Rehabilitation Training Program Research Articles

The Patient with Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a multisymptom syndrome involving aberrant pathophysiology of the peripheral, autonomic, and/or central nervous systems. The central feature is severe, often debilitating pain. This is accompanied by a collection of sensory, motor, autonomic, skin, and/or bone abnormalities. A key feature is allodynia, where otherwise innocuous stimulation will cause pain and hyperalgesia. The patient will present with varying degrees of pain, allodynia, hyperalgesia, swelling, and color and temperature changes. There are often changes in motor function, such as muscle stiffness or even involuntary movements. Regional osteopenia, changes to hair and nail growth, and dystrophic cutaneous changes may occur. The Budapest criteria have been twice validated and are used to diagnose CRPS. A patient-centric clinical approach is important in the treatment of CRPS. Key domains to be addressed in the management of CRPS include rehabilitation and pain management with adjunct psychological therapy. It is important that these interventions happen concurrently within the continuum of care. With the guidance of a physician, physical therapist, occupational therapist, and neuropsychologist, rehabilitative training programs are designed to address motor, sensory, and cognitive deficits. This review contains 2 highly rendered figures, 4 tables, and 110 references. Key Words: Budapest criteria, complex regional pain syndrome, reflex sympathetic dystrophy, sympathetically mediated pain

Developing a Virtual Reality-Based Vocational Rehabilitation Training Program for Patients with Schizophrenia.

Maintaining employment is difficult for patients with schizophrenia because of deterioration of psychosocial and cognitive functions. Such patients usually require vocational rehabilitation training, which is both demanding and costly. In this study, we developed a virtual reality-based vocational rehabilitation training program (VR-VRTP) for such patients and evaluated its feasibility as an alternative to traditional rehabilitation programs. We developed the VR-VRTP to include various situations commonly encountered in two types of occupations: convenience store employee and supermarket clerk. We developed practical situations, as well as a system for providing feedback, to ensure patients would not lose interest during training. Nine participants each performed the VR-VRTP repeatedly per week for a total of 8 weeks. At baseline and after training, all participants were evaluated using the following clinical and neuropsychological tests: Manchester Scale, Clinical Global Impression, Personal and Social Performance Scale (PSP), Hamilton Depression Rating Scale, Zung Depression Rating Scale, Beck Anxiety Inventory, Wisconsin Card Sorting Test, Stroop Test, Rey-Osterrieth Complex Figure Test (RCFT), and Auditory Verbal Learning Test (AVLT). After training, patient scores improved on the PSP, general symptoms on the Manchester Scale, AVLT, and delayed recall on the RCFT. The Manchester positive symptom score showed a trend of improvement. No significant changes were observed for other measures. The VR-VRTP may improve general psychosocial function and memory, potentially influencing real-world vocational performance. These findings provide preliminary evidence regarding the utility of the VR-VRTP in patients with schizophrenia.

The Patient with Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a multisymptom syndrome involving aberrant pathophysiology of the peripheral, autonomic, and/or central nervous systems. The central feature is severe, often debilitating pain. This is accompanied by a collection of sensory, motor, autonomic, skin, and/or bone abnormalities. A key feature is allodynia, where otherwise innocuous stimulation will cause pain and hyperalgesia. The patient will present with varying degrees of pain, allodynia, hyperalgesia, swelling, and color and temperature changes. There are often changes in motor function, such as muscle stiffness or even involuntary movements. Regional osteopenia, changes to hair and nail growth, and dystrophic cutaneous changes may occur. The Budapest criteria have been twice validated and are used to diagnose CRPS. A patient-centric clinical approach is important in the treatment of CRPS. Key domains to be addressed in the management of CRPS include rehabilitation and pain management with adjunct psychological therapy. It is important that these interventions happen concurrently within the continuum of care. With the guidance of a physician, physical therapist, occupational therapist, and neuropsychologist, rehabilitative training programs are designed to address motor, sensory, and cognitive deficits. Key Words: Budapest criteria, complex regional pain syndrome, reflex sympathetic dystrophy, sympathetically mediated pain

A Study on the Effects of In-Service Rehabilitation Training Program and Program Satisfaction of Community-based Rehabilitation Workers

A Study on the Effects of In-Service Rehabilitation Training Program and Program Satisfaction of Community-based Rehabilitation Workers

Thinking, Walking, Talking: Integratory Motor and Cognitive Brain Function.

In this article, we argue that motor and cognitive processes are functionally related and most likely share a similar evolutionary history. This is supported by clinical and neural data showing that some brain regions integrate both motor and cognitive functions. In addition, we also argue that cognitive processes coincide with complex motor output. Further, we also review data that support the converse notion that motor processes can contribute to cognitive function, as found by many rehabilitation and aerobic exercise training programs. Support is provided for motor and cognitive processes possessing dynamic bidirectional influences on each other.

Número de repetições em diferentes porcentagens de carga máxima de exercícios neuromusculares

Introdução: Os exercícios neuromusculares são componentes essenciais nos programas de reabilitação física e treinamento esportivo, entretanto, ainda existem importantes lacunas sobre a sua prescrição. Objetivo: Verificar se existe diferença no número de Repetições Máximas (RM) de exercícios neuromusculares com diferentes intensidades de Carga Máxima (CM). Métodos: Avaliados 26 jovens, sadios e sedentários, submetidos a um teste de CM e a três testes de RM com 50%, 70% e 90% da CM. Movimentos analisados: Flexão do Cotovelo (FC), Extensão do Cotovelo (EC) e Abdução do Ombro (AO). Resultados: Observou-se diferença na comparação das RM nos movimentos de FC vs. EC e FC vs. AO. Na comparação da RM em cada exercício, verificou-se diferença significante entre as cargas de 50% e 70% e entre 50% e 90%. Conclusão: Existe diferença no número de RM de movimentos resistidos com pesos livres a partir de diferentes intensidades da carga máxima.

Self management interventions for type 2 diabetes in adult people with severe mental illness.

People with severe mental illness are twice as likely to develop type 2 diabetes as those without severe mental illness. Treatment guidelines for type 2 diabetes recommend that structured education should be integrated into routine care and should be offered to all. However, for people with severe mental illness, physical health may be a low priority, and motivation to change may be limited. These additional challenges mean that the findings reported in previous systematic reviews of diabetes self management interventions may not be generalised to those with severe mental illness, and that tailored approaches to effective diabetes education may be required for this population. To assess the effects of diabetes self management interventions specifically tailored for people with type 2 diabetes and severe mental illness. We searched the Cochrane Library, MEDLINE, EMBASE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the International Clinical Trials Registry Platform (ICTRP) Search Portal, ClinicalTrials.gov and grey literature. The date of the last search of all databases was 07 March 2016. Randomised controlled trials of diabetes self management interventions for people with type 2 diabetes and severe mental illness. Two review authors independently screened abstracts and full-text articles, extracted data and conducted the risk of bias assessment. We used a taxonomy of behaviour change techniques and the framework for behaviour change theory to describe the theoretical basis of the interventions and active ingredients. We used the GRADE method (Grades of Recommendation, Assessment, Development and Evaluation Working Group) to assess trials for overall quality of evidence. We included one randomised controlled trial involving 64 participants with schizophrenia or schizoaffective disorder. The average age of participants was 54 years; participants had been living with type 2 diabetes for on average nine years, and with their psychiatric diagnosis since they were on average 28 years of age. Investigators evaluated the 24-week Diabetes Awareness and Rehabilitation Training (DART) programme in comparison with usual care plus information (UCI). Follow-up after trial completion was six months. Risk of bias was mostly unclear but was high for selective reporting. Trial authors did not report on diabetes-related complications, all-cause mortality, adverse events, health-related quality of life nor socioeconomic effects. Twelve months of data on self care behaviours as measured by total energy expenditure showed a mean of 2148 kcal for DART and 1496 kcal for UCI (52 participants; very low-quality evidence), indicating no substantial improvement. The intervention did not have a substantial effect on glycosylated haemoglobin A1c (HbA1c) at 6 or 12 months of follow-up (12-month HbA1c data 7.9% for DART vs 6.9% for UCI; 52 participants; very low-quality evidence). Researchers noted small improvements in body mass index immediately after the intervention was provided and at six months, along with improved weight post intervention. Diabetes knowledge and self efficacy improved immediately following receipt of the intervention, and knowledge also at six months. The intervention did not improve blood pressure. Evidence is insufficient to show whether type 2 diabetes self management interventions for people with severe mental illness are effective in improving outcomes. Researchers must conduct additional trials to establish efficacy, and to identify the active ingredients in these interventions and the people most likely to benefit from them.

Clinical neuropsychology in Israel: history, training, practice and future challenges

Objective: This is an invited paper for a special issue on international perspectives on training and practice in clinical neuropsychology. We provide a review of the status of clinical neuropsychology in Israel, including the history of neuropsychological, educational, and accreditation requirements to become a clinical neuropsychologist and to practice clinical neuropsychology. Method: The information is based primarily on the personal knowledge of the authors who have been practicing clinical neuropsychology for over three decades and hold various administrative and academic positions in this field. Second, we conducted three ad hoc surveys among clinical and rehabilitation psychologists; heads of academic programs for rehabilitation and neuropsychology; and heads of accredited service providers. Third, we present a literature review of publications by clinical neuropsychologists in Israel. Results: Most of the clinical neuropsychologists are graduates of either rehabilitation or clinical training programs. The vast majority of neuropsychologists are affiliated with rehabilitation psychology. The training programs (2–3 years of graduate school) provide solid therapeutic and diagnostic skills to the students. Seventy-five percent of the participants in this survey are employed at least part-time by public or state-funded institutions. Israeli neuropsychologists are heavily involved in case management, including vocational counseling, and rehabilitation psychotherapy. Conclusions and future goals: Although clinical neuropsychologists in Israel are well educated and valued by all health professionals, there are still several challenges that must be addressed in order to further advance the field and the profession. These included the need for Hebrew-language standardized and normalized neuropsychological tests and the application of evidence-based interventions in neuropsychological rehabilitation.

Disabled employees in Jordanian public sector: an exploratory study

Purpose – The purpose of this paper is to explore the attitudes of disabled employees toward availability of work facilities, treatment of other employees, and the working conditions in the Jordanian public sector. Design/methodology/approach – A purposive sample of disabled public sector employees (198) was selected to participate in the study by filling the designated questionnaire. Findings – Disabled employees reported a relatively moderate level of satisfaction about the availability of facilities. Also, participants are satisfied with the treatment of their supervisors and colleagues and of the working conditions. Disabled female participants and those who hold graduate degrees reported high-satisfaction level about the treatment they receive from their colleagues at work. The findings also showed that 55 percent of the participants were hired based on humanitarian bases as a result of their disability cases compared with 45 percent who were hired based on their qualifications and merits. Practical implications – This research significantly contributes to the scarce knowledge that currently exists in the position of disabled employees in the Arab world. Policy makers and human resource managers should develop a clear strategy to provide the facilities for disabled people to accommodate at work. In addition, they should provide professional guidance and rehabilitation training programs aiming to enhance disabled employees’ participation and involvement in the labor market. Originality/value – The study is one of the first to investigate the status of disabled public sector employees in Jordan and in the Arab world.

Effects of two programs of metabolic resistance training on strength and hypertrophy

Abstract Introduction: The effects of low intensity resistance training combined with vascular occlusion have been investigated by several studies. Similar results on strength and hypertrophy have been observed when such method was compared to high intensity protocols. However, due to the specific apparatus needed to apply vascular occlusion (ex.: Kaatsu) on some exercises, alternative forms of metabolic training might be used. In the present study, an isometric contraction was performed within each concentric-eccentric transition phase, for every repetition, to elicit metabolic stress. Objective: The aim of the present study was to analyze the effects of two resistance training protocols with metabolic characteristics on strength (1MR), circumference (CIRC) and muscle thickness (measured with ultrasonography [MT]). Subjective perception of discomfort was also recorded with an analogical-visual pain scale (AVP). Methods: Twelve young, healthy men were trained with two different methods during 10 weeks. The right limb was trained with an isometric contraction within each concentric-eccentric transition phases for every repetition (ISO) whereas the left limb was trained with a pneumatic cuff to apply vascular occlusion (OC) on the knee extensor muscles. Both methods were trained at 20% 1MR. Results: It was observed increases on medial tight CIRC, proximal MT, medial MT, distal MT and 1MR, with no difference between both methods. The perception of discomfort was greater for ISO at the end of the third set and lower than reported by OC, at the beginning and end of the training program. Conclusions: Both protocols produced similar gains on strength and hypertrophy. The advantages of training with low loads are important to elderly or rehabilitation training programs. Other studies that compare this method with conventional resistance training are warranted.

Book Review: Making Life More Livable: Simple Adaptations for Living at Home after Vision Loss

Making Life More Livable: Simple Adaptations for Living at Home After Vision Loss, Third Edition, Maureen A. Duffy. New York: AFB Press, 2016,234 pp. Paperback, $39.95; e-book (ePUB or Kindle), $27.95; online, $23.95. Making Life More Livable: Simple Adaptations for Living at Home After Vision Loss, Third Edition, by Maureen A. Duffy, is an exceptional revision of the previous edition. It includes information that has been updated to address the changing trends in adapting to vision loss, as well as expanded information regarding a variety of vision rehabilitation services that can be offered to individuals with visual impairments. The foundational information and techniques for adapting the home and everyday activities remains the same as described in earlier editions; however, the new edition introduces information about advancing technologies (smartphones, tablets, and electronic independent living devices), provides new and updated resources, and includes full-color photographs and illustrations of described adaptations. In addition, the Preventing Falls in Your Home section in Chapter 4 and the Notes section at the end of the book are welcome additions. A PERFECT RESOURCE FOR INDIVIDUALS AND FAMILY MEMBERS The book is a perfect resource for individuals who are experiencing vision loss and the loved ones who support them. The book presents a comprehensive list of simple adaptations, information, and resources for living safely and functioning efficiently in every room of the home; it also provides practical tips on ways to modify everyday tasks in an affordable manner. The book provides immediate assistance to individuals who are visually impaired and their loved ones by providing information on how to tackle the everyday challenges that are experienced with vision loss. It also introduces and describes the network of vision rehabilitation services and professionals who are available to offer more specialized training. In addition, the large-print book is easy to read, with balanced spacing, color, and contrast among text; bulleted lists; and colored illustrations and text boxes. It is written in a straightforward tone in layman's language, which is appropriate for readers who are new to vision loss. Although much of the information represented in the book can be accessed on vision loss-related websites (such as VisionAware.org) and from professional vision rehabilitation textbooks written by seasoned educators and practitioners, which validates the authenticity of the book's content, the option to have this information compiled in a comprehensive resource is invaluable, since it allows for easier access to the information. Subsequently, the book can also serve as a resource for new and existing vision rehabilitation professionals as a complement to the professional texts that are used in training programs for vision rehabilitation. In fact, any person who is connected to an individual who has vision loss should buy and read this book. CLEAR, CONCISE, AND WELL ORGANIZED The information in the book is well organized and presented in a clear and concise manner. It informs readers that it is possible to live independently with vision loss and provides general principles on how to make the home environment more comfortable and functional. It offers tips, solutions, and adaptations on how to modify every area of the home room by room to achieve safety and independence, while also promoting safe movement and addressing additional health complications that often occur simultaneously with vision loss. The information provided is extremely coherent and consistent--each chapter is organized in a like manner, which allows for more fluid reading. The book opens with an overview of the impact of vision loss in adulthood. It provides current statistics on vision loss among the various adult age groups (that is, those aged 18 years and older), and describes normal changes in vision and the major eye disorders that affect adults and older adults. …

Six-Week Nordic Treadmill Training Compared with Treadmill Training on Balance, Gait, and Activities of Daily Living for Stroke Patients: A Randomized Controlled Trial

Recently, stroke rehabilitation training programs have contained elements of sporting activities. Arm swing is a particularly important factor in gait; accordingly, the use of the Nordic walking exercise has been advocated in the literature. Our objective is to compare the effects of Nordic treadmill training (NTT) and treadmill training (TT) on balance, gait, and activities of daily living (ADL) in stroke patients. Thirty stroke patients were randomly allocated to NTT and TT groups. NTT and TT were performed for 30 minutes each day, 5 times per week for 6 weeks. The Berg Balance Scale, the timed up and go test, and the tetra-ataxiometric posturography tests were used to assess balance; the 10-meter walk test, 6-minute walk test, and modified Barthel Index were used to measure balance, gait, and ADL. After 6 weeks of training, balance, gait, and ADL improved significantly in both groups, but NTT was associated with greater improvements compared to TT for all 3 measures. This study is the first to assess the effects of NTT on balance, gait, and ADL in stroke patients. The data indicate that NTT represents an effective adjunctive treatment to TT in this population.

An Assessment of Rehabilitation Protocols following Anterior Cruciate Ligament Reconstruction: A Systematic Review

The present study provided a systematic review with meta-analysis of randomized controlled trials involving the effectiveness of various rehabilitation methods that have been implemented for the treatment of anterior cruciate ligament reconstruction (ACLR). The review of the literature revealed the following as evidence for effective ACLR rehabilitation: early intervention strategy focused on restoring range of motion, muscle strength, and ligament stability with the utilization of closed kinetic chain exercises. The literature supports the use of dynamic intraligamentary stabilization, which should also be implemented in the rehabilitation protocol within the first three months after surgery. The research suggests that the patient should undergo at least 30-90 minutes of cryotherapy immediately following ACLR surgery. There is also some evidence regarding the effectiveness of neuromuscular rehabilitation training programs, but further investigations are needed. Future research should consider the timing of rehabilitation as well as supplemental rehabilitation exercises to continue to improve the quality of care delivered to patients following ACLR.

Court Supervised Institutional Transformation in South Africa

The traditional adversarial model of litigation in South Africa operates on the basis that two or more parties approach the court, each with its own desired outcome. The court is then obliged to decide in favour of one of the parties.
 A different model of litigation is emerging in South African law. This model involves actions against public institutions that are failing to comply with their constitutional mandate. In this type of litigation there is seldom a dispute regarding the eventual outcome that is desired. Both the applicant and the state, in its capacity of the respondent, have a broad consensus about the manner in which the institution should operate or be transformed. There is accordingly agreement regarding the eventual outcome and the shortcomings that should be addressed. The primary issue relates to the details of the implementation of the transformation of the institution in question, in order that the constitutional mandate of the institution in question will be met.
 An example of this form of litigation can be seen in litigation concerning the conditions in which prisoners are detained in South African prisons. The constitutional mandate for the imprisonment of offenders is contained in the Correctional Services Act.
 Ongoing human rights violations often take place in prisons. These include staff shortages, shortages of medical staff and facilities, prison overcrowding, inadequate staff development, the prevalence of HIV/AIDS, infrastructure defects and maintenance problems, gangsterism, requests for prisoner transfers and problems associated therewith, the ineffectiveness of parole boards, staff development needs that are not addressed, an excessive focus on security, lack of rehabilitation and vocational training programmes and assaults of prisoners.
 The courts have on occasion issued a structured interdict as an appropriate remedy. However, problems arise when violations are widespread and no single order can cause the problems to be properly addressed or where the executive fails to implement or even ignores court orders.
 Thus, the wrong which is complained of is not a wrong done to a particular person, but the constitutional wrong is the manner in which the institution executes its mandate vis-a-vis the vulnerable beneficiaries of the public service in question. The transformation thereof is designed to bring the institution within its constitutional duties and bounds. There is usually no dispute about the failures of the organisation and court orders are often taken by consent.
 The question which arises is how it can be ensured that a public institution such as a school, welfare department, hospital for the mentally disabled, home for the elderly or prison, which is designed to serve or accommodate the vulnerable may be brought into conformity with its constitutional mandate where there are continual and persistent failures to do so.
 Even where court orders are obtained, there are often significant problems with the implementation thereof. In the case of prisons, a possible solution, which has been employed in the United States of America and which may be adapted for use in the South African context, is that of a post-trial special master or court appointed supervisor, who supervises the transformation of the public institution until such time as the non-compliance has been appropriately resolved.
 In this article the role and functions of the American special master will be set out. The feasibility of importing such an office into the South African context will be evaluated.

The effect of the rehabilitation program on balance, gait, physical performance and trunk rotation in Parkinson's disease.

BackgroundParkinson’s disease (PD) is a progressive, neurodegenerative disease which leads to postural and gait disorders, limitation in mobility, activities of daily living and disability.AimsThe aim of the study is to assess the effects of the rehabilitation program on balance, gait, motor performance and trunk rotations in PD patients.MethodsSixty-four patients with 1.5–3.0 stage PD in the Hoehn and Yahr scale were randomly allocated to rehabilitation and control groups. Sixty-one patients completed the study. Patients were assessed three times, at month intervals. Between the first and second assessments, the rehabilitation group participated in a rehabilitation training program focused on mobility, balance and gait exercises, consisting of 28 sessions. Balance was assessed with tandem stance and the Pastor test (shoulder tug). Gait was assessed with a 10 m walk at preferred speed and 360° turn. Motor performance was evaluated by means of the Physical Performance Test (PPT) and timed motor activities. The trunk rotations were measured in the lumbar and thoraco-lumbar spine with a tape measure.ResultsThe rehabilitation group significantly improved (p < 0.05) in balance and gait outcomes, PPT score, timed activities and trunk rotations both in comparison to the control group and baseline results. The positive effects of the exercise program maintained for at least 1 month.ConclusionThe 4-week rehabilitation training program focused on mobility, balance and gait exercises improved balance, gait, physical performance and trunk rotations in patients with PD.

Isokinetic Identification of Knee Joint Torques before and after Anterior Cruciate Ligament Reconstruction.

The aim of this study was to evaluate the serial change of isokinetic muscle strength of the knees before and after anterior cruciate ligament reconstruction (ACLR) in physically active males and to estimate the time of return to full physical fitness. Extension and flexion torques were measured for the injured and healthy limbs at two angular velocities approximately 1.5 months before the surgery and 3, 6, and 12 months after ACLR. Significant differences (p ≤ 0.05) in peak knee extension and flexion torques, hamstring/quadriceps (H/Q) strength ratios, uninvolved/involved limb peak torque ratios, and the normalized work of these muscles between the four stages of rehabilitation were identified. Significant differences between extension peak torques for the injured and healthy limbs were also detected at all stages. The obtained results showed that 12 months of rehabilitation were insufficient for the involved knee joint to recover its strength to the level of strength of the uninvolved knee joint. The results helped to evaluate the progress of the rehabilitation and to implement necessary modifications optimizing the rehabilitation training program. The results of the study may also be used as referential data for physically active males of similar age.

Effects of community-based exercise in children with severe burns: A randomized trial

ObjectiveTo counteract long-lasting muscle break down, muscle weakness, and poor physical fitness resulting from severe burns, we recommend a 12-week in-hospital exercise training rehabilitation program. Unfortunately, this in-hospital training program requires time away from home, family, school or work. This study was undertaken to evaluate an alternative exercise rehabilitation strategy involving a 12-week community-based exercise training rehabilitation program (COMBEX) carried out at or near the patient and caretaker's home. Study design and participantsPediatric patients (7–18 years) with ≥30% of total body surface area (TBSA) burns were randomized to participate in COMBEX (N=12) or an outpatient exercise program (EX) at the hospital (N=22). Both programs were started after hospital discharge and consisted of 12 weeks of progressive resistive and aerobic exercise. COMBEX was performed in community fitness centers near the patients’ home. Endpoints were assessed at discharge (pre-exercise) and after the 12-week program. Primary endpoints were lean body mass (dual energy X-ray absorptiometry), muscle strength (isokinetic dynamometry), and peak aerobic capacity (indirect calorimetry). ResultsDemographics, length of hospitalization, and TBSA burned were comparable between groups (P>0.05). Both groups exhibited a significant (P≤0.01 for all) increase (mean±SEM) in lean muscle mass (EX: 6.9±1.7%; COMBEX: 6.5±1.1%), muscle strength (EX: 67.1±7.0%; COMBEX: 49.9±6.8%), and peak aerobic capacity (EX: 35.5±4.0%; COMBEX: 46.9±7.7%). Furthermore, the magnitude of these increases were not different between groups (P>0.12). ConclusionsBoth EX and COMBEX are efficacious in improving lean mass, strength, and cardiopulmonary capacity in severely burned children.

Intervention effects of systemic rehabilitation training on postoperative disuse shoulder dysfunction after abdominal pedicled skin flap transplantation

Objective To evaluate the intervention effects of systemic rehabilitation training on postoperative disuse shoulder dysfunction in hand injury patients received abdominal pedicled skin flap transplantation. Methods The 92 patients received same operation of abdominal pedicled skin flap surgery for unilateral hand in Hand and Foot Surgery Department of Provincial Hospital Affiliated to Shandong University and were divided into two groups, in which 45 patients as control group from March to April 2014 and 47 patients as experimental group from June to July 2014. The patients of control group received conventional therapy and nursing, while the ones of experimental group received systematic rehabilitation training by nurses and doctors before, during and after operation. Shoulder function was scored at the day 1 and day 7 after the pedicle division operation according to the shoulder joint function assessment scale, and we employed SPSS 20.0 to analyze the results. Results The shoulder function scores of experimental group patients were (72.96±4.72) and (87.91±4.74) at the day 1 and day 7 after the pedicle division operation, which were better than the scores of control group patients, [(65.11±6.74) and (79.38±7.31)] (t=6.492, 6.677; P<0.01). Conclusions The systemic rehabilitation training program, which requirements were definite, and guidance was standard and easy to perform, can significantly improve the shoulder function of the patients received abdominal pedicled skin flap transplantation. Key words: Hand injury; Rehabilitation training; Pedicled skin flap; Disuse shoulder dysfunction

Automated Management of Exercise Intervention at the Point of Care: Application of a Web-Based Leg Training System.

BackgroundRecent advances in information and communication technology have prompted development of Web-based health tools to promote physical activity, the key component of cardiac rehabilitation and chronic disease management. Mobile apps can facilitate behavioral changes and help in exercise monitoring, although actual training usually takes place away from the point of care in specialized gyms or outdoors. Daily participation in conventional physical activities is expensive, time consuming, and mostly relies on self-management abilities of patients who are typically aged, overweight, and unfit. Facilitation of sustained exercise training at the point of care might improve patient engagement in cardiac rehabilitation.ObjectiveIn this study we aimed to test the feasibility of execution and automatic monitoring of several exercise regimens on-site using a Web-enabled leg training system.MethodsThe MedExercise leg rehabilitation machine was equipped with wireless temperature sensors in order to monitor its usage by the rise of temperature in the resistance unit (Δt°). Personal electronic devices such as laptop computers were fitted with wireless gateways and relevant software was installed to monitor the usage of training machines. Cloud-based software allowed monitoring of participant training over the Internet. Seven healthy participants applied the system at various locations with training protocols typically used in cardiac rehabilitation. The heart rates were measured by fingertip pulse oximeters.ResultsExercising in home chairs, in bed, and under an office desk was made feasible and resulted in an intensity-dependent increase of participants’ heart rates and Δt° in training machine temperatures. Participants self-controlled their activities on smart devices, while a supervisor monitored them over the Internet. Individual Δt° reached during 30 minutes of moderate-intensity continuous training averaged 7.8°C (SD 1.6). These Δt° were used as personalized daily doses of exercise with automatic email alerts sent upon achieving them. During 1-week training at home, automatic notifications were received on 4.4 days (SD 1.8). Although the high intensity interval training regimen was feasible on-site, it was difficult for self- and remote management. Opportunistic leg exercise under the desk, while working with a computer, and training in bed while viewing television were less intensive than dosed exercise bouts, but allowed prolonged leg mobilization of 73.7 minutes/day (SD 29.7).ConclusionsThis study demonstrated the feasibility of self-control exercise training on-site, which was accompanied by online monitoring, electronic recording, personalization of exercise doses, and automatic reporting of adherence. The results suggest that this technology and its applications are useful for the delivery of Web-based exercise rehabilitation and cardiac training programs at the point of care.

착용형 하지 로봇을 이용한 편마비 보행 재활 훈련 효과에 관한 연구

Conventional gait rehabilitation requires at least three therapists in a traditional rehabilitation training program. Several robots have been developed to reduce human burden and increase rehabilitation efficacy. In this study, we present a lower-limb wearable robot (WA-H) for gait rehabilitation of hemiplegia patients, and propose a protocol of 12 weeks gait rehabilitation training program using WA-H. To identify the efficacy of the robot and protocols, we conducted a clinical study with two actual hemiplegia patients and observed a chronological change of ambulation ability through four assessments. We discovered the progression of results by 6 minute walking test, TUGT (Timed Up and Go Test), SPPB (Short Physical Performance Battery), BBS (Berg Balance Test), and Fugl-Meyer score. The torques generated in the normal side and paralyzed side of the patient became similar, indicating rehabilitation. The result also showed the walking of the paralysis patient improved and imbalance motion had considerable improved performance.