Rehabilitation Of Young Patient Research Articles

Cardiac rehabilitation in young patients post acute coronary syndrome: the keystone in cardiovascular care

Cardiac rehabilitation in young patients post acute coronary syndrome: the keystone in cardiovascular care

Facility-Based and Virtual Cardiac Rehabilitation in Young Patients with Heart Disease During the COVID-19 Era.

Cardiac rehabilitation (CR) is an important tool for improving fitness and quality of life in those with heart disease (HD). Few pediatric centers use CR to care for these patients, and virtual CR is rarely used. In addition, it is unclear how the COVID-19 era has changed CR outcomes. This study assessed fitness improvements in young HD patients participating in both facility-based and virtual CR during the COVID-19 pandemic. This retrospective single-center cohort study included new patients who completed CR from March 2020 through July 2022. CR outcomes included physical, performance, and psychosocial measures. Comparison between serial testing was performed with a paired t test with P < 0.05 was considered significant. Data are reported as mean ± standard deviation. There were 47 patients (19 ± 7.3years old; 49% male) who completed CR. Improvements were seen in peak oxygen consumption (VO2, 62.3 ± 16.1 v 71 ± 18.2% of predicted, p = 0.0007), 6-min walk (6MW) distance (401 ± 163.8 v 480.7 ± 119.2m, p = < 0.0001), sit to stand (16.2 ± 4.9 v 22.1 ± 6.6 repetitions; p = < 0.0001), Patient Health Questionnaire-9 (PHQ-9) (5.9 ± 4.3 v 4.4 ± 4.2; p = 0.002), and Physical Component Score (39.9 ± 10.1 v 44.9 ± 8.8; p = 0.002). Facility-based CR enrollees were less likely to complete CR than virtual patients (60%, 33/55 v 80%, 12/15; p = 0.005). Increases in peak VO2 (60 ± 15.3 v 70.2 ± 17.8% of predicted; p = 0.002) were seen among those that completed facility-based CR; this was not observed in the virtual group. Both groups demonstrated improvement in 6MW distance, sit-to-stand repetitions, and sit-and-reach distance. Completion of a CR program resulted in fitness improvements during the COVID-19 era regardless of location, although peak VO2 improved more for the in-person group.

El impacto del nivel educativo en las valoraciones cognitivas de los pacientes jóvenes ingresados en rehabilitación tras un ictus isquémico

Introduction and objectiveWe propose to assess the impact of educational level on cognitive tests at admission and discharge after a period of cognitive rehabilitation in young patients after ischaemic stroke. Materials and methodsWe considered secondary and higher education (group A) and less than 6 years of formal education (group B). We compared A and B using χ2 and Kruskal–Wallis. We studied A and B as predictors of verbal and working memory at discharge. Verbal and working memories were assessed at admission and discharge using Rey Auditory Verbal Learning Test (RAVLT) and DIGITS of the Barcelona Test respectively. ResultsWe analysed n=277 patients (55% belonging to A, mean age of 51 years) admitted to a specialised centre in Spain between 2009 and 2019.We found significant differences (P<.05) at admission, all in favour of A in the assessments of attention, inhibition, visuoperception, visuoconstruction, verbal fluency and comprehension.In DIGITS and RAVLT-learning we found differences at admission. In Digits and RAVLT-recognition we found differences at discharge, all in favour of A. We found no differences in age, severity, time at admission, or length of stay in hospital.Nor did we find differences in cognitive gains or treatment efficiency in memory tests.The groups A and B did not predict RAVLT (R2=.53) or DIGITS (R2=.48). ConclusionsA scores better in 63% of tests at admission and in 75% of tests at discharge, A and B are similar in gains and efficiency on memory tests.

Cost analysis of prosthetic rehabilitation in young patients with Amelogenesis imperfecta

Objectives: Children and adolescents with amelogenesis imperfecta (AI) have extensive treatment needs, but costs have not been explored previously. We calculated the costs of prosthetic rehabilitation and analyzed whether costs of treatment begun in early adolescence are lower compared with in early adulthood. Methods: Data from the dental records of 25 patients with AI and 25 age- and sex-matched controls were analyzed. Patients were followed for a mean period of 12.3 ± 1.5 years. Number of dental visits, dental treatment costs, and indirect costs were calculated during three time periods, before, during and after prosthetic therapy. Swedish national reference prices for general and specialist dental care were used. Results: The mean number of visits was significantly higher in the AI group: 43.3 ± 19.7 (controls: 17.5 ± 19.8; p < .001). Mean total costs were 8.5 times higher for patients with AI: €16,257 ± 5,595 (controls: €1,904 ± 993). Mean number of crowns made in patients with AI was 12 ± 7 (range 1 − 31). Indirect costs were significantly higher in the AI group and constituted 22% of the total costs. After crown therapy, costs between groups ceased to differ significantly. Calculations of total costs in the hypothetical scenario (discount rate at 3% annually) were €18,475 for prosthetic rehabilitation began at age 12 years compared with €20,227 if treatment began at 20 years of age. Conclusions: Prosthetic rehabilitation costs for children and adolescents with AI can be high. Early crown therapy is associated with lower costs and a lower number of dental visits. Clinical ImplicationsEarly crown therapy in children and adolescents with severe AI is a cost-reducing treatment associated with few complications and reduced need of dental care during adolescence compared with treatment begun at age 20.

Long-term results of Descemet-stripping automated endothelial keratoplasty for endothelial failure caused by phakic intraocular lenses.

To describe the surgical approach and long-term outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) for endothelial failure secondary to phakic intraocular lenses (pIOL). Retrospective, interventional case series of 18 eyes of 13 patients who developed endothelial failure secondary to pIOL implant. Patients were submitted to pIOL explant and DSAEK for visual rehabilitation, with or without phacoemulsification plus posterior-chamber intraocular lens implant. The minimum follow-up time was 3 years and the main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD) and percentage of endothelial cell loss (ECL), intraoperative and postoperative complications. Patients' mean age was 47.44 (7.86) years with a mean follow-up time of 55.61 (14.13) months. Sixteen eyes (88.9%) had an angle-supported pIOL. The mean pIOL implant-to explant time was 8.17 (2.73) years. BCVA improved from 1.00 (0.36) logMAR preoperatively to 0.29 (0.36) logMAR at 1 year of follow-up (p < 0.001), remaining stable over the entire follow-up period (p > 0.05). At the last visit, all corneas were clear, with a mean ECD of 724.74 (325.57) cells/mm2. During the follow-up, two eyes (11.1%) required a re-DSAEK due to early graft failure (<3 months). Our outcomes reveal that an individualized and careful approach may result in a stable visual rehabilitation in young patients with corneal decompensation following pIOL implant.

Exergaming as an Additional Tool in Rehabilitation of Young Patients with Rheumatoid Arthritis: A Pilot Randomized Controlled Trial.

Objective: To assess the effectiveness of home videogame-based exercise (exergaming) as an additional rehabilitative tool in young patients with rheumatoid arthritis (RA). Materials and Methods: After a baseline (T0) evaluation, 40 RA inpatients (18-35 years of age) underwent both a 4-week-lasting traditional rehabilitation program and a training by Nintendo® Wii-Fit™ videogame system. At discharge (T1), subjects were randomly assigned (1:1) to two groups: Group A (experimental group), including subjects who continued Wii-Fit training at home for additional 8 weeks, and Group B (control group), including subjects maintaining their habitual activity during the 8-week follow-up (T2). Measures of disease activity, quality of life, and fatigue were evaluated at each time point. Results: From T0 to T1, a significant improvement in most evaluated outcomes was reported in both study groups. At T2 assessment, only Group A patients experienced a significant improvement of quality of life and fatigue, with a 13.4% reduction in Global Health (GH) values, only a slight increase (4.2%) in Health Assessment Questionnaire (HAQ) score, and a 19.1% Functional Assessment of Chronic Illness Therapy (FACIT) improvement as compared with T1. In contrast, Group B patients reported a 65.8% increase in GH values, a 33% increase in HAQ score, and a 53.4% reduction in FACIT values from T1 to T2. The extended videogame-based home training was an independent predictor of Δ%GH (β = 0.851; P < 0.001), Δ%HAQ (β = 0.542; P < 0.001), and Δ%FACIT (β = -0.505; P < 0.001). Conclusions: Home exergaming may be an effective additional rehabilitative tool in RA, since it allows to maintain the benefits of traditional multidisciplinary rehabilitation.

Complete esthetic rehabilitation of young patient with gingival pigmentation

Smile is an expression which can help people feel better. Smile can express a sense of affection, joy, happiness, kindness, and confidence. Dentistry is one such profession which deals with smile esthetics. Smile esthetics is a type of subjective evaluation. Few clinicians believe that smile harmony is determined by only the shape, position, and color of teeth. However, actually, gingival tissue also plays an important role in determining smile harmony. Visibility of periodontium depends on smile line which is the ratio between the upper lip and usually is convex in appearance. Excessive exposure of gums while smiling is referred to as gummy smile.

Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series.

To describe a cognitive-behavioural treatment and clinical outcomes in a series of children with functional neurological symptoms (FNS). Thirty-six children with FNS were assessed and of these twenty-two (13 male, 9 female) with a mean age 14.5 years (SD=2.6, range 6-17 years) completed treatment with cognitive behaviour therapy embedded in routine child and adolescent clinical/systemic practice. Treatment outcomes were measured at baseline and post-intervention on the Child Global Assessment Scale (CGAS), Strengths and Difficulties Questionnaire (SDQ), Goal Based Outcomes (GBO) and Revised Child Anxiety and Depression Scale (RCADS). Scores on the CGAS improved significantly post-intervention (p<0.001) with 82% of participants showing reliable change. Individualised goals (GBO) also showed clinically meaningful gains. Standard measures of emotional and behavioural symptoms (SDQ and RCADS) did not correlate well with clinical diagnoses, were usually subthreshold at baseline, and did not show significant improvement post-intervention. The outcome of this pilot study suggests that CBT can be effective in the rehabilitation of young patients with FNS. Detection of common comorbid psychiatric disorders was not assisted by use of standardised measures, although most participants were clinically anxious or depressed. More research is needed to understand why children with FNS and their parents may not endorse mental health symptoms on questionnaires, and to further evaluate interventions within randomised controlled trials.

P.1.j.018 - Executive functions and dissociative symptoms in conversion disorder patients

To describe a cognitive-behavioural treatment and clinical outcomes in a series of children with functional neurological symptoms (FNS).Thirty-six children with FNS were assessed and of these twenty-two (13 male, 9 female) with a mean age 14.5 years (SD = 2.6, range 6–17 years) completed treatment with cognitive behaviour therapy embedded in routine child and adolescent clinical/systemic practice. Treatment outcomes were measured at baseline and post-intervention on the Child Global Assessment Scale (CGAS), Strengths and Difficulties Questionnaire (SDQ), Goal Based Outcomes (GBO) and Revised Child Anxiety and Depression Scale (RCADS).Scores on the CGAS improved significantly post-intervention (p < 0.001) with 82% of participants showing reliable change. Individualised goals (GBO) also showed clinically meaningful gains. Standard measures of emotional and behavioural symptoms (SDQ and RCADS) did not correlate well with clinical diagnoses, were usually subthreshold at baseline, and did not show significant improvement post-intervention.The outcome of this pilot study suggests that CBT can be effective in the rehabilitation of young patients with FNS. Detection of common comorbid psychiatric disorders was not assisted by use of standardised measures, although most participants were clinically anxious or depressed. More research is needed to understand why children with FNS and their parents may not endorse mental health symptoms on questionnaires, and to further evaluate interventions within randomised controlled trials.

English

Congenital tooth agenesis and tooth loss due to dental traumatism are some of the most common causes leading to rehabilitation of young patients with dental implants. The success of treating congenitally missing teeth with implant-supported prosthesis is no more guided only by osseointegration criteria. Nowadays the successful rehabilitation of these cases involves the adequate installation of dental implants with suitable prosthetic contour, color, and emergence profile closer to that found in natural dentition. Several treatment options are available for restoring patients with congenitally missing teeth such as maxillary lateral incisors. Fixed prosthodontics and orthodontics managements are considered acceptable treatment protocols. However, the gold standard rehabilitation of congenitally missing maxillary incisors is performed with implant-based prosthesis since no tooth wear neither extensive tooth movements are necessary. The present paper reports the treatment of a young adult woman with congenitally missing maxillary lateral incisors who underwent orthodontic treatment for improvement of teeth alignment and occlusal balance previous to dental implant surgery. This treatment also allowed appropriate space for the future lateral incisors crowns. Then, Morse-type conical implants were positioned and prosthetic abutments installed. Ceramic laminates were planned on central incisors in order to improve anterior aesthetics. All-ceramic crowns and laminates were made using lithium dissilicate-based ceramic (e-Max Press). The multidisciplinary association of orthodontic, implant and prosthetic techniques resulted in successful functional and aesthetic rehabilitation of the case, which was maintained after 1 year follow up.

Treatment of patients with knee cartilage injury combined with lesions of the anterior crucial ligament and meniscus

Purpose: to study the possibility to use rational arthroscopic tactics of treatment and duration of rehabilitation of patients with injured knee cartilage combined with the anterior cruciate ligament (ACL) and menisci lesions on the basis of retrospective analysis of 735 knee joint surgeries with using of arthroscopic methods.Methods: combined injury of the joint cartilage of different severity was diagnosed in 519 patients (71.7 %), primary ACL lesion was observed in 221 patients. Meniscectomy was performed in 514 patients. In 106 patients with menisci and ACL lesions posttraumatic changes in joint cartilage of different severity according to Outerbridge were detected. In accordance with this patients were categorised into 4 groups. The 5th group (control) contains patients with ACL and meniscus lesions without any changes in joint cartilage. Patients with menisci lesions in 97% of cases underwent partial resection of the injured part, and just in 3% (cases of paracapsular injuries) meniscus suturing was performed. In 91% patients meniscus posterior horn lesions were revealed, in 6% - injuries of the meniscus body, and just in 3% of all meniscus lesions anterior horn of meniscus was injured.Results: for restoration of ACL injured were used tendons of semitendinous and gracilis muscles. In postoperative period we recommended offloading of the operated lower extremity depend on changes in joint cartilage but not longer than 6 months after surgery. Thus in case of changes in cartilage of the first grade no other manipulations on cartilage except restoration of intraarticular structures were performed. In cases of changes in cartilage of the second and third grades we performed vaporization of its injured parts, in cases of the fourth grade osteoperforation of the defected segments was done.Conclusions: it was confirmed that arthroscopy is the «gold standard» in diagnostics and treatment of injured structures of knee joint enabling visualisation of the degree and depth of joint cartilage changes, determining of indications for appropriate treatment, performing of medicinal manipulations, planning adequate comprehensive postoperative therapy and rehabilitation. Intraoperative tactics of treatment of patients with combined ACL, meniscus and joint cartilage lesion depends on severity of cartilage changes. Duration of postoperative rehabilitation increased with the growth of severity of joint cartilage changes. Therefore, combination of arthroscopic treatment of injured joint cartilage injury of ІІІ-ІV grades and proper rehabilitation in young patients now remains the most relevant and requires further study and improvement.

Oral rehabilitation with implant-supported overdenture (ISO) in four children with ectodermal dysplasia

Ectodermal Dysplasias (ED) are a heterogeneous group of inherited disorders characterized by dysplasia of tissues of ectodermal origin. Complete or partial anodontia are the most frequent dental findings. Prosthetic rehabilitation is recommended from functional, esthetic, and psychological points of view. Because of the anatomical abnormalities of existing teeth and alveolar ridges, conventional prosthetic rehabilitation in young patient is often difficult.

Rehabilitation bei jüngeren Endoprothesenpatienten

In the treatment of younger patients following total joint replacement there are different methods for inpatient and outpatient rehabilitation. In principal medical rehabilitation of younger patients does not differ from rehabilitation of older patients. However, the rehabilitation process is not restricted by coexisting diseases. Higher demands on function and performance of the artificial joint have to be considered. Especially in younger patients education and information about use, load and sports following total joint replacement are necessary. In this context occupational rehabilitation concerning restrictions caused by the artificial joint and measures for participation in working life is of special importance.