Rehabilitation Process Research Articles

Dental implantation in patients with comorbid diseases: yes or no?

Patients with multiple pathologies are a high-risk group, which requires a personalized approach to surgical rehabilitation in dentistry. Inadequate diagnosis of clinical manifestations when a patient is in remission often leads to severe surgical complications. However, modern methods of dental implantation and rehabilitation are possible even in patients with oncology, those who underwent surgical therapy, chemo- or radiotherapy. Gilbert syndrome, one of the risk factors for post-surgery inflammatory complications, is associated with defects in bilirubin metabolism. It inhibits platelet activity. It is a genetic disease leading to a loss of liver enzyme activity and the accumulation of indirect bilirubin that can aggravate the course of other diseases in patients. In acute stages, it is characterized by jaundice of the skin, eyes, and mucosa and is followed by immunosuppression and the post-surgical complications associated with it. A patient with Gilbert syndrome was administered for surgical treatment of a chronic infection and follow-up rehabilitation via dental implantation and reconstruction of the bone. In this case, we faced Gilbert syndrome in association with polycythemia (a myeloproliferative disease in the compensation stage). In such cases, dental implantation cannot be achieved in the complex dental rehabilitation process. Such diseases require special attention from dental surgeons due to possible complications (bleeding, thrombosis, or disseminated intravascular coagulation). In this specific case, the patient belongs to the risk group, and its history, although in remission, is still a contraindication for dental surgery and dental implantation.

Modelling drift of cold-stunned Kemp's ridley turtles stranding on the Dutch coast

Background Every few years, juvenile Kemp’s ridley turtles (Lepidochelys kempii) are stranded on the Dutch coasts. The main population distribution of this critically endangered species primarily inhabits the Gulf of Mexico and the east coast of the United States. This study focuses on five reports from the Netherlands between 2007 and 2022, where juvenile turtles were reported to strand alive during the winter, albeit in a hypothermic state. At ambient ocean temperatures between 10°C and 13°C, Kemp’s ridley turtles begin to show an inability to actively swim and remain afloat on the ocean’s surface, a condition termed ‘cold stunning’. Understanding their transport in cold-stunned state can help improve the rehabilitation process of stranded turtles. Methods Cold-stunned turtles are back-tracked as passive, virtual particles from their stranding location using Lagrangian flow modelling. This study investigates when and where these juvenile turtles cross the threshold temperatures between 10° C and 14° C before stranding by tracking the temperature along the trajectories. Results As expected, the simulations show the transport of the cold-stunned turtles via the English Channel. More surprisingly, the analysis suggests they likely experience cold-stunning in the southern North Sea region and encounter temperatures below 10°C for only a few days to up to three weeks, and below 12°C for up to a month before stranding. Conclusions The estimate of cold-stunned drift duration of the turtles provides additional knowledge about their health status at the time of stranding. Adherence to rehabilitation protocols for Kemp’s ridley and post-release monitoring are recommended to improve their long-term survival.

Review perspective on advanced nutrachemicals and anterior cruciate ligament rehabilitation.

Anterior cruciate ligament (ACL) injuries are prevalent among athletes, necessitating surgical intervention followed by comprehensive rehabilitation. Recently, the integration of nutraceuticals- bioactive compounds from food sources- into rehabilitation protocols has shown promise in enhancing recovery outcomes. This review explores the potential benefits of various nutraceuticals, including omega-3 fatty acids, collagen supplements, vitamin D, glucosamine and chondroitin, curcumin, and branched-chain amino acids (BCAAs), in ACL rehabilitation. These nutraceuticals offer anti-inflammatory properties, support tissue repair, and improve joint and muscle health, which are critical during the rehabilitation process. Despite encouraging preclinical findings, there is a need for robust clinical trials to confirm their efficacy and establish optimal dosages and formulations. Personalized nutrition plans and interdisciplinary collaboration among healthcare providers are essential for optimizing patient care. This perspective underscores the potential of advanced nutraceuticals to revolutionize ACL rehabilitation, paving the way for faster and more effective recovery pathways.

Patient Perspectives on Blended Internet-Based and Face-to-Face Cognitive Behavioral Therapy for Alcohol Use Disorder: Qualitative Study.

Harmful alcohol consumption has been identified as a major contributor to disease, mortality, and social harm, accounting for 5.3% of worldwide deaths annually. In Denmark, an estimated 150,000 people suffer from alcohol use disorder (AUD), but a low proportion seek treatment due to person- and treatment-related barriers. Internet-based cognitive behavioral therapy (iCBT) has shown positive effects on the treatment gap, with patients reporting benefits such as increased knowledge and flexibility. However, there is a lack of research on blended cognitive behavioral therapy (bCBT), which combines face-to-face CBT (FtF CBT) and iCBT for AUD. This study aims to investigate user experiences of bCBT. More specifically, it seeks to explore the advantages and disadvantages that users have experienced with bCBT for AUD, as well as their motivations for choosing this treatment format. A total of 30 patients who had participated in the Blend-A (Blending Internet Treatment into Conventional Face-to-Face Treatment for AUD) study and received the intervention were contacted and offered the opportunity to participate in semistructured individual telephone interviews. Of these, 12 patients consented to participate. Furthermore, an additional participant was approached at a municipal clinic and agreed to engage in an individual FtF interview. Thus, the final sample consisted of 13 patients. The interviews explored their background, experiences with digital technology, motivations for choosing internet-based treatment, and experiences with the program during AUD treatment. The interviews were audio-recorded and transcribed in full length and analyzed using thematic analysis. All data were anonymized and securely stored. We found that users experienced several advantages of iCBT over a larger part of the treatment course, including increased anonymity and privacy. Most importantly, it offered flexibility, allowing patients to focus on their rehabilitation process at their own pace. Patients appreciated the availability of written text in the online program, finding it helpful for gaining knowledge and understanding of AUD and its impact on the individual with the condition. They emphasized how the assignments helped them fully engage in treatment by first acknowledging their problem with alcohol and then dedicating time to self-reflection before FtF sessions, allowing for more in-depth discussions with the therapist. They also appreciated the reminders, which motivated them to complete their assignments. Overall, patients perceived more benefits than disadvantages in using bCBT. Essentially, bCBT offers a form of assisted autonomy that cannot be fully achieved through iCBT or FtF CBT alone. It is only through their combination that patients can fully appreciate the benefits of the treatment, as they have time for self-reflection, with guidance from the therapist between FtF CBT sessions. ClinicalTrials.gov NCT04535258; https://clinicaltrials.gov/ct2/show/NCT04535258.

Implementing AI-Driven Bed Sensors: Perspectives from Interdisciplinary Teams in Geriatric Care

Sleep is a crucial aspect of geriatric assessment for hospitalized older adults, and implementing AI-driven technology for sleep monitoring can significantly enhance the rehabilitation process. Sleepsense, an AI-driven sleep-tracking device, provides real-time data and insights, enabling healthcare professionals to tailor interventions and improve sleep quality. This study explores the perspectives of an interdisciplinary hospital team on implementing Sleepsense in geriatric hospital care. Using the interpretive description approach, we conducted focus groups with physicians, nurses, care aides, and an activity worker. The Consolidated Framework for Implementation Research (CFIR) informed our thematic analysis to identify barriers and facilitators to implementation. Among 27 healthcare staff, predominantly female (88.89%) and Asian (74.1%) and mostly aged 30–50 years, themes emerged that Sleepsense is perceived as a timesaving and data-driven tool that enhances patient monitoring and assessment. However, barriers such as resistance to change and concerns about trusting the device for patient comfort and safety were noted, while facilitators included training and staff engagement. The CFIR framework proved useful for analyzing implementation barriers and facilitators, suggesting future research should prioritize effective strategies for interdisciplinary team support to enhance innovation adoption and patient outcomes in rehabilitation settings.

Sensor-Acquired Reachable Workspace (RWS) Correlates with Activities of Daily Living (ADL) Function in Stroke as Measured by Functional Independence Measure (FIM) Self-Care

Optimal upper extremity motor control and range of motion are necessary to achieve even the basic activities of daily living (ADL) function. Stroke, with resulting hemiparesis, can significantly and negatively impact an individual’s ADL function. Functional Independence Measure (FIM) self-care score can provide an assessment of what aspects and to what degree ADL functions are impaired. FIM self-care assessment can also track changes in ADL function during stroke recovery and rehabilitation. Recently, the sensor-acquired 3D motion analysis of stroke patients’ upper extremity has shown promise as a potential alternative to assess ADL function. This observational study evaluates whether the sensor-acquired upper extremity reachable workspace (RWS) measure correlates with clinician-evaluated FIM self-care score in stroke patients. Seventeen patients with stroke were enrolled in the study. FIM self-care, NeuroQoL upper extremity, and reachable workspace outcome measures (relative surface area, RSA) were collected upon rehabilitation hospital admission, at discharge, and at the 3-month visit. Pearson and Spearman’s rank correlation coefficients as well as multiple linear regression analyses were used to determine the relationships between FIM self-care, NeuroQoL, and reachable workspace RSAs. Moderately strong correlation between total reachable workspace RSA and total FIM self-care score at discharge and at 3 months were noted (r = 0.619, r = 0.661, p < 0.05), and similarly strong correlation was also noted with the upper extremity NeuroQoL total score (r = 0.690, r = 0.815, p < 0.05). Multiple linear regression analyses revealed a change in average bilateral total RSA of 0.1 unit from admission to the 3-month follow-up correlated with a respective change in the FIM self-care score of 2.011 points (95%CI: 0.663–3.360). Longitudinal improvement in ADL function during stroke rehabilitation and recovery process is correlated with improvement in reachable workspace.

Kutatások a szimbolikus térhasználat témakörében: áttekintés és szintézis

The study analyzes the symbolical space using practice in the period from the social-political turnaround of Romania in 1989 to the present in Szeklerland. The aim is to present the trended changes in the symbolical space using practice in the public space since the regime change. The study is based on results of research programs conducted at WAC – Centre for Regional and Anthropological Research. Analyzing the results of the research programs, we determined three intervals from 1990 to the present. In the first interval, symbolical space using practice was dominated by rehabilitation processes. In the second interval, creating new symbolic spaces and events was more typical. In the last interval, new processes have emerged, such as integration and individualization. In addition to analyzing the changes, we also aim at presenting the social function of symbolical space using practice in different time intervals.

Assessing the impact of virtual reality on the restoration of motor function in the acute period of ischemic stroke

Aim: to evaluate the effectiveness of using virtual reality to restore motor function in patients in the acute period of ischemic stroke.Material and methods. We studied 207 patients in the acute period of ischemic stroke, who were divided into two groups by randomization: study group – 105 patients, comparison group – 102 patients. All patients received all necessary standardized therapy. Patients in the study group additionally received classes using the ReviVR device. Efficacy was assessed using the NIHSS, FMA-LE, and BBS scales.Results. On all scales studied, patients in the study group demonstrated better results in relation to the comparison group, both in terms of the final result and in terms of the level of change in indicators during the rehabilitation process. The use of virtual reality made it possible to reduce disability on the NIHSS scale to 7.0 (4.0; 9.0) points, which is better than the results of the comparison group – 9.0 (5.0; 13.0) points with a high level of significance p < 0.001. The increase in motor function according to FMA-LE in the study group was higher and amounted to 21.0 (15.0; 24.0) points versus 18.0 (7.0; 22.0) points in the comparison group with a significance level of p = 0.002. The study group also showed better results on the BBS scale – 26.0 (17.0; 34.0) versus 18.0 (5.0; 29.0) points with a significance level of p < 0.001.Conclusion. The use of virtual reality together with standardized therapy in the acute period of ischemic stroke is effective in restoring motor function of the affected lower limb, improving balance and reducing general disability in general.

Results of the rehabilitation program for patients after suting the meniscues according to the "all-inside" method

The menisci play an important role in the functioning of the knee joint. Ruptures of the menisci cause significant changes in joint kinematics, which is one of the prerequisites for the development of early osteoarthritis. Suturing a torn meniscus prevents this complication. The aim of the study was to study the results of the implemented program of physical rehabilitation of patients after suturing vertical tears of the meniscus of the knee joint using the "all-inside" technique. 43 patients who underwent suturing of a vertical meniscus tear using the "all-inside" technique took part in the study. Patients were divided into 2 groups. The first experimental group - 21 people who were given a rehabilitation program according to our method. The second group, the control group - 22 patients who underwent rehabilitation according to the existing program. In the process of rehabilitation measures, the intensity of pain in patients of the experimental group according to VAS significantly decreased (p < 0,001). Bending of the knee joint in the experimental group reached 96,42% of the normal, in the control group 78,57%. During the rehabilitation process, there was an increase in muscle tone and amplitude of the quadriceps muscle among patients in the experimental group.

Local Cultural Approach in Navigating Family Conflict: Understanding Cultural Strategies for Human Well-Being

Objective: This study explores the complexities of family conflict within a local cultural framework, focusing on its impacts on physical and mental well-being through mapping its intensity, root causes, and long-term consequences. The study aims to understand how unresolved interpersonal tensions can negatively impact emotional and social health, ultimately affecting harmony and balance within local communities. The approach uses a theoretical framework that underscores the importance of culture-based communication, negotiation skills that respect local norms, and appreciation for diverse perspectives as steps to reduce conflict and promote mental health. This research contextualizes conflict within various local cultural settings, specifically within families influenced by communal and intergenerational values. Through in-depth analysis of the family as the unit of study, variables such as communication and social relationships are examined with an emphasis on unique socio-cultural dynamics. The findings highlight the negative impact of unresolved family conflict on emotional well-being and the stability of social relationships within the family unit. Conflict can disrupt interpersonal dynamics, creating long-term disharmony that undermines family cohesion. These adverse effects underscore the need for systematic, ongoing interventions to support mental health and collective well-being. This study emphasizes the importance of addressing family conflict as a critical component in achieving the Sustainable Development Goal (SDG) of Good Health and Well-being. Interventions that adopt a local cultural approach—such as effective communication strategies and conflict resolution skills rooted in communal norms—are essential for fostering healthier and more harmonious family environments. By identifying three primary approaches—cultural rehabilitation processes, the development of communication that values local culture, and conflict management skills—the study provides practical insights aligned with global efforts to improve mental health and social well-being in accordance with the SDG framework.

Design and Application of Intelligent Recommender Systems in Vocational Rehabilitation

With the rapid development of information technology, the application of intelligent recommender systems in various fields has become more and more extensive, and vocational rehabilitation, as a field focusing on personalized services, faces the challenge of how to effectively use big data and intelligent algorithms to enhance the rehabilitation effect. This paper discusses the design principles and key technologies of intelligent recommender system in vocational rehabilitation, combining data-driven recommendation algorithms with users' personalized needs to achieve accurate recommendation of vocational rehabilitation programs. Through the optimization of system architecture and functional implementation, the intelligent recommender system shows remarkable effects in practical application, effectively improving the decision-making efficiency and user satisfaction in the rehabilitation process. Finally, this paper gives an outlook on the future development of the intelligent recommendation system in the field of vocational rehabilitation, and proposes possible research directions and application expansion paths.

The impact of rehabilitation on the recovery of executive functions in stroke patients with different location of the ischemic focus.

Cognitive dysfunction is part of the clinical picture of stroke. Most of the executive dysfunctions are diagnosed in the early stage of rehabilitation, a few weeks after the vascular incident. Coexistence of executive dysfunctions with other disorders in stroke patients may hinder patient's functions, slow down the rehabilitation process, and disrupt self-awareness, interpersonal communication, and professional activity in everyday life. Ninety patients after ischemic stroke were examined (right hemisphere stroke: N = 33, left hemisphere stroke: N = 57). The study group (N = 45) consisted of patients rehabilitated in the Department of Rehabilitation and Physical Medicine of the University Teaching Hospital of the Military Medical Academy in Lodz, Łódź, Poland, in whom a comprehensive neurorehabilitation program was implemented, consisting of motor and neuropsychological rehabilitation. The control group (N = 45) consisted of patients awaiting admission to the department, who were covered by comprehensive environmental rehabilitation including exercise therapy and neuropsychological therapy. Executive function was measured with 3 popular diagnostic tools: the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT part A, TMT part B), and the letter test and category test with the Verbal Fluency Test (VFT). The tests were carried out twice: the first time before the start of rehabilitation and 5 weeks later after its completion. Although patients with right-hemispheric stroke showed better improvement in executive functions, stroke location did not prove to have significant impact on how effective the rehabilitation was. Right hemisphere stroke patients showed greater improvement in restoring executive functions after rehabilitation compared to left hemisphere stroke patients. The location of the stroke did not significantly correlate with the efficiency of the rehabilitation setting. Int J Occup Med Environ Health. 2024;37(4).

Multidisciplinary Home-Based Rehabilitation Program for Individuals With Disabilities: Longitudinal Observational Study.

Disability affects a significant portion of the global population nowadays, necessitating innovative approaches to access rehabilitation processes. Home-based rehabilitation has emerged as a beneficial approach, offering comfort and context-specific therapy. This study aims to evaluate the impact of a multidisciplinary home-based rehabilitation program for individuals with moderate neuromusculoskeletal disabilities in terms of motor function and mood. A total of 270 participants with median age of 66 (IQR 20-98) years were recruited from the National Disability Registry of Chile. The intervention involved a multidisciplinary team composed of 49 health care professionals providing personalized treatment plans over 4 months (32 sessions for physical therapy, 8 sessions for occupational therapy, 4 sessions for nutrition, 8 sessions for psychology, and 4 sessions for nursing and podiatry). This program also included 2 medical evaluations (at the beginning and the end) to monitor clinical progress in terms of motor function and mental health, using the Berg Balance Scale and Beck Depression Inventory, respectively. The home-based rehabilitation program showed significant improvements (P<.001) in motor function and balance with a reduction in fall risk. Specifically, the Berg Balance Scale score decreased close to 15% after the home-based rehabilitation program for all enrolled participants. On the other hand, depression levels showed no significant changes (P=.27), with percentages of variation less than 8% between the 2 assessed conditions. In this sense, participants remained with the same mild depression level (14 of 63) concerning the Beck Depression Inventory score. This study concludes that personalized home-based rehabilitation programs are effective in enhancing motor function and balance, particularly in individuals with neurological conditions. On the other hand, the findings in terms of mood advocate for further exploration of psychological support within such programs to enhance overall patient well-being. ClinicalTrials.gov NCT06537791; https://clinicaltrials.gov/study/NCT06537791.

SPECIFICITIES OF PHYSICAL DEVELOPMENT OF CHILDREN WITH CEREBRAL PARALYSIS IN A FAMILY-ORIENTED MODEL OF INTERVENTIONS

Families with a child with cerebral palsy (CP) face a number of medical, economic, legal, educational and psychological problems from the moment of birth. The main responsibility for the child's development lies with families, as it is there that key aspects of the child's personality are formed. There is a clear dependence of a child's psychological and physical health on the psychological climate of the family. Children with such disorders need to be provided with favorable conditions that will help compensate for the consequences of their disabilities. They need the support of qualified specialists and, most importantly, a warm and friendly attitude from their parents and the environment [1]. It should be emphasized that there are a number of factors that contribute to the psychological maladjustment of children with cerebral palsy in the family environment, which should be known to the child's relatives. First and foremost, it is the inadequate assessment of physical and mental development by parents, as well as the psychological atmosphere in the family. These factors cause deformation of the child's psyche and complicate his or her social adaptation, and negatively affect motor activity and treatment and rehabilitation processes. There are two sides to this situation: on the one hand, parents who find it difficult to understand the complexity of the situation and the child who needs special care, treatment and education. Physical rehabilitation requires the active participation of the person being rehabilitated, but with children, especially young children, this process is too complex for quality rehabilitation and requires the participation of parents. It is also important to take into account the role of the family in the development of motor skills, as it helps to integrate therapeutic techniques into the child's daily life. The aim of the study was to analyze the latest research and approaches to determine the peculiarities of cooperation between a physical therapist and families raising children with cerebral palsy. Using the Internet search databases and the bibliosemantic method, the peculiarities of applying a family-centered approach, motor training, principles of neuroplasticity and home exercise programs to improve the motor activity of children with cerebral palsy were determined. This article describes some peculiarities of physical therapist's work with patients suffering from cerebral palsy. The peculiarity is that these patients are children and when working with children, unlike adults where motivation comes first, intervention approaches in children are formed on the basis of pleasure. Accordingly, various specialists should be involved at all stages to ensure the normal functioning and development of the child. However, the role of parents in this process remains no less important, as they should be the main link that connects these processes for the well-being of the child. The review analyses research on motor training and home exercise programs. The family-centred approach to physical rehabilitation for children with cerebral palsy emphasizes the role of the family as a key factor in achieving goals and improving the child's quality of life. Involving the family in physical therapy helps to integrate therapeutic techniques into the daily life of the child and his or her family. Conclusions. The family-centred approach is characterised by the active participation of the family in the rehabilitation process. This is important because the family plays a crucial role in supporting and motivating the child during treatment. This approach not only provides treatment, but also provides the family with the knowledge, skills and resources to continue to help the child in their daily lives. This approach aims not only to improve the child's functioning, but also to help the child become part of the wider family and social environment. This promotes greater integration and independence. Thus, the family-centred approach to physical rehabilitation of children with cerebral palsy demonstrates the importance of family support and integration during treatment, contributing to the comprehensive improvement of both the physical and psychosocial condition of the child.

IMPROVEMENT OF THE QUALITY OF LIFE OF PATIENTS WITH CONCUSSION BY MEANS OF PHYSICAL THERAPY

Brain concussion from blast waves is one of the most common injuries in combat. This injury is three times more common than wounds. Blast wave brain concussion has significant consequences and impairs the quality of life for an indefinite period of time, so the use of physical therapy to improve the quality of life of patients with its consequences is an urgent issue. Purpose to prove the effectiveness of physical therapy in improving the quality of life of patients after blast concussion. Methods. To achieve the aim of the study, the scientific literature was analyzed and information was systematised using electronic databases such as PubMed, Google Scholar and others. To assess: sleep function, the Insomnia Severity Index (ISI) was used; pain perception, the Visual Analogue Scale (VAS) and the Verbal Rating Scale were used; changes in emotional functions, the Wessman-Ricks Emotional State Self-Assessment (WESA) was used; and quality of life, the Health Survey (SF-36 v2) was used. Research results. The initial treatment of concussion is of great importance and includes a number of important aspects that can be performed by a first responder. Since concussion leads to partial or complete disability and largely results in disability, which leads to other problems at different levels, the prerequisites for developing a physical therapy programme aimed at improving the quality of life of patients were the selection of ICF components appropriate to the patients' condition. The physical therapy programme was individualised, tailored to each patient individually, taking into account their condition and wishes, with special attention paid to the primary tasks of pain relief and normalisation of sleep function, which is key to reducing all other consequences of concussion and improving the quality of life. After the implementation of the proposed physical therapy programme, patients in the main group improved their sleep, decreased their pain levels and improved their emotional state. All indicators at the end of the study were better in the main group than in the control group, although at the beginning of the study the indicators in both groups did not differ significantly. Comparison of the results of the SF-36 v2 Health Survey proves the effectiveness of the developed physical therapy programme in combination with conventional treatment of blast injury. Conclusions. The results of the study proved the positive impact of the physical therapy programme for patients with blast concussion, which took into account the patient's condition and wishes, and whose primary objectives were to stop the manifestation of pain and normalise sleep function, actively involve the patient in the rehabilitation process through Pilates, Yoga, Nordic walking and an obstacle course with a sports focus. Motivation for action and normalisation of the emotional state are important during the rehabilitation period. The combination of active activities with massage therapy, namely Thai traditional massage, Thai foot massage, Tibetan singing bowl massage and Rebozo massage, contributed to general relaxation, reducing the effects of stress, muscle and emotional stress, harmonising the emotional state, improving blood circulation and restoring all body systems.

РЕАБИЛИТАЦИОННАЯ РОЛЬ ПАТОЛОГИЧЕСКИХ РЕФЛЕКСОВ

In most post-stroke patients, an increase in muscle tone on the hemiplegic side is accompanied by a revival of tendon reflexes and an expansion of their reflexogenic zone, as well as the appearance of specific abnormal reflexes. All these signs have long been considered when diagnosing damage to the pyramidal system in diseases of the spinal cord and brain, but their rehabilitation significance has not yet been considered. Based on literature data, the clinical and neurophysiological characteristics of known abnormal reflexes were assessed. It is concluded that it is possible to use lively tendon reflexes, as well as tonic reflexes of the foot and hand (Babinsky and its analogues, Mayer's, Klippel – Feil, Larry`s reflexes) in rehabilitation practice. The role of phasic abnormal hand and foot reflexes (Rossolimo's sign and its analogues) in the rehabilitation process is considered insignificant due to their short duration.

From passenger to driver: an interview study on person-centeredness in clinical reasoning during stroke rehabilitation

Purpose To explore how stroke survivors experience and prefer to participate in clinical reasoning processes in the subacute phase of stroke rehabilitation. Methods An explorative qualitative design was used. Individual interviews were conducted with 10 stroke survivors (4 women and 6 men, mean age 68 years) 4 weeks after their stroke, and follow-up interviews were conducted with 6 of them after 10 weeks. The interview settings were the patient’s home during their home rehabilitation, an inpatient and an outpatient rehabilitation unit. A reflexive thematic analysis was performed. Results Four themes were identified: discharge as a critical point for participation, describing a stressful time with varying involvement; supportive actions and context as crucial for participation, describing collaboration with the stroke team, the team’s consideration of the stroke survivor’s resources and needs, and a supportive home environment; the importance of goals and follow-up, describing goals as motivational and an unstructured use of goals; and difficulties in participation, describing a lack of dialogue with the stroke team and undetected resources and needs. Conclusions The stroke survivors experienced changes in their participation in the clinical reasoning process as their rehabilitation progressed. They moved from perceiving themselves as passengers at the time of their hospital discharge to gradually seeing themselves as the driver of their rehabilitation process. Some person-centered attributes, such as respectful relationships and a health focus, were incorporated into the clinical reasoning, while others, such as a holistic view and shared goal-setting, required further emphasis for improved person-centeredness in stroke rehabilitation.

Externalities on The Conversion of Mangrove into Salt Pond in Bipolo Village, Sulamu District, Kupang Regency, East Nusa Tenggara

The utilization of mangrove forest land for the expansion of salt pond areas with the aim of increasing salt production in Bipolo Village causes the loss of economic value of marine biota in the mangrove ecosystem. Mangrove ecosystem resources that are utilized as salt ponds if not accompanied by a rehabilitation process will cause a decrease in the function of the mangrove ecosystem. This will later become a challenge as well as create externalities that need attention from the Kupang district government in regulating the utilization of the mangrove ecosystem in Bipolo Village. This study aims to analyze the positive and negative externality values ??resulting from the development of salt pond businesses in Bipolo Village, Sulamu District, Kupang Regency. To determine the positive and negative externality values ??using the economic valuation method. Based on the results of the study, it is known that the salt pond business in Bipolo Village provides a negative externality value of Rp. 21,439,466,084 and a positive externality value of Rp. 235,280,000 which means that the opening of salt pond land has caused losses from the ecological side of the mangrove which is quite large compared to the benefits obtained.

FAMILY-ORIENTED PHYSICAL THERAPY PROGRAM FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS

Family-centered physical therapy programs for children with autism involve the child, family members, and professionals working together. They aim to provide support, education, and resources that enable the family to understand and cope with the special needs associated with the rehabilitation of a child with autism. By involving the entire family in the therapy process, such programs help improve communication, enhance the quality of life for the entire family, help the child develop skills to participate in various activities with peers, strengthen family ties and provide a more holistic approach to child care. Aim. To substantiate the structure and program of family-oriented physical therapy for preschool children with autism spectrum disorders (ASD). Materials and methods. Analysis of literature sources, including clinical guidelines and recommendations, as well as scientific research on the rehabilitation of patients with autism spectrum disorders; systematic analysis and synthesis, methods of analogy, abstraction and generalization. The experience of rehabilitation and physical therapy of children with ASD, gained by the NGO Agape, which is engaged in the rehabilitation and habilitation of children with disabilities in Khmelnytskyi, was also taken into account. Results. A child's atypical development and disabilities affect the entire family. Caregivers and family members may develop feelings of vulnerability and guilt, or they may feel unable to care for their child. In addition, the patient-centered and biopsychosocial approach assumes that decisions about therapy are made by caregivers, as they are the best experts on their needs and abilities. There has also been a shift in emphasis from impairment of body structures and functions to the child's participation in family life and activities with the family, as well as from what the child cannot do to what the child can do. Supporting the child and family through this complex process of rehabilitation and physical therapy with this in mind, and recognizing the family's interests and values, is crucial and helps families feel stronger and more confident as they face daily challenges. Family-centered physical therapy takes all of these approaches into account. Family-centered physical therapy is a set of activities aimed at involving the family and the family environment in the child's physical therapy process to provide support, necessary skills and resources to both the patient and the family at each stage of therapy, ensuring the best possible results. All phases of physical therapy involve the child and family members in the evaluation, goal and objective setting, education, implementation of the planned intervention program, counseling and monitoring, and adjustment of the goal, objectives and physical therapy program. Conclusions. Family-centered service programs encourage therapists to move from focusing on an isolated impairment and the needs of the child alone to understanding disability within the social model of services and the context of the family and community. A family-centered physical therapy program for children with ASD involves close collaboration between physical therapists, the child, and parents and other family members. This ensures an individualized approach to therapy, increased effectiveness of the sessions, and improved quality of life for the child and the entire family. Active involvement of parents and providing them with the knowledge and skills to conduct sessions at home helps to achieve sustainable results in the child's development and strengthens family ties, increasing the overall level of satisfaction.

CURRENT TRENDS IN THE REHABILITATION OF PATIENTS WITH LOWER LIMB AMPUTATION

Amputation of a lower limb is a serious intervention that has a profound impact on a person's life and ability to work. The loss of a limb often causes significant physical and psychological changes that require comprehensive rehabilitation. The patient faces new physical limitations, such as loss of mobility, changes in balance and the need to adapt to prostheses. According to a report by the Wall Street Journal, since the beginning of the Russian-Ukrainian war, the number of people in need of amputation in Ukraine has risen to levels not seen since the First World War. The publication estimates that between 20,000 and 50,000 Ukrainians have lost one or two limbs. Therefore, the study of current trends in the rehabilitation of patients with lower limb amputation in the context of war in Ukraine is extremely relevant. Purpose. To analyse and systematise current trends in the rehabilitation of patients with lower limb amputation. Materials and methods. To achieve the objectives of the study, the researchers analysed scientific literature and systematised information using electronic databases such as PubMed, Google Scholar and others. Research results. Today, physical therapy for patients with lower limb amputation is characterised by a combination of traditional rehabilitation methods and innovative approaches. Kireev and others developed an algorithm that includes rehabilitation activities at 4 main stages. Preoperative rehabilitation, stage I, is aimed at improving postoperative outcomes. It has been suggested that the preoperative programme used in the treatment of young patients with lower limb amputation should consist of chest physiotherapy, muscle and joint mobility training, focusing on maintaining strength and function. During the second stage, before prosthetics, the rehabilitation process includes the aforementioned therapeutic gymnastics and physiotherapy, as well as massage and kinesiotaping. Important issues in preparing an amputated stump for prosthetics include preparing the postoperative wound and scar, controlling edema, preventing muscle atrophy, and preventing the formation of contractures in the joints of the amputated lower limb. In addition to the above-mentioned traditional methods, innovative approaches are actively used at the stage of training with a prosthesis: robotic prostheses, biofeedback technologies, and VR technologies. Giacomo Valle's research has shown that the use of a robotic prosthesis in combination with biofeedback technology not only increases the patient's movement speed, but also increases his or her confidence. Research by Rami L. Abbas demonstrated the feasibility of using VR technologies, which showed a significant improvement in the balance markers, TUG, DGI and BBS tests (P &lt; 0.05). Lifelong rehabilitation, stage IV, involves monitoring the patient for psychosocial adaptation, stump skin pathologies, pain, musculoskeletal disorders, cardiovascular diseases, other chronic diseases, health, and ensuring the use of appropriate footwear for the contralateral limb. Conclusions. Thus, the current trends in combining traditional methods with innovative approaches in the rehabilitation of patients with lower limb amputation are appropriate and justified. It is through the use of therapeutic gymnastics, massage and kinesiotaping in combination with the use of biofeedback technologies, robotic systems and virtual reality that the best results are achieved.