Structured Rehabilitation Program Research Articles

A CASE OF PARTIAL PROXIMAL AVULSION OF THE RECTUS FEMORIS MANAGED CONSERVATIVELY WITH GOOD FUNCTIONAL OUTCOME

Proximal rectus femoris avulsion is an uncommon injury that is usually seen in athletes, particularly in the Western population. While the existing literature largely focuses on surgical treatment as the main approach, growing evidence suggests that conservative management for these injuries can also be effective. Such injuries are rarely associated with non-sport activities and have not been documented in the Indian population to date. In this report, we present a case of partial proximal avulsion of the rectus femoris that was managed conservatively with a structured rehabilitation programme, leading to good functional outcome.

The Benefits of a Rehabilitation Program Following Medial Patellofemoral Ligament Reconstruction

The medial patellofemoral ligament (MPFL) is critical for patellar stability. This study investigates the efficacy of a one-year physical therapy rehabilitation program following MPFL reconstruction using Synthetic Graft (SG) and Quadriceps Tendon Autograft (QTA). Thirty-five patients aged 18–38 underwent MPFL reconstruction (20 SG, 15 QTA). They participated in a structured rehabilitation program to improve their range of motion (ROM), muscle strength, pain management, and overall quality of life (QoL). The program included physiotherapy and MLS laser, Game Ready Therapy, EMS, TENS, TECAR, and lymphatic drainage. Before and after the program, assessments included knee flexion and extension using goniometry, muscle strength via the Medical Research Council (MRC) scale, knee circumference, pain intensity on the Visual Analogue Scale (VAS), and QoL with the EQ-5D instrument. Significant improvements were observed in knee flexion (37.57° vs. 114.71°, p < 0.001), muscle strength (MRC scale 1–4 points vs. 4–5 points, p < 0.001), and pain reduction (VAS 6.66 vs. 0.46, p < 0.001). The functional coefficient of mobility and QoL scores also markedly increased. Patients with QTA improved some parameters better than those with SG. These findings support the effectiveness of a comprehensive rehabilitation program in enhancing knee functionality, reducing pain, and improving QoL post-MPFL reconstruction. Personalized rehabilitation protocols are recommended to optimize recovery outcomes.

Mechanisms and benefits of cardiac rehabilitation in individuals with stroke: emerging role of its impact on improving cardiovascular and neurovascular health.

Human and animal studies have demonstrated the mechanisms and benefits of aerobic exercise for both cardiovascular and neurovascular health. Aerobic exercise induces neuroplasticity and neurophysiologic reorganization of brain networks, improves cerebral blood flow, and increases whole-body VO2peak (peak oxygen consumption). The effectiveness of a structured cardiac rehabilitation (CR) program is well established and a vital part of the continuum of care for people with cardiovascular disease. Individuals post stroke exhibit decreased cardiovascular capacity which impacts their neurologic recovery and extends disability. Stroke survivors share the same risk factors as patients with cardiac disease and can therefore benefit significantly from a comprehensive CR program in addition to neurorehabilitation to address their cardiovascular health. The inclusion of individuals with stroke into a CR program, with appropriate adaptations, can significantly improve their cardiovascular health, promote functional recovery, and reduce future cardiovascular and cerebrovascular events thereby reducing the economic burden of stroke.

A RANDOMIZED CONTROLLED TRIAL INVESTIGATING PATIENT RECOVERY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION UNDERTAKEN WITH A QUADRICEPS VERSUS HAMSTRINGS TENDON AUTOGRAFT

INTRODUCTION & AIMS Anterior cruciate ligament (ACL) tears are common. However, a lack of high-quality evidence exists comparing different graft options in patients undergoing surgical reconstruction (ACLR). This randomized controlled trial (RCT) investigated the course of recovery in patients undergoing ACLR with either a quadriceps (QT) or hamstrings (HT) tendon autograft. METHODS This study randomized 112 patients to one of the two graft reconstruction cohorts (HT=55, QT=57), subsequently undergoing ACLR and a structured rehabilitation program. Patients were assessed pre-surgery and at 6 weeks and 3, 6, 12 and 24 months, with a range of patient-reported outcome measures (PROMs) including the International Knee Documentation Committee form (IKDC) and the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score. Graft laxity, peak isokinetic knee extensor and flexor strength and a 6-hop performance battery were assessed. Limb Symmetry Indices (LSIs) were calculated. RESULTS All PROMs significantly improved (p<0.0001). Apart from the ACL-RSI score which was significantly better (p<0.05) in the HT group at 3, 6 and 12 months, no other group differences (p>0.05) were observed. No group differences (p=0.407) were observed for knee laxity. While the HT group demonstrated significantly greater (p<0.05) quadriceps strength LSIs at 6 and 12 months, the QT group demonstrated significantly greater (p<0.05) hamstrings strength LSIs at 6, 12 and 24 months. The HT group demonstrated significantly greater (p<0.05) LSIs for the single horizontal (6 months), lateral (6 and 12 months) and medial (6 months) hop tests. CONCLUSION The HT group reported a higher level of psychological readiness to return to sport, while demonstrating greater quadriceps strength (and hop test) LSIs. Greater hamstring strength LSIs were observed for the QT cohort. Longer-term review will continue to evaluate RTS and later-stage re-injury between the two graft constructs.

A RANDOMIZED CONTROLLED TRIAL INVESTIGATING FUNCTIONAL RECOVERY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING A SINGLE VERSUS DOUBLE TENDON HARVEST

INTRODUCTION & AIMS Anterior cruciate ligament (ACL) tears are common. While surgical reconstruction (ACLR) is commonly advocated and a hamstring autograft is the popular choice, hamstring tendon harvest has been linked to reduced hamstring strength and ongoing donor site pain. While traditional surgical techniques required a harvest of both semitendinosus/gracilis tendons, modern harvesting and fixation methods permit a shorter, broader harvest of semitendinosus only. This study investigated donor site pain, strength and functional recovery in patients undergoing ACLR via a single (ST) versus dual (DT) tendon hamstring harvest. METHODS This prospective randomized controlled trial (RCT) allocated 138 patients to ACLR with one of the two hamstring tendon graft options (ST=71, DT=67) followed by a structured rehabilitation program. Patients were assessed pre-surgery and at 3, 6, and 12 months, with a range of patient-reported outcome measures (PROMs) including a validated donor-site morbidity score. Graft laxity, peak isokinetic knee extensor and flexor strength and a 6-hop performance battery were assessed. Limb Symmetry Indices (LSIs) were calculated. RESULTS All PROMs significantly improved (p<0.0001) and were largely similar between groups (p>0.05), apart from significantly less graft morbidity reported in the ST group (p=0.001). No group differences were observed for knee laxity or LSIs for hop measures (p>0.05), nor the LSIs for peak knee flexor (p=0.113) or extensor (p=0.286) torque. CONCLUSION While the ST ACLR group reported significantly less harvest site morbidity, no other subjective or functional differences were observed in patients undergoing ACLR with either a single or dual hamstring tendon autograft harvest.

Intramedullary Kirschner Wire Fixation for Metatarsal Fractures: A Comprehensive Review of Treatment Outcomes.

Metatarsal fractures pose significant challenges in orthopedic practice, necessitating effective treatment methods to ensure optimal patient outcomes. This comprehensive review focuses on intramedullary Kirschner wire fixation as a promising intervention for metatarsal fractures. Beginning with an overview of metatarsal fractures and the imperative for effective treatments, the review delves into intramedullary fixation's definition, historical background, advantages, and disadvantages. Indications for its use in metatarsal fractures are discussed, providing a foundation for understanding its application. The surgical technique section outlines critical aspects, including patient selection criteria and preoperative planning. Before presenting a detailed step-by-step procedure for intramedullary Kirschner wire fixation, anesthesia considerations are explored. Emphasizing precision, fluoroscopic guidance, and meticulous postoperative care, this section provides insights for surgeons and healthcare practitioners. Considerations for rehabilitation follow, addressing postoperative care, expected recovery timelines, and physical therapy recommendations. Early mobilization, weight-bearing guidelines, and a structured rehabilitation program play pivotal roles in recovery. In the conclusion, key findings are summarized, highlighting the efficacy of intramedullary Kirschner wire fixation, its advantages, and recommendations for clinical practice. Additionally, areas for future research are identified, guiding further exploration and refinement of this surgical approach. This review is valuable for clinicians, researchers, and healthcare practitioners involved in metatarsal fracture management, contributing to the evolution of treatment strategies and improving patient care.

The Effects of Six Weeks Pulmonary Rehabilitation on Functional and Psychological Outcomes in Long-COVID Patients: Preliminary Results from Serbian Single Center Study.

Background and Objectives: In this study, we aimed to evaluate the effects of six weeks of pulmonary rehabilitation on functional and psychological outcomes in long-COVID patients. Material and Methods: The prospective clinical study included 46 patients that were diagnosed with COVID-19. A respiratory rehabilitation program was implemented for six weeks. Further valuables were tested before the beginning of the rehabilitation program (admission) and six weeks after (discharge): SpO2, heart rate, respiratory rate, Visual Analogue Scale (VAS) score, Borg score, Sit-to-Stand (StS) test number of repetition, distance of 6-Minute Walking Test (6MWT), Patient Health Questionnaire (PHQ) 9 score and Generalized anxiety disorder (GAD) anxiety score. These parameters were tested before the rehabilitation program on admission and at discharge and after the rehabilitation program on admission and at discharge. The results were presented with standard descriptive and analytical methods. Differences between the continuous variables before and after physical rehabilitation intervention were tested using the Wilcoxon test. Graphical analysis is presented with a box plot. Results: On discharge, in comparison with admission, the values of SpO2 were significantly lower (p = 0.007) before the 6MWT, and VAS scores were significantly higher (p = 0.036), while after the 6MWT, VAS scores were significantly lower (p < 0.001) as were Borg scores (p = 0.016). On discharge, in comparison with admission, the respiratory rate was significantly higher (p = 0.005) before the StS test, and Borg scores were significantly lower (p = 0.001), while after the StS test, SpO2 levels were significantly higher (p = 0.036) and VAS scores were significantly lower (p < 0.001), as were Borg scores (p = 0.008). After discharge, the values of the StS test were significantly higher (p = 0.011), PHQ9 scores were significantly lower (p < 0.001) and GAD anxiety scores were significantly lower as well (p = 0.005), while the distances measured in meters on the 6MWT were significantly increased (p < 0.001). Conclusions: A structured rehabilitation program in our study was shown to have beneficial effects on physiological, psychological and functional improvements in patients with long-COVID, and therefore it is advisable for these patients.

Effectiveness of High Load Plantar Fascia Resistance Training among Athletes with Plantar Fasciitis

Background: Plantar fasciitis is a common condition characterized by pain and inflammation in the plantar fascia,a thick band of tissue that runs along the bottom of the feet, connecting the heel to the toes. It is particularlyprevalent among athletes who engage in activities that involve repetitive impact, such as running, jumping.Athletes with plantar fasciitis often undergo a structured rehabilitation program that incorporates high loadresistance training alongside other interventions such as stretching, massage, orthotic devices, and modificationsin training and footwear.Purpose: To compare the effectiveness of High Load Plantar Fascia Resistance Training with ultrasound andIntrinsic Muscle strengthening with ultrasound among athletes with Plantar Fasciitis.Materials and Methods: Total of 60 subjects were selected from Sri Sai Ortho General Clinic based on the selectioncriteria and randomly divided into two groups; High load plantar fascia resistance training (HLST) with ultrasound(n=30) and Intrinsic muscle strengthening with ultrasound (n=30). The subjects were assessed for pain intensityusing NPRS and using LEFS, for pre and post-test values. The interventions were given for 2 weeks. Study period: November 2022 to March 2023Result: The result of the study revealed that both exercises are effective but (HLST) with ultrasound was moreeffective and significant in terms of decreasing pain and improving functional mobility.Conclusion: Hence the study concludes that HLST was more effective in managing plantar fasciitis in terms ofboth relieving pain as well as functional mobility among athletes with plantar fasciitis.

Knee-Related Quality of Life Compared Between 20 and 35 Years After an Anterior Cruciate Ligament Injury Treated Surgically With Primary Repair or Reconstruction, or Nonsurgically

Background: Quality of life (QoL) is affected up to 5 years after an anterior cruciate ligament (ACL) injury. Knee impairment and osteoarthritis (OA) development increase over time, and this may affect QoL at a long-term follow-up. Purpose: To investigate changes in health- and knee-related QoL between 20 and 35 years after ACL injury and compare it between patients treated with or without ACL surgery, as well as to study how symptomatic OA (SOA) is associated with change in QoL. Study Design: Cohort study; Level of evidence, 2. Methods: Between 1980 and 1983, 139 patients with acute ACL rupture were allocated to surgical or nonsurgical treatment of the ACL. Both groups completed a structured rehabilitation program. Of those patients, 59 were followed for 20 and 35 years after ACL rupture. After 10 crossovers, 33 patients were treated with primary repair or ACL reconstruction, and 26 were treated without ACL surgery. Combined radiographic OA and knee symptoms at 35 years was defined as SOA. QoL was assessed at 20 and 35 years after injury with the Knee injury and Osteoarthritis Outcome Score QoL (KOOS-QoL) subscale (range, 1-100), ACL-QoL questionnaire (total score and 5 subscales; range, 1-100), European QoL–5 Dimensions Questionnaire, and visual analog scale. Results were analyzed with paired and independent-sample t tests and chi-square tests. Results: Knee-related QoL was impaired at both 20 and 35 years after ACL injury, and differences were dependent on the measurement outcome. In the total cohort, KOOS-QoL did not change but both total ACL-QoL score (7.1 points; 95% CI, 2.2-11.9) and 4 of 5 subscales (5-10 points) decreased (P < .05). No differences were found between treatment groups. QoL decreased overall in patients with SOA, with a 21-point difference within-group change in KOOS-QoL (SOA or non-SOA) between 20 and 35 years of follow-up (P = .001; Cohen d = 1.0). Conclusion: An ACL injury impairs knee-related QoL for up to 35 years, with no difference between treatment approaches (initial repair or later reconstruction compared with nonsurgical treatment). The deterioration decreases with longer follow-up. Clinicians should be aware of differences in QoL depending on the measurement outcome.

Minimally invasive techniques for treating proximal humerus fractures: a clinical case analysis case presentation

Background: Proximal humerus fractures are prevalent among elderly patients, particularly those with osteoporosis, and are traditionally managed with open reduction and internal fixation (ORIF). However, ORIF can be associated with significant surgical trauma, increased risk of complications, and prolonged recovery. Minimally invasive techniques, such as percutaneous fixation, have emerged as viable alternatives, promising reduced surgical disruption and faster recovery. This study evaluated the efficacy and safety of minimally invasive techniques for treating proximal humerus fractures. Case Presentation: A 68-year-old female with osteoporosis sustained a comminuted proximal humerus fracture following a fall. Radiographic imaging revealed a Neer type II fracture with significant displacement. Given the patient&amp;apos;s age and bone quality, a minimally invasive approach was selected. The patient underwent percutaneous fixation using locking plate and screws, with real-time fluoroscopic guidance to ensure precise fracture reduction and stabilization. Postoperative management included pain control and a structured rehabilitation program. At follow-up, the patient demonstrated satisfactory fracture healing and functional recovery. Conclusion: The use of minimally invasive techniques for managing proximal humerus fractures in elderly patients with osteoporosis offers significant advantages, including reduced surgical trauma, lower risk of complications, and accelerated recovery. This case underscores the efficacy of percutaneous fixation in achieving stable fracture repair and favorable outcomes, supporting its role as a viable alternative to traditional surgical methods. Continued research and clinical application are necessary to further refine these techniques and optimize patient care.

Osteochondral Fragment Fixation in Transient Patellar Dislocation of an Adolescent: A Case Report

Osteochondral Fractures (OCFs) of the patella are common in adolescents due to ligament laxity and weak osteochondral junctions. OCFs following patellar dislocation are particularly challenging in this age group. Magnetic Resonance Imaging (MRI) aids in comprehensive evaluation, and surgical fixation with bioabsorbable sutures is a reliable treatment option. Early intervention and proper rehabilitation are essential to ensure optimal outcomes and prevent long-term complications. The present case report details the presentation, diagnosis, surgical intervention and outcome of a 16-year-old male with an OCF following patellar dislocation. Examination revealed significant ligament laxity and patellar hypermobility, along with patella alta (Insall-Salvati ratio of 2.1) on the affected side. The neurovascular examination was normal. Initial X-rays showed no abnormalities; however, Computed Tomography (CT) and MRI scans revealed a displaced OCF fragment in the anterior intercondylar region, along with lateral patellar tilt, marrow contusion, chondral delamination and partial thickness tearing of the Medial Patellofemoral Ligament (MPFL). Surgical intervention involved open reduction and internal fixation using absorbable Vicryl sutures. Postoperatively, the patient was immobilised for six weeks, followed by a structured rehabilitation program. The patient achieved a full range of motion and restored knee function within six months, with satisfactory radiographic and functional outcomes. At the latest follow-up, the knee range of motion was from 0 degrees of extension to 130 degrees of flexion, with complete pain alleviation. OCFs of the patella in adolescents require timely diagnosis and intervention to prevent degenerative changes. MRI is essential for evaluating soft tissue injuries. Surgical fixation using bioabsorbable sutures provides effective treatment, offering strong fixation without the need for implant removal. Addressing associated injuries, such as MPFL tears, is crucial to prevent recurrent dislocation.

Rethinking recovery: rehabilitation and intra-abdominal pressure management to reduce the risk of parastomal hernia.

Julie Mills, RN, Global Ostomy Nurse Engagement Manager, Convatec, writes that parastomal hernia is a common and consequential complication of stoma surgery, but the risk can be reduced with a structured rehabilitation programme based on appropriate core abdominal exercises, supported by the full multidisciplinary team.

Comparison of telerehabilitation methods for patients with systemic sclerosis in the COVID-19 Era: A randomized controlled study

Study DesignThis was a single-blinded randomized clinical trial. IntroductionSystemic sclerosis (SSc) is an autoimmune connective tissue disease that progresses with fibrosis. Patients with SSc need to be protected against epidemic diseases and provided for in terms of rehabilitation needs. Purpose of the StudyTo compare the effects of real-time telerehabilitation (RTT) and asynchronous telerehabilitation (AT) on individuals with SSc. MethodsForty-two participants with SSc with a mean age of 44.17 ± 11.05 years were included in the study. The patients were randomly divided into three groups, RTT (n = 16), AT (n = 16), and control (n = 16) groups. A structured rehabilitation program was performed in real-time (RTT group) and asynchronously (AT group) for 40 minutes per day, in three sessions per week for 8 weeks. The participants' finger and wrist joint range of motion (ROM), upper extremity functions, grip strength, superficial sense of touch, activities of daily living (ADL), and general health status were assessed at baseline and after treatment. ResultsAfter 8 weeks, there were improvements in finger ROM (effect size [ES] = 0.23 to 0.60), wrist ROM (ES = 0.45 to 0.83), upper extremity functions (ES = 0.61 to 1.00), and ADL parameters (ES = 0.74) in the RTT group (p < 0.05). Also, there were improvements in finger ROM (ES = 0.16 to 0.45) and hand functions (ES = 0.54 to 0.55) in the AT group (p < 0.05). The RTT and AT groups had better hand functions and finger ROM than the control group in (p < 0.05). In addition, the RTT group had better wrist ROM than the control group (p = 0.008). RTT was superior to AT only in lateral pinch strength (p = 0.025). DiscussionExperimental groups achieved a statistically significant change in ROM, upper extremity functions and ADL over time in concordance with prior investigations. Changes in grip strength, superficial sense of touch, and general health status scores differed from previous investigations and the between-group comparison was not statistically significant. ConclusionsBoth RTT and AT may be effective in individuals with SSc, and RTT has additional benefits.

Barriers and facilitators of cardiac rehabilitation uptake and completion in south Asian minorities: a meta-synthesis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation is a proven modality to prevent future cardiac events and complications in cardiac patients. However, the uptake and completion rate are suboptimal in cardiac patients and even worse in ethnic minorities and women. South Asian minorities experience several barriers and facilitators to cardiac rehabilitation uptake and completion. Aim To develop a comprehensive understanding of barriers and facilitators to cardiac rehabilitation uptake and completion by South Asian minorities. Methods A meta-synthesis was conducted, and findings were reported using PRISMA guidelines. The following databases: Medline, Embase, APA PsycInfo, Cochrane Database of Systematic Review, CINHAL, Scopus, and Web of Science were searched from inception to July 2022. The inclusion criteria comprised the studies that focused on South Asian adult minorities’ barriers and/or facilitators of a structured cardiac rehabilitation program. Studies were critically appraised using the Mixed Methods Appraisal Tool. Thematic synthesis was used in the analysis. Results A total of 7110 records were retrieved and eight studies from Canada and United Kingdom met the inclusion criteria. There were more identified barriers than facilitators. Communication constraints resulted in inadequate health education, while conservative socio-religious beliefs, negative attitudes about healthcare professionals, and systemic constraints (e.g., transportation problems, and work schedule concerns) were the key barriers themes. Peer and family support and patient-preferred specific mechanisms for cardiac rehabilitation implementation were substantial facilitators. Conclusion South Asian minorities experience multilevel barriers and facilitators to cardiac rehabilitation uptake and completion. Further research with a robust and culturally contextual intervention and methodology can help improve the uptake and cardiac rehabilitation completion in this population. Healthcare professionals and policymakers can utilize these findings to develop tailored cardiac rehabilitation programs for South Asian minorities.

PENATALAKSANAAN FISIOTERAPI PADA KASUS SINDROM OBSTRUKSI PASCA TUBERKULOSIS PARU : STUDI KASUS

Introduction : Tuberculosis is a pathological condition caused by the bacterium Mycobacterium tuberculosis. Even though it has been treated, sometimes pulmonary TB cases still leave sequelae called TB sequelae. Improper management of TB sequelae can increase the risk of mortality. Thus, it is necessary to have a structured rehabilitation program in cases of TB sequelae.&#x0D; Purpose : to determine the effect of physical therapy exercise on the management of TB sequelae cases.&#x0D; Methods : Research method using a case report.&#x0D; Outcome measurement: measurement of sputum using auscultation, muscle spasm using palpation, examination of lung volume capacity using Voldyne and peak flow meter, examination of thoracic cage expansion using the midline.&#x0D; Results: after 5 times of therapy, there was decreasing sputum volume, decreasing spasm of the accessory muscles of breathing, improve thoracic expansion, and improve lung volume capacity.&#x0D; Conclusions: Administration of programmed exercise in cases of TB sequelae can increase lung volume and increase thoracic expansion.

Assessing the need for rehabilitation programme for individuals living with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Saudi Arabia cultural Bureau. Introduction Individuals living with Atrial Fibrillation (AF) can experience a variety of symptoms such as palpitation, dyspnea, fatigue and dizziness which lead to reduced physical activity levels and quality of life.(1) Current management of AF mainly focus on pharmacological treatments and invasive procedures, while no routine prescription of exercise or rehabilitation programme is offered. Aims To understand the severity of symptoms that individuals with AF may experience and their preference of a structured rehabilitation programme. Methods A cross-sectional survey was conducted through the phone and face to face between 20th of September and 20thof December 2021 for individuals with documented AF. The survey included fifteen multiple-choice closed questions and free text spaces for additional comments. Results Overall, 50 individuals (54% male, mean (SD) age 62 (15) years) with a clinical diagnosis of AF were approached and participated in the study. The majority of participants reported they had a severe shortness of breath 27 (54%) and 25 (50%) reported a severe levels of anxiety related to living with AF. In addition, 20 (40%) reported a severe levels of tiredness and 20 (40%) demonstrated a mild palpitations. Moreover, 8 (16%) reported a severe feeling of faint or lightheaded, while chest pain was the least symptom which only 3 (6%) rated it as a severe. (Figure 1). 47 (94%) of participants reported their desire to participate into a programme which could help managing their symptoms, and 35 (70%) reported their preference to receive the programme at home, while 30 (60%) reported a preference for a web-based rehabilitation programme with support from healthcare professionals (HCPs). (Figure 2). Conclusion The responses indicate a need for a rehabilitation programme for individuals living with AF. Shortness of breath, anxiety and tiredness were the main bothersome symptoms. Home-based rehabilitation was the most preferred way to deliver the programme followed by using digital interventions.

Brain-derived neurotrophic factor and matrix metalloproteinase-9 activity during rehabilitation therapy of schizophrenic patients - environmental pilot study.

The aim of the study was to evaluate the peripheral level of brain-derived neurotrophic factor (BDNF) and matrix metalloproteinase-9 (MMP-9) during rehabilitation therapy, combined with neurofeedback in schizophrenic patients, and to investigate whether these biomarkers are related to psychopathological symptoms, changes in auditory evoked potentials (AEPs), and quantitative EEG (QEEGs) mapping. The study involved two groups of patients diagnosed with paranoid schizophrenia in partial remission who participated in a 3-month structured rehabilitation programme combined with neurofeedback (REH group) and a standard support group (CON group). The following parameters were assessed: BDNF and MMP-9 serum levels, AEPs, QEEGs, and psychopathological symptoms (PANSS). A clinical improvement within the 3-month rehabilitation therapy course was correlated with the increase in BDNF and MMP-9 serum level. Despite the increase in BDNF and MMP-9 during the 3-month rehabilitation therapy, it was not possible to demonstrate any strong and significant correlation between the 2 examined neuropeptides. During the 3-month rehabilitation therapy, the theta waveform share reduction in QEEG, P50 latency reduction and amplitude increase correlated with PANSS Total and MMP-9 results. All clinical (PANSS Positive, Negative, General, Total) and biochemical results (BDNF, MMP-9) of the REH group changed significantly over the 3-month period. Positive symptoms improved only in the CON group.

Rehabilitation Challenges in Orthotic Offloading with Dual Disability Involving Bilateral Lower Limbs with Right Transtibial Amputation for Charcot Joint, Left Neuropathic Foot of Hereditary Motor and Sensory Neuropathy Aetiology

Orthotic management of offloading neuropathic foot in hereditary motor and sensory neuropathy (HMSN) is challenging due to motor, sensory and functional deficits which may interfere with weight distribution over the foot. The challenge further becomes difficult with the involvement of the contralateral lower limb with below-knee amputation. This study is regarding challenges in offloading, weight transmission and distribution during the stance phase of gait in the case of a 35-year-old female with a left neuropathic foot due to HMSN with concomitant right transtibial amputation. The energy expenditure and cosmetic issues for the right lower limb and aiming for maximum functional conservation of the left foot, were considered by taking into account the heel pad thickness measured by musculoskeletal ultrasound, dynamic plantar pressure measured by footplate pressure measurement, the integrity of the ankle joint mobility and stability by clinical assessment, the electrophysiological status of the neuropathic foot by nerve conduction study and the weight-bearing capability of the right below-knee stump. The following management measures are planned for effective offloading with therapeutic footwear modification with silicone gel cushion heel and insole and rocker bottom outsole as an alternative to conventional weight-relieving calliper in a government tertiary care set-up, thereby conserving the foot function and morphology. This will help in planning a structured rehabilitation programme which will be beneficial in preventing future foot changes including trophic ulceration and subsequent amputation. Case follow-up after patient education and assessment of disease progression in each visit is being done. A better outcome in terms of quality of life and level of independent ambulation with concomitant bio-functionality of the left neuropathic foot was accomplished with community ambulation.

Rehabilitative interventions for impaired handwriting in people with Parkinson's disease: a scoping review.

People with Parkinson's disease (PD) often complain about handwriting difficulties. Currently, there is no consensus on the rehabilitative treatment and outcome measures for handwriting rehabilitation in PD. This study aims to investigate evidence on handwriting rehabilitation in people with PD, examining characteristics of interventions and outcomes. A scoping review was conducted according to Arksey and O'Malley's framework and PRISMA-ScR List. We searched electronic databases of PubMed, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, and Embase since inception to January 2023. We included interventional studies assessing the effects of structured rehabilitation programs for impaired handwriting in people with PD. Two reviewers independently selected studies, extracted data, and assessed the risk of bias using the Cochrane Collaboration's tool for assessing Risk of Bias version 2 or the Risk Of Bias In Non-randomized Studies. We performed a narrative analysis on training characteristics and assessed outcomes. We included eight studies. The risk of bias was generally high. Either handwriting-specific or handwriting-non-specific trainings were proposed, and most studies provided a home-based training. Handwriting-specific training improved writing amplitude while handwriting-non-specific trainings, such as resistance and stretching/relaxation programs, resulted in increased writing speed. The current knowledge is based on few and heterogeneous studies with high risk of bias. Handwriting-specific training might show potential benefits on handwriting in people with PD. Further high-quality randomized controlled trials are needed to reveal the effect of handwriting training in people with PD on standardized outcome measures. Handwriting-specific training could be combined to resistance training and stretching, which seemed to influence writing performance.

Good clinical scores, no evidence of excessive anterior tibial translation, a high return to sport rate and a low re-injury rate is observed following anterior cruciate ligament reconstruction using autologous hamstrings augmented with suture tape.

Augmented anterior cruciate ligament reconstruction (ACLR) techniques have been proposed to reduce the high reported re-injury rates and low rates of return to sport (RTS). This study reports clinical outcomes, RTS and re-injury rates in patients undergoing ACLR using autologous hamstrings augmented with suture tape. A total of 53 patients were prospectively recruited, undergoing ACLR using hamstrings with suture tape augmentation, combined with a structured rehabilitation programme. Outcomes were collected to 24months, including patient-reported outcome measures (PROMs), KT-1000 measurements, peak isokinetic knee strength and a four hop test battery. Limb Symmetry Indices (LSIs) were calculated for performance measures, whilst RTS rates, re-tears and re-operations were presented. There were no significant side-to-side differences in anterior tibial translation between the operated and non-operated knees at 6months (p = 0.433), with no increase (p = 0.841) in side-to-side anterior tibial translation from 6 to 24months. At 24months, 98.0% of patients demonstrated normal (< 3mm) or near normal (3-5mm) side-to-side differences. LSIs for peak knee extensor torque (p < 0.0001) and the single (p = 0.001), triple (p = 0.001) and triple crossover (p < 0.0001) hop tests for distance significantly improved. All PROMs significantly improved (p < 0.0001), with 70.2% and 85.7% of patients actively participating in pivoting sports at 12 and 24months, respectively. Three patients underwent secondary procedures for meniscal symptoms. One patient suffered an ACL re-tear (17months), with no further ipsilateral or contralateral injuries. ACLR with suture tape augmentation demonstrated no evidence of excessive anterior tibial translation, high-scoring PROMs, sound performance scores, a high rate of RTS and low re-injury rate.