Physiotherapy Sessions Research Articles

Effect of Botulinum Toxin Type-A on Improvement of Muscle Function of Lower Limb in Children with Spastic Cerebral Palsy

Background: Spasticity significantly contributes to the functional and postural impairments in children with cerebral palsy (CP), leading to limitations in daily independence, participation, and quality of life. Botulinum Toxin-A (BTX-A) is recognized as an effective treatment for improving outcomes related to spasticity in individuals with CP. Objectives: This study aimed to evaluate the impact of BTX-A treatment on lower limb muscle function in children with spastic CP who were unable to complete physiotherapy sessions due to muscle spasms. Methods: This cross-sectional study reviewed the medical records of 24 children with CP (14 boys, 10 girls; average age: 4.50 ± 2.70 years) who had received BTX-A injections. We recorded demographic characteristics, types of muscle dysfunction, and the number of muscles involved. BTX-A injections were administered at a dosage of 5 units/kg across multiple sites. The severity of spasticity (measured using the Ashworth scale) and motor performance (assessed by the ability to walk and stand) were evaluated 30 days after the BTX-A injection. Satisfaction levels of surgeons, physiotherapists, and parents, along with final functional outcomes, were also gathered. Data analysis was performed using SPSS. Results: The most common movement disorders observed were equinus, knee flexion, and adduction. The median score on the Ashworth scale significantly decreased (P < 0.001) following BTX-A injection. There was a notable improvement in walking and standing performance (P < 0.05), particularly among boys aged 3 years or younger (P < 0.05). Most cases showed satisfactory outcomes 30 days after BTX-A injection. Significant enhancements in the functional outcomes of children with CP were noted after a 30-day follow-up, with no significant differences related to gender, age, or the muscles involved (P > 0.05). Conclusions: The findings suggest a substantial reduction in spasticity and enhancement of functional outcomes in children with cerebral palsy after BTX-A injections. This improvement was especially evident in boys and younger children with fewer muscles involved, accompanied by notably satisfactory outcomes.

Predictive Factors for Physiotherapy Session Length at an Adult Intensive Care Unit: A Longitudinal Panel Study

ObjectiveTo identify predictive factors for the length of physiotherapy sessions for adult intensive care unit (ICU) patients. DesignLongitudinal panel study. SettingICU of a secondary-care public teaching hospital, the University Hospital at the University of Sao Paulo, Brazil. ParticipantsMedical and surgical patients who received physiotherapy (N=181) assessed in 339 physiotherapy sessions.Interventions:Not applicable. Main Outcome MeasuresThe study investigator followed physiotherapists during their work shift and timed the physiotherapy session's length with a stopwatch. The association between session length and patient, physiotherapist, and service-related factors was evaluated by a mixed model. ResultsAssessed in this study were 339 physiotherapy sessions during 79 periods of observation that involved 181 patients and 19 physiotherapists. Median session length was 29 (interquartile range: 22.6-38.9) minutes; median number of patients assisted per physiotherapist per 6-hour shift was 5 (4-5). Physiotherapist's median age was 35 (26-39) years old, and median ICU experience was 13.0 (0.4-16.0) years. Patients were mostly older adults who were post surgery and had been at the ICU for 5 (2-9) days. Factors associated with physiotherapy session length (min) were the following: performing both motor- and respiratory-related physiotherapy procedures during the session (β=6.5; 95% confidence interval [CI], 3.8-9.2), altered chest x-ray (β=2.8; 95% CI, 0.3-5.3), ICU mobility scale (IMS) (β=1.2; 95% CI, 0.4-2.0), contraindication to any level of out-of-bed mobilization (β=–6.9; 95% CI, –10.5 to –3.3), afternoon shift (β=–4.0; 95% CI, –6.7 to –1.4), and Barthel index (β=–0.2; 95% CI, –0.3 to –0.1). ConclusionsThe factors associated with longer session lengths were performing both motor- and respiratory-related physiotherapy procedures during the session, altered chest x-ray, and the IMS. Contraindication to any level of out-of-bed mobilization and sessions performed during the afternoon shift (vs the morning shift) were associated with shorter session lengths.

DIAGNOSIS-RELATED BELIEFS OF FILIPINOS WITH CHRONIC BACK PAIN: A QUALITATIVE STUDY

Introduction: Patient education is needed in the effective management of chronic low back pain (CLBP). To be effective, education resources need to target key beliefs and attitudes around back pain. This study aimed to explore the diagnosis-related beliefs of Filipinos who are seeking treatment for CLBP. The specific objective is to explore patients’ understanding of their diagnoses and their beliefs about how health care professionals might help them. Methods: We used a qualitative research design with an interpretive description approach. We conducted a semi-structured phone interview strategy, using piloted questions. Patients’ understanding of diagnosis and their beliefs was explored using a thematic analysis. We had seven adult participants with non-specific CLBP of at least three months duration attending physiotherapy sessions at the Department of Rehabilitation Medicine outpatient clinic of a tertiary teaching hospital in Metro Manila. To the researchers’ judgement, these selected participants could provide information-rich data, communicate experiences and opinions in an articulate (self-reported ability to understand, speak and write in Filipino), expressive and reflective manner. Results: The analysis of data identified four themes with subthemes related to information that clinicians need to understand and consider when developing effective educational resources for patients with CLBP: (1) Beliefs about causes of back pain; (2) Experience of Back Pain; (3) Actions & Responses to Back Pain; and (4) What might help. Discussion: The overall finding of this study is that many of the beliefs and experiences in this group of Filipinos with back pain are similar to those from other populations and some of the findings were somewhat unique or at the least nuanced to Filipinos with back pain. One of the themes that appeared more unique to these participants were the beliefs about cold and damp weather causing back pain. These beliefs appear to inform the choices of treatment – hot pack, liniments, and avoidance behavior described by the participants in relation to cold weather. Another unique theme that emerged in this study is the role of faith and religion in managing back pain. Participants from this study appeared to portray prayer as a potential form of therapy to manage back pain rather than as a form of coping mechanism. When developing education resources for patients with CLBP, clinicians may consider integrating information that matches the beliefs and understanding of Filipinos with CLBP to make the education resources more suitable, relevant, and fit to the Filipino context.

Effectiveness of Chest Physiotherapy in Broncho Pulmonary Clearance in Respiratory Distress Neonates

Purpose: Globally, the mortality rate of respiratory distress has been quite high due to unability to maintain oxygenation and overcome abnormal work of breathing. Chest Physical therapy, apart from providing advantageous outcomes to the adults, chest physical therapy is pivotal for newborns too but differs in terms of physiology and anatomy. Various chest physiotherapy techniques including percussions, vibrations, and compressions are quite effective in reducing mortality rate in neonates.Many studies has been conducted worldwidely, but still there has been limited data in Pakistan about the effect of bronchopulmonary clearance in neonatal intensive care unit, so this study was conducted to find the effectiveness of chest physiotherapy in neonatal intensive care unit
 Materials and Methods: This was the non-randomized controlled trial study conducted in tertiary care hospital of karachi , Pakistan. Total 40 samples collected through convenient based sampling were included in this study . The inclusion criteria including gestational age more than 37 weeks with atelactasis, mucous plugging, airway compromised, intubated or extubated, hospital admission, and chest complications where as exclusion criteria included cardiopulmonary instability, post surgery, pre term, intra ventricular hemmorage, fits or epilepsy, failure to thrive, and on consistent feed. Bronchopulmonary Clearance techniques such as Percussions , Compressions, and Vibrations along with suctioning and postural drainage were performed routinely twice daily session one in morning and one in evening was performed for total 14 days which means total 28 sessions of chest physiotherapy was implemented and chest xray, sp02, Heart rate, and respiratory rate was measured pre and post the sessions.
 Findings: The mean age of the participants were 37.050±5.57, out of which 20(52.5%) were females and 19(47.5%) were males. Result showed that post chest xray after chest physiotherapy was .2500±.49355 and post session spo2 was 2. .075 ± 4.56513. The chest physiotherapy was statistically significant in mucociliary clearance, lung expansion, preventing atelectasis, airway clearance, and other chest complications (0.008).
 Implications to Theory, Practice and Policy: Limitations of this study were that small sample size was taken, and data was collected from one tertiary care hospital of Karachi so it doesn’t showed generalization. Further studies in terms of large sample size are required for validity and reliability of this research.

The Role of Motion Sensitivity and Headaches on Vestibular Rehabilitation Outcomes in Pediatric Vestibular Migraines.

To determine the utility of the motion sensitivity quotient (MSQ) in diagnosing pediatric vestibular migraine (VM) and to characterize the role of motion sensitivity and headache control on vestibular rehabilitation (VR) outcomes in pediatric VM. Retrospective cohort analysis. Pediatric tertiary referral center. Children (≤18 years old) with dizziness who completed vestibular testing from January 2016 to August 2022, diagnosed with either VM or another vestibular disorder. VR, which included MSQ testing. Initial MSQ, number and duration of vestibular physical therapy (PT) sessions, PT goals met, and posttreatment MSQ. Two hundred fifty-seven patients met study criteria. MSQ was not a reliable diagnostic marker in pediatric VM as there was no difference in initial MSQ between VM and non-VM patients (9.4 vs. 7.8 in non-VM, p = 0.014). Both VM (n = 116) and non-VM (n = 141) patients demonstrated significant improvement in MSQ after VR (p = 0.004). However, VM patients tended to be less likely to meet at least one PT goal (60 vs. 77% in non-VM, p = 0.016, d = 0.37), although not significant. VM patients with more frequent headaches had significantly higher initial MSQ (p = 0.008). VM patients with more frequent headaches or higher initial MSQ tended to require increased number and longer duration of VR (small/medium effect size although not statistically significant after Bonferroni correction). VR is an effective treatment for both VM and non-VM pediatric patients. VM patients, especially those with severe motion sensitivity or poorly controlled headaches, may be less responsive to VR and may require increased frequency and duration of VR. Our findings propose the importance of counseling pediatric patients with severe motion sensitivity or uncontrolled migraines regarding realistic expectations of their VR course.

Investigation of the barriers to and functional outcomes of telerehabilitation in patients with hand injury

BackgroundTelerehabilitation is an approach that is growing in importance and rapidly becoming more prevalent. However, the potential barriers to this approach and its effectiveness relative to face-to-face treatment still need to be determined. PurposeThe aim of this study was to investigate the technology and access barriers, implementation and organizational challenges, and communication barriers faced by patients undergoing postoperative telerehabilitation after hand tendon repair surgery. It also aimed to investigate the effect of telerehabilitation on pain, kinesiophobia, and functional outcomes. Study designProspective, open-label, nonrandomized comparative clinical study. MethodsThe study was conducted with 44 patients who underwent tendon repair surgery due to tendon injuries of the extrinsic muscles of the hand. Participants were divided into two groups (face-to-face group and telerehabilitation group). All participants received three physiotherapy sessions per week for 8 weeks from their surgery (via video conference using mobile phones to the telerehabilitation group). An early passive motion protocol was applied for flexor tendon and zone 5-7 extensor tendon repairs. Mallet finger rehabilitation was performed for zone 2 extensor tendon repairs, while an early active short arc approach was used for zone 3-4 repairs. The telerehabilitation and face-to-face groups received the same treatment protocols three times a week. In the eighth week of treatment (in the 24th session), the Turkish version of the Arm, Shoulder, and Hand Injury Questionnaire (DASH-T) and Tampa Scale for Kinesiophobia were administered to all patients. The telerehabilitation group also underwent a barrier questionnaire. A pretreatment assessment could not be conducted. The independent-sample t-test was used for DASH-T data, and the Mann-Whitney U-test was used for Tampa Scale for Kinesiophobia to compare groups. ResultsIn the study, there were 24 participants (age: 31.58 ± 12.02 years) in the face-to-face group and 20 participants (age: 39.25 ± 12.72 years) in the telerehabilitation group. The two groups were similar in terms of DASH-T and pain (p = 0.103, effect size = 0.647, and p = 0.086, effect size = 0.652, respectively) in the 8 weeks. However, the telerehabilitation group had a higher fear of movement (p = 0.017, effect size = 3.265). The most common barriers to telerehabilitation practices were the fear of damaging the tendon repair and the need for help during the treatment. ConclusionsWe determined that face-to-face treatment in acute physiotherapy for patients who have undergone tendon repair may be more effective compared to telerehabilitation, as it appears to be less likely to induce kinesiophobia. However, in situations where face-to-face treatment is not possible (such as lockdown), telerehabilitation can also be preferred after at least one in-person session to teach and perform exercises.

Comparison of Task-Oriented and Bobath-Based Trunk Training on Balance, Functional abilities and Walking in Ischemic Stroke Patients

Aim: To determine the outcome of task oriented and bobath based trunk training on balance in ischemic stroke patients Study design: Randomized controlled trial Place and duration: Physical Therapy department, Younas health care Hospital Shahdara Methodology: Sixty-six patients rewarding the inclusion and exclusion criteria were assigned in two groups, Group 1 and Group 2. Group 1 was given conventional treatment + Task oriented trunk and Group 2 was given receive Convention treatment + Bobath based trunk training. Participants in both groups were joined in a 12-week physiotherapy session that seen three days a weekly for one sixty minute respectively day. They stayed examined at starting point and after the 12-week mark. Berg Balance Scale and Trunk impairment scale were used as outcome measures. Results: The adjustment score of BBS was 8.93 (6.32-11.54) that helps in investigational set (P<0.001). Furthermore, variation score of the Trunk Impairment Scale between the groups was 3.34 (1.48-4.91). It also helps the Task-oriented group with (P<0.001). However, task-oriented approach is more effective. Conclusion: Exercises performed with task-oriented approach are more effective to improve balance and functions of the patients with ischemic stroke as associated to patients who were treated with Bobath approach. Besides, better improvement has been found on purposeful balance suggesting the surplus effects with task-oriented exercise. Keywords: Stroke, Bobath, Task-oriented, Balance

Prevalence of Body Dysmorphic Disorder in Physically Disabled People

Physically disabled people are only observed by their physical functioning where studies showed that their cognitive functioning has generally been ignored. Body dysmorphic disorder (BDD) is a psychological health condition where the people having this disorder cannot accept their flaws or impairment. The prevalence of this disorder is approximately 2% of the population worldwide. The Quality of life is suppressed who are suffering from this disorder. To maintain their quality-of-life people engage in different physical activities and exercises which help them to overcome problems and they can easily take part in activities of daily living. Objective: To identify the prevalence of body dysmorphic disorder among physically disabled persons. Methods: The duration of the study was six months (January 2023 to July 2023) with a sample size of 139 calculated from online open-Epi version 3. Non-probability sampling technique was used for this study. Data were collected from three tertiary care hospitals by using a validated questionnaire appearance anxiety inventory scoring. The data were analyzed by SPSS 23.0 software. Results: The results extracted through the use of anxiety appearance inventory score was; out of 139 participants, the body dysmorphic disorder was found to be present in 38 participants and absent in 101 participants which constituted 27.3% and 72.7% respectively. Conclusions: Body dysmorphic disorder was found in physically disabled patients but persons attending physiotherapy sessions had improved and accepted their condition.

Evaluating the Immediate Effect of Preextubation Chest Physiotherapy Session on Postextubated Physiological and Diagnostic Cardiorespiratory Parameters in Neonates with Pneumonia: A Randomized Controlled Trial

Evaluating the Immediate Effect of Preextubation Chest Physiotherapy Session on Postextubated Physiological and Diagnostic Cardiorespiratory Parameters in Neonates with Pneumonia: A Randomized Controlled Trial

Community directed assessment of pain in a northern Saskatchewan Cree community

ABSTRACT Indigenous Elder advisors in Pelican Narrows, a Cree community in Northern Saskatchewan, have indicated that Western pain scales may not be responsive tools for pain assessments within their community. This study employed a mixed methods research design that involved two phases. Phase one was the development of a pain scale in collaboration with an Elder and a Knowledge Keeper. Phase two was a pilot of the CDPS utilised during virtual physiotherapy sessions for chronic back pain. Twenty-seven participants completed the pre-physiotherapy treatment questionnaires, and 10 participants engaged in semi-structured interviews (9 community members; 1 healthcare provider). A weighted kappa analysis yielded k = 0.696, indicating a good agreement between the CDPS and Faces Pain Scale-Revised in terms of documenting participants’ pain. Qualitative data from interviews with community members revealed three major themes: 1) Learnings Regarding Pain Scales, 2) Patient Centered Care; and 3) Strength-Based Solutions for Improving Pain Communication. Two themes were uncovered through conversations with the HCP: 1) Perspectives on CDPS and 2) Healthcare Provider Experiences Communicating about Pain. Moreover, a patient-centredcentred approach is important to ensure comprehensive pain assessments.

The effects of exergames on upper extremity performance, trunk mobility, gait, balance, and cognition in Parkinson's disease: a randomized controlled study.

In recent years, game-based exercises have been included more in the rehabilitation programs of Parkinson's disease (PD) patients and positive effects have been observed. This study aims to investigate the effects of innovative games particularly designed for neurological patients on upper extremity performance, trunk mobility and cognition in patients with PD. Twenty-three patients were enrolled in this randomized controlled study and randomly allocated into two groups: Exergames Program (EP) and Conventional Exercise Program (CP). Both groups received supervised physiotherapy sessions for 3days a week and 8weeks in total (24 sessions). Each session lasted 1h. Evaluations were applied before and after the treatment: 9-Hole Peg Test (9-HPT), Minnesota Manual Dexterity Test (MMDT), Trunk Impairment Scale (TIS), Montreal Cognitive Assessment (MoCA), Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Timed Up and Go (TUG), Functional Reach Test (FRT), and Parkinson Disease Questionnaire (PDQ-39). Twenty patients were included in the analysis because of the dropouts. Our findings showed that both groups improved significantly in 9-HPT dominant side, MMDT, TIS, MDS-UPDRS, TUG, FRT, and PDQ-39 (p < 0.05). MoCA scores of EP group improved significantly (p < 0.05) while CP group's did not (p > 0.05). It was found that EP group had better improvements in 9-HPT dominant side, MMDT turning test, and MoCA than CP group when the differences in the changes within the groups were compared (p < 0.05). Game-based training can be a useful rehabilitation tool to improve upper extremities performance, trunk mobility, cognition, functional mobility, balance, and quality of life and may have superiority over conventional exercises in improving cognition and upper extremity functions. NCT05235880. Release Date: April 1, 2022.

Effects of anodal tDCS on resting state eeg power and motor function in acute stroke: a randomized controlled trial

BackgroundAnodal transcranial direct current stimulation (tDCS) is a beneficial adjunctive tool in stroke rehabilitation. However, only a few studies have investigated its effects on acute stroke and recruited only individuals with mild motor deficits. This study investigated the effect of five consecutive sessions of anodal tDCS and conventional physical therapy on brain activity and motor outcomes in individuals with acute stroke, with low and high motor impairments.MethodsThirty participants were recruited and randomly allocated to either the anodal or sham tDCS group. Five consecutive sessions of tDCS (1.5 mA anodal or sham tDCS for 20 min) were administered, followed by conventional physical therapy. Electroencephalography (EEG), Fugl-Meyer Motor Assessment (FMA), and Wolf Motor Function Test (WMFT) were performed at pre-, post-intervention (day 5), and 1-month follow-up. Sub-analyses were performed on participants with low and high motor impairments. The relationship between EEG power and changes in motor functions was assessed.ResultsLinear regression showed a significant positive correlation between beta bands and the FMA score in the anodal group. Elevated high frequency bands (alpha and beta) were observed at post-intervention and follow-up in all areas of both hemispheres in the anodal group, while only in the posterior area of the non-lesioned hemisphere in the sham group; however, such elevation induced by tDCS was not greater than sham. Lower limb function assessed by FMA was improved in the anodal group compared with the sham group at post-intervention and follow-up only in those with low motor impairment. For the upper limb outcomes, no difference between groups was found.ConclusionsFive consecutive days of anodal tDCS and physical therapy in acute stroke did not result in a superior improvement of beta bands that commonly related to stroke recovery over sham, but improved lower extremity functions with a post-effect at 1-month follow-up in low motor impairment participants. The increase of beta bands in the lesioned brain in the anodal group was associated with improvement in lower limb function.Trial registration: NCT04578080, date of first registration 10/01/2020.

Optimal Duration of Physical Therapy Following Total Knee Arthroplasty.

The purpose of this study was to identify patient characteristics associated with engagement and completion of physical therapy (PT) following total knee arthroplasty (TKA) and examine the relationship between number of PT sessions attended and outcomes during the first 12weeks after surgery. Patients underwent unilateral primary TKA by a single surgeon and were advised to complete 17 PT sessions over 6weeks at a hospital-affiliated facility. Analyses examined predictors of PT engagement (attendance of ≥2 sessions) and completion (attendance of 17 ± 1 sessions) within 6weeks and associations between number of PT sessions attended and changes in range of motion (ROM) and Knee Injury and Osteoarthritis Outcome Score (KOOS) values. Patients living <40km were more likely to be engaged in PT than those living ≥40km from the clinic (P < .0001). Among patients who completed PT within 6weeks, 95.0%, 85.1%, and 56.4% achieved flexion of, respectively, ≥90°, ≥100°, and ≥110°. Among engaged patients, the active flexion thresholds of ≥90°, ≥100°, and ≥110° were achieved by, respectively, 94.4%, 82.5%, and 58.1% by 6weeks and by 96.7%, 92.1%, and 84.2% by 12weeks. Improvement in KOOS Symptoms (P = .029), Function in daily living (P = .030) and quality of life (P = .031) linearly decreased as number of PT sessions increased. These results raise the question of whether patients who meet satisfactory outcomes before completing 6weeks of prescribed PT and those who attend more PT sessions than prescribed may be over-utilizing healthcare resources without additional benefit.

Multimodal approach to rehabilitating a traumatic brachial plexus lesion in a Thoroughbred yearling

Forelimb peripheral neuropathy is uncommon and is usually caused by traumatic injury to the brachial plexus or nerves arising from it. Common clinical signs include instability of the shoulder, dropped elbow, inability to fully bear weight and difficulty in protraction. A 16-month-old Thoroughbred colt was found non-weight bearing in the field. The horse was referred to the Veterinary Teaching Hospital of the University of Perugia, Italy, after two days of treatment with anti-inflammatory drugs and stable rest without improvement. At admission, the horse was unable to bear weight on the limb. Diagnostic imaging was unremarkable and a diagnosis of brachial plexus injury with major involvement of suprascapular and radial nerves was made. The horse was treated with a combination of drugs, electrical modalities, physical therapy sessions and holistic techniques. Pharmacological treatment included gabapentin, dexamethasone, phenylbutazone and mesotherapy of the shoulder and neck area. Physical treatments, electrical modalities and holistic therapies included neuromuscular electrical stimulation, acupuncture, kinesiology taping, eccentric loading and dynamic mobilization exercises. The horse was discharged from the hospital after 26 days, having fully regained the ability to bear weight on the limb and the ability to walk normally, although a degree of shoulder instability was still present. Follow-up of the case showed that the horse made a full athletic recovery and raced successfully a year after discharge. This multimodal approach to severe peripheral neuropathy responsible for severe lameness resulted in a fast and efficient option for initial recovery while reducing the risk of complications such as contralateral limb laminitis.

Effect of physiotherapy on infertility treatment in polycystic ovary syndrome patients.

Polycystic ovary syndrome (PCOS) is a complex hormonal condition associated with psychological, reproductive, and metabolic features. Low-grade inflammation is a recognised factor causing metabolic and reproductive disorders in PCOS, which is why anti-inflammation approaches in PCOS treatment, especially during the COVID pandemic, are considered. A promising therapeutic option is osteopathic manipulative treatment (OMT), which activates the cholinergic anti-inflammatory pathway and can inhibit proinflammatory cytokines, such as TNF, IL-1β, and TNF-β. In our paper we analysed the influence of OMT in women with PCOS. Seventy-three patients, aged 29-46 years, with a history of reproductive failure, who underwent a physiotherapeutic treatment were evaluated. Six months after the end of a physiotherapy session, a follow-up questionnaire was performed. The results show that most women (83.6%) were satisfied with the therapeutic process, and that the sessions met the patient's expectations. Reducing the level of anxiety related to infertility treatment and pregnancy was declared by 60 (82.2%) women, an improvement in well-being was declared by 72 (97.3%) (p = 0.04), and increasing awareness of the body after physiotherapy sessions was declared by 70 (95.9%) women. The physiotherapeutic sessions improved infertility treatment, enhanced quality of life, and had a positive effect on overall health in PCOS women.

Impact of Focal Muscle Vibration on Flaccid Upper Limb Motor Paralysis following Acute Brain Disease: A Case Study

Focal muscle vibration (FMV) is increasingly being recognized as a rehabilitative therapy for enhancing motor function in central nervous system (CNS) diseases, particularly in patients with fine motor control deficits stemming from CNS damage. Brain lesions from these diseases disrupt the motor networks, necessitating novel rehabilitation strategies. By applying vibrations to muscles, FMV stimulates sensory fibers to induce cortical activity and kinesthetic illusions. While initial studies have highlighted FMV’s role in reducing spasticity, recent evidence points to its potential in treating motor paralysis. However, prior research has been limited by the lack of acute‐phase studies and a focus on patients with minimal muscle contraction capability. This report aimed to explore FMV’s efficacy on upper limb motor function in patients with flaccid motor paralysis immediately after acute CNS diseases. We report the case of a septuagenarian male with a brain abscess in the right parietal lobe, leading to flaccid motor paralysis. Rehabilitation included 28 sessions of occupational and physical therapy that incorporated FMV. Significant improvements were observed in upper extremity function, with moderate to very large effect sizes, while lower limb function showed lesser improvement without adverse effects. This case suggests the utility of FMV in enhancing upper‐limb motor function after acute CNS injuries, potentially serving as a supplementary therapy for spontaneous recovery. This report contributes to emerging evidence on FMV’s benefits in acute flaccid motor paralysis, expanding the documented therapeutic scope.

Coming back for more: factors linked to higher participation among Veterans with chronic pain in an innovative VA-YMCA wellness clinic

In 2019, the Indianapolis VA developed a Wellness Clinic in partnership with the Young Men’s Christian Associations (YMCA) to comprehensively address Veterans’ chronic pain. Our specific aims were twofold: (1)...

Paresis of an upper extremity. Action observation and motor imagery in recovery of patients with chronic stroke

Action observation (AO) and motor imagery (MI) are considered functionally equivalent forms of motor representation related to movement execution (ME). Because of their characteristics, AO and MI have been proposed as techniques to facilitate the recovery of post-stroke hemiparesis in the upper extremities. An experimental, longitudinal, prospective, single-blinded design was undertaken. Eleven patients participated, and were randomly assigned to each study group. Both groups received 10 to 12 sessions of physical therapy. Five patients were assigned to the control treatment group, and six patients to the experimental treatment group (AO + MI). All were assessed before and after treatment for function, strength (newtons) and mobility (percentage) in the affected limb, as well as alpha desynchronisation (8-13 Hz) in the supplementary motor area, the premotor cortex and primary motor cortex while performing AO + MI tasks and action observation plus motor execution (AO + ME). The experimental group presented improvement in function and strength. A negative correlation was found between desynchronisation in the supplementary motor area and function, as well as a post-treatment increase in desynchronisation in the premotor cortex of the injured hemisphere in the experimental group only. An AO + MI-based intervention positively impacts recovery of the paretic upper extremity by stimulating the supplementary motor area, a cortex involved in movement preparation and learning. AO + MI therapy can be used as adjunctive treatment in patients with upper extremity paresis following chronic stroke.

The Interruption of Rehabilitation Following Anterior Cruciate Ligament Reconstruction due to COVID-19 Restrictions: Association With Return-to-Sport Testing.

Among many unanticipated changes, access to rehabilitation was disrupted during the onset of the COVID-19 pandemic. It is unclear how the timing of late-stage rehabilitation following anterior cruciate ligament with surgical reconstruction (ACLR) during the initial months of the pandemic affected outcomes. The purpose of this study was to compare physical performance outcome measures in patients following ACLR prior to and following COVID-19-related restrictions. Retrospective cohort study. Data from patients who underwent return-to-sport testing following ACLR were analyzed based on date. December 2018 through March of 2020 (n = 66) was defined as the baseline period, and June through October 2020 (n = 27) was defined as the surveillance period. Outcome measures included single leg hop, triple hop, single leg vertical jump, and the lower-extremity functional test(LEFT). Linear mixed models were used to compare outcome measures before and after the onset of pandemic-related restrictions, clustered by sex and sport. A 1-way analysis of variance was performed to analyze the association between the number of virtual rehabilitation visits and outcome measures for subjects in the surveillance period. Subjects in the surveillance period performed significantly worse in the LEFT (+7.88s; 95% confidence interval, 1.11 to 14.66; P = .02) and single leg vertical jump on the unaffected side (-4.32cm; 95% confidence interval, -7.44 to -1.19, P < .01), and performed better with single leg vertical jump symmetry (+6.3%; 95% confidence interval, 1.0% to 11.5%; P = .02). There were no other statistically significant differences. There was no significant association between having virtual rehabilitation visits and any of the performance outcomes. There was a decline in physical performance outcome measures in patients following ACLR who did not attend regular in-person physical therapy sessions in the late-stage rehabilitation due to COVID-19-related restrictions. Other factors during this unique time period, such as access to training facilities or psychosocial stressors, may have also influenced outcomes.

Ab. No. 134 Exploring Shared Decision-Making in Pediatric Multidisciplinary Team: A Mixed-Methods Investigation Into the Roles of Children, Caregivers, And Health Care Professionals

Introduction: Pediatric physiotherapy relies on collaborative decision-making among children, caregivers, and healthcare professionals for optimal outcomes. This study addresses the current gap in understanding the dynamics of shared decision-making in this context. Our research focuses on quantitatively assessing the involvement of children, caregivers, and healthcare professionals during pediatric physiotherapy sessions. Through the Shared Decision-Making Questionnaire (SDM-Q-9 and SDM-Q-Doc), we aim to measure the extent of participation and identify factors influencing decision-making roles. Methods: In parallel, semi-structured interviews with 26 participants, including six children, five parents, and 15 healthcare professionals, provide qualitative insights. Results underscore a complex interplay of perspectives, emphasizing the need for inclusivity and effective communication. Children’s limited participation highlights gaps in their care programs, emphasizing the crucial role of caregivers in advocating for the child’s best interests. Semi-structured interviews were conducted with 26 participants (six children, five parents and 15 healthcare professionals), and data analyzed using thematic analysis. Results: Healthcare professionals grapple with the delicate balance between their medical expertise and consensus-building. The study advocates for a collaborative atmosphere, emphasizing that the combined knowledge of children, parents, and medical professionals should inform pediatric healthcare choices, thereby enhancing overall care quality. Educationally, our findings have implications for healthcare training. By identifying key factors influencing decision-making, the study contributes to the development of educational programs that prepare healthcare professionals to navigate shared decision-making effectively. Conclusion: In summary, this study sheds light on the intricate dynamics of shared decision-making in pediatric physiotherapy, emphasizing the importance of a collaborative approach for enhanced patient-centered care. Implications: The findings offer valuable insights for researchers, practitioners, and policymakers, contributing to a more comprehensive understanding of shared decision-making in pediatric healthcare.