patients to regain their self-care ability, yet it is still a difficult point in clinical practice of neurological rehabilitation. This study aimed to investigate the effect of Maitland joint mobilization technique on the recovery of upper extremity function in patients with spasticity after stroke. From August to December 2023, 71 patients with upper extremity flexor spasm after stroke were recruited and randomly divided into experimental group (n = 35) and control group (n = 36). The control group was given conventional rehabilitation treatment, while the experimental group was treated with Maitland mobilization technique treatment of upper extremity joints on the basis of the control group. The experiment lasted for 8 weeks. Participants of the 2 groups were observed for Fugl-Meyer motor assessment-upper extremity (FMA-UE), box and block test (BBT) and Brunnstrom stage, modified Ashworth scale (MAS), and functional independence measure (FIM) at pre- and post-8 weeks study. There was no significant difference in gender distribution, hemiplegic side, diagnosis, past history, age, duration, body mass index, and mini-mental state examination between the 2 groups (P > .05). After 8 weeks of intervention, both groups showed significant improvement in FMA-UE, Brunnstrom stage, BBT, FIM, and MAS of the shoulder (P < .05); however, there was no significant change in MAS of the elbow, wrist, and finger joints (P > .05). The posttreatment values showed a significant improvement in FMA-UE, BBT, and FIM in the experimental group compared to the control group. Comparing the changes in pretreatment and posttreatment, FMA-UE, BBT, and FIM in the experimental group were significantly improved compared with those in the control group (P < .05). Maitland joint mobilization can improve the motor function of upper extremity and the spasticity of shoulder joint complex in patients with stroke.

Age-Related Variations in Breast Cancer Complications: Insights from Physical Medicine and Rehabilitation Clinical Practice.

Background Breast cancer patients often experience complications related to the disease or its treatment. With the rising average life expectancy, age is becoming less of a factor in treatment decisions for this condition. This study aims to evaluate differences in breast cancer complications among various age groups in patients referred to a hospital's physical medicine and rehabilitation (PMR) department. Methodology A retrospective study was conducted among all breast cancer patients evaluated in a PMR department between November 2019 and March 2021. Data were collected from patients' clinical files. SPSS® version 24 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results We assessed 85 patients with a mean age of 56 years, finding that shoulder pain was the primary referral reason, reported by 85.9% of patients, followed by lymphedema in 32% of cases. Patients aged 56-65 years exhibited greater deficits in shoulder mobility compared to those between 66 and 75 years old, as well as greater functional limitations compared to other age groups. Most patients reported symptoms post-surgery, with an average delay of 24 months in PMR consultation. Despite this, nearly all patients (89.3%) reported clinical improvement following interventions. Conclusions We found that individuals in the 56-65-year age group were more prone to develop functional and shoulder mobility limitations. Despite delayed consultation, the majority of patients experienced clinical improvement, highlighting the intervention effectiveness of PMR interventions. These findings suggest that age alone may not be a determining factor in the reported breast cancer sequelae, implying the influence of other contributing factors in patient management. Further research is needed to elucidate the underlying mechanisms contributing to the diverse burden of disease sequelae observed across different age groups and to devise tailored interventions.

Sport-based psychosocial interventions for people suffering from severe mental disorders: EASMH pilot actions from 4 European Countries

IntroductionThe European Alliance for Sport and Mental Health (EASMH) is a partnership of scientific institutions, charity associations and sport organizations, funded by EU-Erasmus+. It aimed at developing good clinical practice in psychiatric rehabilitation through sport-based interventions as an integration of pharmacological and psychological therapies. Within the framework of the EASMH projects, several actions have been promoted including an assessment of the dissemination of sport-based interventions, a training course for specialized coaches and the implementation of pilot actions in four European Countries.ObjectivesTo briefly describe EASMH pilot actions performed in Finland, Italy, Romania and United Kingdom, where trained coaches delivered sport-based interventions to patients with severe mental disorders.MethodsAfter completing pilot actions, charity associations and sport organizations belonging to EASMH network described general and specific aims, sport activities, composition of staff, timing and tools for assessing the outcomes.ResultsIn Italy, “Crazy for Rugby”, including adolescents and young patients, and “Not only headshots”, a football project for adults with severe mental disorders were performed. In UK, a football-based activity called “Imagine Your Goal” and a walking-football program for participants aged more than 40 were delivered. In Romania, two courses including gymnastics, yoga and pilates called “Get fit!” were provided. Different team sport-based activities were implemented in Finland, where “Multiple Sport Group” and “Rehabilitating Sports” aimed at increasing patients’ autonomy. Assessment of psychopathological, social, cognitive and sport/fitness outcomes confirmed the overall beneficial effects of sport on mental health.ConclusionsPilot actions represent the final step of EASMH project, which showed improvement of mental health outcomes by also delivering sport-based rehabilitation to patients with severe mental disorders. Institutions and stakeholders are now called to promote the implementation of such initiatives on a broader scale.Disclosure of InterestNone Declared

Effects of transcranial direct current stimulation alone and in combination with rehabilitation therapies on gait and balance among individuals with Parkinson's disease: a systematic review and meta-analysis.

Parkinson's disease (PD) is a neurogenerative disorder implicated in dysfunctions of motor functions, particularly gait and balance. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation offered as a potential adjuvant therapy for PD. This systematic review and meta-analysis were conducted to identify whether tDCS alone and combined with additional rehabilitation therapies improve gait and balance among individuals with PD. We searched PubMed, Embase, Web of Science, and relevant databases for eligible studies from inception to December 2022. Studies with a comparative design investigating the effects of tDCS on motor functions, including gait and balance among individuals with PD, were included. A meta-analysis was performed for each outcome using a random effects model for subgroup analysis and pooling of overall effect sizes. A total of 23 studies were included in the meta-analysis. The pooled results revealed that tDCS has moderate overall effects on gait, measured by gait speed (standardized mean deviation [SMD] = 0.238; 95% confidence interval [CI] - 0.026 to 0.502); stride length (SMD = 0.318; 95% CI - 0.015 to 0.652); cadence (SMD = - 0.632; 95% CI - 0.932 to - 0.333); freezing of gait questionnaire scores (SMD = - 0.360; 95% CI - 0.692 to - 0.027); step length (SMD = 0.459; 95% CI - 0.031 to 0.949); walking time (SMD = - 0.253; 95% CI - 0.758 to 0.252); stride time (SMD = - 0.785; 95% CI: - 1.680 to 0.111); double support time (SMD = 1.139; 95% CI - 0.244 to 0.523); and balance, measured by timed up and go (TUG) test (SMD = - 0.294; 95% CI - 0.516 to - 0.073), Berg balance scale (BBS) scores (SMD = 0.406; 95% CI - 0.059 to 0.87), and dynamic gait index (SMD = 0.275; 95% CI - 0.349 to 0.898). For the subgroup analysis, gait and balance demonstrated moderate effect sizes. However, only cadence, stride time, and TUG indicated a significant difference between real and sham tDCS (P = 0.027, P = 0.002, and P = 0.023, respectively), whereas cadence and BBS (P < 0.01 and P = 0.045, respectively) significantly differed after real tDCS plus other therapies rather than after sham tDCS plus other therapies. Our results indicated that tDCS is significantly associated with gait and balance improvements among individuals with PD. The findings of this study provide more proof supporting the effectiveness of tDCS, encouraging tDCS to be utilized alone or in combination with other therapies in clinical practice for PD rehabilitation.

Spatial Neglect: An Exploration of Clinical Assessment Behaviour in Stroke Rehabilitation.

There is a large gap between evidence-based recommendations for spatial neglect assessment and clinical practice in stroke rehabilitation. We aimed to describe factors that may contribute to this gap, clinician perceptions of an ideal assessment tool, and potential implementation strategies to change clinical practice in this area. Qualitative focus group investigation. Focus group questions were mapped to the Theoretical Domains Framework and asked participants to describe their experiences and perceptions of spatial neglect assessment. Online stroke rehabilitation educational bootcamp. A sample of 23 occupational therapists, three physiotherapists, and one orthoptist that attended the bootcamp. Prior to their focus group, participants watched an hour-long educational session about spatial neglect. A deductive analysis with the Theoretical Domains Framework was used to describe perceived determinants of clinical spatial neglect assessment. An inductive thematic analysis was used to describe perceptions of an ideal assessment tool and practice-change strategies in this area. Participants reported that their choice of spatial neglect assessment was influenced by a belief that it would positively impact the function of people with stroke. However, a lack of knowledge about spatial neglect assessment appeared to drive low clinical use of standardised functional assessments. Participants recommended open-source online education involving a multidisciplinary team, with live-skill practice for the implementation of spatial neglect assessment tools. Our results suggest that clinicians prefer functional assessments of spatial neglect, but multiple factors such as knowledge, training, and policy change are required to enable their translation to clinical practice.

Investigating shared decision-making during the use of a digital health tool for physical activity planning in cardiac rehabilitation.

Shared decision making (SDM) between healthcare professionals and persons with CVD can have a positive impact on motivation, adherence, or sustainability regarding long-term goals and integration of cardiovascular disease (CVD) rehabilitation in the everyday lives of persons with CVD. SDM can foster the transition between regular heart-healthy activity at rehabilitation facilities and more independent activity at home, but it is often challenging to implement SDM given limited time and resources, e.g., in the daily practice of rehabilitation. Digital tools can help but must be appropriately tailored for situated use and user needs. We aimed to (1) describe in how far SDM is manifested in the situated context when using a digital tool developed by our group, and, based on that, (2) reflect on how digital health tools can be designed to facilitate and improve the SDM process. In the context of a field study, we investigated how SDM is already naturally applied and manifested when using a digital tool for joint physical activity planning in cardiac rehabilitation in clinical practice. In a two-week qualitative study, we collected data on expectations, experiences and interactions during the use of a digital health tool by seven persons with CVD and five healthcare professionals. Data was collected by means of observations, interviews, questionnaires and a self-reported diary, and analysed with a particular focus on episodes related to SDM. We found that SDM was manifested in the situated context to limited extent. For example, we identified high improvement potential for more structured goal-setting and more explicit consideration of preferences and routines. Based on mapping our findings to temporal phases where SDM can be adopted, we highlight implications for design to further support SDM in clinical practice. We consider this as "SDM supportive design in digital health apps," suggesting for example step-by-step guidance to be used during the actual consultation. This study contributes to further understanding and integration of SDM in digital health tools with a focus on rehabilitation, to empower and support both persons with CVD and healthcare professionals.

Phytotherapy: knowledge, experience and prescription in oral healthcare. A cross-sectional survey of dental practitioners.

This exploratory survey assessed Brazilian dentists' knowledge, attitudes, and practices regarding phytotherapy. This study used a consecutive sample of registered dentists who were active in clinical practice and attending advanced training for complex oral rehabilitation at a leading dental school in Latin America. Participants responded to a semi-structured 38-item instrument designed to collect data on sociodemographic, professional and health variables, and on their knowledge, use, prescription and opinions of phytotherapy. Quantitative data were analyzed with descriptive and inferential statistics. Qualitative data were described and analyzed with a thematic approach. A total 53 dentists responded the survey (88.3% response rate). Six dentists reported formal education in phytotherapy and 33 had informal knowledge. Twenty-one dentists (39.6%) reported using herbal medicine, and 17 (32.1%) prescribed phytotherapy to their patients, mostly traditional medicinal plants. A logistic regression model showed that post-graduate degree and personal use of phytotherapy were associated with phytotherapy prescription. Opinions on how to improve the rational use of phytotherapy included the need for research evidence, specific academic education, and knowledge dissemination to clinicians. As a clinical recommendation, it was proposed that questions on herbal medicine should be asked during the dental patient's anamnesis. Dentists with post-graduate degrees and personal use of phytotherapy prescribe herbal medicines for their patients in real-world clinics, regardless of formal education on the subject. Qualitative findings indicate the need to implement scientific initiatives.

Use of Virtual Reality in Patients with Acquired Brain Injury: A Systematic Review.

ABI is found in all societies as the most severe, disabling neurological disorder. A cognitive rehabilitation program is essential for the clinical recovery of these patients, improving functional outcomes and quality of life. Modern technologies such as virtual reality (VR) offer several advantages over traditional therapies, including the ability to engage people in simulated performance of functional tasks. This review will examine the studies in which virtual reality has been used as an aid, technique, or intervention in patients with acquired brain injury. Studies were identified from an online search of PubMed, Cochrane Library, and Web of Science databases. We found that TBI patients responded positively to VR treatment depending on the damaged or impaired cognitive and motor functions they acquired. It is now a tool that is available in the rehabilitation of these patients and supports the recovery of various motor and cognitive functions. This review has shown that VR is an intervention technique that increasingly exists in clinical rehabilitation practice for ABI patients. The device uses advanced technologies that can cause general changes in cognitive, motor, and psychological aspects and create a simulated environment that can partially restore these functions and behaviors, as well as the behaviors of everyday life.

Expert consensus on management of pain, agitation and related issues in adult patients with critical respiratory diseases

As patients with critical respiratory diseases suffer from the discomfort of disease, frequent medical and nursing procedures, and the noise disturbance of the ICU environment, it is necessary to implement analgesia and sedation to reduce their negative stress and oxygen consumption. Special emphasis will be placed on the clinical practice of analgesia, sedation and rehabilitation in critically ill patients with respiratory diseases, as different pathophysiological features of the respective pulmonary diseases are presented, such as severe asthma and acute exacerbations of chronic obstructive pulmonary disease, as well as the exclusive situations during respiratory therapy, such as recruitment maneuvers, bedside bronchoscopy and operation of extracorporeal membrane oxygenators. To standardize the prevention and management of pain, agitation, delirium, immobility, and sleep disturbance in adult patients with critical respiratory diseases, the Chinese Thoracic Society and Critical Care Medicine Group of Chinese Association of Chest Physicians, Chinese Medical Doctor Association organized pulmonary and critical care experts to discuss 19 important issues and ultimately provided 20 recommendations based on the best available evidence.Assessment, prevention and management of pain should be prioritized before the administration of continuous infused sedatives in all patients with critical respiratory diseases. Bundles that include multiple strategies of non-pharmacological interventions to prevent and manage delirium and sleep disruption are encouraged. For the patients with stable respiratory and hemodynamic status, early mobility and exercise could be safe and beneficial. Respiratory drive control by addressing patient and ventilator factors should be the priority before administration of analog-sedation protocol in the ARDS patients. Deep sedation could be necessary in the early stage of ARDS with high respiratory drive, and during the recruitment maneuver, prone position and measurement of the respiratory mechanics. Maintaining spontaneous breathing with a lower level of sedation is recommended in COPD patients on invasive mechanical ventilation, while a deeper level of sedation, even with a short course of neuromuscular blockade, may be beneficial among severe asthma patients with high peak airway pressure. Pharmacokinetic alterations in patients with critical respiratory diseases during ECMO support are complicated as varied factors are involved, including ECMO circuit factors, drug factors, and patient factors. Therefore, the dosage of analgesics and sedatives should be adjusted according to the target of analog-sedation protocol in the respective disease.

Efficacy of rehabilitation interventions evaluated in common neurological conditions in improving participation outcomes: A systematic review

Objective Modern clinical rehabilitation practice aligned to the International Classification of Functioning, Disability and Health and the Convention on the Rights of Persons with Disabilities highlights the importance of attention to participation in the rehabilitation formulation. This systematic review investigates the efficacy of rehabilitation interventions evaluated in common neurological disorders reported to influence participation outcomes. Data sources PubMed, Web of Science and PsycINFO databases were searched from inception to 25 April 2023. Only randomised controlled trials were considered for inclusion. Review methods The data were extracted by two independent reviewers in the following categories: characteristics of the included study publications, description of intervention and outcome measures. Results A total of 1248 unique article records were identified through the databases. Twenty-eight randomized controlled trials were included with 15 publications having participation as a primary outcome measure. Articles were related to multiple sclerosis (N = 4), spinal cord injury (N = 2), stroke (N = 16) and traumatic brain injury (N = 6). Four publications showed significant differences in pre- and post-intervention within experimental groups. All four articles described participation as primary outcome measure. Conclusion There is a limited evidence of the identified rehabilitation interventions to improve participation in common neurological conditions. However, there was a paucity of articles involving individual with Parkinson's disease that met the inclusion criteria.

Strengthening the connection between clinical research and clinical practice of cognitive rehabilitation.

Strengthening the connection between clinical research and clinical practice of cognitive rehabilitation.