Specific Rehabilitation Program Research Articles

Rehabilitation of oncological patients: a comparative analysis of clinical guidelines for managing oncological patients with renal parenchyma cancer, bladder cancer and female cancer in Russia, Europe, and USA

Backround. Current medicine pays significant attention to an integrated approach in managing cancer patients, from the stage of diagnosis to rehabilitation. Sections on rehabilitation have been added to respective guidelines to maintain the proper quality of life of patients and standardization of clinical protocols. Due to the different levels of medicine in Europe, Russia and USA, it is important to analyze guidelines for supporting oncological patients at the rehabilitation stage.Objective: to conduct a comparative analysis of guidelines for managing cancer patients.Material and methods. The search and selection of publications were performed according to PRISMA recommendations. In scientific databases PubMed/MEDLINE, Google Scholar, ScienceDirect, eLibrary as well as via search engines and the Rubricator of Clinical Guidelines of the Ministry of Health of Russia, 725 sources were found. After the selection procedure, 30 publications and guidelines were included in the review.Results. Rehabilitation programs are presented in many Russian, American and European guidelines for the support of cancer patients. In Russian guidelines for managing patients with renal parenchyma and bladder cancer, a significant emphasis is made on the pre-rehabilitation and using fast-track approach. A lot of attention is paid to therapeutic physical culture and instrumental methods. American and European guidelines are more detailed, in particular, protocols for the correction of certain adverse events are presented, psychological assistance and complex rehabilitation play an essential role. The absence of specialized rehabilitation program in Russian clinical guidelines for supporting oncogynecological patients, and universal character of protocols were noted. According to foreign guidelines, the rehabilitation of such patients is multidisciplinary and personalized, and is carried out in specialized centers.Conclusion. The review showed a number of deficiencies in Russian clinical guidelines. In certain documents, due attention is not paid to the provision of rehabilitation. It’s necessary to expand multidisciplinary approach in cancer patients' rehabilitation as well as the evidence base to improve Russian guidelines.

Rehabilitation of patients with vulvovaginal atrophy

Background. Genitourinary syndrome of menopause (GSM) is characterized by a number of pathological changes, in particular urological disorders, vulvovaginal atrophy (VVA) and sexual dysfunction. They are commonly accompanied by decreased quality of life (QoL) and often require medical intervention. At the same time, the steps taken to effectively solve this problem are not enough. Thus, it seems relevant to search for rehabilitation methods for VVA patients.Objective: to determine the effectiveness of current rehabilitation methods for VVA patients.Material and methods. The search of publications in international scientific databases PubMed/MEDLINE, ScienceDirect, search engines and eLibrary revealed 4,330 publications, of them 44 sources were selected for the analysis after the screening procedure according to PRISMA scheme.Results. VVA is based on decreased serum estrogen level and estrogen receptors quantity. Estrogen is a vasoactive hormone that promotes blood supply to the genitals and is involved in maintaining the normal genitourinary microflora. This may occur in women for age-related reasons or as a result of ongoing therapy or radical surgical intervention. At the same time, GSM is often formed, where VVA is one of the key elements. These changes are accompanied by sexual dysfunction, distress and decreased overall QoL in women. It is advisable to carry out complex personalized rehabilitation and QoL monitoring for such patients. The effectiveness of estrogen-containing therapy for topical use as well as adjunctive therapy with non-hormonal lubricants and moisturizing gels or creams was shown for VVA patients.Conclusion. It was determined that VVA symptoms, in general, significantly affect the patients’ QoL, regardless of age. The necessity of developing specialized rehabilitation programs conducted by specialists of various profiles was noted. The effectiveness of these programs will be higher with timely diagnosis, which also requires significant attention.

Beyond Confinement: A Legal Exploration of the Rights of Vulnerable Groups in the Indonesian Correctional System

The Indonesian correctional system, while tasked with upholding justice, grapples with the challenge of safeguarding the rights of vulnerable groups within its confines. This study delves into the legal framework and practical realities concerning the rights of these groups, encompassing women, children, the elderly, and individuals with disabilities, within the Indonesian prison system. The research employs a hybrid methodology, integrating normative legal analysis with empirical insights gleaned from interviews and case studies. The normative legal analysis scrutinizes pertinent laws, regulations, and international human rights instruments to gauge the extent of legal protection afforded to vulnerable groups in the correctional context. The empirical component, through interviews with correctional officers, inmates, and legal experts, sheds light on the lived experiences of these groups and the practical implementation of their rights. The study reveals a complex interplay between legal provisions and ground realities. While Indonesian law enshrines the rights of vulnerable groups, their actualization within the correctional system faces formidable obstacles. Overcrowding, inadequate healthcare, and limited access to rehabilitation programs disproportionately impact these groups, hindering their reintegration into society. In conclusion, our study underscores the imperative of bridging the chasm between legal safeguards and their practical implementation. It advocates for targeted interventions, including enhanced healthcare provisions, specialized rehabilitation programs, and heightened sensitivity training for correctional staff, to ensure the holistic well-being and successful reintegration of vulnerable groups within the Indonesian correctional system.

Finding peace in a new version of oneself- a qualitative study of post operative patients after aorta dissection and their experiences of cardiac rehabilitation

Abstract Background Aortic dissection, characterized by a sudden rupture in the carotid artery allowing blood to enter the aortic wall. The mortality rate is 1% per hour, and half of the patients die within 48 hours. Following surgery, patients are advised to limit arm lifting to 2 kg, maintain strict blood pressure control for life, and engage in physical activities that do not strain the aorta. Despite the limited evidence on optimal rehabilitation, our University Hospital in Denmark has established a team that secure patients with aortic dissection a structured post operative rehabilitation program. Aim This study aims to explore the experiences and importance of a specialized rehabilitation program for individuals post-surgery for aortic dissection. Method A qualitative interview study, analyzed using content analysis inspired by Graneheim & Lundman. Interview participants were recruited through the physiotherapist at the hospital either at the end or shortly after their rehabilitation program. Interviews were conducted over the phone or in a private room at the hospital. Results Based on interviews with eight patients (three women and five men aged 43-73), an overarching theme emerged; "Finding peace in a new version of oneself." This theme encapsulates the journey of adapting to a new identity with a changed body that has limitations, combined with a sense of gratitude for being alive. Three subthemes describe the period from surgery to the end of the rehabilitation course: 1) Surviving the operation - the initial miracle and the subsequent uncertainties, 2) The rehabilitation course enhance a sense of security and well-being, and 3) Reclaiming wholeness. Conclusion A specialized rehabilitation program proves to be a crucial support in helping individuals with aortic dissection find peace in their altered selves after facing a life-threatening trauma. These patients require comprehensive physical and psychological support through cardiac rehabilitation provided by cardiac nurses, along with prompt initiation of specialized rehabilitation led by physiotherapists with expertise in aortic dissection.

Evaluating the Effectiveness of Geriatric-Specific Cancer Rehabilitation Programs on Patient Health Outcomes.

This study evaluated a specialized rehabilitation program's impact on senior cancer patients' quality of life. one hundred and thirty patients aged ≥65 years with various cancer types undergoing/recovering from treatment were enrolled in oncology clinics in Al-Ahsa, Saudi Arabia. The intervention arm (n=65) participated in a tailored geriatric cancer rehabilitation program. The control group (n=65) received standard oncology care. The Functional Assessment of Cancer Therapy-General (FACT-G) tool assessed the quality of life across physical, social, emotional, and functional domains. T-tests and multivariate regression analyses compared outcomes. Total FACT-G scores showed a significantly higher quality of life for the geriatric cancer rehabilitation group versus standard care. Rehabilitation patients also demonstrated meaningful improvements across physical, social, and functional subscales. Rehabilitation involvement was the most predictive factor for optimized outcomes. Specialized geriatric cancer rehabilitation meaningfully improved several quality of life domains in older patients over standard care. Despite persistent barriers, rehabilitation programming optimized older cancer patients' physical and psychosocial health. Oncology and geriatrics must collaborate to ensure evidence-based rehabilitation access meets older cohorts' unique needs.

Changes in fatigue symptoms following an exercise-based rehabilitation programme for patients with long COVID.

There is evidence to support COVID-19 rehabilitation programmes improving persistent COVID-19 symptoms; however, there is concern that therapies that include an exercise component may increase fatigue and post-exertional symptom exacerbation (PESE). The objectives of the present study were to determine the effect of a 6-week COVID-19 rehabilitation programme on fatigue and PESE in individuals with ongoing COVID-19 symptoms. After a routine medical assessment, individuals with persistent COVID-19 symptoms were enrolled on a 6-week COVID-19 specific rehabilitation programme. The programme included symptom-titrated exercise, education and self-management advice. Fatigue was assessed pre- and post-programme using the Functional Assessment Chronic Illness Therapy Fatigue questionnaire (FACIT). Exercise capacity (Incremental and Endurance Shuttle Walking Test (ISWT and ESWT)) and PESE (DePaul Symptom Questionnaire (DSQ)) were also assessed pre- and post-programme. Composite scores were calculated for the frequency and severity domains of the DSQ. 148 patients (median (IQR) age 59 (49-72) years, 82 (55%) female, 81 (54%) hospitalised) completed the COVID-19 rehabilitation programme. FACIT score was reduced pre- to post-programme by a mean (CI) change of -5 (-7- -4); p<0.01. Exercise capacity increased by 82 (65-99) m for the ISWT and 398 (333-462) s for the ESWT (n=148). PESE was assessed in 44 patients. The DSQ frequency and severity composite score improved by 20 (13-28) and 19 (13-26) points, respectively (p<0.01, n=44). These data demonstrate the potential benefits of a COVID-19 rehabilitation programme in improving fatigue, exercise capacity and symptom exacerbation in those with persistent COVID-19 symptoms.

Combination of anodal tDCS of the cerebellum with a goal-oriented motor training to treat cervical dystonia: a pilot case series.

Transcranial Direct Current Stimulation (tDCS) of the cerebellum shows promise for the treatment of dystonia. Specific motor rehabilitation programs have also been developed in this context. However, the combination of these two approaches has not yet been evaluated to determine their therapeutic potential. We report a series of 5 patients with cervical dystonia (CD) poorly controlled by botulinum toxin injections. They were initially treated by a protocol of repeated daily sessions (for 3 or 5 days) of cerebellar anodal tDCS (cer-atDCS) applied alone. In a second time, additional protocols of cer-atDCS were performed in combination with a program of goal-oriented motor training exercises (Mot-Training), specifically developed for the treatment of CD. The clinical impact of the procedures was assessed on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Compared to baseline, the maximum percentage of TWSTRS total score improvement was 37% on average after cer-atDCS performed alone (p = 0.147, not significant) and 53% on average after cer-atDCS combined with Mot-Training (p = 0.014, significant). The TWSTRS pain and functional handicap subscores also improved after the combined protocol. A score of (+3) to (+5) was rated on the TWSTRS response scale after cer-atDCS performed alone or the combined protocol, corresponding to a moderate to striking improvement on dystonia and pain. This improvement lasted longer after the combined protocol than after cer-atDCS alone (3.4 vs. 1.4 months on average, p = 0.011). The combination of cer-atDCS with Mot-Training produced a greater and more prolonged improvement than the application of cer-atDCS alone. Such a combined therapeutic procedure is easy to perform and opens important perspectives in the long-term treatment of CD. These results remain to be confirmed by a randomized sham-controlled trial on a larger sample.

Rehabilitation needs screening to identify potential beneficiaries: a scoping review

ObjectivesThe aim is to identify and compare the content of screening tools and needs assessments used to select rehabilitation beneficiaries and to describe the context of their use.DesignScoping review.Data sourcesWe...

The Complex Role of Botulinum Toxin in Enhancing Goal Achievement for Post-Stroke Patients.

The rehabilitation medical team is responsible for the therapeutic management of post-stroke patients and, therefore, for the complex therapeutic approach of spasticity. Considering the generous arsenal at our disposal in terms of both pharmacological treatment, through the possibility of administering botulinum toxin to combat spasticity, and in terms of accurate assessment through developed functional scales such as the GAS (Goal Attainment Scale), one of our purposes is to monitor the parameters that influence the achievement of functional goals set by patients together with the medical team in order to render the patients as close as possible to achieving their proposed functional goals, thus enhancing their quality of life. By assessing and establishing statistical and clinical correlations between the GAS and quantifiable parameters related to the affected post-stroke upper limb, namely degree of spasticity, motor control, pain level and evolution of pain under treatment with BoNT-A (abobotulinum toxin A), and patients' overall response to BoNT-A treatment, we aim to quantify the improvement of the therapeutic management of post-stroke patients with spasticity and develop a more personalized and effective approach to their disability and impairment. The analysis concluded that there were two independent predictors of the Achieved GAS-T score (the study's endpoint parameter) motor control at any level of the upper limb and number of prior BoNT-A injections. The number of prior BoNT-A injections was an independent predictor of Achieved GAS-T score improvement but had no significant influence over Baseline GAS-T score. Enhancement in proximal and intermediate motor control showed a GAS score improvement of 3.3 points and a 0.93-point GAS score improvement for wrist motor control progress. From a separate viewpoint, patients with motor deficit on the left side have shown significantly greater improvement in Changed GAS-T scores by 2.5 points compared to patients with deficits on the right side; however, we note as a study limitation the fact that there was no statistical analysis over the dominant cerebral hemisphere of each patient. Improvement in the Achieved GAS-T score means better achievement of patients' goals. Thus, after the BoNT- A intervention, at follow-up evaluation, GAS was found to be directly correlated with improvement in motor control of the affected upper limb. Mobility of the corresponding limb was enhanced by pain decrease during p-ROM (passive range of motion) and by amelioration of spasticity. We conducted an observational, non-randomized clinical study on 52 stroke patients, a representative sample of patients with post-stroke spasticity and disability from our neurological rehabilitation clinic, who have been treated and undergone a specific rehabilitation program in our tertiary diagnostic and treatment medical center, including BoNT-A focal treatment for spasticity in the affected upper limb. The primary objective of the study was to assess the influence of abobotulinum toxin A treatment on the Goal Attainment Scale. Secondary objectives of the study included the assessment of BoNT-A treatment efficacy on spasticity with the MAS (Modified Ashworth Scale), pain with the NRS (Numerical Rating Scale), and joint passive range of motion (p-ROM), identifying demographic, clinical, and pharmacological factors that influence the response to BoNT-A treatment, as well as to conduct a descriptive and exploratory analysis of the studied variables.

Sexual Functioning and Sexual Health in Female Patients following Stroke: A Scoping Review with Implications for Rehabilitation.

The impact of stroke on the sexual functioning of female survivors can arise from direct neurological effects or be triggered indirectly through various psychophysiological processes. Although an increasing number of publications exist, the topic of sexuality remains seldom discussed in the stroke literature, even though patients have expressed a need for sexual rehabilitation services. A literature review on sexual functioning in post-stroke females examining existing rehabilitation programs addressing patients' sexuality and exploring the perspectives of nurses and caregivers on sexual issues constitutes a novel approach. Therefore, we conducted a scoping review to better investigate this hot topic. Studies were identified by searching Scopus, PubMed, Web of Science, Cochrane Library, PsychINFO, and Embase databases. Current data indicates substantial connections between stroke and female sexual dysfunction (SD), including factors like desire/libido, sexual satisfaction, and sexual intercourse. Some intervention programs have been created to provide specific guidance to healthcare professionals in addressing patients' requirements for sexual recovery, although their adequacy remains uncertain. However, to date, there are neither specific rehabilitation programs for post-stroke female SD nor healthcare personnel trained to deal with post-stroke sexual issues adequately and efficiently. The incorporation of sexual rehabilitation into the overall rehabilitation process for stroke patients is crucial, ideally within an interdisciplinary framework. Despite being a fundamental aspect of post-stroke women's lives, sexuality remains taboo.

ACROMORFO study: gait analysis in a cohort of acromegalic patients

PurposeIn acromegaly, skeletal complications resulted to be associated with low quality of life (QoL) and high risk of falls. The aim of the present study was to perform a quantitative assessment of movement through gait analysis technique in patients with acromegaly.Study populationThirty-three acromegalic patients [9 with active disease (AD), 14 with controlled disease (CD) and 10 with disease remission (RD)] and 20 healthy subjects were enrolled for the study.MeasurementsKinetic and kinematic data were collected with 3D-gait analysis. Kinematic data were processed to compute the Gait Profile Score (GPS), a parameter that summarizes the overall deviation of kinematic gait data relative to unaffected population.ResultsThe acromegalic group showed longer stance phase duration (p < 0.0001) compared to controls. The GPS and several gait variable scores resulted to be statistically higher in the acromegalic group compared to healthy controls. GPS values were significantly higher in AD compared to CD (p < 0.05) and RD groups (p = 0.001). The AD group presented significantly higher values in terms of hip rotation and ankle dorsiflexion compared to CD and RD groups and with regard to the foot progression compared to RD. Interestingly, patients with RD exhibited a more physiological gait pattern.ConclusionAcromegalic patients showed quantitative alterations of gait pattern, suggesting instability and increased risk of falls. Arthropathy, along with its associated abnormal joint loading, proprioceptive impairment and hyperkyphosis could be contributing factors. Disease control and remission appear to improve postural balance. A better knowledge on walking performance in acromegaly would help to develop specific rehabilitation programmes to reduce falls’ risk and improve QoL.

Outcome of severe COVID-19: spotlight on fatigue, fatigability, multidomain complaints and pattern of cognitive deficits in a case series without prior brain dysfunction and without COVID-19-related stroke and/or cardiac arrest

BackgroundPopulation-wide surveys and large-scale investigations highlighted the presence of cognitive deficits in the acute and postacute stages of severe COVID-19; a few studies documented their occurrence in cases without prior or COVID-19-related brain damage. The evolution of cognitive deficits in the latter population and their relationship to the post-COVID-19 fatigue syndrome are poorly understood.Case presentationWe report the outcome at 12 months after severe COVID-19 involving an intensive care unit stay and mechanical ventilation in six (five Caucasian and one Asian) patients (age range: 53–71 years, mean age 61.7 ± 6.5 years) without history of prior brain dysfunction and without stroke and/or cardiac arrest during or after COVID-19. All patients reported pervading mental and physical fatigue as well as numerous multidomain complaints, which impacted everyday life. Individual patients described mental fatigability, apathy, and/or anxiety. Standardized neuropsychological tests revealed isolated symptoms of cognitive dysfunction or performance at the lower limit of the norm in the attentional, executive, and/or working memory domains in four of the six patients. Somatic scales documented dyspnoea, muscle weakness, olfactory disorder, and/or minor sleep problems in some, but not all, patients.ConclusionFatigue, fatigability, multidomain complaints, cognitive difficulties, or dysfunction, as well as isolated neurobehavioral and/or psychiatric and/or somatic symptoms, tend to occur in the aftermath of severe COVID-19 and persist at 12 months, even in the absence of prior and/or COVID-19-related brain damage. This clinical situation, which impacts everyday life, calls for a detailed investigation of patients’ complaints, its neural underpinning, and an elaboration of specific rehabilitation programs.

Driving under the influence of alcohol and alcohol use disorder: the relevance of early identification from an Italian retrospective outpatient study.

Worldwide, almost 1.2 million people drive under the influence of alcohol. However, early identification of alcohol use disorder (AUD) in subjects driving under the influence (DUI) of alcohol is seldom achieved. The aim of our retrospective study is to investigate the presence of AUD in a population of DUI subjects who had their driving license suspended, and if they were following a specific rehabilitation program. 750 subjects were retrospectively enrolled from 2018 to 2021. DSM-V to assess AUD was used. Forty-eight (6.4%) subjects presented a diagnosis of AUD, after one month they showed a statistically significant reduction of carbohydrate-deficient transferrin (CDT) (p<0.0001); however, none were following a program for the treatment of AUD. This outpatient setting may be considered a place of primary and secondary prevention where DUI subjects with a diagnosis of AUD may be entrusted to a Centre in order to follow rehabilitation treatment.

Feasibility of a Novel Geriatric Rehabilitation Program for People With COPD-induced Malnutrition and Muscle Wasting: A Qualitative Study.

Background and Purpose: Patients with COPD-induced malnutrition and muscle wasting are often frail. Consequently, traditional rehabilitation may be even counterproductive due to energy costs and there is a need for specialized rehabilitation programs, which are lacking for these patients. We developed such a program, which includes resistance training, following Nonlinear Periodized Exercise principles and physical energy management, in combination with a restriction of physical activities. The purpose of the study was to investigate the feasibility and the potential effects of this program. Methods: Patients who are eligible for the program are those with COPD gold III/IV and a fat free mass index below standard. We conducted a qualitative feasibility study and interviewed both patients and healthcare professionals (HCPs), using a deductive approach. The open interviews were qualitatively analyzed focussing on six areas of Bowens' feasibility model: acceptability, demand, implementation, practicality, limited efficacy, and integration. Results and discussions: Seven patients and seven HCPs were interviewed. For patients, key factors that helped to adhere to the program were knowledge about energy management, alternative skills to cope with COPD, and social support. They found the program beneficial. However, several patients considered a limitation of walking and ADL activities challenging. HCPs considered the program feasible and beneficial especially for those patients who accept they need a behavior change and who adhere to the program. For HCPs, key factors were the consistent approach and coaching skills of the multidisciplinary team members, and the monitoring role of the nurses. The limitation of physical activity and endurance training deviates from existing geriatric rehabilitation programs which propagate functional activity and training. Still, evidence from the current study suggests that our tailored approach for these patients might be more appropriate and also potentially effective without harm for physical function. Conclusions: Our novel, multidisciplinary rehabilitation program is considered feasible and clinically relevant by both patients and healthcare professionals. The next step is to explore its effects on muscle strength, physical functioning, and quality of life.

Community Reentry Program: A Therapeutic Management

ABSTRACT Community Re Entry Program (CREP) is a specialized rehabilitation program for individuals with mental disorders, recovering from mental illness. This program is specifically designed to develop and integrate the skills that enable individuals to relearn the skills necessary to fully participate in activities of daily living successfully and return to home or community.

Structural and pathophysiological muscle changes up to one year after post-stroke hemiplegia: a systematic review.

Muscle changes after stroke cannot be explained solely on the basis of corticospinal bundle damage. Muscle-specific changes contribute to limited functional recovery but have been poorly characterized. We conducted a systematic review of muscular changes occurring at the histological, neuromuscular and functional levels during the first year after the onset of post-stroke hemiplegia. A literature search was performed on PubMed, Embase and CINHAL databases up to November 2022 using a keyword combination comprising cerebral stroke, hemiplegic, atrophy, muscle structure, paresis, skeletal muscle fiber type, motor unit, oxidative stress, strength, motor control. Twenty-seven trial reports were included in the review, out of 12,798 articles screened. Structural modifications described on the paretic side include atrophy, transformation of type II fibers into type I fibers, decrease in fiber diameter and apparent myofilament disorganization from the first week post-stroke up to the fourth month. Reported biochemical changes comprise the abnormal presence of lipid droplets and glycogen granules in the subsarcolemmal region during the first month post-stroke. At the neurophysiological level, studies indicate an early decrease in the number and activity of motor units, correlated with the degree of motor impairment. All these modifications were present to a lesser degree on the non-paretic side. Although only sparse data concerning the subacute stage are available, these changes seem to appear during the first two weeks post-stroke and continue up to the third or fourth month. Considering these early pathophysiological changes on both the paretic and non-paretic sides, it seems crucial to promptly stimulate central and also peripheral muscular activation after stroke through specific rehabilitation programs focused on the maintenance of muscle capacities associated with neurological recovery or plasticity.

Adherence of females to Fitcor’s cardiopulmonary and metabolic rehabilitation program during 34 years

Introduction: In recent decades the number of deaths from heart disease among women in Brazil has increased a lot considerably, however those who accumulate more risk factors do not practice physical exercises. Objective: to investigate the adherence behavior of women aged between 12 and 80 years, to a specialized cardiac prevention and rehabilitation program (CPRP). Method: This cross-sectional descriptive study was carried out in a clinic specialized in cardiology diagnosis and CPRP between 1972 and 2006. Patients were separated into two groups, prevention (PG) and rehabilitation (RG) after physical evaluation and diagnosis. Both groups of women were separated by age and by the date of beginning CPRP. Results: Based on the entry diagnosis in the records of 958 women who attended the CPRP, we identified that 655 of them were in the prevention group (PG) and 303 in the rehabilitation group (PG). In both groups, the adherence to the program decreased with advancing age and worsening of risk factors. Conclusions: Contrary to the increase on statistics of women victims of cardiovascular diseases in Brazil, the number of those who seek CPRP through physical exercises has decreased and, what is worse, the number or places that facilitate women’s access to this type of intervention has also decreased.

Shoulder Pain Biomechanics, Rehabilitation and Prevention in Wheelchair Basketball Players: A Narrative Review

Wheelchair basketball (WB) is an increasingly popular sport that guarantees numerous health benefits for people with disabilities who regularly practice it, such as an improved quality of life and psychophysical well-being. However, WB is a contact and high-stress sport, which exposes players to frequent overloads and injuries, mainly affecting the upper limbs. Therefore, shoulder pain (SP) is the most common musculoskeletal disorder among WB players, forcing them to suspend or abandon this sport activity. This narrative review aims to summarize all the known literature on this topic and to be a starting point for further research. Firstly, it explores the biomechanical causes that lead to SP and the underlying diseases, among which the most recurrent are rotator cuff tendinopathies. Furthermore, this overview deepens the most effective and specific rehabilitation programs for SP in WB players and it emphasizes the need for further studies to trial new rehabilitative protocols using novel technologies to make them faster and more personalized. In this regard, the general recommendation still remains to perform a combination of exercises such as strengthening, endurance and stretching exercises of various durations and intensities. To conclude, the most important prevention strategies are described, underlining the need for constant sport-specific training led by qualified personnel and suggesting some insights on possible new research aimed at improving wheelchair ergonomics, stressing the importance of a multidisciplinary team fully dedicated to the individual athlete.

Pulmonary recovery directly after COVID-19 and in Long-COVID

Permanent impairment in patients after SARS-CoV-2 infection is frequent, but neither pathophysiology nor mechanisms of the so-called Post-COVID-Syndrome (Long-COVID) are well understood. We present data on pulmonary impairment, pulmonary recovery and outcome comparing patients admitted to a specific COVID-19 rehabilitation program directly after COVID-19 infection with patients long after COVID-19 infection. Diagnostic work up included echocardiography, cardiopulmonary exercise testing and pleural sonography. The rehabilitation program included multimodal respiratory therapy, endurance and resistance muscular training, psychological assistance, and educational measures. Patients in both groups showed similar pulmonary problems. Diaphragm dysfunction was common in both groups. Cardiopulmonary exercise testing showed dysfunctional breathing in most patients of both groups. The specific rehabilitation program applied yielded marked improvements with satisfying pulmonary recovery in both groups. Return to work was possible or expected in most patients. In conclusion, directly after COVID-19 infection as well as in long Covid 4–20 months after COVID-19 dysfunctional breathing patterns in cardiopulmonary exercise testing and diaphragm dysfunction on ultrasound are common and need diagnostic awareness and therapy measures. Specialized rehabilitation programs directly after COVID-19 as well as for Long-COVID patients are effective therapeutic options.

Does Anterior Cruciate Ligament Reconstruction with a Hamstring Tendon Autograft Predispose to a Knee Valgus Alignment on Initial Contact during Landing? A Drop Vertical Jump Movement Analysis

The mechanism most correlated with anterior cruciate ligament (ACL) tears is the simultaneous valgus and external rotation of the knee. This study investigated if ACL reconstruction with a hamstring tendon autograft predisposes to “knee-in &amp; toe-out” compared to ACL reconstruction with a patellar tendon autograft and to healthy individuals during a drop vertical jump. A three-dimensional markerless motion capture was used to conduct a case control study, collecting data from 11 healthy participants and 14 participants who underwent ACL reconstruction, 8 with a hamstring tendon autograft and 6 with a patellar tendon autograft, while performing a bilateral drop vertical jump. Joint kinematic variables such as angular positions, moments and velocities were obtained by processing video recordings with the Theia Markerless system and Visual3D. Differences between groups were calculated using the independent Sample T-test and One-Way ANOVA with Bonferroni post hoc adjustments. No significant differences were found at the peak knee valgus for the maximum valgus (mean difference (md): −2.14 ± 1.57 deg, t (23): 0.171, p = 0.187, d = 0.548), rotation (md: 1.04 ± 1.97°, t (23): 0.001, p = 0.601, d = 0.214) and flexion (md: −10.29 ± 11.82°, t (23): 0.917, p = 0.393, d = 0.351) of the knee, when comparing healthy participants with those who underwent ACL reconstruction. Vertical ground reaction forces were significantly higher in the healthy group when compared to the ACL reconstruction group (md: 20.11 ± 6.29 N/kg, t (23): 1.264, p = 0.049, d = 0.836). The knee extension angular moment and angular velocity were significantly higher for the healthy participants, when compared to participants who underwent ACL reconstruction with a patellar tendon autograft (md: 0.65 ± 0.18 Nm/kg, F (2.22): 7.090, p = 0.004, d = 0.804; md: −111.51 ± 38.31°/s, F (2.22): 4.431, p = 0.024, d = 1.000, respectively). ACL reconstruction with a hamstring tendon autograft does not increase the risk of a valgus knee alignment movement on initial contact during landing. Differences found in various parameters may justify the evaluation of the quality movement with a motion capture system while performing the drop vertical jump for the creation of specialized rehabilitation programs.