Rehabilitation Therapy Research Articles

Homeward Stroke Recovery: Results of a Home Rehabilitation Program

Evaluate the feasibility of a homeward stroke recovery (HSR) program by measuring functional outcomes, intervention fidelity, and Profit & Loss. A retrospective observational analysis of 23 stroke survivors discharged to a home healthcare (HHC) program offering early and intensive rehabilitative therapy within 24 hours of index hospitalization. Functional outcomes include timed up-and-go, transfer functional independent measures, and Barthel Index. Clinical outcomes are mortality, all-cause 30-day hospital readmission, and fall rates. Process measures consist of time-to-first HHC visit, number of physical therapy (PT) and occupational therapy (OT) visits from initial evaluation, and total number of visits by clinician type. Financial outcomes include average daily gross HSR revenue compared with an inpatient rehabilitation facility (IRF) stay and average daily net HSR profit. Functional outcomes significantly improved across all measures ( p < .001) without reported falls, deaths, and only one unrelated readmission. On average, HSR began within 1.6 days from hospital discharge including 4.2 PT and 3.7 OT visits within 5 days of respective initial evaluation. Patients received an average of 9.4 nursing, 9.2 PT, 6.4 OT, and 2.2 speech therapy visits. Exploratory analyses demonstrated similar functional recovery despite longer hospitalization (rs = 0.43; p = .039). Revenue per day was lower for HSR than IRF services but costs exceeded the reimbursement rates for this program. The HSR program is feasible given that patients realized significant functional improvement with negligible consequences. Reimbursement reform is necessary to sustain and scale the program. Further studies with larger sample sizes are warranted.

Comparison of mental fatigue using EEG signals and task performance in normal and slump posture adults during computer typing

ObjectivesSlump sitting at workstations has been focused on by clinicians and researchers nowadays; however, there is limited evidence to date that improper positioning affects the mental state. Accordingly, the main objective of this research was to examine the impact of slump posture on mental fatigue and task performance. MethodsA sample of 60 participants, 30 in each group including those with normal and slump postures were recruited to perform an hour of typing on the computer. Mental fatigue through EEG and task performances were considered as outcome measures and then were analyzed statistically in the first and last 3 min of typing. ResultsThe EEG showed a significant increasing trend in theta rhythm at different brain regions during 60 min of typing (P < 0.05). Besides, an interaction between time and posture was observed; it can mean the increasing trend of theta rhythm is different in normal and slump posture acquired sets (P < 0.05).Interestingly the speed of typing was found to be better (P < 0.05) in the normal posture group while no difference found between the groups in terms of errors (P > 0.05). ConclusionOur results showed poor posture can induce more mental fatigue during the given task, than the normal posture. These findings have provided evidence to indicate that in addition to the peripheral and biomechanical component, the assessment of the cortex as the central component should be considered in poor posture individuals. Besides, for any possible physical therapy rehabilitation protocol for the management of poor posture, the peripheral and central components should be focused. Trial registrationRegistered on the Iranian Registry of Clinical Trials on September 21, 2022, IRCT Identifier: IRCT20161026030516N2.

Rehabilitative subacute inpatient care-Optimizing posthospital care for geriatric patients with rehabilitation needs: results of the REKUP study

Geriatric patients in subacute inpatient care (SC) with rehabilitation needs after hospitalization seldom utilize rehabilitative services and are often transitioned to long-term care (LTC), suggesting that their care in SC can be optimized. To evaluate the effectiveness of rehabilitative subacute inpatient care (REKUP) in improving the care of geriatric patients in SC with rehabilitation needs after hospitalization. The study was conducted as anonrandomized intervention trial with an historical control group (CG). The intervention group (IG: n = 49) received REKUP (activating therapeutic care, functional rehabilitative therapy, psychosocial services, medical care), while the CG (n = 57) received usual care during SC. Primary outcomes were transition to inpatient rehabilitation, home, and LTC, deteriorated care setting, care level, and mortality within 3months after SC. Secondary outcomes were functional, motor and psychological variables. The transition rate to inpatient rehabilitation (82% vs.37%) and home (86% vs.65%) was higher (p < 0.05) in the IG than in the CG. The proportion of persons utilizing LTC (12% vs.35%) and with deteriorated care setting (35% vs.60%) was lower (p < 0.01) in the IG than in the CG. The Barthel Index, visual analogue scale of the EQ-5D, and numerical pain scale improved (p < 0.05) during the SC stay in the IG but not in the CG. REKUP as anew care model for SC promotes the transition to inpatient rehabilitation, reduces the utilization of LTC and improves the chances of returning home and achieving greater independence in geriatric patients with rehabilitation needs after hospitalization.

Virtual Obstacle Avoidance Strategy: Navigating through a Complex Environment While Interacting with Virtual and Physical Elements.

Robotic walking devices can be used for intensive exercises to enhance gait rehabilitation therapies. Mixed Reality (MR) techniques may improve engagement through immersive and interactive environments. This article introduces an MR-based multimodal human-robot interaction strategy designed to enable shared control with a Smart Walker. The MR system integrates virtual and physical sensors to (i) enhance safe navigation and (ii) facilitate intuitive mobility training in personalized virtual scenarios by using an interface with three elements: an arrow to indicate where to go, laser lines to indicate nearby obstacles, and an ellipse to show the activation zone. The multimodal interaction is context-based; the presence of nearby individuals and obstacles modulates the robot's behavior during navigation to simplify collision avoidance while allowing for proper social navigation. An experiment was conducted to evaluate the proposed strategy and the self-explanatory nature of the interface. The volunteers were divided into four groups, with each navigating under different conditions. Three evaluation methods were employed: task performance, self-assessment, and observational measurement. Analysis revealed that participants enjoyed the MR system and understood most of the interface elements without prior explanation. Regarding the interface, volunteers who did not receive any introductory explanation about the interface elements were mostly able to guess their purpose. Volunteers that interacted with the interface in the first session provided more correct answers. In future research, virtual elements will be integrated with the physical environment to enhance user safety during navigation, and the control strategy will be improved to consider both physical and virtual obstacles.

Eficacy of sulfurous water from Mangalia in Helicobacter Pylori infection: a clinical study

Mangalia balneary resort is situated in the south of the Black Sea and uses sulphurous water springs for rehabilitation therapy. The purpose of this study is to demonstrate the effectiveness of Mangalia sulphurous water on Helicobacter Pylori (H. Pylori) infection. Considering that sulfurous water has a bacteriostatic effect and that most gastritis are caused by H. Pylori infection, we propose that a group of 27 H. Pylori positive patients with or without digestive symptoms ingest sulfurous water daily, for a few days. At the end of the study, 15 of the patients tested negative for H pylori antigen. The curative effects are due to the bacteriostatic effect of sulfurous water and its stimulating action on the digestive tube.

The long-term impact of rehabilitation in upper limb plexopathies

The main objective of the research consists in providing evidence that a long-term rehabilitation protocol is favorable for the patient. In adult brachial plexus (BP) palsies, after several surgical attempts, the lack of results in the upper limb’s functionality leads to less compliance to rehabilitation therapy. The upper limb’s functionality of 22 patients with posttraumatic operated chronic BP paresis (either on the right or left, regardless the dominant limb) was assessed retrospectively. The patients were evaluated regarding MRC scaling, dynamometric tests and electroneuromyographic examination. All patients have gone through at least one rehabilitation interval (10 days) after an initial evaluation, and were evaluated again, by same methods, at a second session, at least 6 months later, but no more than one year.. Mild and inconstant improvements were obtained in a total of 9 patients, especially in better dynamometric results and improved amplitudes of motor and sensory action potentials. The electrodiagnosis correlates with dynamometric parameters (muscle strength) and slight amelioration of the motor deficit. Given the small sample size as a limitation, as well as no standardized therapeutic protocol, it should be noted that the 9 patients were the only ones who either attended more than one interval or did more procedures as frequency in time (more often meaning 3 times weekly for 6 months, in 6 patients). Although the most frequent procedures were neuromuscular electrical stimulation (NMES) and proprioceptive neuromuscular facilitation (PNF), the results suggest that regardless of the techniques, the more active patients had better results. Proving the need for long-term rehabilitation, even contrary to the less visible results, can be the trigger point for future research and therapy strategies, as the results suggest central mechanisms involved, adding the cortical ongoing plasticity into the equation.

Mandalas as a Source of Self-Expression

The article is a presentation of the meaning and characteristics of mandalas that derive from Sanskrit symbolism. The Kabbalistic overtones of their compositions intrigued early psychoanalysts. They have been assimilated to treat and calm patients suffering from neurosis, psychosis, depression. They were seen as expressive, diagnostic and therapeutic. The article presents different views on the values and effects of the use of mandalas in education, relaxation and therapy. Due to the lack of scientific premises for use, relaxation use is encouraged during rehabilitation, after-school and speech therapy classes. A substantive approach to the subject encourages the search for applications in education in various fields, but this requires undertaking scientific research and verification of applications. The article is an exhaustive analysis of the literature on the use of mandalas.

Diabetes Genetic Epidemiology and Associated Comorbidities: A Comprehensive Review

Diabetes is characterized by elevated blood glucose levels in humans, which are mostly brought on by poor insulin production and utilization. Numerous genetic factors are responsible for causing TIDM such as PTPN22 and CTLA. People with diabetes mellitus are more likely to acquire a variety of linked conditions and conditions known as comorbidities because of a number of hereditary factors, environmental factors, certain medications, and other causes. Some of the common comorbidities that are prevalent in the T2DM patient population include congestive kidney disease, retinopathy, neuropathy, cardiovascular disease, urinary disorders, hyperlipidemia, and obesity. Diabetes has a high rate of hypertension, obesity, hyperlipidemia, and cardiovascular disease frequently coexist in patients as comorbid conditions. Knowing how genes function differs and how particular genetic factors raise the likelihood of comorbidities during diabetes can help develop effective medication for the management of diabetes Insight into how different genes operate and how specific genetic factors increase the risk of comorbidities during diabetes can aid in the development of effective diabetic medications to curb the epidemic of diabetes and its associated complications. A multifaceted approach is required, including early detection of diabetes, checking for its consequences, providing the best possible care at all levels of treatment for those who currently have the disease, and preventing diabetes in those with prediabetes. Diabetes prevalence is expected to increase, which will increase the need for rehabilitation therapy to decrease any problems the condition can cause. Exercise has been reported to improve insulin sensitivity to elevated blood sugar levels, enhance glucose absorption, decrease intra-abdominal fat a known risk factor for insulin resistance—and prevent cardiovascular issues.

Оценка результатов лечения больных с синдромом шейного ребра в послеоперационном периоде

The pectoral exit syndrome is of undoubted interest for surgeons, angiosurgeons and neurologists due to the possible compression of the vascular-nervous plexus, causing certain symptoms and reducing work abilities. Objective To conduct an analysis of the results of the treatment of patients with cervical rib syndrome in the short and remote observation periods in the postoperative period. Material and methods 138 patients with abnormal cervical ribs were the clinical material and the object for the study, abnormal cervical ribs caused the extravasal compression of the vascular bunch of the upper extremities at the exit from the chest. These patients were treated and were operated on in the vascular surgery department of the Republican Scientific Center of Cardiovascular Surgery from January 1990 to May 2020. Results Good postoperative results were observed in 89.1 % of patients in the short postoperative period. Intraoperative complications were noted in 5 (3.6 %), and in the short postoperative period – in 10 (7.2 %) patients. In the remote period, relapse of preoperative symptoms of the disease was noted in 8 (5.8 %) of all 138 patients observed. Relapse (or renewal of the symptoms of Reino) was mainly observed in the period of up to 3 years. At different times of observation, 5 patients were lost from sight. In the remote period, in terms of up to 1 year of observation, a good result was 97.2 %, from 2–3 years to more than 5 years – 90.6 %. Conclusions The early identification of intraoperative and postoperative complications allows to timely eliminate these complications. In the nearest postoperative period, only the hemodynamic effect of decompression operations and selective cervical-breed sympathctomy is obvious. Neurological symptoms regressed gradually in the remote period. In this case, it is necessary to emphasize the importance of timely rehabilitation therapy, the implementation of the recommendations of a specialist, since the restoration of dystrophic changes in the nerve trunks is a long process.

Memory problems in elderly people with traumatic brain injury

AbstractThe aim of this study is to assess the effectiveness of various therapy methods in elderly individuals with traumatic brain injury (TBI), taking into account the degree of memory loss and the severity of the injury. The study was conducted in 2022 in Moscow, Russia, and Sofia, Bulgaria, involving six clinics. A total of 200 elderly patients with TBI participated in the study, with a mean age of 72 years. Patients were categorized into groups based on the degree of memory loss and severity of the injury. Standardized tests, including the Mini‐Mental State Examination (MMSE), Clock Drawing Test, Digit Symbol Substitution Test, and Free, and Cued Selective Reminding Test, were used to assess cognitive functions. The Progressive Learning Test evaluated patients' ability to memorize and reproduce information over time. Groups receiving physical therapy and cognitive rehabilitation showed statistically significant improvement in cognitive functions compared to other therapy methods. Specifically, the mean score of the MMSE in these groups increased by 7 points (p &lt; .001). Patients with more severe memory loss demonstrated more pronounced improvement in cognitive functions following the integrated therapy approach. The mean MMSE score increased by 10 points (p &lt; .001), whereas in patients with milder memory loss, the growth was less significant (mean increase of 5 points, p &lt; .05). Groups receiving physical therapy and cognitive rehabilitation consistently demonstrated significantly better results compared to speech therapy and psychological support throughout the study period.

Research on the Safety Design and Trajectory Planning for a New Dual Upper Limb Rehabilitation Robot

The increasing utilization of upper limb rehabilitation robots in rehabilitation therapy has brought to light significant safety concerns regarding their mechanical structures and control systems. This study focuses on a six degrees of freedom (DOF) upper limb rehabilitation robot, which has been designed with an emphasis on safety through careful consideration of its mechanical structure and trajectory planning. Various parameter schemes for the shoulder joint angles were proposed, and the robotic arm’s structure was developed by analyzing the spatial motion trajectories of the shoulder joint motor. This design successfully achieves the objective of minimizing the installation space while maximizing the range of motion. Additionally, an enhanced artificial field method is introduced to facilitate the planning of self-collision avoidance trajectories for dual-arm movements. This approach effectively mitigates the risk of collisions between the robotic arm and the human body, as well as between the two robotic arms, during movement. The efficacy of this method has been validated through experimental testing.

Atrial Fibrillation Status and Physical Rehabilitation in Older Patients With Acute Decompensated Heart Failure: An Analysis From the REHAB-HF Trial.

The REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial demonstrated that a transitional, tailored, progressive rehabilitation intervention improved physical function, 6-minute walk distance, frailty, quality-of-life, and depression in older patients hospitalized for acute decompensated heart failure. This analysis assessed the impact of atrial fibrillation (AF) on intervention benefits. Of 349 enrolled patients hospitalized for acute decompensated heart failure (mean age 72.7±8.1 years), 176 (50.4%) had AF. Participants were randomly assigned to 12-week rehabilitation intervention or attention control. The primary outcome was Short Physical Performance Battery score at 3 months. Participants with AF were older (74.4±8.3 versus 70.8±7.5, P<0.0001) and had higher prevalence of heart failure with preserved ejection fraction (58.5% versus 47.4%, P=0.037). Patients with and without AF had similar improvement in Short Physical Performance Battery score (mean difference between rehabilitation intervention and attention control, 1.5 [95% CI, 0.6-2.3] versus 1.5 [95% CI, 0.7-2.3]; P<0.001). Those with AF had significant improvement in 6-minute walk distance (all P<0.05) and each of the Short Physical Performance Battery domains: balance, 4-meter walk, and chair rise. Kansas City Cardiomyopathy Questionnaire score significantly improved in patients with AF (P<0.05) but not those without AF (P>0.05). Interaction P values for 3-month outcomes by AF status were not significant (P>0.1). No significant differences were observed in deaths, all-cause rehospitalizations, or heart failure hospitalizations at 6 months. In older, hospitalized patients with acute decompensated heart failure, the presence of AF did not significantly affect the benefit of the rehabilitation intervention on physical function and quality of life. The intervention appears safe and effective regardless of AF status. URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02196038.

Combining early lower eyelid surgery with neuromuscular retraining for synkinesis prevention after facial palsy: the role of the eye in aberrant facial nerve regeneration.

Facial synkinesis (FS) is a distressing sequela of facial palsy (FP) characterized by involuntary, simultaneous movements of facial muscles occurring during voluntary facial expressions. Treatment of synkinesis is challenging, and preventive methods are needed. This study evaluated the efficacy of physical facial nerve rehabilitation (PFNR) therapy alone vs. PNFR with eyelid surgery to correct lagophthalmos and prevent the onset of synkinesis. Twenty five outpatients were randomized to receive either PFNR alone (neuromuscular retraining and Kabat proprioceptive neuromuscular facilitation) or PNFR and early (90 days after FP onset) eyelid surgery (involving a conservative oculoplastic correction for lagophthalmos with epiphora or ectropion). Comprehensive otolaryngological assessments and Magnetic Resonance Imaging (MRI) were conducted. Synkinesis progression was measured using Another Disease Scale (ADS) at baseline, 3-, 6-, 12-, and 24-months post-treatment. The data were analyzed with ANOVA, τ-test, Chi-Square analyses. Patients undergoing eyelid surgery with PFNR showed faster (p < 0.001) and better recovery of facial movements (p < 0.05) than patients receiving PFNR alone comparing T0 and T12 (p < 0.0001). No synkinesis were observed in the PFNR plus surgery group while 37% of patients in PFNR alone had synkinesis (p = 0.03). At 24 months, none of the patients in the surgery group presented synkinesis. Combining early surgical treatment of paralytic lagophthalmos or epiphora with PFNR accelerated functional recovery and reduced synkinesis in patients with FP compared to facial rehabilitation alone. Further investigations in larger populations with long-term follow-up are needed. https://clinicaltrials.gov/study/NCT06538103, NCT06538103.

Impact of early swallowing rehabilitation on oral feeding in patients with dysphagia following traumatic brain injury

ABSTRACT Objective This study aimed to evaluate the effects of early swallowing rehabilitation on safe oral feeding in dysphagia patients following traumatic brain injury. Methods Sixty-nine patients were divided into intervention and control groups, with the intervention group receiving swallowing rehabilitation therapy. The severity of swallowing disorders, cognitive function, and level of consciousness were assessed using the Mann Assessment of Swallowing Ability (MASA), Rancho Los Amigos (RLA), and Glasgow Coma Scale (GCS) before and after the intervention. Additionally, data on ventilator use duration and hospital stay length were collected. Result The intervention group exhibited a significant improvement in MASA scores (68.58) compared to the control group (38.10). No significant differences were observed in GCS and RLA scores post-intervention, indicating similar levels of consciousness and cognitive function between groups. While the duration of ventilator use was comparable, the intervention group achieved safe oral swallowing 12.12 days earlier than the control group. Discussion The findings demonstrate that early swallowing rehabilitation significantly enhances recovery dysphagia post-brain injury, as evidenced by improved MASA scores and earlier achievement of safe oral feeding, despite no notable changes in cognition or consciousness. This underscores the importance of implementing early rehabilitation strategies in clinical practice.

Efficacy and safety of using a unilateral lower limb exoskeleton combined with conventional treatment in post-stroke rehabilitation: a randomized controlled trial.

The incidence of hemiplegia caused by stroke is high. In particular, lower limb dysfunction affects the daily activities of patients, and lower limb robotic devices have been proposed to provide rehabilitation therapy to improve balance function in this patient population. To assess the effectiveness of the LiteStepper® unilateral lower limb exoskeleton (ULLE) combined with conventional treatment for balance function training in patients with post-stroke hemiplegia. This multicenter randomized controlled trial, conducted in the convalescent rehabilitation ward of four hospitals, involved 92 patients in their post-stroke phase. Participants were randomized into an experimental group (EG) or a conventional group (CG). The EG adopted the LiteStepper® ULLE combined with conventional treatment for 21days. The CG underwent a standard daily rehabilitation routine for 21days. The Berg Balance Scale (BBS), Functional Ambulation Category scale (FAC), 6-min walk test (6MWT), and Barthel Index (Barthel) were used for evaluations before and after 21days of rehabilitative training. The BBS scores in EG was significantly elevated compared to CG, exhibiting a profound statistical difference (P< 0.0001). Notably, these disparities persisted at both day 21 (P < 0.0001) and day 14 (P < 0.0047) post-intervention, underscoring the efficacy of the treatment in the EG. The EG demonstrated a markedly greater improvement in BBS scores from pre-rehabilitation to 21days post-training, significantly outperforming the CG. Furthermore, at both day 14 and day 21, functional assessments including the FAC, 6MWT, and Barthel revealed improvements in both groups. However, the improvements in the EG were statistically significant compared to the CG at both time points: day 14 (FAC, P = 0.0377; 6MWT, P = 0.0494; Barthel, P = 0.0225) and day 21 (FAC, P = 0.0015; 6MWT, P = 0.0005; Barthel, P = 0.0004). These findings highlight the superiority of the intervention in the EG in enhancing functional outcomes. Regarding safety, the analysis revealed a solitary adverse event (AEs) related to the LiteStepper®ULLE device during the study period, affirming the combination therapy's safety profile when administered alongside conventional balance training in post-stroke hemiplegic patients. This underscores the feasibility and potential of incorporating LiteStepper®ULLE into rehabilitation protocols for this patient population. The LiteStepper® ULLE combined with conventional treatment is effective and safe for balance function training in patients with post-stroke hemiplegia.

Study of psychophysiological indicators of sensorimotor Integration in PTSD. Justification of the choice of targets for biofeedback

Post-traumatic stress disorder (PTSD) is an actual medico-social problem. The pathogenesis of PTSD closely relates to impairment of sensorimotor integration (SMI). The effectiveness of psychosomatic disorder therapy for PTSD rehabilitation can be improved by restoring normal sensorimotor integration. The review examines various autonomic, electro-physiological and postural markers of high sensory motor integration in highly skilled athletes and musicians, as well as impairment of these indices in persons with PTSD. We have established that the most accessible and informative indicators of SMI are: an increase in EEG power in the individually adjusted high-frequency alpha-band, a reduction in energy demands for posture control and a decrease in the electromyographic activity of redundant muscles, not involved in motor-cognitive dual task. In the future, it is planned to use these indicators to diagnose stress disorders and to develop sensorimotor integration recovery training in patients with PTSD.

Instagram and Achilles tendon surgery: Evaluation of patients' perceptions of surgery

Background/Aim: The primary objective of this study was to conduct comprehensive research and analysis of patient-generated content related to Achilles tendon surgery on the social media platform Instagram. The aim was to gain deeper insights into patients' experiences during the perioperative period, which may contain valuable information pertinent to their condition, information of which the physicians may be unaware. Methods: A search was conducted on the Instagram database, covering a period of 78 months from February 2015 to August 2021. Posts utilizing the hashtags "#achillessurgery" and "#achillesrepair" were included in the analysis. Posts were assessed using a binary scoring system, considering variables such as tone, media format, return to work, rehabilitation or physical therapy, return to sports, images related to the ankle (e.g., scars, stitches, casts, dressings, walking boots), activities of daily living, and pain. Results: A total of 500 posts were reviewed, and a positive tone was observed in 77.8% of these. The average Instagram like ratio for these posts was computed as 9%. Statistical analysis revealed a significant relationship between post content and tone status (P=0.001). Specifically, within the positive tone group, informative content about the disease was comparatively lower and statistically significant when compared to exercise training and patient experience (P=0.001). Additionally, exercise training posts were found to be significantly lower than patient experience posts (P=0.001) within the positive tone group. In contrast, within the negative tone group, patient experience posts were significantly higher compared to informative content and exercise training posts (P=0.001). Moreover, the quantity of informative posts markedly surpassed the number of posts related to exercise training (P=0.001). Conclusion: In the positive tone category, people tended to emphasize personal experiences and participate in posts related to exercise training rather than actively seeking or exchanging information about the disorder. On the other hand, within the negative tone group, individuals were more likely to share adverse experiences, pursue support, and seek a deeper understanding from others. Their priority may also lie in sharing and gaining information specifically about the disorder. Our exploration of the use of social media platforms to delve into patient perspectives on Achilles tendon surgery provides an alternative insight into patients' experiences with the surgical process. By comprehending the content shared by patients on social media, surgeons may gain an improved opportunity to assess and address the surgical experience of their patients more effectively, ultimately contributing to enhanced patient care.

Studying the need for creating nursing care and rehabilitation departments

The nursing care and rehabilitation department should be designed to conduct a course of rehabilitation therapy for patients with diseases of the musculoskeletal system, neurological diseases, as well as to conduct a course of maintenance therapy for patients, mainly elderly and senile, suf fering from chronic diseases and in need of medical and social care. Target. To study the need for creating a nursing care and rehabilitation department for elderly and senile patients. Results. The population’s need for the creation of a nursing care and rehabilitation department was identified, the necessary resources for the department’s activities and possible undesirable risks of the depar tment were determined. Conclusion. The creation of nursing care and rehabilitation departments for elderly and senile patients is necessary in order to improve the quality of life of patients, reduce treatment costs, introduce paid ser vices, and increase the prestige of the nursing profession.

EngageHealth: a mobile device application designed to deliver stroke rehabilitation exercises using asynchronous video recordings

BackgroundStroke survivors who receive more rehabilitation therapy achieve better functional outcomes. The amount of rehabilitation that patients receive is, however, limited due to constraints of the healthcare system.ObjectiveTo assess whether EngageHealth, a mobile device application designed to deliver stroke rehabilitation exercises using asynchronous video recordings, increases the amount of outpatient rehabilitation in stroke patients and improves their upper extremity function and quality of life.DesignProspective single-arm study consisting of a 2-week pre-intervention phase without EngageHealth followed by a 4-week intervention period with EngageHealth.SettingAmbulatory care.ParticipantsTwenty-four stroke patients with upper extremity impairment were recruited at the Stanford Stroke Center outpatient clinic.InterventionsParticipants were instructed to use the EngageHealth application daily.Main outcome measuresAdherence, user experience, and change in the upper extremity Fugl-Meyer (UE-FM), Quality of Life in Neurological Disorders (Neuro-QoL), and Stroke Impact Scale (SIS).ResultsOf 23 participants, five (22%) used the application for 17 days, six (26%) used the application for 9–16 days, and 12 (52%) used it &amp;lt; 9 days. Sixty-three percent of participants would recommend the application to other stroke survivors, with fifty percent indicating they would continue using the application, if available. During the pre-intervention phase, there were no changes in hand function. During the intervention period, participants improved by 4 points on the UE-FM (P &amp;lt; 0.01), and 15 points in the hand-function domain of SIS (P = 0.03). Videos of participants' exercises were successfully recorded, allowing the clinician to review videos of the participants' completed tasks asynchronously. In-depth interviews revealed that participants viewed the EngageHealth application favorably, and that their perceived usefulness of the exercises affected their motivation.ConclusionsUse of the EngageHealth application in the home environment may improve upper extremity function in subacute/chronic stroke patients. Additional support strategies should be implemented in future studies to improve adherence. These findings from a prospective single-arm study, support the design of a randomized controlled trial to determine the efficacy of long-term use of the EngageHealth application.

Handgrip Evaluation Before and After Pulmonary Rehabilitation Therapy in Patients With Chronic Obstructive Pulmonary Disease (COPD).

Introduction Chronic Obstructive Pulmonary Disease (COPD) is a systemic disease characterized by skeletal muscle dysfunction, leading to increased morbidity and mortality and deteriorating quality of life. Pulmonary rehabilitation therapy improves symptoms and long-term adherence. This study aimed to evaluate how COPD patients respond to pulmonary rehabilitation therapy and its correlation with handgrip strength measurements. Materials and methods A prospective cohort study was conducted in patients over 45 years old with a spirometric diagnosis of COPD from a specialized reference center in Bucaramanga. Handgrip strength was measured before and after completing the pulmonary rehabilitation program. Patients with neurological or cognitive impairments, decompensated cardiovascular disease, nutritional diseases, or those in a telerehabilitation program were excluded. Results Seventy-one patients were included in the study, with 66.2% completing follow-up after the program. The average age was 73.38 years (SD ±7.77), 53.52% were women, and 60.56% had a history of smoking. After the follow-up, the average handgrip strength delta was 1.64 kg (SD ±3.48) p<0.001, 74.47% of them representing a positive result after pulmonary rehabilitation program. A higher Charlson index correlated with a positive delta, while a negative delta correlated with a lower Charlson index (p=0.01). A positive handgrip strength delta was associated with higher baseline quality of life scores. Conclusions Periodic handgrip strength measurements predict frailty and muscle dysfunction in COPD patients. Pulmonary rehabilitation therapy isa simple and cost-effective intervention that correlates with the improvement of indirect prognosis and survival indicators.