Rehabilitation Potential Research Articles

Diaphragm Pacing Elicits Ventilatory Plasticity in a Rodent Model of Spinal Cord Injury

Cervical spinal cord injury (cSCI) often results in respiratory impairments requiring the use of chronic mechanical ventilation (MV). Diaphragm pacing (DP) is an emerging clinical intervention designed to combat the deleterious effects of chronic MV by electrically stimulating the diaphragm muscle to maintain ventilation. Anecdotal clinical evidence suggests a rehabilitative benefit of DP; however, current clinical practice is limited by a lack of controlled investigations. Thus, the purpose of this ongoing study was to determine if daily DP could be used as a rehabilitative tool following cSCI. We hypothesized that following cSCI, DP would 1) induce a long-lasting increase in tidal volume 60 minutes after stimulation, and 2) result in sustained improvements in tidal volume after four days of daily DP in awake, behaving rats. To test these hypotheses, we implanted custom electromyography electrodes in the mid-costal region of the left and right hemidiaphragms of male Sprague-Dawley rats. One week later, all animals received a left C2 hemisection (C2Hx; n=14) and a subset also received a left C4-6 dorsal rhizotomy (n=3). One week after injury, rats received stimulation on the paralyzed hemidiaphragm (biphasic 30Hz, 0.8mA, 80 μs pulse width) in phase with breathing (Pacing n=5, Rhizotomy n=3), or served as controls (n=6). We delivered DP to animals within plethysmography chambers in an intermittent pattern (5 minutes on/5 minutes off) for 1 hour/day over 4 consecutive days. Using whole body plethysmography, we recorded ventilation before, during, and for 60 minutes after to examine the acute effects of DP. Additionally, we measured ventilation during normoxia (21% FiO2) and respiratory challenge (10.5% FiO2, 7% FiCO2) before and after C2Hx, and 24 hours after four days of DP to assess the rehabilitative potential of pacing. DP increased tidal volume (% change from pre-pacing) compared to control animals during stimulation (P =0.021). Animals receiving DP displayed an elevated tidal volume compared to controls for at least 60 minutes after DP (P=0.015). When compared to control animals 24 hours after the completion of the pacing protocol, DP animals displayed an increased tidal volume (mL/breath/100g) during both normoxia (P =0.006) and respiratory challenge (P =0.019). In contrast, animals pre-treated with rhizotomy showed a similar tidal volume (mL/breath/100g) compared to controls (normoxia: P=0.597; respiratory challenge: P=0.191), suggesting that DP-induced ventilatory plasticity requires phrenic afferents. Taken together, our data suggest that diaphragm pacing has rehabilitative potential and elicits functional respiratory improvements in rodents following C2Hx. Acknowledgements: This work was supported by funding from the National Institute of Health, grant numbers: R00 HL143207-01 (KAS), UL1TR001436 (TCH) and the APTA Acute Care Physical Therapy Seed Grant (TCH). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Phenomenology of the inclusive potential of the family as a factor in socialization of children with disabilities

Introduction. The lack of tools for studying the potential resources and capabilities of the family, as well as the search for optimal strategies and mechanisms for the real inclusion of people with disabilities in all spheres of public life is on the current national and international agenda. Aspects of rehabilitation potential of the individual and the environment, educational potential, functionality and effectiveness of the family, competence, including inclusive competence, are considered for a comprehensive analysis of inclusive potential of families raising children with disabilities. The emphasis is shifted to understanding the potential of the family as a factor in socialization of children with disabilities. The article aims to systematize and scientifically analyze ideas about the potential opportunities and resources for the socialization of children with disabilities and their families, followed by justification of the criteria base and mechanism for assessing the inclusive potential of families. Materials and methods. Within the framework of interdisciplinary scientific discourse, a model of a criteria base and of mechanism for analyzing and assessing the inclusive potential of a family raising a child with disabilities is proposed. The basis for constructing such model is decomposition of groups of competencies through indicators of parental effectiveness based on formalization. Results and discussion. Based on the analysis of the terminological field related to assessing and developing family potential in matters of development and socialization of a child with disabilities, the author’s positions on ‘inclusive family potential’ are presented. Some socio-psychological phenomena are considered that reflect the capabilities and resources of both the children themselves and their social environment. Particular attention is paid to indicating the functional effectiveness of parents of children with disabilities. Conclusion. The discussed model for assessing the inclusive potential of families raising children with disabilities has a universal design, formed as a result of initial testing and expert assessment. This approach allows for a comparative analysis of individual indicators and assessment of the influence certain factors exert on the effectiveness of accompanying children of different categories of disabilities. Systematically analyzing individual groups of parents’ inclusive competencies allows optimizing their inclusion in comprehensive support of children with disabilities.

Recent Advances in Biomimetics for the Development of Bio-Inspired Prosthetic Limbs.

Recent advancements in biomimetics have spurred significant innovations in prosthetic limb development by leveraging the intricate designs and mechanisms found in nature. Biomimetics, also known as "nature-inspired engineering", involves studying and emulating biological systems to address complex human challenges. This comprehensive review provides insights into the latest trends in biomimetic prosthetics, focusing on leveraging knowledge from natural biomechanics, sensory feedback mechanisms, and control systems to closely mimic biological appendages. Highlighted breakthroughs include the integration of cutting-edge materials and manufacturing techniques such as 3D printing, facilitating seamless anatomical integration of prosthetic limbs. Additionally, the incorporation of neural interfaces and sensory feedback systems enhances control and movement, while technologies like 3D scanning enable personalized customization, optimizing comfort and functionality for individual users. Ongoing research efforts in biomimetics hold promise for further advancements, offering enhanced mobility and integration for individuals with limb loss or impairment. This review illuminates the dynamic landscape of biomimetic prosthetic technology, emphasizing its transformative potential in rehabilitation and assistive technologies. It envisions a future where prosthetic solutions seamlessly integrate with the human body, augmenting both mobility and quality of life.

Needs assessment in long-term care: expression of national principles for priority setting in service allocation

BackgroundLong-term care services for older adults are characterised by increasing needs and scarce resources. Political strategies have led to the reorganisation of long-term care services, with an increased focus on “ageing in place” and efficient use of resources. There is currently limited research on the processes by which resource allocation decisions are made by service allocators of long-term care services for older adults. The aim of this study is to explore how three political principles for priority setting in long-term care, resource, severity and benefit, are expressed in service allocation to older adults.MethodsThis qualitative study uses data from semi-structured individual interviews, focus groups and observations of service allocators who assess needs and assign long-term care services to older adults in Norway. The data were supplemented with individual decision letters from the allocation office, granting or denying long-term care services. The data were analysed using reflexive thematic analysis.ResultsThe allocators drew on all three principles for priority setting when assessing older adults’ long-term care needs and allocating services. We found that the three principles pushed in different directions in the allocation process. We identified six themes related to service allocators’ expression of the principles: (1) lowest effective level of care as a criterion for service allocation (resource), (2) blanket allocation of low-cost care services (resource), (3) severity of medical and rehabilitation needs (severity), (4) severity of care needs (severity), (5) benefit of generous service allocation (benefit) and (6) benefit of avoiding services (benefit).ConclusionsThe expressions of the three political principles for priority setting in long-term care allocation are in accordance with broader political trends and discourses regarding “ageing in place”, active ageing, an investment ideology, and prioritising those who are “worse off”. Increasing attention to the rehabilitation potential of older adults and expectations that they will take care of themselves increase the risk of not meeting frail older adults’ care needs. Additionally, difficulties in defining the severity of older adults’ complex needs lead to debates regarding “worse off” versus potentiality in future long-term care services allocation.Trial registrationNot applicable.

Clinical characteristics and rehabilitation potential in children with cerebral palsy based on MRI classification system.

The correlation of clinical characteristics of cerebral palsy (CP) and the magnetic resonance imaging classification system (MRICS) for (CP) is inconsistent. Specifically, the variance in rehabilitation potential across MRICS remains underexplored. To investigate the clinical characteristics and potential for rehabilitation in children with CP based on MRICS. Children with CP admitted to the Department of Rehabilitation, Children's Hospital of Chongqing Medical University between 2017 and 2021 were included in the study. Qualified cases underwent a follow-up period of at least one year. The clinical characteristics of CP among different MRICS were analyzed, then the rehabilitation potential was explored by a retrospective cohort study. Among the 384 initially enrolled children, the male-to-female ratio was 2.3:1, and the median age of diagnosis was 6.5 months (interquartile range: 4-12). The most prevalent MRICS categorization was predominant white matter injury (40.6%), followed by miscellaneous (29.2%) and predominant gray matter injury (15.6%). For the predominant white matter injury and miscellaneous categories, spastic diplegia emerged as the leading subtype of CP, with incidences of 59.6% and 36.6%, respectively, while mixed CP (36.7%) was the most common type in children with predominant gray matter. Notably, 76.4% of children with predominant white matter injury were classified as levels I-III on the gross motor function classification system (GMFCS), indicating significantly less severity than other groups (χ2 = 12.438, p = 0.013). No significant difference across MRICS categories was observed for the manual ability classification system (MACS) (H = 8.176, p = 0.085). Rehabilitation potential regarding fine motor function and adaptability based on Gesell assessment was dependent on MRICS over the follow-up period. Children with normal MRI scans exhibited superior rehabilitation outcomes. Commencing rehabilitation at an earlier stage produced consistent and beneficial results in terms of fine motor function and adaptability across all MRICS categories. Moreover, participants below 2 years of age demonstrated enhanced rehabilitation potential regarding fine motor outcomes and adaptability within the MRICS framework. MRICS displayed a significant association with clinical characteristics and rehabilitation efficacy in children with CP.

“I’m still in the lap of the gods… I don’t know whether I’m going to improve or not”: listening to people with dementia or cognitive impairment and their support people, talking about inpatient rehabilitation experiences

Purpose People with dementia often experience poor outcomes in hospital and prolonged lengths of stay. They are sometimes labelled as having “poor rehabilitation potential”. This study aimed to understand the inpatient rehabilitation experiences of people with dementia or cognitive impairment, and their support people, to inform future work to improve rehabilitation access and outcomes. Materials and methods An exploratory qualitative study from an interpretivist perspective. Participants were inpatients of a geriatric rehabilitation unit in Australia, and their chosen support people. Semi-structured interviews were audio-recorded and transcribed. An analytical framework was developed and indexed to the dataset, followed by charting and thematic analysis. Results Ten people with dementia or cognitive impairment and nine support people participated (n = 19). Four themes were identified representing an interpretation of the analysis intended to inform clinical practice: Support patients to engage in the rehabilitation process; create a hospitable environment; recognise and work with care partners; and ensure staff have adequate dementia knowledge. Conclusions Practical, emotional, process-related, and dementia-specific factors may influence the experiences of people living with dementia or cognitive impairment when participating in inpatient rehabilitation. Future research could investigate whether improvements focused on these factors might enhance quality of care for people with dementia.

A hybrid brain-muscle-machine interface for stroke rehabilitation: Usability and functionality validation in a 2-week intensive intervention.

Introduction: The primary constraint of non-invasive brain-machine interfaces (BMIs) in stroke rehabilitation lies in the poor spatial resolution of motor intention related neural activity capture. To address this limitation, hybrid brain-muscle-machine interfaces (hBMIs) have been suggested as superior alternatives. These hybrid interfaces incorporate supplementary input data from muscle signals to enhance the accuracy, smoothness and dexterity of rehabilitation device control. Nevertheless, determining the distribution of control between the brain and muscles is a complex task, particularly when applied to exoskeletons with multiple degrees of freedom (DoFs). Here we present a feasibility, usability and functionality study of a bio-inspired hybrid brain-muscle machine interface to continuously control an upper limb exoskeleton with 7 DoFs. Methods: The system implements a hierarchical control strategy that follows the biologically natural motor command pathway from the brain to the muscles. Additionally, it employs an innovative mirror myoelectric decoder, offering patients a reference model to assist them in relearning healthy muscle activation patterns during training. Furthermore, the multi-DoF exoskeleton enables the practice of coordinated arm and hand movements, which may facilitate the early use of the affected arm in daily life activities. In this pilot trial six chronic and severely paralyzed patients controlled the multi-DoF exoskeleton using their brain and muscle activity. The intervention consisted of 2 weeks of hBMI training of functional tasks with the system followed by physiotherapy. Patients' feedback was collected during and after the trial by means of several feedback questionnaires. Assessment sessions comprised clinical scales and neurophysiological measurements, conducted prior to, immediately following the intervention, and at a 2-week follow-up. Results: Patients' feedback indicates a great adoption of the technology and their confidence in its rehabilitation potential. Half of the patients showed improvements in their arm function and 83% improved their hand function. Furthermore, we found improved patterns of muscle activation as well as increased motor evoked potentials after the intervention. Discussion: This underscores the significant potential of bio-inspired interfaces that engage the entire nervous system, spanning from the brain to the muscles, for the rehabilitation of stroke patients, even those who are severely paralyzed and in the chronic phase.

Corneal Neurotization for Neurotrophic Keratopathy: A Multicenter Experience.

Corneal neurotization is an emerging technique that offers potential for visual rehabilitation in neurotrophic keratopathy. This study reports on a multicenter experience and outcomes for both direct and indirect methods of corneal neurotization. Retrospective case series. Sixteen patients with neurotrophic keratopathy who underwent corneal neurotization across 5 centers in Australia and Israel were identified for inclusion. Corneal neurotization was performed via direct neurotization from the ipsilateral or contralateral supraorbital/supratrochlear nerve or by the use of an interpositional sural nerve graft. Change in corneal sensitivity (measured in millimeters by the Cochet-Bonnet aesthesiometer), visual acuity, and corneal health. Over a mean follow-up period of 31.3 months (range: 3 months-8 years), mean corneal sensitivity improved from 3.6 mm (range: 0-25 mm) to 25.3 mm (range: 0-57 mm). Visual acuity improved on average from 20/380 to 20/260. Twelve of 16 patients (75.0%) improved in at least 2 out of the 3 main outcome measures. Nine patients (56.3%) showed an improvement in visual acuity; 13 (81.3%) showed an improvement in average corneal sensitivity; and 11 (68.8%) showed an improvement in corneal health. There were no intraoperative or postoperative complications. Corneal neurotization is an emerging surgical treatment option for the management of neurotrophic keratopathy. With appropriate case selection, outcomes are favorable and complication rates are low, for a condition that is otherwise challenging to manage. Patients with severe neurotrophic keratopathy should be considered for this surgical treatment option.

Posttraumatic growth and rehabilitative resources of the combatants and demobilized servicemen

The combat experience of military and demobilized persons combines the influence of combat and non-combat stressors with combat conditions and stressors associated with being in the combat zone, which leads to severe personal injury, symptoms of posttraumatic stress disorder and severe stress adaptive capacity. The resource of mastering combat stress is vitality, which is confirmed by the general viable position of the subjects, focused on effective self-development. Combatants show marked signs of maladaptation, but half of them report an increase in the value of life, spiritual growth and a general trend of personal growth, with women significantly exceeding men in terms of increasing personal strength. The aim of the research is to reveal the indicators of posttraumatic growth and personality rehabilitative resources of combatants and demobilized servicemen. Therefore, the posttraumatic growth of combatants goes hand in hand with attempts to adapt to a difficult situation. The main strategies for resisting stress in these conditions are cognition and recourse to physical activity. It is the resource of physical activity that is significantly positively correlated with indicators of posttraumatic personal growth. Personality posttraumatic growth indicators have been substantiated: change in attitude toward others, emergence of new opportunities, increase in strength of personality, spiritual changes, increase in the value of life, and general posttraumatic growth. The resource of rehabilitation potential, which is little used, is the appeal to the sphere of imagination and emotional sphere. The military does not sufficiently use the resources of faith and search for social support, which in crisis conditions are productive strategies. Sustainability is an important component of personal rehabilitation potential, but at this stage of a difficult situation, the personal resources involved are a person’s activity in overcoming difficulties, his/her desire to act and win, the desire not to lose this meaning, to express their personal potential.

“Beenomials”: exploring beekeeping as a rehabilitation tool in the field of mental health

IntroductionBeekeeping is a peculiar activity able to connect people both to nature and to other people. Extant research shows how it provides beekeepers with meaning, opportunities for learning, and a sense of connection to bees as well as to the surrounding ecosystem. The relationship of care and interdependence that is established supports well-being, encourages collaboration and positive social relations.Objectives“Beenomies” is a pilot project inspired by the union of opposites symbolically associated with bees: love and war, sweetness (honey) and bitterness (venom), the individual and multiplicity (society), regeneration and death. As CG Jung observed, honey expresses, psychologically, “the joy of life and the life urge which overcome […] the dark and the inhibiting. Where spring-like joy and expectation reign, spirit can embrace nature and nature, spirit”. Drawing on this psychological and philosophical basis, the project aimed to introduce beekeeping in a therapeutic community placed in the Alpine environment (Mondovì, Italy), to explore its rehabilitative potential and its ability to promote well-being in the field of mental health.MethodsThe project stems from the collaboration between mental health services, a local agriculture high school, and a farm involved in social agriculture. Initially, some beehives have been settled on the land surrounding the therapeutic community. Activities of beekeeping have been conducted and supervised by experienced beekeepers of the farm involved, who engaged a selected group of users hosted in the community (n=15), instructed them and worked side by side for several weeks, according to the bees’ needs and the seasonal rhytms. Once the training was completed, teaching activities have been co-conducted by beekeepers and participants, to introduce and train a group of students from the local agriculture high school. A study encompassing observational data, surveys, and semi-structured interviews was conducted to monitor and evaluate the project as it unfolded.ResultsThe performance of practical activities (i.e. beekeeping operations) proved successful in relaxing social norms around talking, lowering the emotional intensity of the encounter, allowing non-verbal communication and normalizing silence. These features supported participants with relational difficulties and encouraged the gradual development of skills in the social area. In the second part of the project, the involvement of high school students that needed to be trained allowed participants to have an active role as teachers; this contributed to the development of positive feelings, increased self-esteem and self-efficacy, eventually supporting the recovery process.ConclusionsPreliminary findings suggest further collaboration between different social actors and further research to develop inclusive, effective, and community-based interventions in the field of mental health and rehabilitation.Disclosure of InterestNone Declared

Dysphagia After Total Laryngectomy: An Exploratory Study and Clinical Phase II Rehabilitation Trial with the Novel Swallowing Exercise Aid (SEA 2.0)

The aims of this exploratory study and clinical phase II trial were to assess the specific nature and extent of dysphagia in laryngectomized patients with self-reported dysphagia, and its rehabilitation potential using the novel Swallowing Exercise Aid (SEA 2.0). Twenty laryngectomized patients participated in a six-week exercise program with the SEA 2.0. Exercises consisted of Chin Tuck Against Resistance (CTAR), Jaw Opening Against Resistance (JOAR), and Effortful Swallow Against Resistance, conducted three times per day. Swallowing was assessed at baseline (T0), six (T1) and 14 (T2) weeks, consisting of patient-reported outcomes, BMI, videofluoroscopy, swallowing capacity, and muscle strength measurements. Dysphagia significantly impacts quality of life, with impaired swallowing speed and bolus propulsion as main reported issues. Subjective dysphagia parameters, swallowing capacity, and pharyngeal residue clearance were reduced, but BMI was normal. Muscle and tongue strength were within normal ranges. All participants managed to use the SEA 2.0. Adherence was 95%. At T1, subjective swallowing parameters (MDADI and EAT-10) showed clinically relevant improvements. Objectively, CTAR and JOAR strength increased with 27.4 and 20.1 Newton, respectively. Also, swallowing capacity (from 2.4 g/s to 3.8 g/s) and pharyngeal residue clearance improved. At T2, results were slightly lower than at T1, but still better than at baseline. Dysphagia in laryngectomized patients affects quality of life, but swallowing can be improved with a six-week rehabilitation program using the novel SEA 2.0. Adherence was excellent and several subjective and objective swallowing parameters improved.

Clinical significance of immunological indicators in the remote period after traumatic brain injury

The article describes the clinical significance of immunological indicators in the remote period after traumatic brain injury (TBI). Immunological indicators take a key role in determining the clinical outcomes in the remote period of TBI, as they reflect the state of the body’s immune reactivity and correlate with the body’s ability to recover. Changes in both humoral and cellular immunity have been observed in patients with TBI. Variations in immunological parameters can serve as predictors for assessing the rehabilitative potential of patients after TBI. Key words: traumatic brain injury, consequences, immunology, neuropathophysiology

Project “Educational and Rehabilitation Hub” in the Conditions of War and Post-War Times: the Alternative Model

The article offers the basics of creating an educational hub with rehabilitation potential. Approaches to the peculiarities of the organization of this type of activity, including in extreme conditions, were analyzed and systematized. The peculiarities and experience of the organization of educational hubs, relevant during the war and in the post-war period, were analyzed from the point of view of the effectiveness of educational and rehabilitation processes and their compliance with modern educational standards. The authors also propose their vision of an alternative educational hub. Its main sense is to focus attention on the possibilities of the individual’s self-organization in extreme conditions, as well as actualization of potential possibilities of self-rehabilitation, learning the art of self-help. The hub is created in the context of the professional training of specialists in the socionomic profile and provides the supervision of teachers-scientists, who ensure the appropriate content and methodical support of the educational and rehabilitation process. The effectiveness of this approach was determined due to approbation of the part of educational and rehabilitation program, in particular, the organization of a psychotherapeutic space for students with the aim of forming their professional and personal resistance to traumatic events caused by war and other challenges of the time.

Case Analysis on Three Methods of BCI Systems for Stroke Rehabilitation

Stroke is a disease that can cause disability to patients, and many people suffer from stroke. Brain-computer interface (BCI) technology development leads to BCI stroke rehabilitation system. After several years of development of theory and technology, BCI systems show great potential in stroke rehabilitation. There are three specific methods of BCI stroke rehabilitation systems. The methods involve Functional Electric Stimulation, Robotics Assisted Systems, and Virtual Reality. This paper will introduce three methods and analyze the research cases of each technique. The article will introduce the principle and investigate some research cases of each method. The paper will present the procedure, analyze the results and evaluate each experiment. By analyzing the cases, it can be learned that all three methods are feasible and effective, proving that the BCI system for stroke rehabilitation is a promising therapy. At last, limitations on BCI systems will be analyzed, such as small sample size and limitations on particular actions.

Real Time Monitoring Research on Rehabilitation Effect of Artificial Intelligence Wearable Equipment on Track and Field Athletes

INTRODUCTION: With the rapid development of artificial intelligence technology, wearable artificial intelligence devices show great potential in medical rehabilitation. This study explores the Real Time monitoring effect of AI wearable devices in the rehabilitation process of track and field athletes. The application of this technology in rehabilitation monitoring was investigated through the introduction of advanced sensing technology and data analysis algorithms to provide track and field athletes with more scientific and personalized rehabilitation programs. OBJECTIVES: A group of track and field athletes was selected as the research object and equipped with an artificial intelligence wearable device, which is capable of Real Time monitoring of the athletes' physiological parameters, sports postures, joint mobility, and other rehabilitation-related data. An individualized rehabilitation model was established through the data collected by these sensors, and advanced artificial intelligence algorithms were used to analyze the data in Real Time. At the same time, the sensor data were combined with the actual performance of the athletes' rehabilitation training to comprehensively assess the effectiveness of AI wearable devices in rehabilitation monitoring. METHODS: This study aims to assess the effect of Real Time monitoring of AI wearable devices in the rehabilitation of track and field athletes and to explore their potential application in the rehabilitation process. Real Time tracking of athletes' physiological status and athletic performance aims to provide more accurate and timely information to rehabilitation doctors and coaches to optimize the rehabilitation training program and promote the rehabilitation process of athletes. RESULTS: The study showed that artificial intelligence wearable devices have significant Real Time monitoring effects in rehabilitating track and field athletes. Through Real Time monitoring of data such as physiological parameters, sports posture, and joint mobility, the rehabilitation team was able to identify potential problems and adjust the rehabilitation program in a more timely manner. Athletes using artificial intelligence wearable devices improved the personalization and targeting of rehabilitation training, and the rehabilitation effect was significantly better than that of traditional monitoring methods. CONCLUSION: This study concludes that artificial intelligence wearable devices perform well in rehabilitating track and field athletes, providing a more scientific and comprehensive means of rehabilitation monitoring. Through Real Time tracking, the rehabilitation team could better understand the rehabilitation progress of the athletes, adjust the rehabilitation program in a targeted manner, and improve the rehabilitation effect. However, future research still needs to optimize the performance of the devices further, expand the sample size, and thoroughly study the monitoring needs at different stages of rehabilitation to better meet the individualized requirements of track and field athletes' rehabilitation process.

Pulmonary Sequelae of COVID-19 in Patients With Lung Damage Over 75% (CT-4)

Introduction: A number of studies uses severity of lung damage as a predictor of lung changes in the long-term period.Objective: To evaluate computed tomography (CT) findings in the long-term period after extremely severe lung damage (CT-4) caused by COVID-19 during different pandemic waves and compare those with clinical data.Materials and methods: The study included 51 patients (51.0% of them were women; age, 57 ± 12 years [95% CI, 53-60]) that were treated for COVID-19 with lung damage (CT-4) in O.M. Filatov City Clinical Hospital No. 15 (Moscow, Russian Federation) and gave their consent for examination after discharge. The patients underwent chest CT and dyspnea assessment (Medical Research Council [MRC] dyspnea scale) in the long-term period and were grouped based on the pandemic wave and dyspnea grade. Twelve patients from the first pandemic wave were examined 12.5 months after discharge; 13 patients from the second pandemic wave were examined in 6.5 months, and 26 patients from the third pandemic wave were examined in 8 months. The group with MRC dyspnea grade 0 included 19 patients, whereas 32 patients comprised the group with MRC dyspnea grades 1 and 2.Results: CT revealed changes in 50 (98.0%) of the examined patients, with fibrotic-like changes (88.2%), areas of consolidation (47.1%), and ground-glass opacity (13.7%) being the most common findings. All 3 patterns were equally common, regardless of the pandemic wave. No dyspnea higher than MRC grade 2 was observed. Fibrotic-like changes were found in 100.0% of the patients with MRC dyspnea grades 1 and 2, whereas they were detected only in 68.4% of the patients with MRC dyspnea grade 0, P = .002. The multivariate analysis showed that fibrotic-like changes were the only factor associated with dyspnea higher than grade 0.Conclusions: After extremely severe lung damage (CT-4) CT changes were present in almost all the patients. The study results highlight clinical significance of these changes and demonstrate the rehabilitation potential of this group.

Enhancing the Management of Pediatric Sickle Cell Disease by Integrating Functional Evaluation to Mitigate the Burden of Vaso-Occlusive Crises

Sickle cell disease (SCD) imposes a significant health burden, particularly in low- and middle-income countries where healthcare professionals and resources are scarce. This opinion paper delves into the management strategies employed for vaso-occlusive crises (VOCs) in pediatric patients with SCD, advocating for the adoption of a transformative strategy. We explore the integration of functional assessment approaches into existing procedures, highlighting the potential of technology-assisted rehabilitation, including wearable sensors and digital biomarkers, to enhance the effectiveness of managing and preventing VOCs. Rehabilomics, as a comprehensive framework, merges rehabilitation-related data with biomarkers, providing a basis for personalized therapeutic interventions. Despite the promising advantages of these approaches, persistent obstacles such as the limited availability of rehabilitation programs, especially in resource-limited settings, pose challenges. This paper underscores the importance of a collaborative strategy to effectively address the unique obstacles faced by patients with SCD. This collaborative approach involves improving accessibility to rehabilitation services, incorporating technology-supported therapy, and fostering focused research endeavors. The primary objective of this comprehensive approach is to enhance the overall care of SCD patients, with a specific focus on preventing VOCs, as well as providing tailored (neuro)rehabilitation services in resource-limited settings. By examining the current state of SCD management and proposing transformative strategies, this opinion paper seeks to inspire collective action and collaboration to improve outcomes for pediatric SCD patients globally.

Phenomenology of the inclusive potential of the family as a factor in the socialization of children with disabilities

Introduction. Lack of tools for studying the potential resources and capabilities of the family, as well as search for optimal strategies and mechanisms for the real inclusion of people with disabilities in all spheres of public life is on the current agenda of national and international initiatives. For a comprehensive analysis of inclusive potential of families raising children with disabilities, aspects of the rehabilitation potential of the individual and the environment, of educational potential, functionality and effectiveness of the family, and of competence, including inclusive competence, are considered. The emphasis is shifted to understanding the potential of the family as a factor in the socialization of children with disabilities. The article aims to systematize and scientifically analyze ideas about the potential opportunities and resources for the socialization of children with disabilities and their families, and to justify the criteria base and mechanism for assessing the inclusive potential of families. Materials and methods. Within the framework of interdisciplinary scientific discourse, a model of the criteria base and mechanism for analyzing and assessing the inclusive potential of a family raising a child with disabilities is proposed. The basis for constructing the model is the decomposition of groups of competencies through indicators of parental effectiveness based on formalization. Results and discussion. Based on the analysis of the terminological field related to the assessment and development of family potential in matters of socialization and development of a child with disabilities, the author’s positions on inclusive family potential are presented. Some socio-psychological phenomena are considered that reflect the capabilities and resources of both the children themselves and their social environment. Particular attention is paid to indicating the functional effectiveness of parents of children with disabilities. Conclusion. The discussed model for assessing the inclusive potential of families raising children with disabilities has a universal design, formed as a result of initial testing and expert assessment of the professional community. This approach allows analyzing individual indicators and assessing influence of certain factors on the effectiveness of accompanying children of different categories of disabilities. A systematic analysis of individual groups of parents’ inclusive competencies allows optimizing their inclusion in the comprehensive support of children with disabilities.

Patellofemoral Pain Syndrome and its Association with Balance and Proprioception: A Cross-Sectional Study

Background: Patellofemoral Pain Syndrome (PFPS) is a prevalent condition characterized by anterior knee pain, significantly affecting individuals' balance and proprioception. Despite its commonality, the relationship between PFPS and these functional impairments remains inadequately explored. Previous studies have suggested a link, but comprehensive analyses incorporating balance, proprioception, and PFPS are scarce. Objective: This study aimed to investigate the association between PFPS and deficits in balance and proprioception, emphasizing the potential for rehabilitation focused on these areas to improve patient outcomes. Methods: A cross-sectional study was conducted with 103 participants diagnosed with PFPS, utilizing non-probability convenience sampling at the Out-Patient Department of Physical Therapy, Akbar Medical Complex, Mardan, Pakistan. Participants underwent assessments for balance (using static and dynamic balance tests) and proprioception (via joint position sense testing). Data analysis was performed using SPSS version 22, with chi-square tests to assess statistical associations between PFPS and the measured variables. Results: Among the participants, 60.2% were males, and 39.8% were females, with an injured limb distribution of 30.1% for both the left and right legs and 39.8% for both legs. The duration of symptoms varied, with 51.5% experiencing symptoms for 1-3 months. Proprioception degree angles showed mean values of 37.5728 (SD=3.76933) for the right limb and 38.4272 (SD=5.81681) for the left limb. Chi-square tests revealed significant impairments in balance and proprioception among individuals with PFPS (p < 0.05). Conclusion: The study confirmed a significant association between PFPS and impairments in balance and proprioception. These findings support the integration of balance and proprioceptive training into rehabilitation programs for PFPS patients, potentially improving symptoms and functional outcomes.

Anthropomorphic Soft Hand: Dexterity, Sensing, and Machine Learning

Humans possess dexterous hands that surpass those of other animals, enabling them to perform intricate, complex movements. Soft hands, known for their inherent flexibility, aim to replicate the functionality of human hands. This article provides an overview of the development processes and key directions in soft hand evolution. Starting from basic multi-finger grippers, these hands have made significant advancements in the field of robotics. By mimicking the shape, structure, and functionality of human hands, soft hands can partially replicate human-like movements, offering adaptability and operability during grasping tasks. In addition to mimicking human hand structure, advancements in flexible sensor technology enable soft hands to exhibit touch and perceptual capabilities similar to humans, enhancing their performance in complex tasks. Furthermore, integrating machine learning techniques has significantly promoted the advancement of soft hands, making it possible for them to intelligently adapt to a variety of environments and tasks. It is anticipated that these soft hands, designed to mimic human dexterity, will become a focal point in robotic hand development. They hold significant application potential for industrial flexible gripping solutions, medical rehabilitation, household services, and other domains, offering broad market prospects.